Teeth hurt during pregnancy: what to do. Toothache during pregnancy: the most “mild” treatment methods How to rinse a sore tooth during pregnancy

Often the period of happy anticipation of a baby is overshadowed by a sudden severe toothache. But there is no need to be afraid of contacting a specialist. The most dangerous enemy for the expectant mother and her child is the fear of dental procedures. This negative emotion experienced by a pregnant woman directly affects the well-being of the fetus. In addition, the infection itself in the mouth, which can easily penetrate the internal organs and reach the baby through the bloodstream, also poses a danger. If toothache occurs during pregnancy, the only right solution is to visit the dentist.

Common sources of discomfort and pain in the oral cavity are some dental diseases:

  1. The developing carious process is sometimes accompanied by unpleasant sensations when eating hot or cold foods, as well as sweet or sour foods.
  2. Pulpitis is accompanied by acute toothache during pregnancy, especially worse at night.
  3. When inflammation occurs at the root of a tooth, pain is felt when pressing on it, which occurs as a result of the development of apical periodontitis.
  4. Difficulty in the eruption of wisdom teeth can also force the expectant mother to look for ways to help relieve toothache during pregnancy.

The female body during pregnancy is vulnerable and sensitive to changes in the internal balance of the body. The natural hormonal level changes, which causes disturbances in blood circulation, which negatively affects the condition of the gums and oral mucosa. In this case, gingivitis may occur and chronic processes may worsen.

As the child grows in utero, his needs for minerals and nutrients increase. The mother's body is especially sensitive to increased calcium excretion to build the bone skeleton of the unborn baby. This manifests itself in joint pain, and also negatively affects the teeth and jaw bones.

In addition, the changed composition and viscosity of saliva impairs the washing of teeth and their natural cleansing, and its protective properties are greatly reduced. All this leads to the formation of cavities in the teeth, and the resulting caries affects the reduced immunity of the expectant mother.

Why is toothache dangerous during pregnancy?

The occurrence of discomfort in the oral cavity, unfortunately, encourages only a few expectant mothers to visit the dentist. And in vain. It is not advisable to take tablets for toothache during pregnancy, and if such a need arises, it should be done with extreme caution. Therefore, a woman should understand that she should not endure toothache during pregnancy, because this condition is dangerous.

Here are some consequences that a pregnant woman who neglects a visit to the dentist can expect:

  1. A disturbing toothache is a signal indicating that an infectious process is developing in the mother’s body, which can harm the fetal development of the baby. This is especially true for the first 12-15 weeks, when the baby’s place is still being formed, because it is a barrier that protects the baby from unfavorable factors.
  2. A sharp toothache during pregnancy forces a woman to take painkillers. Although there are medications that can be taken in such a situation, you should not expose your child to unreasonable risk.
  3. A severe pain attack provokes the release of adrenaline into the blood, which leads to an increase in body tone and acts on the vascular walls, narrowing them. This can negatively affect the fetus, because the amount of blood and oxygen supplied to it decreases.
  4. A small carious cavity that is not eliminated at the beginning of pregnancy increases over time and can become a reason for toothache and subsequent removal, which is undesirable to do several weeks before childbirth, because tooth extraction is stressful and can trigger the onset of labor.

Early toothache

Ideally, before planning a family, a woman should undergo a full examination and cure all existing diseases. This also applies to the sanitation of the oral cavity, because existing carious cavities increase over time, which can provoke the occurrence of toothache in the early or late stages of pregnancy.

A painful attack in the 1st trimester is an undesirable reaction of the body, because at this time the formation of all the systems and organs of the future little person occurs.

What are the dangers of a bad tooth during pregnancy?

  • The source of infection present in the mother’s mouth is able to penetrate through the bloodstream to the fetus and make changes in the formation of the body.
  • The pain syndrome is accompanied by an increase in the concentration of adrenaline, which in the early stages can cause bleeding.
  • It is undesirable to carry out dental anesthesia during pregnancy during the first 12 weeks due to the immature hematoplacental barrier and the possible toxic effect of the drug on the child.

