TOOTH   WHITENING  INSTRUCTIONS

     The active ingredient in the gel that causes the whitening is carbamide peroxide. This ingredient breaks down into hydrogen peroxide, which acts as an oxygenating agent causing oxygen to enter the enamel and dentin (the outers layer of your teeth) to break up deposits lodged in your tooth structure. 

     This whitening acts only on the molecules that carry the discoloration and its affects will depend on the strength and duration it is in contact with your teeth. 

     The strength of this active agent is limited by safety concerns. Your tooth structure remains unchanged, only the tooth surface is made lighter. Porcelain restorations and white fillings will not usually whiten.

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• Brush you teeth twice a day with a desensitizing toothpaste that contains potassium nitrate and fluoride to decrease tooth sensitivity while you whiten.
• Make sure any gum tissue cuts or scratches are healed.
• Before and after pictures will be taken.

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• Brush and floss your teeth before putting in your bleaching trays

• Apply a small thin line of gel or a drop in each tooth indentation for a total of 10-12 drops into each of the tooth imprints in the tray.

• DO NOT OVERFILL THE TRAY

• Insert the tray into your mouth and seat the tray firmly against your teeth, be sure not to push all the gel out
• Wipe the excess material from your gum with your finger or dry toothbrush
• Try to wear the trays about 2-3 hours per day or for convenience sake you can wear the trays over night (the gel loses 80% of its activity after 2 hours of being in your mouth)
• Rinse your mouth after removing the trays and brush away any remaining gel

• Clean the tray with a toothbrush and warm water, hot water will damage the tray; dry carefully and store in the tray holder in a cool, dry place
• Fill your tray with professional strength fluoride and wear for about 2-5 minutes following the whitening.  Make sure you remove all the fluoride and avoid swallowing any of the fluoride
• AVOID EATING, DRINKING OR SMOKING while the whitening tray is in place
• Don’t use any household or other whitening products to whiten your teeth
• Keep out of reach of children
• Keep away from direct sunlight
• Maximum results are achieved when the process is continued for 14 nights
• AVOID citrus fruits and other acidic foods while in process of bleaching. They can contribute to sensitivity by changing the acidity of your saliva and could cause damage to the outer tooth surfaces or slow down the whitening process
• AVOID tobacco, coffee, dark colas and red wines because these substances may stain your teeth again
• You should AVOID stain-causing beverages such as coffee, tea, coke for several days after the procedure, because your teeth may more readily absorb stain at this time.  
• Try using a straw.
• Utilize automated toothbrushes and whitening toothpastes.
• After 2-4 weeks your teeth are probably bleached as much as possible
• The area of the tooth closest to the gums may take longer to whiten than the biting edge and will continue to remain the darkest part of the tooth
• Renew the whitening as needed (every 3-6 months), by re-applying the gel in the tray and wearing the tray with the get for 2-3 hours for two to three applications
• Daily brushing, flossing.
• Regular dental cleanings will keep your teeth whiter, maintain gum tissue health, keep staining to a minimum and determine need for whitening touch-ups.!

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    10% of patients might experience some discomfort to their teeth, gums, lips, or throat and increased sensitivity to cold, heat, or pressure during the whitening process. 

     This sensitivity is short lived and usually ends a day or two after the treatment is completed. If any of these symptoms occur and are more than mild, and you have persistent discomfort, discontinue the treatment until you can contact Dr. Ramsey at 615-459-6354. These symptoms usually reside 1-2 days after interrupting the treatment. 

     If this uncommon cause of sensitivity develops he can adjust your treatment regimen to help you attain the best results while ensuring your safety.

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Sensitivity can develop in 15-20% or more of patients just from wearing the tray alone!

If you do develop sensitive teeth try these things:

• Determine if the sensitivity is in the teeth or the gums.  The symptoms are temporary and will subside in 1-3 days following termination of use of the whitening gel.
• Check to make sure you are not overloading the tray with gel.  Follow the dosage markings on the syringe.
• Use a soft-bristle toothbrush
• Special toothpaste (i.e. Sensodyne) for sensitive teeth. You may also try an application of potassium nitrate or fluoride  for 10-30 minutes prior to or after whitening, or alternating night with whitening material, is more than 90% effective in reducing sensitivity. 
• Fluoride rinse or gel for sensitive teeth. A sensitivity protection toothpaste will usually take a couple of weeks to ease the discomfort. Ask us for potassium nitrate and fluoride to put in the tray after your "bleaching".  
• Use short-term treatments (20-60 minutes) in order to control these problems. 
• Brushing the teeth with baking soda using a wet toothbrush for 30-60 seconds may help decrease tooth sensitivity.  
• Some times breaking up the amount of time whitening is done into smaller, longer spaced segments, will alleviate the sensitivity problem.  Try taking a break for a day or two.
• Try taking ibuprofen for acute sensitivity.  However, only take this medication if you have do NOT adverse reactions to this medication and it does not interact with any medications you are currently taking.
• If you have a jolt or sharp pain you could have recessed gums, enamel fractures, a chipped tooth or leaking margins.   This is why an exam is performed before whitening is started in order deal with these problems first so you will be able to whitening your teeth with fewer complications.
• As of this time there seems to be no apparent long term problems with tooth whitening
• Apply a ribbon of Sensodyne or Crest Sensitive toothpaste (alone) into their bleaching tray for either 30 minutes before or for 30 minutes after bleaching.

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     The whitening process may cause some temporary dehydration of the teeth.  This dehydration may appear as white spots or striations on the teeth.  These spots will disappear within 1-2 weeks after completion of the whitening process. Because a tooth is translucent, and because of light reflection the same tooth can look a different color under a different light. This is why is is difficult to tell patients exactly how many shade changes they may reach with the whitening procedure.  Teeth all respond differently.  But remember this general rule to match the whites of your eyes for the most natural look. #

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    Usually we cannot predict the effectiveness of whitening for each individual patient. The degree of whitening is variable because each person’s reaction to the procedure is individual.

But your own long term results will depend on if you smoke, drink coffee/tea/red wine and if you have good dental health habits.

    Depending on your oral health habits you may need "touch-up’ treatments at regular intervals You can periodic re-treat at home to maintain the desired color and shade. To help keep your teeth white, don’t forget to see us twice a year!

For a permanent change, you should consider the placement of Veneers.

***An Update on Tooth Whitening, Woman Dentist Journal, pg 10-22, Jan/Feb 2003

# Nightguard Vital Bleaching; Dr. Haywood; Dental Products Report pg 82-86,96; Oct 2002.

This information is courtesy of Gentle Dental Care.

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Last modified: 04/03/12