The Cosmetic Dentistry Blog

August 19, 2014

How white are bleached teeth?

I’ve had this question come up in discussions with dental writers and with patients who have a misconception about teeth bleaching. They understand that teeth tend to accumulate stains over the years. They absorb the pigments from coffee, highly pigmented fruits, wine, and other sources. Bleaching, they think, is a way to remove all those stains.

They’re only partly right. Yes, bleaching will remove those stains, but it will whiten even the natural pigment in your teeth. Let me illustrate this with a couple of stories.

When I went to dental school, I learned about shade guides. The most popular one was the Vita shade guide. Here is a picture of it:
vita-shade-guide

It has a full spectrum of the range of shades a dentist is likely to encounter in natural teeth. When we needed a porcelain crown to match a patient’s other teeth, we could almost always find a shade in this guide that came pretty close to the patient’s natural tooth color.

In the 90′s, ivoclar-shade-guide-bleached-teeth when teeth bleaching became popular, we started to have a problem with this shade guide. We would have people who needed porcelain crowns, and when we tried to find a shade that matched them, they would be “off the chart.” Their teeth would be much whiter than the whitest natural shade on the shade guide. In response, shade guide manufacturers developed new whiter shades. Ivoclar was the first manufacturer that I remember doing this, and our office purchased this four-shade guide and used it to communicate with dental laboratories. You can see that shade guide at the right.

Vita also updated their shade guide, and here is a picture of the current version, with what they call the “bleached extension” shades on the left:
vita-shade-guide-bleached-extension

Serious cosmetic dentists will, of course, use this amplified shade guide because they are frequently dealing with patients who have bleached their teeth. Often, regular family dentists will only use the original A1-D4 shade guide. This led to a problem with one patient who e-mailed me around 2005. She had bleached her teeth, and was now getting porcelain veneers on four front teeth. Not knowing how specialized cosmetic dentistry is, she chose a regular family dentist to do these veneers. For the shade, this dentist selected the whitest shade on his chart. When the veneers came back from the lab, they were noticeably darker than her teeth. The dentist assured her that by using the whitest cement the veneers would match her teeth. She wrote to me, “Alas, this was not the result: there is at least an entire shade (if not more) of difference between my porcelain veneers and my other teeth.” I answered her that unfortunately, her dentist used the classical shade guide, and the whitest shade on that guide could be considerably darker than bleached teeth. For the full story, see the page under “Cosmetic Dentistry Horror Stories” where I discuss her question, can you bleach porcelain veneers?

When my own children got all of their permanent teeth in, I let them bleach their teeth if they wanted to. Even though they weren’t old enough to have any accumulated stains, they were able to whiten their teeth significantly.

So how white can you get your teeth? The results of studies seem to show that the longer you bleach, the whiter they will become, and no one, to my knowledge, has found the limit. The rate of whitening decreases the longer someone uses the bleaching gel, and everyone will hit a point where they don’t want to do it anymore. Some people get them so white that they seem to glow.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 6, 2011

Can you bleach porcelain veneers?

Filed under: Choosing a cosmetic dentist — Tags: , — mesasmiles @ 3:28 pm

I had a new way to explain an answer I gave to a Stacy in Missouri, several years ago. She e-mailed me about the shade of her porcelain veneers. She explained that she had decided to get porcelain veneers for her four front teeth and asked her family dentist to do that for her. She was concerned about getting the shade right, because her teeth were bleached. The dentist produced a shade tab that he said was the whitest shade available. She was skeptical, but let him go ahead.

The final result left her very disappointed and self-concious. She said that the veneers were at least an entire shade, maybe more, darker than her own teeth.

She asked me if she could bleach her porcelain veneers. Unfortunately, they don’t bleach. They’ll have to be re-done.

The problem here is the insensitivity of the dentist to esthetic issues. This is an important issue, and goes to the vast differences between dentists when it comes to cosmetic dentistry.

Porcelain veneers can be any color, as white as you want. Much whiter, even, than bleached teeth. But I have had e-mails where this has happened to patients. The dentist is so tuned out on esthetic issues that he doesn’t realize that the bleached teeth are much whiter. The dentist isn’t a bad dentist. Some of them are excellent. But he or she is a “fixer”, not an artist. He or she looks at the teeth, sees they’re pretty white, and so goes to his shade guide to write the prescription. He thinks: “They taught in dental school that B1 is the whitest shade, or was it A1? OK, we’ll ask for B1. That’s pretty white.” He doesn’t have the supplemental shade guide for bleached teeth that goes 4 shades whiter than B1. He may not even know it exists. And if he takes the trouble to hold the shade guide up to the teeth, he thinks, “That’s close enough.” This is what we’re dealing with in the case of a majority of dentists, unfortunately. And the fraction of dentists that are REALLY tuned in to esthetics is even smaller, like 1-2% that I would say are capable of creating a truly beautiful smile makeover.

 

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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