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Orthodontics/Invisalign Attachments

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Hello Dr. Supan,
 I am in the middle of treatment with Invisalign braces. I have noticed my teeth have become much more yellow than I prefer. I have read mixed advice on whether or not I can use Crest Whitestrips with attachments on as they do not penetrate the attachments and will leave me with discoloration after removal. My question is, how long does the whitening effect last? I still have over a year and if I do a strip or two to get a little whiter, will there still be a noticeable difference by next year or do the whitening effects lessen a few months later? I am a regular coffee drinker, and do brush my teeth frequently with whitening toothpaste and use a fluoride mouthwash.
Thank you so much,
Sarah

Answer

Hi Sarah,

I recommend the use of Crest White Strips to,any of my patients, including ones who are either currently in or have completed their treatment using clear removable aligners such as the Invisalign appliances.   First let me say What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on using whitening strips during  orthodontic treatment..  You  wrote:

" My question is, how long does the whitening effect last? I still have over a year and if I do a strip or two to get a little whiter, will there still be a noticeable difference by next year or do the whitening effects lessen a few months later? "  

I am an avid tea drinker myself Sarah, so I share your experiences regarding stains. I also want to say that there may be several issues regarding these strips if you have numerous ' Invisalign attachments".

These attachments are made out of a resin which will not "whiten" in an identical manner as your enamel. Also, if you do experience a substantial change in the whiteness of your teeth during your treatment, once the " resin attachments" are removed, the unexposed enamel which will then be revealed obviously will not have been exposed to the whitening process. You may see some " darker areas" relative to the other more whitened enamel on the exposed parts of the crown. This is much like a bikini line where you do not tan underneath the swim suit.

From a practical perspective, I would say give it a try and see how it goes. I do not know how much whitening you are trying to achieve given your coffee intake. There are also whitening tooth pastes on the market and this may another option to consider. I do believe that definitive whitening by whatever method, will best be done after your treatment is done and all attachments are off.

The use of a profession strength fluoride containing mouth wash is important because many whitening agents act by using a weak acidic process to whiten the teeth. This slight demineralization of the enamel gives a positive esthetic effect, but may at the same time create opportunities for white spots and demineralization. I do not have an evidence based dentistry response to whether aggressive use of fluoride containing mouth rinses will substantially effect or even negate the use of tooth whitening agents using weak acidic processes to whiten the teeth.

This is a fascinating question Sarah, and I hope you will post a follow up comment or question. I wish you all the best, and enjoy your coffee.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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