Late toothache

When a painful reaction in the teeth appears in the last months of pregnancy, you should not hope that you will be able to deal with this problem after discharge from the hospital. In the 3rd trimester, the baby actively grows, for which he needs a large amount of calcium, which he receives from the mother. At this time, the female body often experiences tooth decay and bone fragility.

Therefore, even a small caries during pregnancy can turn into pulpitis in a month or two, which unexpectedly causes toothache, and the expectant mother does not know what to do and how to treat it, because childbirth can begin any day.

There is no need to endure unpleasant sensations, because up to 36 weeks of gestation you can absolutely safely seek treatment from a dentist. Today, dentists have in their arsenal a sufficient number of medications approved for pregnant women, which do not penetrate the placental barrier.

For example, articaine-based anesthetics can be used for pain relief in expectant mothers. Pulpitis and periodontitis are treated absolutely painlessly, which is important for pregnant women, since additional stress in this situation only interferes. If there is a small carious cavity, the doctor can eliminate it without anesthesia injections. Therefore, you should not be afraid of dental treatment while waiting for your baby.

Remedies for toothache

Unfortunately, pain often occurs unexpectedly. What to do if a tooth hurts during pregnancy, how to treat it? The first thing you need to do is visit a dentist as soon as possible. The doctor will determine the source of the problem and choose the most gentle treatment method. You should not be afraid of dental intervention, because modern painkillers do not cause harm during pregnancy and help cope with discomfort even with severe toothache.

The optimal period for manipulations in the oral cavity is the 2nd trimester, so if the expectant mother did not have time to cure caries before pregnancy, this is the best time to visit the dentist. However, if pain occurs early, you should not wait 12 weeks to get rid of it. Carious cavities that are not eliminated in a timely manner can develop into inflammation of the pulp and peri-root space, and in advanced cases - into periostitis, which is accompanied by the formation of pus, which is unfavorable for the unborn baby.

If painful sensations occur in the evening or at night, then in order to wait for a visit to the doctor, you can take some painkillers during pregnancy for toothache, but you should carefully read the instructions. If the discomfort is moderate and can be tolerated, then you should not take medication. You should see a doctor as soon as possible. In extreme cases, pregnant women are allowed to take, which helps to calm the pain, as well as No-shpa, which has a relaxing effect on the muscles and relieves vascular spasm.

Sometimes, for toothache during pregnancy, you can resort to folk remedies, but you need to understand that they will not get rid of the existing problem, will not eliminate existing cavities in the teeth, but will only reduce discomfort for a short time. For treatment, be sure to consult a dentist; after an examination, he will tell you what needs to be done to solve the existing problem.

Here are some folk recipes:

  1. Apply a cotton swab soaked in melted propolis to the sore tooth.
  2. To eliminate infection and pain, you can use a solution of soda and salt; for this, dissolve 1 teaspoon of the substances in a glass of warm water. You are allowed to rinse your mouth up to 6-8 times a day.
  3. You can chew clove powder or whole inflorescences, because the aromatic oils present act as an antiseptic and are a good pain reliever.
  4. A decoction of medicinal herbs eliminates food residues and fights inflammation. To prepare the infusion, pour 3-4 grams of chamomile, sage or medicinal marigold flowers into a thermos and pour boiling water over it.

You should not rely on the miraculous properties of folk recipes, because they are not always justified and can sometimes cause harm. A pregnant woman should be attentive to her health, because she is responsible not only for herself, but also for her small, unborn child.

Prevention

To reduce the likelihood of toothache during pregnancy, you should follow simple recommendations:

  • visit the dentist regularly;
  • Treat carious cavities in teeth in a timely manner;
  • make your diet balanced, make sure that your body receives enough nutrients;
  • do not overuse sweets;
  • take vitamin and mineral complexes to avoid treating toothache during pregnancy;
  • brush your teeth twice daily, and also rinse your mouth with water after each meal;
  • use additional hygiene products such as flosses and elixirs.

The expectant mother is responsible for the safe intrauterine development of the baby, so a pregnant woman should worry not only about her well-being, but also constantly think about how her actions will not harm the baby. It is impossible to completely eliminate problems with the oral cavity, however, thanks to modern preventive measures, a healthy diet and visits to the doctor, you can reduce the risk of developing toothache during pregnancy.

