Improving My Smile: Tooth Whitening and Tooth Bonding

Over time, everyone's teeth can go from white to more yellow, gray, or reddish-brown – unless you're hyper-diligent about your oral care, avoid particular food and beverages, and don't suffer dental trauma. Otherwise, various factors contribute to two different types of teeth stains.

Surface Stains: Known as extrinsic stains, they're found on your tooth enamel and can be caused by:

• Tobacco (whether smoked or chewed)
• Drinking coffee, tea, or red wine
• Eating highly pigmented foods such as cherries and blueberries
• Accumulation of tartar deposits, resulting from hardened plaque

Surface stains should respond to teeth-whitening methods.

Internal Stains: Also called intrinsic stains, they appear when your enamel erodes to expose your dentin, which is darker. These stains can be caused by:

• Treatment with the antibiotic tetracycline when your teeth are forming
• Trauma to the teeth resulting in the death of the tooth's nerve, giving the tooth a brown, gray, or black color
• Ingesting too much fluoride when teeth are forming (from birth to age 16), giving teeth a "mottled" look

Internal stains might require bonding your teeth if teeth bleaching doesn't work.

Depending on the type of stain, your options will vary.

Whitening Surface Stains: Thorough cleanings by your dental professional will remove most extrinsic stains caused by food and tobacco. Using whitening toothpaste can also help remove these surface stains between dental visits.

But if the surface stains are stubborn, to effectively whiten your teeth, you might need to:

• Use an over-the-counter whitening product, such as strips, gels, and pens.
• Have your dental professional whiten your teeth.

Whitening Internal Stains: These can be bleached, bonded, or capped (crowned). While each of these methods is safe and effective, your dentist will recommend the treatment appropriate for you. The best treatment will depend on the state of your teeth and the results you wish to achieve. Your dentist will consider:

• The degree and type of staining
• How much of the tooth structure is remaining

Bleaching to whiten teeth can be done either in a dentist's office or at home using a system your dentist provides. Both methods use tooth-bleaching gels that oxidize out the stain.

It's not uncommon for teeth to become slightly sensitive during the whitening process. So, be sure to ask your dentist in advance of the treatment how to deal with this sensitivity should it arise.

At-Home Whitening: This is a popular option because it combines the best of both worlds: dental office-grade solution and the convenience of doing most of the procedure at home. Another benefit is that when done under the supervision of your dentist, at-home whitening is very effective. Here's how it works:

1. Your dentist takes an impression of your teeth and makes a custom-fitted tray.
2. Your dental professional supplies you with a whitening gel.
3. You take the custom tray and whitening gel home and use it as prescribed. Your doctor will provide instructions on properly wearing your new fitted tray and how long you should wear them.

In-Office Whitening: You might prefer to sit back and let your dental professionals do all the work – even if the process is more expensive. The benefit is that the procedure takes 30 minutes to one hour per visit, but you might have to return for several visits to achieve the desired whiteness.

According to the Consumer Guide to Dentistry, the in-office whitening procedure is a seven-step process that includes extensive safety measures, a powerful bleaching solution, an activation light, and constant monitoring.

Bonding uses composite resins or porcelain/composite veneers to cover the surface of stained teeth. Bonding also gives broken or misshapen teeth a nice, even (and whiter) appearance. There are two basic bonding techniques.

Composite Bonding: The procedure for this starts with determining the tooth shade. That's why it's a good idea to whiten your teeth first. After that, your dental professionals:

1. Slightly reduce the front of the tooth to prevent the "new" tooth from being too bulky.
2. Etch microscopic grooves into the tooth surface with a mild acid
3. Apply to the tooth a composite resin matched to the surrounding teeth's color
4. Contour the resin into shape, set it using a curing light, and finally smooth and polish the bonded tooth

Veneer Bonding: A veneer matches the color and shape of your tooth. So, again, it's best to whiten your teeth first. You and your dentist may choose porcelain or composite veneers. Here is the difference:

• Porcelain veneers are generally more expensive, but they're stronger and last longer. They also offer a better color match to your surrounding teeth. But the process is longer: Your dentist takes an impression of the tooth and sends it to a dental lab to design the veneer.
• Composite veneers main advantage is that they're the less expensive option.

Your dentist prepares the tooth for bonding with both veneers by roughening the front surface with a mild etching solution. The veneer can then be bonded to your tooth using dental bonding cement.

Any tooth can stain, including veneers and bonds. To help prevent stains from coming back, avoid smoking, coffee, tea, red wine, and heavily colored foods.

Regarding brushing, the type of toothpaste differs depending on the procedure you received:

• For whitened natural teeth, brush your teeth twice a day with a whitening toothpaste. Active ingredients can include abrasive agents (i.e., baking soda) or chemicals (i.e., hydrogen peroxide) that work to maintain your whitened teeth and remove any new surface stains.
• For bonded teeth, you won't want to use whitening toothpaste. Though effective on natural teeth, this toothpaste, with its abrasiveness and chemicals, can damage composite bonding and veneers – perhaps leading to them easily taking on more stains. The best toothpaste for teeth with composite bonding or veneers is a non-abrasive gel, which can also serve as a polishing agent.

The options for improving your smile are many. So, talk to your dental professionals about the most beneficial procedure for you – using tooth-whitening methods or bonding your teeth. Depending on the type of teeth stains you have, each procedure has its pros and cons. Whatever process you choose, the key is to achieve a picture-perfect smile.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.