Introduction
From the Broadway musical Annie, “You’re Never Fully Dressed Without a Smile” is a song that delightfully represents the importance of smiling. With that, it is always nicer to have a gleaming set of teeth as you meet people “fully dressed with your smile”.
Our pearly whites are so important and sometimes it does great damage to our self-esteem and confidence when our pearly whites aren’t so pearly white anymore! Studies even show that the colour of our teeth influences social perceptions, which means landing that job interview or that new date [1].
Let experienced dentist, Dr Kevin Ong, take you through all there is to know about teeth whitening in Singapore — what causes teeth stains, treatment options for getting a brighter smile, what to avoid after treatment, amongst much other important information.
Why do people go for teeth whitening?
People opt to undergo teeth whitening because they are not satisfied with the current colour of their teeth. As the name suggests, a beautiful set of pearly whites are associated with youth and beauty, which is why it is a key pursuit for many.
Teeth whitening can also have great positive psychological effects on the patient, especially in their social encounters.
What are the causes of teeth stains?
The causes of teeth stains can be classified into two categories: intrinsic and extrinsic.
Extrinsic stains are basically surface discolouration on the enamel, or the thin outer layer of the tooth. Most stains are extrinsic in nature. Extrinsic stains can arise from common causes such as:
- Coffee
- Tea
- Red Wine
- Smoking
- Infrequent cleaning
- Some types of Chinese medication
Intrinsic stains are created within the tooth during its development or from old amalgam fillings. The colour can range from yellow to dark brown, grey to even purple.
Intrinsic stains can arise from:
**Antibiotics
**Antibiotics like tetracycline should be avoided by pregnant and lactating women, as it may bring about teeth discolouration in the developing foetus in the mother’s womb. [2]**High fevers in toddlers
**High fevers may lead to an imbalance in the amount of calcium and protein in the enamel of the teeth, leading to intrinsically-stained teeth especially in toddlers. [3]**Too much fluoride ingestion (fluorosis)
**Children may also ingest products containing fluoride, such as toothpaste while brushing their teeth. Parents can keep a lookout for this — especially in toddlers and young children who cannot spit well during toothbrushing. Hyperfluorosis is common in Singapore (because of the fluoridation of our water supply and the abundance of fluoride toothpastes).
What are the treatment options for teeth whitening?
Teeth whitening can be achieved through routine cleaning, scaling and polishing — but if it proves unsatisfactory, tooth bleaching may be considered. Professional teeth whitening can be done via two main ways:
- In-office (clinical)
- Take-home kits
In-office bleaching has many advantages over take-home kits.
In-office techniques
Power bleaching
Power bleaching is a tooth whitening method performed in a dental clinic. The first power bleaching systems were introduced in the late 1980s and are suitable for patients with even coloured teeth and no intrinsic stains.
The advantage of in-surgery power bleaching is that extremely concentrated gels (up to 37% Hydrogen Peroxide) can be applied, as the dentist can protect your gums and cheeks from chemical burns. The concentration allows for whiter teeth and quicker results that are more long-lasting. The application of a light or heat source can speed up the process.
Hydrogen peroxide is used by hairdressers to bleach hair. In a tooth, because of its instability, the peroxide breaks down into water (H2O) and a negatively charged oxygen ion. This oxygen ion, when encountering the long-chain colour molecules in our teeth, tends to act like microscopic scissors and snips the chains into shorter chains. The result is that less light is absorbed and more reflected and hence, you get whiter teeth (remember your “A” Level Physics?).
It would be a point of note that racial differences (and hence, genetics) may alter the effectiveness of teeth whitening. For example, East Asians tend to have thinner teeth and, therefore, thinner enamel — making bleaching less effective. Thicker teeth of Caucasians tend to make bleaching much more effective. Additionally, older patients with worn-out teeth may have a less satisfactory result.
Power bleaching can be done by non-professionals such as by aestheticians but the gels used cannot exceed 6% Hydrogen Peroxide as they have no way of protecting the gums.
Veneers
For teeth that have intrinsic stains, teeth whitening is not advisable. The whiter stains will bleach very easily while the darker parts of the teeth will be very difficult to bleach, causing uneven and patchy colouration.