Useful video about dental treatment during pregnancy

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A tooth hurts during pregnancy, what to do in this situation, how can you help yourself if you can’t immediately visit a doctor? Of course, any pain is very harmful for the expectant mother, although the child does not feel it, but infection is no less harmful, so the standard recommendation is to visit a doctor no matter what. But if it’s a day off or night, toothache during pregnancy is a reason to provide your body with independent help.

First of all, by ambulance we mean taking medications. But if, outside the period of waiting for a child, it can be any drug, like Analgin, Baralgin, Ketarol, etc., then the expectant mother can only take guaranteed safe painkillers during pregnancy, for example, Paracetamol. This drug is safe to use in any trimester in a dosage of up to 4 grams per day, while a single dosage should not exceed two 500 mg tablets. For toothache during pregnancy, paracetamol is not a bad medicine, but you need to understand that it does not treat the very cause of the pain, it only muffles it. And not suitable for long-term regular use. Doctors usually advise taking analgesics for no more than 3 days, that is, until the opportunity to visit the dentist arises. And then there will be no need to think about what pills you can take for toothache during pregnancy. Already in the first appointment you will feel much better. Dental treatment for pregnant women must be done using anesthesia. It is also safe for the child and makes the treatment process comfortable.

By the way, it is impossible to relieve toothache with an antispasmodic, that is, no-shpa during pregnancy simply because this remedy is useless in this case. It is intended to relieve muscle spasm, that is, it is not suitable for action.

What else can you do to relieve toothache during pregnancy, from products sold in pharmacies? You can try using so-called dental drops. They contain natural ingredients such as camphor, valerian, mint. A small cotton swab is soaked with these drops and placed in the tooth cavity.

You can also relieve toothache at home using folk remedies. You need to try not to get food stuck in your tooth. This is the main rule. And the second is to treat the tooth with some kind of antiseptic. A saline solution is suitable for this. You just need to dissolve a teaspoon of salt in a glass of water and rinse or keep the solution in your mouth, near the sore tooth.

Many people soak a cotton swab in alcohol or vodka, or simply rinse their mouths with alcohol. For obvious reasons, this is contraindicated for the expectant mother. But there are effective antiseptics that she can use without fear. This is chlorhexidine or miramistin. They will partially kill pathogens that provoke the inflammatory process and, as a result, pain.

Housewives have much of what is available for toothache during pregnancy in their kitchens and medicine cabinets. For example, sage, chamomile, eucalyptus, mint leaves. All this can be brewed with boiling water and rinsed in the mouth. But the effectiveness of these remedies for severe pain is not so great, unfortunately. They help more with gum disease rather than cavities.

A good pain reliever for acute toothache during pregnancy is clove oil. By the way, even dentists use it. If you don’t have one at home, then clove seasoning is also suitable, which you can simply chew. Other oils useful in dentistry are sea buckthorn and fir. Use similarly to dental drops.

But even if you manage to relieve the pain on your own, do not put off visiting a doctor. The improvement is temporary. And an infection in the body can have a very bad effect not only on your health, but also on the health of the unborn child.

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While expecting a baby, a pregnant woman needs to treat her health with doubly care: protect herself from excessive emotional and physical stress, communication with unpleasant people, junk food and medications. Unfortunately, it is often sudden and rapidly progressing – it exhausts and drives you crazy. How can I manage without pills? Sometimes the tooth ache so much that it seems that without the usual analgesic you won’t be able to live until the morning to go to the dentist. Are there ways to overcome such torment without resorting to pills? MirSovetov will try to answer this question!

Why do pregnant women have toothache?

Before figuring out how to get rid of excruciating pain, let's talk about the reasons for its occurrence. The opinion is firmly rooted in society that teeth will certainly hurt if you don’t take basic care of them, but in reality this is not entirely true. Sometimes problems associated with the development of an inflammatory process in the oral cavity are caused by objective factors.

For example, during pregnancy the risk of getting dental caries doubles. The reason lies in the deficiency of vitamins and minerals in the body of the expectant mother, as well as in a radical change in her hormonal levels. To this list we still need to add a disorder and a significant increase in the level of acidity in the mouth due to. Frequent vomiting and aversion to various foods causes a lack of calcium in the pregnant woman’s body, which primarily affects the condition of the woman’s jaws.

