When bleaching one’s teeth, it must be kept in mind that the bleaching process will not effect the color of dental restorations such as tooth-colored fillings, bonding, or porcelain laminate veneers or crowns. It will not harm porcelain, but scanning electron microscope studies have shown some some minor pitting in composite (tooth-colored) restorations. Hypocalcified and fluorosed areas have stark white splotches. When initially bleaching the teeth, these areas tend to stand out dramatically, however, as time goes on, the surrounding tooth structure will begin to lighten, thus allowing the hypocalcification to blend in better. Teeth bleaching will not remove these splotchy areas, just make them less noticeable. Many people have grey stains in their teeth. These stains can be very resistant to the bleaching process. The products that cause the grey color do not appear to oxidize as well. On the other hand, yellow stains are very amenable to bleaching and will lighten very well. The nice thing about the grey stain is that it is not as noticeable from a conversational distance as the yellow, so the teeth can still have a light, appealing appearance even with some residual grey.
Before bleaching one’s teeth, they should have a thorough dental examination by their dentist. One would not want to place bleach over cavities. The bleaching process many times will cause the teeth to be sensitive, so placing bleach into a cavity could increase the sensitivity. Bleaching is also not recommended for children under 16 because their pulp chamber in the center of the teeth where the nerves reside are very large which could make for extremely sensitive teeth. The peroxide ion has been shown to give off oxygen free radicals which have been shown to cause tissue damage. That is something I would not want to take a chance with in a growing child. Other issues include the possibility of gum irritation. The bleaching solutions, especially at the higher concentrations, can be somewhat caustic, and can injure the gums. Most of the time, it is just a temporary reddening and discomfort. This can be reduced by cutting the bleaching time or by switching to a weaker concentration of the bleaching solution. Both sensitivity and gum irritation tend to go away when the bleaching is stopped.
Vital teeth bleaching is performed by placing a peroxide based solution on the tooth surface. Even though tooth enamel is extremely hard, it is somewhat porous which allows the bleaching solution to leach into the tooth. The solution can be either hydrogen peroxide or carbamide peroxide. Carbamide peroxide will turn into hydrogen peroxide when it comes in contact with water. Once the peroxide ion has permeated into the body of the enamel and dentin, it will oxidize the stains that are residing inside the tooth structure thus, effectively lightening the tooth color. Studies have not shown any harm done to the enamel. The peroxide ion has been shown to give of oxygen free radicals which has been implicated as being possibly carcinogenic. No study has shown this to be a problem with short term use of the solutions. However, I personally feel that one should use caution when selecting a “whitening” toothpaste to make certain that they do not contain peroxides. Since toothpastes are used daily for not only years, but decades, I don’t think that it is a good idea to find out after the fact that there was some harm being done.
Bleaching of vital teeth has been a great thing for cosmetic dentistry. Teeth can be lightened considerably with out having to do any invasive drilling or bonding of tooth-colored materials onto the teeth. The cost is significantly cheaper than all other cosmetic dental procedures. Discolorations in teeth can come from many sources. Intrinsic stains (ones that are actually incorporated into the tooth structure itself), include antibiotics (especially tetracycline), fluorosis, and enamel hyperplasia. Aging will also naturally yellow the teeth. Foods such as tea, coffee, red wine, and colas and tobacco products will also discolor teeth. Extrinsic stains, stains that reside on the surface of the teeth, are caused by bacterial plaque accumulations soaking up pigmented food and drink. Extrinsic stains can be removed by a professional cleaning or by using a “whitening” toothpaste that has extra abrasives in it. Since intrinsic stains reside within the tooth enamel, they must be removed by chemicals that have the ability to soak into the tooth structure itself.
A dental rubber dam is an extremely useful adjunct to dental treatment. It is an extremely thin sheet of latex rubber usually cut into six inch squares. A latex-free variety is also available for those who are allergic to latex. A rubber dam is used to isolate a patient’s mouth from the various instruments and chemicals that a dentist uses in the mouth. For teeth bleaching, the chemicals that are used are very caustic and would not bode well floating around in someone’s mouth. There are “paint on” dental dams available for bleaching which are more convenient to use for bleaching procedures. Rubber dams are are extremely important for endodontic (root canal) procedures. A sodium hypochlorite solution (the same chemical found in household bleach) is used to flush out the inside of root canals. It is certainly a good idea to keep that confined to the inside of a tooth. The rubber dam also keeps the thin, sharp files from going down the patient’s throat (or worse yet, their lungs). A rubber dam is also very helpful in children’s dentistry. Placing a rubber dam over a tooth on a fearful child can make them feel isolated from the dental treatment being done and can help calm them down.
