Q. I’m getting married in six weeks time, and want everything to be just right for my big day. I am concerned that my teeth look yellowish and I would like to have a whiter and brighter smile, especially for my wedding photos. I have tried many “over-the-counter” tooth whitening products, I have brought from the chemist or supermarket, but none have had that much effect. I understand there are new tooth whitening systems available, that may be able to help me achieve a better smile? Can you advise me, what I can do to get a beautiful smile for my big day!

A. unfortunately, many of the over-the-counter tooth whitening products that can be purchased from the chemist or supermarket, have a very low percentage of active ingredients to achieve any sort of significant tooth whitening effect. Further, these products commonly lack appropriate application trays, so that even these small percentage of active ingredients are rapidly diluted with saliva etc. Tooth whitening procedures; often employ the use of special agents of either carbamide peroxide or hydrogen peroxide, in high concentrations, as their active ingredients. These medicaments are utilised in special gels to maximise the affective of the agents and also prevent tooth dehydration, which may lead to excessive tooth sensitivity. Often these agents may also be activated by UV, halogen light or even lasers.

Research has indicated that professionally applied tooth whitening procedures will achieve a more rapid tooth whitening effect, however, unfortunately, there is still considerable marketing hype associated with some of the new systems purporting improved affects that is unfounded. Essentially, you can achieve the same level of tooth whitening, utilising professional systems applied in special trays to be worn for a half an hour to an hour per day for 10 to 14 days, as you can achieve with the use of some of the accelerated tooth whitening professional systems, overtime.

However, for some people who find compliance in using the tray systems everyday for some two weeks, hard to achieve, then in- surgery tooth whitening systems are of great benefit, or alternatively, if you are wishing to achieve a rapid start to your tooth whitening process. Systems such as “Zoom”, “Laser Bright” or “Bright Smile” are all affective in achieving an additional and rapid tooth whitening effect. To achieve the most desired result, this effect can be further improved with some “at home” tooth whitening, utilising professional tray systems. Ideally to achieve your beautiful smile for your wedding day, I would recommend some in-surgery accelerated tooth whitening with some at home tooth whitening for a further 10 to 14 days for the best effect. I hope you have a wonderful day, and smile radiantly!

Tooth Chatter

Many people want whiter and brighter smiles, whether they be 16 or 60! However, most are confused as to how they can achieve this improvement in their existing smile. For some, generally young people, with minimally restored teeth, tooth whitening procedures can be utilised, to achieve a significant whitening improvement. For others however, where the teeth are more heavily restored, may require a combination of tooth whitening and the replacement of existing fillings with new tooth coloured restorations. As the teeth are more heavily restored or filled, the effectiveness of tooth whitening diminishes greatly, and then other techniques, such as the use of porcelain veneers or all porcelain crowns, will provide a more predictable and significantly improved result.

Tooth discoloration can be due to many reasons. “Extrinsic” causes are for example, tobacco smoking, red wine, tea etc. “Intrinsic” causes can include nutritional and genetic disorders, trauma to the teeth, endodontic treatment or drug-induced, such as Tetracycline antibiotics. The success of tooth whitening procedures will be dependent upon the cause and severity of the discoloration. It is thus important, for a properly trained dental professional, to assess your individual discoloration issue, and provide appropriate advice as to the predictability of tooth whitening procedures or indeed, other restorative options, that can be utilised to achieve your desired result.

Many patients ask “does tooth whitening damage my teeth?â€� The answer is No! However, and there is a transient softening of the superficial enamel of the teeth along with some dehydration of the surface. This dehydration results in the appearance of the teeth looking “super bleached,â€� when in actual fact, it is simply the surface dehydration causing this effect. The tooth rehydrates within a few days, and patients perceive this as a reduction in the whiteness of their teeth. The initial superficial softening of the enamel can be reversed, with certain medicaments, which should be used with the tooth whitening process, to re-harden the tooth surface. There is no long-term detriment to the teeth, provided these precautions are undertaken.

In -office or in- surgery tooth whitening procedures utilise strong concentrations of either carbamide peroxide or hydrogen peroxide which are activated by heat, halogen light or laser energy. This process can lead to some transient sensitivity of the teeth, especially in those people with abrasion areas around the necks of their teeth (possibly due to toothbrush abrasion) or old and leaking restorations. Again, proper diagnosis is the key, and patients should be advised of these situations and the relevance of these issues in their particular case. The sensitivity that can sometime be experienced, with approximately 10% of patients, can be minimised with the use of certain medications and topical fluoride applications. Most patients can quite easily cope with in -office tooth whitening systems and achieve a rapid and effective whitening of their teeth.

There are many in- surgery tooth whitening systems being promoted heavily in the media at present, with the most popular being “Zoom,” “Laser bright,” and “Bright smile.” Anecdotally, many of these systems presume to be better than the other however, in clinical reality, most perform in a similar way and with similar results!

To achieve the most ideal and long-term tooth whitening result, a combination of in-surgery and at home tooth whitening procedures should be employed. Custom fitting, special trays or mouthguards, are required in utilising at -home tooth whitening. These trays are required to be worn approximately a half an hour to an hour a day, for 10 to 14 days. Most usually, two in -surgery tooth whitening appointments are required, along with the at- home tooth whitening, to achieve the desired results. For certain tooth discolorations, such as Tetracycline drugs staining, tooth whitening procedures maybe required for extended periods of some two months or so, in order to achieve an acceptable result.

