Teeth Whitening: Expert Q&A Dr James Hanna.

You’d think that dental hygiene wouldn’t be something that is up for debate but bicker we do. Is charcoal any good for us? The fluoride argument is back! And what ever happened to mouth wash? We get the straight talk from  Dr James Hanna from Complete Slimes Bella Vista.

What are the biggest indicators of age when it comes to teeth?

 There are two major effects that people notice as we get older. The first is the facial symmetry. This is really important because as we get older, our teeth will start to crowd forward, and this is nothing to do with wisdom teeth, it is a natural progression. This is where your front teeth start to cross over, canine start to tilt forward a bit more, everything collapses in a little bit more the older we get.

The second thing is always colour. Colour is a huge thing that stands out for people because a smile can either make or break a person- if your teeth don’t match the brightness that you exude.

 Our older generation has silver fillings, so you start to see the teeth become black. Not because they are unhealthy, they’ve got this big silver filling that’s been in there for forty years. But that is potentially one of the biggest factors to teeth discolouration.

 Fluoride seems to have suddenly become controversial. What is your opinion of fluoride in our water systems?

Okay. The reason fluoride got into water-systems is to actually protect the teeth and to kill any bacteria that is in the piping as well. That’s why they put chlorine and a bunch of other substitutes in there. This is a bit of a contentious topic. For me, it all comes back to if there is a benefit that out weights the cost there.

 If we just look at how the idea originally came about, it worked really well protecting the teeth, and it still does. In the classic cases, you can look at the kids in Queensland, and the reason why Queensland took a long time to have fluoridated water. We are relying on toothpaste, or you’re relying on rural towns that would put fluoride into their tank-water supplies. In the ‘70s, ‘80s and ‘90s, Queensland health had double or sometimes triple the rate of decay on bacteria eating on the teeth as anyone else in Australia. That was only ever attributed to one thing, and that was the lack of Fluoride.

So, they tried with fluoride in some areas in Queensland, in particular Southeast Queensland, Ipswich and places like that, and they found a dramatic decrease in a rate of decay in kids. What I always say to my patients is, “Look, there’s nothing wrong with not having fluoride at the dentist, if you really want it, there’s nothing wrong with having a fluoridated toothpaste

 How do you feel about charcoal toothpaste?

Charcoal works off the same cleaning premise, which is the foamy action and lifting off the stains. As an old-school form of lifting up the teeth and whitening, back in the day it worked quite well, but if that’s what you’re relying on, I’d still be far more comfortable if you use everyday whitening toothpaste. They’re great and if you’re going to use it and are already brushing your teeth, there is no reason why can’t you use this toothpaste as a substitute for the normal toothpaste.

 It’s all horses for courses. If something really works for you, at the end of the day I’m just glad that you’re brushing and cleaning and coming in. If baking soda is getting you across the line, then so be it.

What are the true teeth staining culprits?

Green teas are the worst. This is where a lot of people get caught up. Basically, any tea out there has tannins. Tannin is a natural clotting factor that’s found in the human body and makes the blood clot. But tannin is also highly intrinsic. Let me talk about extrinsic and intrinsic. Alfa stains, which are easily removed with brushing and intrinsic are internal, the deepest stains you need whitening to get rid of. Tea has a very good way of becoming an intrinsic stain, getting deep into the teeth. A really simple way think of your teeth as the same as your skin, where teeth actually have pores or openings. When you have wine or tea, or when you smoke, it creates a porous layer on a tooth and everything dries out.

Most people combine drinking wine with a cigarette, or their morning tea/coffee with a cigarette. And most won’t stop at one coffee in the morning, I’ll have two, its similar with wine at night. If you’re having one glass of wine, it’s very easy to have two. There is nothing wrong with having all this stuff, but if you leave it to linger or to sit on the surface of the tooth, that’s when that external stain that’s easy to clean off feeds into the deeper layers.

Enjoy your drinks, but always remember, you want to stick to a twenty-minute rule which is how long it takes for the saliva to build up in the mouth and neutralize the acidity or the pH level. I say to people, “Look, you can speed this up by having a glass of water on the side.” Now they’re looking at me funny and say, “You want me to drink water in-between my wine?” I’m saying no. What I do is every half hour, hour, if I’m still going on drinking, I’ll have a glass in between. I won’t just drink it; I actually rinse it around my mouth.

Doing that and making sure you brush at night, after a night of drinking or having coffee is really important, because you don’t want to leave those stains overnight. Rinsing with water helps greatly

Stopping short of big procedures like Veneers, what whitening really does work for ex-smoker teeth?

 The first is always to regularly cleanse, that’s the biggest thing. The second thing always comes back to rinsing and chewing sugar-free chewing gum. Coming off smoking, the first thing that we do before the whitening is a full thorough clean. We use a particular smoker’s pomace or protein, which is kind of a paste that cleans off that external layer of staining. Once we do that, we give them a whitening toothpaste for a couple of days that also is a sensitive toothpaste for when we do the whitening.