Unfortunately, the result of the listed metamorphoses in the body of a pregnant woman is not only: women often suffer from toothache caused by both periodontitis and gingivitis.

Teeth hurt during pregnancy: suffering cannot be treated?

Let's try to figure out what an expectant mother should do if a severe toothache takes her by surprise. Remember that the most important condition for dealing with pain at home during pregnancy is safety. To get by without strong drugs, you don’t have to overcome the pain, calling on all your patience to help. Try to reduce pain and partially relieve gum inflammation using the following recommendations:

If traditional medicine is powerless

Sometimes the problem associated with the condition of the teeth and oral cavity is so serious that it cannot be treated with folk remedies. However, pain - be it dental or of another origin - can cause no less harm to a pregnant woman and her baby than medications. In this case, it is important to get rid of it faster by using any of the painkillers listed below, the use of which is allowed during a delicate situation:

  1. A tablet or Drotaverine (the same domestically produced drug) will help reduce toothache. The product has established itself as an excellent antispasmodic, therefore it successfully fights pain that is localized in the head, stomach or teeth.
  2. The cold remedy Grippostad will help reduce discomfort in the area of ​​a sore tooth. However, at the initial stage of pregnancy it must be used very carefully.
  3. If the pain syndrome is not severe, the expectant mother can take 1 tablet of Paracetamol, ½ tablet of Tempalgin, ½ tablet of Pentalgin (optional).
  4. When a pregnant woman’s teeth hurt, it’s time to remember the remedies that are used for teething in babies. For example, Kalgel and Dentol-baby gels are famous for their analgesic and anti-inflammatory properties. A small amount of the product should be applied to the irritated gum.
  5. For very severe toothache, a pregnant woman can take 1 tablet of Ketanov.

Features of the use of analgesics during pregnancy

Whatever the expectant mother does to eliminate toothache, she must remember that it is better to coordinate all her actions with a therapist. All types of treatment in early pregnancy are carried out with great caution. A woman responsible for the health of the baby she carries under her heart must remember the following:

  1. At the beginning of the first trimester of pregnancy, the fetus is still very small and any careless decision by the mother can greatly harm it. After 3 months, the baby is already protected by a strong placental membrane, so the influence of various potentially dangerous factors on his condition is not so pronounced.
  2. If circumstances force a pregnant woman to take a medication, the dosage of the chosen drug must be strictly followed! For example, medications such as Ketanov, Ketorol, Nurofen, Grippostad can be taken by expectant mothers in quantities of no more than 1 tablet. Such drugs should be used in case of urgent need and after consultation with a competent specialist (preferably).
  3. You need to make an appointment with a dentist immediately after the appearance of suspicious or unpleasant sensations in the area of ​​a particular tooth. Only a doctor can solve this problem: he will eliminate the cause, not the symptoms of the disease. To treat and remove teeth, modern dentistry uses high-quality painkillers that do not penetrate the placenta to the fetus.
  4. To eliminate toothache, it is strictly forbidden to rinse your mouth with cold water - such a procedure will only worsen your situation, accelerating the development of the inflammatory process and, as a result, complications.

Toothache plunges many into panic – childhood fears make themselves known. However, the expectant mother has no time to be afraid, because she must first take care of the well-being of her baby. A sore tooth and sore gum represent open doors for various kinds of infections, which are just waiting to attack the vulnerable union of mother and child. The sooner a pregnant woman goes to the dentist with complaints of toothache, the sooner she will forget about this trouble.

Each woman’s well-being during pregnancy is purely individual. However, expectant mothers can really be bothered by such a problem as toothache. Women who have always had a perfect smile sometimes develop caries and gum inflammation, and frequent dental visitors note an exacerbation of chronic diseases. The fact is that pregnant women's teeth are really very vulnerable. Lack of vitamins and minerals, metabolic disorders in the body, changes in hormonal levels, increased acidity of the oral cavity as a result of toxicosis - all these are factors that can negatively affect dental health and provoke caries and toothache in pregnant women.

What symptoms should you see a doctor for?

