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2011 - Volume 2 Issue 1
Vida Buena
Health & Wellness
Article: Charlotte Tallman
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Tooth-enamel discoloration is caused by a variety of things including aging, superficial stains from drinking coffee, cola and wine; smoking; taking medications such as tetracycline; diseases and genetics. Teeth have a porcelain-like enamel surface composed of microscopic crystalline rods. Tooth enamel is designed to protect the teeth, but over the years enamel is worn down, becoming more transparent and permitting the yellow color of dentin, the tooth's core material, to show through. During routine chewing, dentin remains intact while millions of micro-cracks occur in the enamel. These cracks, as well as the spaces between the crystalline enamel rods, that gradually fill up with stains and debris. As a result, the teeth eventually develop a dull, lackluster appearance.

    It is said that the practice of teeth-whitening began around 4,000 years ago with the ancient Egyptians, who created a whitening paste using ground pumice stone mixed in wine vinegar. During a time when beauty, wealth and agelessness were admired, white teeth were desired by many.
  Now, thousands of years later, the emergence of teeth whitening is back in full-force after dentists in the 1980s found whitened teeth as a side effect of leaving peroxide on as an oral antiseptic gel to treat the gums.
Teeth whitening removes the stains and debris, leaving the enamel cracks open and exposed. Some of the cracks are quickly re-mineralized by saliva, while others are filled up again with organic debris. There are many ways of whitening teeth, from bleaching sessions at the dentist's office to home-use bleaching kits purchased at the local drugstore. There are also many questions to ask when considering it, including the cost, whether the process is permanent and what the side-effects will be.

Teeth Whitening Risks
Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch, commonly occurring during in-office whitening, where higher-concentration bleach is used. Some individuals experience spontaneous shooting pains down the middle of their front teeth. Those who might have greater sensitivity have gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. Some dentists recommend a toothpaste containing potassium nitrate for sensitive teeth.

Many who use peroxide whiteners experience some degree of gum irritation resulting from the bleach concentration or from contact with the whitening trays. Such irritation typically lasts up to several days, dissipating after bleaching has stopped or the peroxide concentration lowered.

Tooth Discoloration
There are two categories of staining as it relates to the teeth. Extrinsic stains are stains that appear on the surface of the teeth as a result of exposure to dark-colored beverages, foods and tobacco, and routine wear and tear. Superficial extrinsic stains are minor and can be removed with brushing and prophylactic dental cleaning. Stubborn extrinsic stains can be removed with more involved efforts, like teeth bleaching. Intrinsic stains are those that form on the interior of teeth, resulting from trauma, aging, exposure to minerals (like tetracycline) during tooth formation and excessive ingestion of fluoride. Deep set intrinsic stains can be removed with supervised take-home teeth whitening kits that are maintained over a matter of months or even a year.

Teeth Whitening Options
In-Office Whitening
Significant color change in a short period of time is the major benefit of in-office whitening. During the whitening, a carefully controlled amount of a relatively high-concentration peroxide gel is applied to the teeth by a dentist or trained technician after the gums have been protected with a paint-on rubber dam. Generally, the peroxide remains on the teeth for several 15 to 20 minute intervals that add up to an hour. Those with particularly stubborn staining may be advised to return for one or more additional bleaching sessions, or may be asked to continue with a home-use whitening system. In-office teeth whitening cost: $650 per visit

Professionally Dispensed Take-Home Whitening Kits

Take-home kits incorporate an easy-to-use, lower-concentration peroxide gel that remains on the teeth for an hour or longer (sometimes overnight). The lower the peroxide percentage, the longer it may safely remain on the teeth. The gel is applied to the teeth using custom-made bleaching trays that resemble mouth guards. Take-home teeth whitening kits cost: $100 to $400

Over-the-Counter Whitening
The cheapest and most convenient of the teeth whitening options is over-the-counter bleaching, which involves the use of a store-bought whitening kit, featuring a bleaching gel with a concentration lower than that of the professionally dispensed take-home whiteners. The gel is applied to the teeth on one-size-fits-all trays, whitening strips or paint-on applicators. Because take-home teeth whitening kits have a lower concentration peroxide gel, they are not as effective as in-office whitening and may take longer to work. Over-the-counter teeth whitening cost: $20 to $100

Maintaining Your Whiter Smile
Once teeth are whitened, it is important to keep them that way as long as possible by at-home follow-up or maintenance whitening; avoiding dark-colored foods and beverages for at least a week after whitening; sipping dark-colored beverages with a straw and practicing excellent oral hygiene – brushing and flossing after meals and at bedtime.

Are veneers an option?
A veneer is a thin shield of porcelain that is used to cover the front surface of the tooth. They are designed as a permanent way to change or enhance the look of stained, chipped, broken or undesired teeth. Veneers are reasonable facsimiles of natural teeth, but it is not uncommon to see slight variations in the color of veneers upon close inspection. ///
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