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The treatment phase of teeth whitening involves the application of the bleaching agent to the teeth. This can be done through various delivery systems, ranging from high concentration in office procedures to lower concentration take home trays. The goal is to maximize the whitening effect while minimizing sensitivity and protecting the soft tissues.
Care during the whitening process is critical. Patients must adhere to specific protocols to ensure safety. The chemicals used are potent oxidizers, and misuse can lead to chemical burns on the gums or damage to the tooth nerve.
Whether performed in the dental chair or at home, the process requires diligence. Professional supervision ensures that the treatment can be adjusted if side effects occur, providing a safety net that over the counter products lack.
In office whitening is the fastest way to achieve results. The dentist uses a high concentration hydrogen peroxide gel (typically 25% to 40%). Because the gel is so potent, strict isolation is required.
A liquid dam is painted onto the gums and cured with a light to harden it. This barrier protects the gum tissue from chemical burns. The gel is then applied to the teeth and left for 15 to 20 minute intervals, often repeated up to three or four times in one visit.
Take home trays are considered the gold standard for long term stability. The dentist takes an impression or scan of the teeth to fabricate clear plastic trays that fit the patient’s teeth perfectly.
The patient is given syringes of carbamide peroxide gel (typically 10% to 22%). They dispense a small dot of gel into the tray for each tooth and wear it for a specified time, ranging from 30 minutes to overnight, depending on the concentration. This method takes 1 to 2 weeks for full results.
Many clinicians recommend a hybrid approach: a single in office session to “jump start” the whitening, followed by take home trays to stabilize and enhance the shade.
The in office session dehydrates the teeth, making them look very white immediately, but some color rebounds as they rehydrate. The take home trays counteract this rebound, ensuring the deep stains are fully oxidized and the color is “locked in.”
During in office whitening, a specialized light (LED or Laser) is often focused on the teeth. The light energy activates a photo initiator in the gel, accelerating the chemical breakdown of the peroxide.
While the light speeds up the process, it can also generate heat. The dentist monitors the patient to ensure the heat does not irritate the pulp. Modern lights use cool LED technology to minimize this thermal risk while maximizing the photochemical reaction.
For a single dark tooth that has had a root canal, the dentist performs internal bleaching. An access hole is made in the back of the tooth. The whitening agent is placed inside the pulp chamber and sealed with a temporary filling.
The patient “walks” out with the bleach inside the tooth. It works over 3 to 5 days to whiten the tooth from the inside out. This process may be repeated until the tooth matches the neighbors, after which a permanent seal is placed.
If sensitivity occurs, the treatment protocol is adjusted. For in office patients, the gel is removed immediately. For home users, they are instructed to skip a night or reduce the wear time.
Relief gels containing potassium nitrate or fluoride can be placed in the custom trays and worn for 30 minutes instead of the bleach. This bathes the teeth in soothing minerals, calming the nerve and allowing the patient to continue treatment comfortably.
If the whitening gel touches the gums, it causes a chemical burn. The tissue turns white (blanching) and may sting. This is usually temporary and heals within a few days.
To prevent this with home trays, patients are taught not to overfill the tray. A “bead” size amount is sufficient. If gel squeezes out, it should be wiped away immediately with a finger or cotton swab. Vitamin E oil can be applied to soothe irritated gums.
The custom trays must be cared for to last. After each use, they should be rinsed with cold water. Hot water can warp the plastic, ruining the precise fit.
Residual gel should be brushed out of the tray with a soft toothbrush. The trays should be stored in their case to allow air circulation and prevent loss or damage by pets.
Patients should monitor their shade progression. It is easy to become “blind” to the changes when looking in the mirror every day. Comparing the smile to the baseline shade guide or photos helps verify progress.
Treatment should stop when the teeth reach the desired whiteness or if the teeth become translucent at the edges. Over whitening can lead to a bluish, transparent look that appears unnatural and aged.
Immediately after whitening, the teeth are dehydrated. The pores are open and the enamel is dry. This makes them appear chalky white. As they rehydrate over the next week, the color will settle and look more natural.
During this rehydration phase, the teeth are like sponges. They will absorb stains rapidly. This leads to the critical “White Diet” period immediately following treatment.
Swallowing a tiny amount of gel is generally harmless but may cause a mild sore throat or upset stomach. If you swallow a large amount, it can cause nausea and vomiting due to the foaming action. Drink water to dilute it. Always wipe excess gel off your gums to prevent swallowing.
Whitening opens the microscopic pores in your enamel to clean them out. This temporarily exposes the nerve pathways to air and temperature changes. It is a normal side effect and means the product is penetrating. It typically resolves once the pores remineralize in a few days.
It is generally recommended to avoid elective dental procedures, including whitening, during pregnancy and breastfeeding. While there is no evidence of harm, there is also no research proving absolute safety. It is prudent to wait until after this period.
White gums indicate a chemical burn from the peroxide. This happens if the protection barrier leaked or if you overfilled your home trays. It looks alarming but is superficial. The white tissue will slough off, and the gums will heal and return to pink within a few days.
Most people touch up their smile once a year or after a dental cleaning. You can use your custom trays for 1 or 2 nights to brighten the smile. Whitening too often (e.g., every month) can damage the enamel protein matrix and lead to brittleness.
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