Whitening Teeth with Bleach and Fillings

Some of the techniques that turn back the dental clock are very simple and inexpensive. Tooth colored fillings (dentists prefer the term "restoration") can replace aging silver ones. Then, after your dentist treats any tooth decay and is sure that your fillings are well sealed you may decide to whiten your teeth.

Often the only complaint new patients have about their teeth is the presence of blackened silver fillings. They feel fine, but they look like cavities or stains. For patients who prefer a more natural look most dentists offer aesthetic alternatives to old silver amalgam fillings - restorations made of porcelain or composite.

Porcelain may be used to fill a cavity by removing the decay and then manufacturing a solid piece of porcelain to replace the missing piece of tooth. The restoration may be carved out of a solid block of porcelain, built up by stacking ground porcelain like wet sand and melting it together in a very hot furnace, or by making a wax pattern of the missing piece of tooth, creating a mould and forcing molten glass into the mould. Dental restorations made this way are called inlays or onlays. Any of these techniques create beautiful, lifelike results. Porcelain fillings are bonded into teeth with adhesives that stick tightly to teeth and porcelain.

Another option for natural looking restoration of tooth decay is tooth colored composite. Composite is a mixture of about 75 percent ground glass or ceramic and 25 percent acrylic. These fillings are formed inside and chemically bonded to teeth. Composite fillings tend to wear away faster than others do.

The placement of composite is very technique sensitive. Many dentists do not treat back teeth with composite because they feel that it cannot be done well enough. Many other dentists use this material universally insisting that it provides the best combination of cost, appearance and strength.

Composite restorations are best used when the cavity is small. Larger cavities and broken teeth are best restored with porcelain inlays, onlays or crowns (crowns are also called caps). To decide which procedure is best for you please consult your dentist.

Once the dentist has treated any decay and replaced leaky fillings you might want to lighten your teeth. Before choosing any whitening procedure, it is very important to consult your dentist. Most dental materials such as porcelain, composite and acrylics used in dentures will not change color when the teeth are bleached. Therefore, it is possible to bleach the natural so as not to match attractive dental work.

Some teeth are discolored due to medications taken in childhood most commonly tetracycline and overdoses of fluoride. Teeth deeply discolored by medications will not respond to surface bleaching as quickly as teeth that were discolored by smoking and colored beverages.

There are many over-the-counter products available. Most are lower strength versions of the products available in dental offices. Some new products use innovative techniques to apply the bleach such as strips or paintbrushes. While these techniques may work for many users, most people are dissatisfied by slow results.

Dental offices bleach teeth two ways. In one technique, highly concentrated bleach is applied in the dental office. While many of these systems claim that the use of a laser or bright light accelerates the bleaching effect, there is strong evidence to show that the bleach is the only part of the treatment responsible for lightening teeth. According to Clinical Research Associates Newsletter, a well respected dental publication similar to Consumer Reports, an average of three hour long applications are necessary to give teeth the desired, lasting effect.

Another bleaching technique requires the dental office to fabricate trays that fit closely over the patient's teeth. Bleach is placed in the tray and worn by the patient for one or more hours up to twice a day. Every application lightens the teeth a bit more. Patients control the amount of bleaching. Some people only want to bleach their teeth for a couple of weeks; some people continue to bleach their teeth for months.

The effect of bleaching may seem quite uneven during treatment. The necks of teeth bleach more slowly than the edges and sides; some spots may bleach more slowly. Don't worry. The color soon evens out.

Most people find that their teeth become sensitive to cold while bleaching. The sensitivity is usually worse for younger patients. Using the bleach for shorter times and less frequently will ameliorate this side effect. Another option is to use bleach that is of a lower strength. Generally, this sensation goes away soon after the applications of bleach stop.

The effect of bleaching lasts for a long time. Some people will have a touch-up done annually. Others will not need to bleach again for years.

Now that your teeth are whiter and healthier looking than they have been in a long time, you may decide that you would like for your teeth to be straighter as well. If so, ask your dentist about improving your look with porcelain veneers or orthodontics (braces).

( Dr. David Leader has practiced in Malden since 1989. He is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs. Dr. Leader is a member of the department of general dentistry at Tufts University School of Dental Medicine. )