Brushing one’s teeth is an extremely important part of one’s daily oral hygiene. Coupled with flossing, it removes the plaque that causes cavities and gum disease. There have been a variety of methods for toothbrushing that have been recommended. The main question is usually “Do I brush side to side or up and down?” Either way, if done properly, can be fine. If one wishes to go up and down, it is best to start above (on the upper) or below (on the lower) the gum line and roll the toothbrush head across the surface of the teeth. I will tell patients who wish to use that technique to brush your teeth in the direction that the teeth grow. When going side to side, the bristles should be angled at a 45 degree angle to the surface of the teeth, and then, the handle should be vibrated side to side. With either method, vigorous scrubbing must be avoided. Dental plaque is not very difficult to remove and only requires a gentle hand on the brush. Too much pressure can cause the gums and tooth enamel to be eroded away causing permanent damage.
One of the most common questions that I get asked is “is it worth it to invest in an electric toothbrush?” The answer that I give is that it is a matter of personal preference. A number of different factors must be considered. Cost is probably top on the list. An electric toothbrush will cost significantly more than a manual one. And the brush portion of the electric model will need to be replaced jut as frequently as the manual variety, and usually at a higher cost. Is an electric toothbrush more effective at cleaning the tooth surfaces? Many studies have shown that both manual and electric toothbrushes perform their job equally well. The main thing is that if it is easier for someone to clean their teeth with an electric toothbrush and they can afford the extra expense, then that is what I would recommend that they use. For people with manual dexterity problems, such as arthritis sufferers, an electric toothbrush can be a great help in cleaning one’s teeth. When buying an electric toothbrush, always look for the American Dental Association seal of approval. The ADA does stringent, independent testing so you can be assured that the manufacturers claims have been verified.
In my previous blog, I discussed head size and bristle stiffness of toothbrushes. Toothbrushes can come in a variety of shapes. It can be helpful to have the type that has rounded bristles. Most bristles are made of nylon so they don’t soften when they gets wet like the natural bristles do. Mom always told us to go into the bathroom and scrub our teeth real hard and thorough. Brushing thoroughly is important. Brushing hard was fine for the old days when the natural bristles would soften in saliva, but since the nylon bristles don’t soften, we must be very judicious in the amount of pressure that we use. Only the tips of the bristles do the cleaning work, so a toothbrush whose bristles are all bent and frayed is ready for the trash can or the household cleaning bucket. Another important aspect of choosing a toothbrush is to look for the American Dental Association seal of approval. The ADA puts dental products through stringent, independent testing to make sure that a manufacturer’s claims are valid. This way, you can be sure that whatever it says on the packaging has been verified and is safe for you and your family to use.
Toothbrushing is a vital part of daily oral hygiene to help prevent cavities and gum disease. Choosing the toothbrush that is right for you is an important part of the process. Toothbrushes come in a variety of shapes, sizes, and styles. Head size is important to make sure that all areas of the mouth are accessible. The larger the head of a toothbrush, the more efficient it will be in cleaning the teeth. However, trying to get the sides of the upper molars can be a challenge for some. When you open your mouth wide, the coronoid process of the jaw bone will drop down right next to the upper molars making it a very tight fit. By closing the mouth halfway and moving the jaw to the side will many times allow enough room to get a brush with a bigger head all of the way back into the mouth. The bristles should be no firmer than the “soft” variety. Plaque is actually not that difficult to remove, so a medium or hard brush is not necessary. Use of too stiff a brush can cause damage to the tooth enamel and the gums which can necessitate fillings and gum grafts.
Flossing you teeth on a daily basis is just as important as toothbrushing. To floss, you need to saw the strand of floss between the teeth, then scrub the tooth surfaces to remove the sticky dental plaque. To manipulate the floss, for the upper teeth, I like to wrap the floss around my index fingers then use my thumbs to do the scrubbing. For the lower, again I like to wrap the floss around my index fingers, but I will manipulate the the floss with my middle fingers. It is important to keep the thumbs (for the upper) and middle fingers (for the lower) very close to the teeth that you are cleaning. That way, the proper pressure can be applied in the correct direction in order to do an efficient job of plaque removal. If the fingers aren’t close enough to the teeth, then you will move a lot of floss and do very little work. As far as type of floss, either waxed or unwaxed are fine. It is just a matter of personal preference. If properly used, both do an adequate job. For those who have difficulty reaching their hands into the back of the mouth, there are little floss picks that are readily available at grocery stores and pharmacies that make it much easier to access and clean the molar teeth.