Prevention is the key to health. Regular dental examinations every six months can save you from serious dental problems. Therefore, I recommend visiting a dental clinic both at the planning stage of pregnancy and during it. And if you are worried about, for example, toothache from cold and hot, you should immediately consult a dentist. The smallest carious cavity is a source of infection, which is an additional burden on the body of a pregnant woman. Moreover, if this caries is not treated on time, pulpitis may develop, accompanied by severe pain symptoms.

If possible, before visiting the dentist, consult with the gynecologist leading your pregnancy. Be sure to inform your dentist about your situation, and best of all, go to a clinic that is equipped with the necessary equipment and has highly qualified specialists on staff who can provide assistance without causing harm to the expectant mother and child.

What to do if you have a toothache during pregnancy?

If you have a toothache during pregnancy, you should see a dentist as soon as possible. The opinion that treating teeth during this period is extremely undesirable and even harmful to health is very firmly rooted in society to this day. However, this is a very dangerous misconception. Even initial caries in pregnant women progresses several times faster. Secondly, at an early stage of treatment you can do without the use of anesthesia or x-rays.

When is the best time to treat teeth for pregnant women?

The most favorable period for a woman and the safest period for a child for dental treatment during pregnancy is the second trimester. But, if you are suffering from toothache or there is a doctor’s prescription, measures can be carried out in the first and even in the third trimester (the only exception may be complex surgical operations). It is important that the expectant mother is as comfortable as possible during treatment. In our clinic, each office is equipped with a soft orthopedic chair and special lumbar bolsters, which allows you to comfortably carry out full treatment even in the third trimester of pregnancy.

What painkillers are used to treat toothache during pregnancy?

When treating, it is better to avoid freezing, but this does not mean that you should endure pain. Only anesthesia with adrenaline, which can increase blood pressure, is strictly prohibited. In case of urgent need, it is preferable to use local anesthetics based on articaine or mepivacaine in small doses.

Is it possible for pregnant women to have dental x-rays?

Contrary to popular belief, pregnant women can have dental photographs taken. But for this purpose, not ordinary X-ray units are used, but computer radiovisiographs. The low radiation dose makes the use of these devices safe for mother and child, but you should still not overuse them: limit yourself to one or two images. The radiologist will definitely provide you with a means of protection - a special apron.

How to relieve toothache during pregnancy?

What to do at home if your tooth hurts a lot? Today, obstetricians and gynecologists around the world allow women to take certain tablets for toothache during pregnancy. For example.

  • Paracetamol
    There is a stereotype that paracetamol is an exclusively antipyretic drug that is taken exclusively for ARVI and influenza. In fact, it has a pronounced analgesic effect, so it will help get rid of toothache. Moreover, despite the fact that the drug penetrates the placenta, it does not pose a threat to the fetus.

  • No-shpa
    But no-spa for toothache will not cause harm, but it will not be beneficial either. The thing is that drotaverine hydrochloride, the active ingredient in the drug, is an antispasmodic, responsible for relaxing smooth muscles. But it is powerless to have a pain-relieving effect. However, for women prone to self-hypnosis, taking No-shpa can bring relief according to the placebo principle.

What medications that we are used to in everyday life should not be taken during pregnancy, even with severe toothache? Firstly, analgin, which negatively affects the blood count, is prohibited. Secondly, you should not resort to Nurofen, which can cause oligohydramnios in a pregnant woman. Thirdly, drugs such as citramon or askofen are not recommended, since they contain a large dose of caffeine.

If we are talking about the need to relieve toothache during pregnancy in the conditions of treatment in the dentist’s office, then you should not be afraid that you will have to endure the pain. Only anesthesia using adrenaline, which can cause an increase in blood pressure, is strictly prohibited. But local painkillers based on mepivacaine or articaine will not cause harm.

What is the prevention of dental diseases in pregnant women?

Following a few simple rules will help you avoid toothache during pregnancy. A woman planning to become a mother definitely needs to see a dentist and undergo a complete sanitation of the oral cavity, that is, to cure all her teeth and put her gums in order. Already during pregnancy, first of all, it is necessary to adhere to a balanced diet and additionally take a complex of vitamins and minerals recommended by the doctor. You need to be especially careful about your oral hygiene: it should include not only regular brushing of your teeth with a brush and toothpaste, but also the use of interdental floss. During pregnancy, it is important to see a dentist: it is advisable to visit the clinic at least twice during the 40 weeks of pregnancy.

