Teeth Whitening

Where it may be suitable

• Healthy teeth that have darkened with age, or from tea, coffee or smoking
• Lightening the natural colour of the teeth first, when crowns, veneers or another cosmetic procedure are being considered

Where it is not suitable, or other treatment is needed first

• Under-18s. The NHS says whitening is not done if you are 17 or younger². Under UK rules, the whitening products sold only to dental practitioners are not used on anyone under 18 (see the product rules below).
• Pregnancy and breastfeeding. Whitening is postponed because there are not enough safety data.
• Untreated decay, gum disease or cracks. Whitening can make pain or irritation worse; these are treated first.
• Exposed root surfaces and marked sensitivity. Sensitivity may increase.
• Allergy to peroxide.

Where its effect is limited

• Fillings, veneers and crowns. Their colour does not lighten. If you have restorations like these on your front teeth, they may need replacing after whitening so that the colours match.
• Discolouration caused by medicines. Dark discolouration caused by some medicines responds to whitening more slowly and to a limited degree; a longer course may be needed.
• A root-filled tooth that has darkened. It responds only partly to whitening from the outside. In suitable teeth, a separate procedure can whiten the tooth from the inside. The condition of the root filling is assessed first, and a protective barrier is placed inside the tooth. Rarely, this internal whitening has been followed by loss of tissue from the outer surface of the root near the gumline (external cervical resorption).

Whether whitening suits you is assessed at an examination, with X-rays where needed.

• Doing nothing, or a professional clean only. If the discolouration comes from surface staining, scaling and polishing may be enough.
• In-clinic whitening. The gums are protected and a high-concentration gel is applied to the teeth. The result starts to show the same day; the colour settles over a few days as the teeth regain their moisture.
• Home whitening. Trays are made to fit your teeth, and you apply a low-concentration gel at home for as long as your dentist tells you. The result appears gradually over several days.
• Both together. Whitening started in the clinic is continued at home with a low-concentration gel.

An umbrella review, which brought together reviews covering hundreds of clinical studies, compared home and in-clinic whitening. Once a suitable programme has been completed, home and in-clinic whitening supervised by a dentist give a similar colour change on average¹. The number of sessions and the time needed vary from person to person. So the choice of method depends less on the result than on your time, how prone you are to sensitivity and what you prefer.

Light and laser

Routine use of light, LED or laser has not been shown to add a clear benefit³ to whitening. The evidence on some specific protocols is limited, and some laser protocols can increase sensitivity.

Who may whiten teeth in the UK, and how strong the products are

In the UK, tooth whitening is the practice of dentistry. Only registered dental professionals may offer or provide it⁴, whatever products are used. The General Dental Council (GDC), in its guidance for patients, names them: registered dentists, dental therapists, dental hygienists or clinical dental technicians working to the prescription of a dentist⁵. The GDC also states that the maximum strength of hydrogen peroxide a dentist can use for cosmetic whitening is 6%⁴.

Under the cosmetics rules that apply in the UK, products with up to 0.1% hydrogen peroxide are sold freely⁶. Whitening products with more than 0.1% and up to 6% are sold only to dental practitioners. The first use of each course is carried out by a dental practitioner or under their direct supervision. These products are not used on anyone under 18. The NHS warns about whitening at places such as beauty salons, and about kits bought from a pharmacy or online. It says they do not work as well and may harm your teeth and gums².

In Turkey, whitening products containing or releasing up to 6% hydrogen peroxide are classed as cosmetics⁷, not medical devices. The Turkish announcement does not restate the UK sales and age conditions above. It also says that for whitening done by a dentist in the surgery, higher concentrations of 30-35% hydrogen peroxide are preferred⁷. A gel of that strength is stronger than a UK dentist may use for cosmetic whitening.

This page does not say which whitening products the clinic uses, or at what strength. Ask for the product names and strengths before treatment, for the clinic session and for any gel you take home. Ask for them in your written plan, too. Some gels contain carbamide peroxide, which releases hydrogen peroxide. The UK limits count the hydrogen peroxide a product contains or releases⁶, so ask for each strength as hydrogen peroxide. You can then compare it with the UK figures above.

Whatever you use at home, highly abrasive products and hard brushing can increase wear, especially on exposed root surfaces. Ask your dentist which toothpaste suits you.

An examination comes first; any decay, cracks or gum problems are treated before whitening. Your starting shade is recorded. How the appointments fit a trip from the UK is covered in "If you live in the UK".

Risks and side effects

• Tooth sensitivity. This is the most common side effect. The risk is higher with some high-concentration products⁸; it also depends on the active ingredient, how long the gel is applied and the person. According to reviews, it usually passes within two to three days¹. Desensitising treatments containing potassium nitrate or fluoride reduce sensitivity³ without reducing the whitening effect.
• Gum irritation. If the gel touches the gums, it can cause burning and white patches. That is why the gums are protected in the clinic; at home, putting too much gel in the tray also leads to overflow and irritation.
• Uneven colour. Fillings, veneers and crowns do not whiten; a colour difference can appear between them and the natural teeth.
• Less change than expected. Not every tooth lightens to the same degree; the shade that will be reached cannot be predicted exactly in advance.
• Colour returning. The colour partly returns over time; the treatment may need repeating.

Benefits

• No tissue is removed from the tooth.
• It is far less invasive than irreversible procedures such as crowns.
• If the result is not enough, your dentist can still assess the other options.

In the first days after treatment, the teeth may be sensitive to hot and cold. Avoiding very hot and very cold food and drink, and using a desensitising toothpaste, helps during this time.

Keeping the colour in the long term

• Tea, coffee, red wine and smoking stain the teeth again over time; cutting down on them keeps the colour longer.
• Brush twice a day with a fluoride toothpaste, and clean between your teeth every day.
• Keep up regular check-ups and cleans.

