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A pearly-white smile never goes out of style.

But we live in a world with coffee, curry, tomato sauce, and other delicious foods and beverages that make the dream of a pristine smile difficult.

When brushing and flossing can’t undo discolouration, patients often request more powerful means of teeth whitening. Treatments involving hydrogen peroxide or carbamide peroxide are commonly relied upon to achieve the desired results.

Regardless of the approach, your patients’ safety should be the topmost priority. Here, we’ll explore the risks associated with some teeth whitening procedures and discuss the steps you can take as a dental hygienist to ensure your patients are safe.

Review of Common Teeth Whitening Procedures

• Whitening toothpaste contains abrasives and detergents to combat surface stains. There’s no bleach in whitening toothpaste, but products may contain a small amount of carbamide peroxide or hydrogen peroxide that help lighten tooth colour. A whitening toothpaste can lighten teeth by 1-2 shades, but it cannot change the natural colour of the teeth or eliminate stains that go below the tooth's surface.
• Over-the-counter whitening strips are thin, plastic trips with a thin layer of peroxide gel, shaped to fit onto the buccal surfaces of the teeth. Peroxide-based gel can also be applied directly to the surface of the teeth. With either method, it is usually recommended to apply twice daily for two weeks. Gels and strips can provide a 1-2 tooth shade improvement after treatment.
• Whitening rinses contain hydrogen peroxide and other oxygen sources, reacting with the chromogens within the dentine to lighten the body colour of the teeth. Whitening rinses are meant to be used two times a day, where the patient rinses for a minute each time. Patients can expect a 1-2 tooth shade improvement in about three months.
• Tray-based teeth whiteners are available over the counter or by prescription. The apparatus consists of a fitted tray with carbamide peroxide bleaching gel. Patients wear the gel between two and four hours a day or overnight. Teeth whitening trays can yield an improvement between 1 and 2 shades in just a few days.
• In-office whitening procedures offer more immediate and noticeable results than over-the-counter alternatives, with higher concentrations of peroxide and the aid of UV light. Patients will notice an improvement in tooth shade after 30 minutes to one hour of treatment, and after several treatments, they will see more significant results.

What Are the Risks Associated with Whitening Procedures?

The two most common issues affecting people who use whitening treatments are tooth sensitivity and slight gingival irritation. The primary factors that impact the intensity of these side effects are:

• Concentration of the peroxide bleach component;
• Duration of treatment; and
• Product’s non-bleach composition.

Usually, any tooth sensitivity starts during the treatment and persists for a couple of days. Irritation from the gingival tissues will last about as long, but often appears within 24 hours of the treatment.

Other reported risks associated with whitening procedures include:

• Tooth erosion
• Tooth mineral degradation
• Increased susceptibility to demineralization
• Pulpal damage
• Enamel damage

One of the best ways to protect your patients is to provide them with sound advice for their at-home whitening routines. This begins with directing them on how to apply the gel. Moderation is key. Your patients shouldn’t go too heavy on teeth whitening gels.

Your patients should also steer clear of teeth whitening procedures by unqualified individuals. Like most things related to oral health, any treatments are best left in the hands of professionals, and the equipment or compounds being used should be approved by the relevant authoritative bodies.

What’s more, not all patients are ideal candidates for teeth whitening procedures. Patients who suffer tooth decay should have that problem treated before beginning in-office whitening. The same applies to patients with cracked or broken teeth, since the gel could seep into a cavity and cause an array of issues, and with an abundance of amalgam restoration.

When it comes to treating your patient in-office, remember the advice about moderation. If more gel is applied after the initial treatment, it should be used on an as-needed basis only.

It is important to use precisely-fitted whitening trays to protect the gums and reduce the risk of spillage. Although you might worry about a patient's pain threshold, avoid using local anesthetic gels to numb the area so the patient can tell if gel is seeping into their gums.

Now, You’re Ready to Help Your Patients Get the Smile They’ve Always Wanted.

A beautiful smile is a powerful thing. However, oral health and safety are much more important. By keeping those precautions in mind, you can confidently help whiten your patients' teeth and give them the smile they've always wanted!