Can you start off by explaining the difference between stain removal and teeth whitening?
Jerome: Food, drink and, most obviously, smoking creates pigments which adhere to the surface of your teeth, causing stains. Stains happen more often on the places that are difficult to reach with brushing – between the teeth and just above the gum line. Unlike whitening (also known as bleaching), removing stains does not change the colour of your teeth, but it does help reveal your natural tooth colour, so it is an effective way to brighten your smile. Brushing your teeth and flossing regularly helps minimise staining. However, if the stains on the enamel cannot be removed, this is when you might want to think about whitening, either professionally or using an over-the-counter product.

Amelia: Stain removal is usually done when you have a hygiene visit. It uses ultra-sonic jets and abrasive polishing paste to remove surface or external stains. Teeth whitening is when hydrogen peroxide is used in some form of gel to actually change the colour of the tooth.

What causes teeth yellowing?
Jerome: Four main factors cause teeth yellowing: diet, smoking, illness and poor oral hygiene. Certain foods that are high in tannins, such as red wine, cause yellow teeth, but actually some of the most common causes of tooth discolouration are from coffee and fizzy soda. Smoking is one of the top causes of yellow teeth and the stains can be really stubborn to remove.

Sunita: Over the course of time, the natural whiteness of our teeth can fade and our day-to-day lifestyle habits can have an impact on the colour of our teeth. Whitening treatments can help restore the natural whiteness of teeth.

How does teeth whitening work?
Jerome: Whitening gels contain an active whitening ingredient that penetrates the enamel to get to the discoloured molecules. Oxygen molecules from the whitening agents react with the discoloured molecules in your teeth, breaking the bonds that hold them together. The oxygen molecules spread, whitening the entire tooth. As a result, you are left with a brighter and whiter smile.

Can you explain the different types of professional teeth whitening available?
Amelia: There are two different types of professional teeth whitening. At home, prescribed whitening is where the dentist will take moulds of the mouth to provide the patient with specific trays to fit their teeth. They will then prescribe a whitening gel which the patient will wear in the trays, at home, for a certain number of hours a day for a short course (advised by the dentist specific to the patient). If needed, this can be ‘topped up’ at a future date at the patient’s convenience. This takes a bit longer to get the desired effect, but usually within one to two weeks.
 
Chair whitening is where higher doses of hydrogen peroxide will be used to whiten the teeth – again in moulds, but in the dental chair, usually during an hour’s appointment. This is done in a dental setting because the higher doses can be damaging to the gums and surrounding tissues if not carefully applied and monitored. Therefore it’s safer to be done under supervision of the dentist. This tends to have a quicker whitening effect, but it does require re-attendance at the practice for a top-up if needed.

What can you expect in a whitening appointment?
Jerome: You will have a full oral examination, checking for possible cavities or gum problems that may need resolving before the whitening treatment. A full mouth hygiene check will also be completed to make sure all the stains and plaque are removed before the whitening process begins. Possible allergies and teeth sensitivity will be checked to ensure you’ll have no pain or problems while undergoing the whitening procedure.
 
Amelia: If you are dentally fit for bleaching, then the first appointment will be to take moulds of the teeth. This involves using a putty-like material in a tray, which is placed at separate times in your upper and lower jaw for roughly one minute and then removed. This provides a mould of the teeth which the dental lab will make the bleaching tray on. The second appointment will change depending on whether you have chosen to do at-home or in-chair bleaching.

And how long does it last?
Amelia: How long your teeth stay white is hugely variable. Ultimately it depends on the colour and status of a person’d teeth prior to the whitening process and also any existing long-term habits. If you smoke or drink lots of red wine after your whitening, they will fade quicker. Case by case, the dentist should have a rough idea on what to expect in terms of lasting effects. Most often top-ups are needed within a year from initial treatment.
 

How white should you go?
Jerome: Deciding the level of whitening will always be a personal choice, and the patient can always top up with home whitening trays and gels. In my opinion, it is always better to be a little more white as the effect of the whitening will fade after a few months.

Overuse of whitening gum, toothpaste, home whitening trays and whitening strips can actually lead to the teeth appearing less lustrous, so be careful not to over-whiten with at-home treatments. Signs you’ve overdone teeth whitening include teeth with a chalky look to them or teeth marred with white spots. One dentist-recommended way of gauging the kind of white you’re aiming for is to look at the whites of your eyes and let that be your guide for how white your teeth should naturally be.

Amelia: There will be a limit on the results of whitening. Every patient should be warned there is a chance the improvement will only be minor. Some products say they guarantee a B1 shade (this is one of the whitest shades used for restorations in dentistry) but it is so patient dependent. One person can have amazing results and another not as extreme.

What's the damage?
Jerome: In-chair whitening costs around £500. At-home prescribed whitening courses cost closer to £300.

Is it uncomfortable?
Jerome: In-chair whitening should never hurt. We do four sessions of ten minutes in a row, leaving the gel on with the activating light. However, you can experience some sensitivity if you wear the trays at home for longer than 90 minutes. It’s not recommended to wear the trays overnight.
 
Sunita: Your teeth may start to get sensitive during the whitening procedure, and you may feel discomfort when drinking or eating hot or cold products. This potential side effect of teeth whitening is usually short term and goes away with time.

 

Let's talk about over-the-counter products – are they any good?
Amelia: Most don’t work or, if they do, the effects will be minimal. It comes down to the percentage of hydrogen peroxide and most over-the-counter products don’t have enough. Any products with no hydrogen peroxide definitely do not work. The charcoal products may get rid of surface stains but won’t change the colour of the underlying tooth. If you do go with over the counter, make sure you are buying from a reputable brand like Crest or Colgate. 

Sunita: There are numerous systems like whitening toothpastes, strips and over-the-counter home kits. In the UK, the highest concentration of hydrogen peroxide permitted in over-the-counter products such as strips is 0.1%, so most of these kits don’t have enough whitening product to be effective. Also, if a dental professional isn’t doing the whitening, the mouth guard provided may not fit properly, so some of the bleaching gel may leak out onto your gums and into your mouth, causing blistering and sensitivity. Teeth whitening carried out in beauty salons by untrained staff or staff without dental qualifications puts your oral health at risk and is also illegal.

Are there any side effects to consider?
Jerome: The two side effects that occur most often are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums. Tooth sensitivity can occur during the early stages of a whitening treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both conditions are usually temporary and disappear within one to three days of stopping or completing treatment.
 
If you do experience sensitivity, you can reduce or eliminate it by wearing the whitening tray for a shorter period of time (for example, two 30-minute sessions versus two 60-minute sessions). Another way to aid sensitivity is to stop whitening your teeth for two to three days to allow them to adjust to the whitening process. You can also ask your dentist or pharmacist for a high fluoride-containing product, which can help re-mineralise your teeth. Apply this to the tray and wear for four minutes prior to and following the whitening agent. Finally, eat more dairy products as the casein protein in milk is one of the best tools to fight sensitivity.

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