The effect of whitening is not permanent. The colour partly returns over time¹; how long the effect lasts depends on the person, the method used and habits such as diet and smoking. Whether it needs repeating is assessed at check-ups.

During home whitening, marked pain or a burning feeling in the gums means you should stop. Take the tray out, rinse your mouth with water and talk to your dentist before starting again.

Contact your dentist if any of the following happens:

• Sensitivity that lasts more than a few days or keeps getting worse
• Throbbing toothache that starts on its own
• Burning, a sore or white patches on the gums that do not go away

Swallowing gel. If you swallow more than a trace of gel, or feel unwell after swallowing it, get medical advice without waiting. Keep the product packaging with you.

Emergencies. Facial swelling, a fever or severe pain are not an expected result of whitening. See a dentist where you are without waiting for the clinic's reply. In the UK, if you have no dentist or cannot get an emergency appointment, the NHS says to call 111 or use 111 online⁹. If you have difficulty breathing or swallowing, go to an emergency department. In Turkey, the emergency number is 112. In the UK, the NHS advises you to call 999 or go to A&E⁹ if swelling makes it hard to breathe, speak or swallow.

Before you fly home

Make sure the shade reached so far has been recorded and that you have written care instructions. If you are continuing whitening at home, check that you know how much gel to use and how long to wear the trays. Ask, in writing, which dentist is responsible for the home course, how and when it will be reviewed, and whom to contact with questions. Your final shade is only known once the home course has ended and the colour has settled. If crowns or veneers are to follow, their shade is chosen after that, as your dentist advises.

Once you are home

If a problem comes up that is not urgent, write to the clinic and send photographs. You can also see your own dentist in the UK; how that works is under "If you live in the UK". In the emergencies above, do not wait for a reply.

Who treats you, and the appointments

Whitening is carried out at our clinic in Antalya, Turkey, by the clinic's dentists. In-clinic whitening is done after the examination and any cleaning or treatment that is needed first. The number of sessions varies from person to person. Home whitening usually goes on for weeks, so most of it happens after you return to the UK. You take the trays and the gel with you and use them as your dentist instructs. Whitening is also available as private treatment at dental practices in the UK², where a dentist can see you in person during a home course. The number of days in Antalya depends on the method and on whether decay, gum problems or cracks need treating first. It also depends on whether fillings, veneers or crowns will be replaced to match the new shade. Before you book, you receive a written preliminary plan with the appointments and how many days they need. It is based on your photographs. The GDC says you should always be assessed by a qualified dentist before being given a treatment plan and cost estimate¹⁰. For whitening, that assessment is the examination in Antalya. It confirms or changes the preliminary plan, and with it the days and the cost. You can say no, or ask to stop, at any stage.

Flying. We have found no guidance that sets a waiting time before flying after whitening itself. If other treatment is done on the same trip, such as fillings or an extraction, ask your dentist when you can fly.

Questions to ask before you book

The GDC lists questions to ask before treatment abroad¹⁰. These are the ones that matter most for whitening, with what this page can tell you.

1. Who will carry out my treatment, and what are their qualifications? Whitening is done by the clinic's dentists. Ask for the name and qualifications of the dentist who will treat you, in writing, before you commit.
2. Is the clinic, and the dentist, registered, and with whom? In Turkey, a facility needs a Ministry of Health authorisation certificate¹¹ to treat international patients. Ask for the clinic's certificate details, and for the treating dentist's own registration and how to check it. The GDC's register covers dental professionals who practise in the UK.
3. Which product will be used, and at what strength? UK rules on product strength are set out in the section on methods above. Ask for the answer in writing.
4. What happens if I am not happy with the result? No method can promise a particular shade. Ask what the clinic offers if your teeth lighten less than expected, and get it in writing.
5. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you travel.
6. What aftercare do you provide, and who can I contact? For a problem that is not urgent, you write to the clinic and send photographs. Ask which channel to use and how quickly you can expect a reply.
7. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC itself cannot resolve complaints or help with refunds¹².

The NHS also lists warning signs to think about before booking treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare¹³. Apply them to this clinic too.

Your records

The GDC suggests talking to your own dentist¹⁰ before you go. Ask for a written record of the treatment to take back to them. It should show the shade before and after, the method and the products used. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging¹¹.

Aftercare once you are back in the UK

If something bothers you after you return, a dentist in the UK can see you, such as your own dentist. In England and Wales, NHS guidance for dentists says a patient treated abroad is dealt with no differently from a patient treated by another provider¹⁴. The same guidance says the NHS rules on free repair or replacement do not apply to work that another provider did¹⁴. Whitening itself is not available on the NHS², so a further course in the UK is private treatment. It starts with a registered dental professional, because under the UK rules above each course of dentist-only products starts with a dental practitioner. The NHS says it is not liable for negligence or failure of treatment¹⁵ abroad.

Whether whitening needs repeating is assessed at check-ups. National guidance in England (NICE) says the interval between check-ups should be set for each person according to their risk¹⁶ and discussed with them.

Insurance. The NHS says most travel insurance policies will not cover you for planned treatment abroad¹⁵, so you may need specialist cover. Tell your insurer about your plans before you travel.

This page does not show prices. A treatment plan is prepared for you after an examination. The main factors that shape it are:

• The method chosen: in the clinic, at home, or both
• Treatment needed first: cleaning, fillings, gum treatment
• For home whitening, making the trays and the amount of gel you take home
• Replacing fillings, crowns or veneers whose colour no longer matches after whitening

Ask for the plan in writing, including what it covers and whether cleaning is included. Ask too who pays for further treatment and extra travel if there is a complication. Ask whether the examination and any X-rays are included. Ask what happens to any payment if the examination shows that whitening is not suitable yet.