FAQ


First of all, one that does not injure the gums during use. At the same time, the quality of oral hygiene depends more on whether the teeth are brushed correctly than on the shape or type of toothbrush. As for electric brushes, for uninformed people they are a more preferable option; although you can clean your teeth efficiently with a simple (manual) brush. In addition, a toothbrush alone is often not enough - floss (special dental floss) must be used to clean between the teeth.

Mouthwashes are additional hygiene products that effectively cleanse the entire oral cavity of harmful bacteria. All these products can be divided into two large groups - therapeutic and preventive and hygienic.

The latter include mouthwashes that eliminate unpleasant odors and promote fresh breath.

As for therapeutic and prophylactic ones, these include rinses that have anti-plaque/anti-inflammatory/anti-carious effects and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence of various biologically active components in the composition. Therefore, the mouthwash must be selected individually for each individual, as well as toothpaste. And since the product is not washed off with water, it only consolidates the effect of the active ingredients of the paste.

This type of cleaning is completely safe for dental tissues and causes less damage to the soft tissues of the oral cavity. The fact is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are treated with an ultrasonic scaler (this is the name of the device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from water droplets, which enter the treatment area and cool the tip of the instrument). The cell membranes of pathogenic microorganisms are ruptured by these molecules, causing the microbes to die.

It turns out that ultrasonic cleaning has a comprehensive effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleansing it. But the same cannot be said about mechanical cleaning. Moreover, ultrasonic cleaning is more pleasant for the patient and takes less time.

According to dentists, dental treatment should be carried out regardless of your situation. Moreover, a pregnant woman is recommended to visit the dentist every one to two months, because, as you know, when carrying a baby, the teeth are significantly weakened, suffer from a deficiency of phosphorus and calcium, and therefore the risk of developing caries or even tooth loss increases significantly. To treat pregnant women, it is necessary to use harmless anesthesia. The most appropriate course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required medications that strengthen tooth enamel.

It is quite difficult to treat wisdom teeth due to their anatomical structure. However, qualified specialists successfully treat them. Wisdom teeth prosthetics are recommended when one (or several) adjacent teeth are missing or need to be removed (if you also remove a wisdom tooth, there will simply be nothing to chew). In addition, removal of a wisdom tooth is undesirable if it is located in the correct place in the jaw, has its own antagonist tooth and takes part in the chewing process. You should also take into account the fact that poor quality treatment can lead to the most serious complications.

Here, of course, a lot depends on a person’s taste. So, there are absolutely invisible systems attached to the inside of the teeth (known as lingual), and there are also transparent ones. But the most popular are still metal bracket systems with colored metal/elastic ligatures. It's really fashionable!

To begin with, it is simply unattractive. If this is not enough for you, we present the following argument - tartar and plaque on the teeth often provoke bad breath. Is this not enough for you? In this case, we move on: if tartar “grows”, this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets form, pus constantly flows out of them, and the teeth themselves become mobile ). And this is a direct path to the loss of healthy teeth. Moreover, the number of harmful bacteria increases, which causes increased dental caries.

The service life of a well-established implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after installation, while the service life is on average 40 years. Typically, this period will depend both on the design of the product and on how carefully the patient cares for it. That is why it is imperative to use an irrigator during cleaning. In addition, it is necessary to visit the dentist at least once a year. All these measures will significantly reduce the risk of implant loss.

Removal of a dental cyst can be done therapeutically or surgically. In the second case, we are talking about tooth extraction with further cleaning of the gums. In addition, there are modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complex operation that involves removing the cyst and the affected root tip. Another method is hemisection, in which the root and a fragment of the tooth above it are removed, after which it (the part) is restored with a crown.

As for therapeutic treatment, it consists of cleaning out the cyst through a root canal. This is also a difficult option, especially not always effective. Which method should you choose? This will be decided by the doctor together with the patient.

In the first case, professional systems based on carbamide peroxide or hydrogen peroxide are used to change the color of teeth. Obviously, it is better to give preference to professional whitening.