Written by James M. Eisdorfer, DDS Saturday, 30 November 2002 19:00
Bleaching is the most popular advance made in cosmetic dentistry in the past few years. The strides that have been made in this field have required dentists to learn how to best assist patients, both in monitoring the shade of the teeth and helping them to achieve the best smile they can have—one that fits their complexion.
My patients are based in New York City and are made up of a wide variety of different ethnicities, among them African-American, Caucasian, Hispanic, and Asian. My goal for each patient is to enhance the natural beauty of the teeth, and create a smile that looks good, without looking artificially brightened. I’d like to share with you some “best practices” I’ve established in bleaching, and offer examples of real patients, from different ethnic backgrounds, who have been some of our favorite success stories.
Although I’m not partial to one bleaching product or another, I’ve found two particular treatments: POLAOFFICE by SDI (containing 35% hydrogen peroxide) and NiteWite Excel 2 by Discus (also 35% hydrogen peroxide) to be both safe and reliable. Also affecting patients’ comfort is the accuracy with which the gum guard paste is applied, in order to protect the gums from the harsh chemicals, and the percentage of hydrogen or carbamide peroxide in the at-home treatments they use.
Once bleach has been applied, we place the Lumalite treatment over the teeth for 8 to 10 minutes at a time, for a total of four applications. Last year, we switched to using the Lumalite procedure that uses a unique heatless light, reduces patient discomfort often associated with lasers, and does an equally effective job in brightening the teeth. Once we’ve completed the first bleaching procedure we sometimes put a fluoride treatment over the teeth, depending on the degree of sensitivity the patient is experiencing. To counter this sensitivity, we provide them with a fluoride treatment to take home, to be applied before their at-home treatment. We also try to minimize tooth sensitivity by choosing at-home kits with a lower dosage of carbamide peroxide for our patients who are experiencing more chairside discomfort than others. The day following our in-office bleaching treatment, I’ll check in with the patient to determine if they are undergoing any degree of discomfort. If they are, we conduct a follow-up procedure in the office, where we can monitor them.
The brightness of the teeth is an extremely delicate issue, both for dentists and patients. As dentists, we first have to understand what level of brightening the teeth need, including following some basic guidelines, to make sure the final result is both attractive and natural looking. A good rule of thumb is to try to achieve a smile brightened by approximately four to seven shades on the VITA shade guide.
One of the primary factors we consider is the patient’s age and skin tone. For example, when working with younger patients whose teeth are already fairly bright, we can aim to make the teeth whiter than other patients, and usually go with a longer bleaching treatment (approximately 10 minutes). The timing of the bleaching has to be adjusted for older patients, whose teeth may have already begun to fade a little and who would look awkward with extremely bright teeth. For these patients, we may only use the treatment for about 7 to 8 minutes. Likewise, fair-skinned patients look better with brighter shades, as opposed to darker-skinned clients, for whom extremely dazzling white teeth—in contrast to their skin tone—may look artificial.
BLEACHING TO MATCH DIFFERENT SKIN TONES
One of my first teeth brightening patients was an Indian woman in her mid 50s and a ballet dancer by trade. Still performing, she wanted her smile to gleam and match her grace as she pirouetted across the stage. Because her teeth had already begun to show signs of fading because of age, and considering her dark-olive complexion, we decided to bleach in short intervals, carefully monitoring the tooth color every 7 minutes. She started out with a beginning shade of A3-VITA, and we were able to achieve A1-VITA in just two applications at 7 minutes each, sending her home the next day with an at-home kit. And her smile? It still looks fabulous because of her own upkeep of careful brushing after drinking coffee or any staining foods.
|Figure 1a. Patient with stained teeth due to age and frequent coffee drinking.|
Last year, a Caucasian male in his late 50s also came in for a bleaching to enhance his professional appearance. Currently handling marketing for a sports team, he knew he needed to look his best at high-profile meetings. At age 58, his teeth showed the tell-tale signs of fading because of his age, and his two to three cups of coffee a day had resulted in caffeine stains on his front teeth (Figure 1a). However, with his fair skin we had a little more leverage in terms of how light we could go with the shade. With the initial bleaching we did four applications of 6 minutes each, and sent him home with a kit to use for 5 to 7 days. We wanted to make sure that we didn’t try to over-bleach the stains, which results in uneven, unnatural coloring.
