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, laminate veneers or another cosmetic procedure are being considered

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

• Under-18s. Under EU 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, laminate 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 benefit² to whitening. The evidence on some specific protocols is limited, and some laser protocols can increase sensitivity.

Over-the-counter and dentist-only products

Under EU cosmetics law, products with up to 0.1% hydrogen peroxide are sold freely³. 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. Products above 6% are not permitted as cosmetics. In Turkey, whitening products containing or releasing up to 6% hydrogen peroxide are classed as cosmetics⁴, not medical devices. The sales conditions above are EU rules; the Turkish announcement does not restate them. If you live outside the EU, the rules where you live are not covered here.

Under the EU rules above, products on free sale contain very little peroxide. 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 is covered in "If you are coming from abroad".

Risks and side effects

• Tooth sensitivity. This is the most common side effect. The risk is higher with some high-concentration products⁵; 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 sensitivity² 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, laminate 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. If you have difficulty breathing or swallowing, go to an emergency department. In an emergency, call the emergency number of the country you are in; in Turkey it is 112.

Before you fly home

Make sure the shade reached so far has been recorded and that you have written care instructions. Take the written record of your treatment with you for your dentist at home. 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. Photographs do not replace an examination, so see your dentist at home as well. In the emergencies above, do not wait for a reply.

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 leave. You take the trays and the gel with you and use them as your dentist instructs. 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, so the examination confirms or changes it, 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.

Your dentist at home. Talk to your own dentist before you go. If you do not have a dentist where you live, it helps to find one before you travel. 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 imaging⁶.

Whether whitening needs repeating is assessed at check-ups, which are usually with a dentist where you live. UK guidance (NICE) says the interval between check-ups should be set for each person according to their risk⁷; agree it with your dentist at home. If you live in the EU and want a further course later, the EU rules above mean it starts with a dental practitioner there. If you live elsewhere, ask your dentist at home which rules apply. Before you travel, check the rules of the health service or your insurer in the country where you live about care after treatment abroad.

Questions to ask before you commit. Before you agree to treatment abroad, ask:

1. Who will carry out my treatment, and what are their qualifications?
2. Are you regulated by a professional body and registered with it?
3. What happens if I am not happy with the result?
4. What aftercare do you provide, and who can I contact after the treatment?
5. If there are complications, who pays for further treatment, extra flights and the hotel?
6. Do you have a complaints system, and can I see a copy?

A longer list, with our answer to each question, is on our page about dental treatment abroad.

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.