One of the best options for tooth surface stain removal and discoloration is to whiten teeth. There are several options and products used for teeth whitening, and it can be performed at home or professionally at a dentist's office. But many people often experience sensitive teeth after whitening. In fact, Reader's Digest states 78 percent of people have tooth sensitivity, also known as dentin hypersensitivity, after undergoing external tooth bleaching that uses the traditional carbamide peroxide.
To Bleach or Not to Bleach
There are many types of whitening products – from gels and bleaching strips to whitening toothpastes and mouthrinses. Tooth whitening, however, can be achieved in two ways, according to the American Dental Association (ADA): the use of bleaching products and non-bleaching products. On the one hand, the tooth can be bleached with a product that changes the natural color of the tooth. Many of these products contain carbamide peroxide, an active ingredient that breaks down into hydrogen peroxide and urea. These substances work to remove stains that are both deep (intrinsic) and those that are on the surface (extrinsic) of the tooth. On the other hand, non-bleaching products contain ingredients or agents that only work to remove surface stains. A dentist can administer whitening products in the dental office or provide one for home use – or you can purchase your own over-the-counter (OTC) whitening products.
Your Sensitive Side
Sensitivity can occur during and after the use of peroxide-based bleaching agents. When your teeth are sensitive, they can have enhanced responses to hot and cold drinks, aggressive toothbrushing or sweet foods – in the form of short, sharp pain. This sensation frequently occurs during the early stages of bleaching treatment when the hydrogen peroxide soaks through your enamel, exposing the nerves in the dentin beneath it.
Unless it contains a peroxide bleaching agent, products like whitening toothpastes (dentifrices) may cause less sensitivity because they only treat your teeth's surface. Different patients can experience different results using the same product depending on their teeth. Generally, gels used in bleaching trays – as well as some OTC bleaching products – have a greater potential for causing sensitive teeth after whitening.
Variations in Sensitivity
Teeth sensitivity is particularly common with higher concentrations and longer contact time with the bleaching product. Most professional whitening products have higher concentrations of hydrogen peroxide compared to OTC whitening products. There is also occasional irritation of the gum tissues with the use of peroxide-based bleaching agents, though sometimes tissue irritation comes from ill-fitting trays used to hold the bleaching agent. Other side effects within the dental and soft tissue (oral mucosa) can involve pulp sensitivity, tooth root resorption and the release of select components of dental restorative materials. ADA reports from two clinical trials indicated that excessive alterations to the enamel – or enamel damage – were likely due to low pH of OTC whitening products or overuse or both.
Sensitivity of the teeth and gums is mainly temporary and stops after the bleaching treatment. However, the frequency and severity of tooth sensitivity can be affected by the techniques used, the quality of the bleaching product and a person's response to the bleaching materials and methods.
There are several products or techniques that are most often used to treat teeth sensitivity also known as dentin hypersensitivity:
- Use a lower concentration of whitening product.
- Reduce the amount of tray bleaching wear time.
- Increase the time between individual bleaching treatments.
- Avoid whitening for an extended period.
- Use a desensitizing treatment or varnish applied chairside in dental office.
- Prescribed gel or toothpaste for tooth sensitivity.
- Gentle brushing with a soft-bristled brush, using lukewarm water.
- Change diet by avoiding hot or cold foods for a day or two after whitening.
- Avoid excessive use of at home whitening treatments.
- Use desensitizing agents 10 to 30 minutes prior and after each bleaching.
- Use bleaching products with added desensitizing agents.
An important step prior to teeth whitening is consultation from your dentist to determine if whitening is an option for you, as well as potential for tooth sensitivity. The dentist can do an evaluation of your teeth and conduct a "touch and air" test to determine the type of whitening treatment method that would be most appropriate for you. Your dentist can also recommend a desensitizing toothpaste, such as Colgate® Sensitive Pro-Relief™, to provide immediate tooth sensitivity relief. Other options used to aid in reducing the feeling of sensitive teeth after whitening may include non-steroidal anti-inflammatory drugs (NSAIDs) and products that contain fluoride or potassium nitrate.
About the author: Yolanda Eddis, RDH, BASDH, is a clinical registered dental hygienist for the United States government. She is a member of the American Dental Education Association and Esther Wilkins Education Program, and is a Colgate Oral Health Advisor. Her research interests include community outreach projects. Eddis is currently pursuing her Masters of Health Science degree in a generalist concentration at Nova Southeastern University in Fort Lauderdale, Florida.