For these teeth, more complex dental treatments, such as dental veneers or composite veneers may be the solution. Veneers are thin shells of porcelain or tooth-coloured fillings that can be bonded onto the surface of the teeth — masking the natural colour of the teeth in a more controllable and effective manner.
Take-home kits
There are numerous home teeth whitening kits that can be purchased both over-the-counter and provided by a dental professional.
Take-home kits are generally cheaper options, but they have the downside of requiring patient compliance. The patients need to have a high level of compliance; applying the gel in correct amounts and doing so for consecutive days. By the late 1990s, studies in America have shown that only 50% of the patients were compliant and completed the full course of take-home kits [4].
In-office techniques vs. Take-home kits
One of the problems with using take-home kits is the fact that the bleaching gel that is used has very low concentrations. Take-home kits can only contain up to 6% hydrogen peroxide which makes its whitening effect slow and be less effective. If the percentage of hydrogen peroxide exceeds 6%, you may suffer painful chemical burns.
The second issue with the take-home kits is patient compliance, as mentioned earlier. You are required to do it consecutively, every day for 7 to 10 days. If you miss a day, you would have to start the process all over again.
A large proportion of users will tend to forget on occasions and have less than satisfactory whitened results. Therefore, I generally prefer not to prescribe take-home kits.
What can one expect during a teeth whitening procedure?
An initial check on your teeth will usually be conducted to ensure that you are suitable for teeth whitening procedures. For instance, we would check mainly through translucency tests to see if the patient’s teeth have sufficient enamel to go for teeth whitening.
It is important to note that there are different brands for in-office bleaching available in the market. The differences in the brands and whitening agents will include:
- The cost
- Speed of treatment
- Amount of whitening it can do
- How long it can last
- Its possible side effects
With the right treatment option, the process will be comfortable. The average bleaching procedure takes about 40 minutes, which includes cleaning up and a post-treatment debrief.
Very few of our patients ever complain about tooth sensitivity, however, some patients have experienced sensitivity during and even after bleaching with other brands. Compared to take-home kits, the special gels that we use in-office contain a very high concentration of hydrogen peroxide of 35% but we are able to protect the gums during the procedure. This ensures minimal risk of chemical burns on the gums.
Due to the high potency of the gel we use, it can achieve the whitest results that can last for 2 to 3 years.
Each patients’ teeth will only achieve a maximum whiteness for their teeth. Carried out properly, the teeth will whiten to the maximum for your teeth. Repeated whitening does not seem to improve the colour. Should the shade of your teeth not be satisfactory, other options, like composite or porcelain veneers, may be considered.
Can I treat a single dark tooth?
Bleaching a single dark tooth is challenging as once the gel has been applied to the tooth, it is not possible to assess the whiteness of the tooth.
Besides that, if there is a single dark tooth, there is normally an underlying issue. It could be due to an injury from impact or if the tooth has undergone root canal treatment. Once a root canal has been done, the blood supply to the tooth is removed and over an extended period, the tooth will desiccate and appear grey to black. External bleaching at this point will not be advised.
In the past, internal bleaching was a procedure which I have used before. It can work well, but there is a downside to it. Long-term studies have shown that there is a very high incidence of internal root resorption with the use of internal bleaching [5]. I have stopped offering internal bleaching treatment since then, as the long term effect could be the loss of that tooth.
How long can teeth whitening last?
Traditionally, most in-surgery power bleaching will last for 18 months to 2 years. The system we use seems to last up to 2 to 3 years. Most of the take-home kits require repeated applications to extend the effect for anything above 6 months
Who should not go for teeth whitening?
Anyone too young should avoid going for teeth whitening procedures. People under the age of 17 should not undergo teeth bleaching because their teeth are going to be very sensitive [6].
People with teeth that are very worn out should also avoid conventional teeth whitening procedures because there is not enough enamel on the teeth left to bleach.
People with teeth that are very patchy with white spots should avoid teeth whitening as well. As mentioned earlier, you should look to dental veneers as an alternative.
On the other hand, who should go for teeth whitening?
Those that have evenly coloured teeth that are darker in colour. Generally, young adults are best suited to go for teeth whitening procedures.
Older individuals may consider teeth whitening if there is still sufficient enamel on the teeth.
Please note that should there be any visible fillings on the front teeth, these will have to be changed after the bleaching procedure as they do not bleach and will, likely, be a darker colour to the rest of the teeth.