The next most readily asked questions regarding tooth whitening are; how long will it last? and what is the cost?

Tooth whitening procedures, following the above protocol can achieve dramatic and significant tooth whitening effects. This result will be stable for approximately 18 months or so, after which a top up, at- home or in- surgery procedure for a few days may be required, to keep the desired shade.

Cost is obviously a variable dependent upon; the diagnostic skills in understanding what cases can, and can not be successfully treated, the materials and technology used and finally the number of in-surgery procedures. As a guide, most tooth whitening procedures, including at home and in-surgery tooth whitening, falls within the range of $1200-$1500.

The Macquarie Street Centre specialises in all aspects of cosmetic, implant and reconstructive dentistry. If you’re interested in tooth whitening or other cosmetic procedures, we look forward to you visiting us, and seeing how state-of-the-art cosmetic dentistry can help your smile!

ACSM Article- October 2005

“Achieving a Healthy, Youthful and BeautifulSmile!”

Most people want to look and feel healthy and attractive. The appearance of your smile and health of you teeth contribute greatly to this feeling and appearance! Take a close look at the world around us…. you will seldom see a model, actor or anyone in the media, or indeed, a friend or acquaintance whom you regard as attractive, with an aged and compromised smile!! Unfortunately, many people are unhappy with their dental health, whether it be discomfort, difficulty in eating hard foods or a generalised dissatisfaction with the appearance of their smile. They may rightly feel they have a prematurely aged smile that makes them look much older than they are, or feel! They commonly, have had a “patch-up” approach to their dental care over the years, resulting in limitations in eating certain foods, high treatment maintenance needs and generally poor dental aesthetics.

They may also have removable dentures rather than fixed bridgework or implants to replace missing teeth. These people often stumble from one dental problem or issue to another, without the benefits of high standard care providing excellent function, aesthetics and minimal ongoing maintenance needs. This is what comprehensive dental care is all about….. full and proper diagnosis and assessment and the development of an overall treatment strategy based upon that person’s individual needs and requirements.

For some, treatment may be spread over years, due to time or financial considerations, however, for others, especially with new no-interest “Dental Care Credit” funding; their treatment desires can be easily and quickly achieved. No matter what the time-frame, it is important that an overall treatment strategy is developed and not compromised by short-term “patch-up” approaches to treatment.Contemporary aesthetic and reconstructive dentistry today offers exciting, attractive and cost effective solutions to the aging smile. At The Macquarie Street Centre for Implant and Aesthetic Dentistry, following a comprehensive examination and diagnostic assessment, an individual treatment plan is designed to address and fulfil our patient’s individual treatment desires. This may also include the use of other specialists, where required, as part of an overall treatment plan.

A full treatment plan is presented to our patient’s for their complete understanding and acceptance, prior to their treatment beginning. This will include the number and time of appointments required, the total cost of treatment (and arrangements for credit facilities where required) and a detailed schedule of treatment to be undertaken as planned for each appointment, as well as the anticipated total time of treatment. Following completion, a continuing care program is provided with the assistance of our Hygenists at The Macquarie Street Centre, to help maintain and protect your new, healthy and beautiful smile.We invite you to share the experience of high quality, comprehensive dental care in the most modern, “state of the art” facility. We look forward to welcoming you soon to our practice.
Tooth Chatter -”Options For Whiter teeth”

Q. I have tried all sorts of tooth-whitening procedures, including different gels in special trays as well as laser whitening etc, but I am still unhappy with the colour of my teeth. I am now 36 years of age, and am starting to feel and look middle-aged, which I hate! What can be done to give me a beautiful smile!?

A. There are many reasons why your teeth may not be responding to tooth whitening procedures.
Surface stains (also known as extrinsic stains) are superficial stains located on the surface of the tooth. Common surface stains are dental plaque and calculus, tars (in tobacco), tannins (in tea or coffee), coloured foods such as soy sauce, cola drinks, and the ingredients in some dental mouth rinses. These surface stains are generally relatively easy to remove, revealing the “true” underlying tooth colour.Internal stains (also known as intrinsic stains) are coloured molecules and pigments that have become incorporated into the internal structure of the tooth. This can occur as the tooth is developing, or after the tooth has been present in the mouth. Some fifty conditions have been associated with changes to tooth structure as it forms. Tetracycline antibiotics, used when teeth are developing, are an example of intrinsic tooth discolouration which can lead to yellow-brown or indeed unsightly grey-blue staining of the teeth. Discoloured or leaking restorations (fillings) are another common cause.

The external or extrinsic stains are removed with professional prophylaxis by our Hygienists in our continuing care program. Internal or intrinsic staining is handled differently. Depending upon the severity of the staining, whitening procedures can be used successfully using a combination of at-home and in-surgery whitening procedures as well as the replacement of any stained or leaking filling materials with colour-matched restorative techniques. However, some stains do not respond as well as others, and in these cases porcelain veneers or all -porcelain crowns (where the teeth are heavily filled and need added protection) are used to not only create the desired tooth colour and characterization, but can also be used to change shape, size, correct rotations and crowding issues as well. These options also have the benefit of providing long term solutions: having a life-span of some 15-20yrs. So don’t despair, you can achieve that smile you have always wanted!