Gum Disease and Decay Before Whitening: Why Health Comes First
For anyone with gum disease, tooth decay or receding gums who is planning whitening. At Deepcar Dental Care, reasons whitening is not suitable include active decay or gum disease. This page covers UK rules, NHS guidance, European safety advice and laboratory studies on whitening gel, and which symptoms need a dentist.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist at Deepcar Dental Care, reviewed this page. He is a General Dental Practitioner, GDC 301711.
Can you have teeth whitening with gum disease or tooth decay?
NHS guidance says teeth whitening is not done if you're 17 years old or younger, or you have unhealthy teeth or gums. It is also not recommended if you have crowns, dentures or implants, because teeth whitening can only lighten the colour of natural teeth, or if you are pregnant or breastfeeding.
At Deepcar Dental Care, reasons teeth whitening is not suitable include active decay or gum disease. Whitening age limits and pregnancy have their own page.
Why are teeth and gums checked before whitening?
UK cosmetic product rules require an appropriate clinical examination before whitening gel containing or releasing 0.1% to 6% hydrogen peroxide is used. The General Dental Council says it is to ensure there are no risk factors or any other oral pathology concerns.
In 2005 the European Commission's Scientific Committee on Consumer Products (SCCP) found an absence of good clinical data and long-term epidemiological studies on possible adverse effects of these products in the mouth.
How can tooth decay affect whitening?
Worsening decay can lead to a hole forming in the tooth, NHS guidance says. The European safety committee (SCCP) noted that all whitening materials show hydrogen peroxide passing through dentine.
The European safety committee (SCCP) noted that whitening agents can also enter the pulp, the tooth's soft centre, through leakage from restorations such as fillings, and advised particular care with defective restorations.
In laboratory studies, more hydrogen peroxide reached the pulp chamber in filled teeth than in intact ones: in cow teeth at 10% and 35% carbamide peroxide, where the higher strength gave more, especially in filled teeth (Benetti, 2004), and in human teeth tested at 10%, 15% and 35% (Gökay, 2000). Both used extracted teeth; neither tested untreated cavities or measured pain. The restorative section covers repairing and rebuilding damaged teeth.
How can whitening gel affect inflamed gums?
Whitening gel can irritate gums, and European safety advice urges particular care with inflamed or damaged gums.
NHS guidance says professional whitening may cause side effects, including teeth becoming sensitive to cold or sweet food and drink, sore gums or throat, and white patches on your gums. Your dentist should use a soft shield or paste to protect your gums, but you may still get side effects for a short time. Talk to your dentist if you have any side effects that bother you.
The European safety committee (SCCP) said hydrogen peroxide, even at concentrations as low as 3%, may be especially harmful to oral tissues that were previously injured. It advised particular care with gingivitis, periodontal disease such as periodontitis, or existing gum lesions, and in people using alcohol or tobacco while whitening, which may make the toxic effects of hydrogen peroxide worse.
NHS guidance says whitening at beauty salons, or with kits bought from a pharmacy or online, may harm teeth and gums; see professional whitening and shop-bought kits compared.
If you are considering teeth whitening, book an appointment online or call 0114 288 2121.
What should you do about bleeding gums or toothache before whitening?
See a dentist. NHS guidance says gum disease is important to get checked by a dentist, and to see a dentist if:
- your gums bleed when you brush your teeth or eat hard foods
- your gums are painful and swollen
- you have bad breath
- your child has sore, bleeding gums
NHS guidance says to ask for an urgent dentist appointment if you or your child has gum disease and other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip. If you do not have a dentist or cannot get an emergency appointment, call 111.
The NHS tooth decay page says to see a dentist as soon as possible if you think you or your child has tooth decay, which may not cause any symptoms at first, and to see a dentist if:
- you have problems with your teeth like toothache or a sharp pain in your tooth when eating or drinking
- your gums are painful, swollen, or bleed when you brush your teeth
The NHS toothache page says to see a dentist if you have toothache that lasts more than 2 days, that does not go away when you take painkillers, with a high temperature, pain when you bite, red gums or a bad taste in your mouth, or with a swollen cheek or jaw. Go to A&E if you have toothache and the area around your eye or your neck is swollen, or swelling in your mouth or neck is making it difficult to breathe, swallow or speak.
Do not drive to A&E: ask someone to drive you or call 999 and ask for an ambulance. If you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online.
NHS guidance also advises regular dental check-ups even with no problems, and the gum disease page explains how gum disease develops.
What about receding gums and exposed roots?
Receding gums can leave dentine exposed, and dentine contains tiny channels linked to the tooth's nerve, the Oral Health Foundation explains.
One concern of the European safety committee (SCCP) was the long-term effect on the pulp, which it said is vulnerable through exposed dentine with receding gums, tooth wear, wear near the gum line and leaking restorations.
A 2018 World Workshop review (Cortellini and Bissada) says an exposed root surface is frequently associated with impaired appearance, dentine sensitivity, and decay or other lesions near the gum line, on recession generally. The safety section covers how whitening affects sensitivity and enamel.
Is a hygiene visit recommended before whitening at Deepcar Dental Care?
Yes. At Deepcar Dental Care, a hygiene visit before whitening is recommended. The main teeth whitening page explains home tray whitening with a dentist.
Frequently asked questions
Can you book a hygiene appointment before whitening without registering?
Yes. At Deepcar Dental Care, a hygiene visit before whitening is recommended. A hygiene appointment can be booked without registering as a patient, and online through the booking portal. The dental hygiene section of the website has more information about hygiene appointments.
Do fillings change colour when teeth are whitened?
No. At Deepcar Dental Care, crowns, veneers and fillings will not change colour. So a filling in a front tooth keeps its colour, while the natural teeth around it may lighten with whitening. See how existing dental work responds to whitening.
Does smoking matter for gum health and whitening?
Yes. The European safety committee (SCCP) said using tobacco or alcohol while whitening may make the toxic effects of hydrogen peroxide worse. NHS guidance lists not smoking as a way to help prevent gum disease. At Deepcar Dental Care, avoiding smoking during whitening treatment is part of the aftercare advice, and smoking cessation advice is available.
How is a dark root-filled tooth whitened?
With internal whitening, offered at Deepcar Dental Care for a dark root-filled tooth over 2 to 4 sessions. NHS guidance says root canal treatment may be needed if tooth decay has reached the pulp. See the page on lightening a dark root-filled tooth.
Can whitening be done before composite bonding?
Yes. At Deepcar Dental Care, if you are planning both, whitening can be done before bonding, and whitening first is optional, not required. The page on why gum health comes before composite bonding explains how gum health applies to that treatment.
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Other suitability questions for teeth whitening are among the options in this section.
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