If the patient is a very heavy smoker, we recommend Zoom in-chair whitening, which is carried out over 60 minutes. It’s broken up into four sessions, which you apply each time. Patients also go on, what we call a white diet, for one to two days, which is nothing really colourful. After that, we wait a week and then we start using a take-home kit which are the best, but compliance is always an issue. This where we treat the person, not the teeth.

To be honest with you, those are all intermediaries, you get the best result with a take-home, because it’s a long application over a long period of time. You are doing the first session for two weeks, and you do that 15 minutes twice a day for two weeks. You can whiten again using a take-home system within three months. Over the course of a year you can do in-chair whitening once a year, but you can actually do a take-home whitening kit some two weeks sessions. You can do that, three to four times a year quite comfortably, monitor, control the sensitivities. If you get sensitivity, you stop, you do one day on, one day off.

You’ve got a lot more advantages to that system, plus, if you have a particular heavy month, let’s say it’s the month of Christmas and you are going out a lot more, eating a lot more decadent foods, it’s quite easy for you to pull out the kit from the fridge, load up the bleach trays and do a couple of days. You don’t have to do a full session, just a couple of days, just for some backup for any special event you have coming up or anything like that. You can’t do that with in-chair systems.

The other really good thing that I love about take-home kits is that they come with two types of whitening agents. This is really important. There is hydrogen-peroxide and carbonite-peroxide. They both work the same. Hydrogen-peroxide is more your traditional bleach, so the higher the percentage of that, the less time needed for whitening, but the higher the chances sensitivity. With the carbonite-peroxide, you need a longer application, because it’s less peroxide percentage in it, less activation, but you get much less sensitivity. You’ve got to pick the right kit each one now. If you come to us in to whitening, it’s really only one data that works really well, and it’s really the only one type of bleach that they sell, it’s the hydrogen-peroxide, and it is very high percentage when you do in-chair whitening.

When we do a take-home, I get a lot more levy. I can pick a better choice for you. We can run through everything together and if it all get sensitive, you can stop for a day or two, start again, not have wasted your money and continue on. With in-chair whitening, we always tell people it’s four sessions, it’s a really high peroxide. If you get sensitivity, we can reduce the intensity, we can slow it down, but if you can’t complete your four sessions, it’s a bit sad for the person, because they’ve come in, they’ve waited, they paid it and it’s not their fault, they just can’t complete the session. We end up in that scenario turning around and say, well, if you can’t complete your sessions, we offer them the take-home kit.

Again, if the person doesn’t follow through on it, it’s not that the whitening failed at that point, it’s that the treatment wasn’t suitable for them. Unfortunately, if the person, once the quick fix in-out doesn’t have the time to sit down and do that, it kind of leaves them with no other option. Then we start looking at the whitening toothpaste again. I would say my favourite is the take-home, just because there is so much that you can do with that, it suits people a lot better.


 Mouthwash seems to be out of fashion a bit. Is it in or out?

A lot of mouthwashes were created with alcohol and with fluoride in them but the alcohol has been removed but in terms of the fad-phase, it’s been and gone now. A lot of companies really pushed against it, and then a lot of companies said that a lot of ingredients were cancerogenic.

They changed a lot of the components and again a lot of the natural companies have come out with natural mouth-rinses. To me, salt water is actually the best thing to rinse with.

 Interesting! It’s never too late to change up a routine. What is the best teeth cleaning practice?

  Brush morning and night. Night-time is most important because when you sleep, you don’t produce any saliva, and saliva is the natural buffer or the natural protecting layer.

Eating a diet that’s nice and clean and healthy. You want a lot of raw unprocessed fruits and veggies, things like that, because they’re rough, they keep everything nice and clean. Biting into a lot of rough chewy stuff is great, and that’s why they say ‘an apple a day keeps the doctor away’, because it’s when you bite into that and chew it, it cleans the surface of the tooth.

The twenty-minute rule is crucial. Don’t eat or drink within twenty minutes after brushing, it allows the toothpaste to get absorbed, and don’t brush within twenty minutes of eating or drinking. So you reduce the chance of removing the enamel layer because of acidity.

Rinse, rinse, rinse. Rinsing throughout the day lubricates the mouth, it keeps everything nice and healthy and it forms the layer over the tooth, which is the protective layer that just sits there.

Using a soft toothbrush. There is no need for medium and hard, I actually encourage all my patients to use a children’s toothbrush. Look at how many bristles they have – the bristles overall are finer, they’re much softer. They have a lot more on the head of the toothbrush. The head of the toothbrush itself is much smaller and much more narrow. You can get into all those little nooks and crannies that you otherwise miss. It’s actually good for those who don’t floss as it’s a better clean.

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