How often can you go for teeth whitening?
There is no harm to the tooth at all when undergoing teeth whitening. The only active ingredient in the gels are the oxygen ions, which are responsible for the whitening effect. Therefore, although there is no harm in repeated whitening cycles, there would be no advantage.
We would only advise further treatment once the darkening of the teeth become apparent.
What should you avoid after a teeth whitening procedure?
In the past, the surface of the teeth tends to become very dehydrated after a teeth whitening procedure. Dentists would recommend patients to abstain from eating or drinking anything that has any intense colouring for up to 48 hours.
Nowadays, with the newer teeth whitening systems, the surface of the teeth do not dehydrate as much. However, I would still advise you to avoid the following foods and drinks for at least 24 hours. You should abstain from things like dark pigments in foods and drinks.
For example, if you want to eat chicken rice, you can. However, unfortunately, you have to avoid the black sauce and chilli sauce. If you want pasta, go for carbonara instead of bolognese because the former is a sauce that is paler in colouring.
For drinks, that means avoiding coffee, tea and Coke. If you would like Sprite or even vodka, you can drink gallons. The main point is that you have to avoid anything with any colour.
Smoking may actually be alright as it only causes external stains.
What is the cost of teeth whitening in Singapore?
The cost of teeth whitening spans a wide range. Some of the beauty salons that offer it are doing teeth whitening for about $100.
For professional whitening, you are looking at anywhere between $450-$900. Bleaching can be about $600-$650 to over $1000.
I remember when Britesmile first came into the market, one of our patients actually paid $2,800 in the late 90s. The price has since dropped dramatically, making it a more affordable procedure for everyone.
Are the teeth whitening procedures Medisave claimable?
Unfortunately not, it is a cosmetic procedure and hence not covered by Medisave.
Are home whitening kits safe?
Home whitening kits are safe as long as the percentage of hydrogen peroxide is low. Beyond 6% concentration, it may start to burn your gums.
I had a patient who went to Bangkok and paid $250 for a home whitening kit. It is cheap and they used good materials because it was an international brand. Unfortunately, he came into my clinic 2 days later in agony because all of his gums have blistered. It took about 2 weeks for the blisters to heal.
When I checked the gel, it contained 10% peroxide!! The difference 4% more hydrogen peroxide can do is very dramatic.
Do home remedies for teeth whitening work?
Whitening toothpastes
Whitening toothpastes, such as the baking soda-based and charcoal-based ones, generally do not help to truly whiten the teeth. They are only able to clean up the surface stains.
The teeth may look whiter as it is cleaned but unfortunately, you may wear out the teeth faster. With overly frequent use, your teeth may turn yellow quicker.
Aside from that, longer-term use of these kinds of toothpaste that contain coarse abrasives may increase teeth sensitivity.
Should you really feel the need that occasional use of these toothpastes may reduce the speed of build-up of stains on your teeth. At some point, you will still need professional scaling and polishing.
Coconut oil
There are a lot of health benefits to using coconut oil such as for hair growth. However, it cannot achieve a whitening effect on your teeth.
Blue LED light
If used by itself, it does not work for teeth whitening. The oxygen ions within the special gel used in in-office techniques are required to activate the bleaching process.
Are there any common misconceptions about teeth whitening?
Whitening your teeth is not going to make your teeth look like in the movie Dumb and Dumber where they tried it and the teeth became as white as a toilet bowl.
Teeth whitening will only realise the maximum potential of how white your teeth can be. We cannot fully control the outcome of the colour. Some teeth may not whiten that much at all.
Generally, dentists want to aim to get your teeth 4 to 5 shades whiter than before and bleach the teeth as white as possible. Treating to get 1 to 2 shades whiter is a waste of time because most patients will find it hard to see the difference. The change in colour of the teeth has to be significant enough to justify the cost of going for the procedure.
If you want to achieve a specific colour shade for the teeth, you should go for dental veneers instead.
Summary
There may be many teeth whitening options but it would be best to consult a dental professional to ensure there is minimal risk of complications. The benefits of having an outstanding smile can undoubtedly boost your image and self-confidence.
With the enlightening song from Annie, get that smile to complete your outfit!
Head over to dentist, Dr Kevin Ong’s profile to book a consultation for a teeth whitening procedure or other dental services.