|Figure 1b. After four treatments of 6 minutes each, followed by at-home bleaching for 5 days, “spot bleaching” was applied to the caffeine stains, isolating the stains and bleaching them separately and longer than the surrounding teeth to achieve this uniform color.|
In order to achieve a uniform color on all of his teeth, we applied “spot bleaching” to the most difficult caffeine stains (Figure 1b). A week after his initial bleaching, we had him return to the office. By carefully applying the gum guard to the teeth surrounding the ones stained, we were able to isolate the stained teeth from the others and bleach them separately, and for a little longer than we had with the other teeth. He was very pleased with the results, and has been back again this year for a touch-up.
|Figure 2a. This patient wanted a younger look to match her recent style makeover.||Figure 2b. After one 10-minute treatment followed by a second 5-minute treatment, the patient obtained the great smile results she was looking for to complete her style makeover.|
A Hispanic woman in her mid 30s came to us because, although she’d always received compliments on her smile, she had recently undergone a personal makeover—transforming her look to a younger style—and wanted her teeth to match it (Figure 2a). Because she was still in her 30s her teeth had retained most of their original luster. However, her smile still would not match her coloring if we had decided to make her teeth extremely white. She wanted them to blend in with her new look—fresh, natural, and pretty. We began with one sitting at 10 minutes, and found that this brought her teeth to almost two complete shades lighter. We then gave her a second treatment for just 5 minutes, which did the trick and resulted in a great smile to complete her makeover (Figure 2b).
An African-American woman in her late 30s felt that she, too, wanted a cosmetic boost to maintain an advantage in her competitive job as a television producer. We applied four applications of 10 minutes each, going from a beginning shade of A3-VITA, and ending with A1-VITA. When she came in for her bleaching, however, we were faced with the challenge of dealing with two porcelain laminates in the middle of her smile. The concern in bleaching porcelain laminates is that they tend to bleach at a slower rate than natural teeth, and a patient can end up with different-colored teeth. The best way to prevent this—and what we ended up doing with her—is to bleach the natural teeth first, then wait 2 weeks to allow for any possible “rebounding” of tooth color. Following this, we had her return to do any spot bleaching on the laminates, which is sometimes necessary for deep stains on the teeth or deformity of the enamel on the teeth with laminates. This approach was a success for her, and she returned to work—and to the compliments of her co-workers—a satisfied patient.
MAINTAINING THE SMILE
Of course, a major concern of many patients is how to properly maintain the color once the bleaching has been completed. With some of our older patients, we see a subtle rebound in color about 2 weeks after the procedure. This is usually because of the chemical makeup of the tooth and the fact that the outer layers have worn down (a temporary condition), and the teeth return to their new shade within 1 or 2 days. In very rare cases, the teeth do not lighten up again, and we recommend our clients return for a re-bleaching. In most cases, however, with regular brushing and flossing, a patient can maintain the effect of the bleaching for approximately 1 to 2 years. We recommend that all patients steer clear of caffeinated drinks or dark berries the day of the bleaching, and it helps for patients to limit their intake of these foods in general to lengthen the effects of the treatment.
I recommend bleaching as a fast, effective way to enhance your patients’ smiles.
Dr. Eisdorfer has served as an attending dentist in the Department of Dentistry at the Montefiore Hospital and Medical Center, and as assistant clinical professor in prosthodontics for the Columbia University School of Dental and Oral Surgery. He is a member of the ADA, the American College of Prosthodontics, and the Academy of Osseointegration. Dr. Eisdorfer has been published in various periodicals, including the Journal of Dental Research, Cosmopolitan, and Gentlemen’s Quarterly. His practice was among the first in the country to offer a new process of in-office teeth whitening using the Lumalite whitening system, and he has improved the smiles of celebrities as well as magazine makeovers. He can be reached at (212) 421-5445.
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