| Whiter Teeth: What Works?
You don't have to be born with perfect teeth to have a bright smile. With a process called tooth whitening, or bleaching, it's possible to erase the stains and discoloration that occur naturally over time.
How effective is bleaching — and is it safe? Should you use over-the-counter products or go to your dentist? To find out, we talked to Sandra Burkett, D.D.S., an instructor in clinical dentistry at Columbia University College of Dental Medicine.
A. Most of the time, yes, but not always. "Extrinsic" stains can be removed easily in the dental office or at home by applying a bleaching agent. This kind of discoloration occurs when the outer layer of the tooth is stained by such things as drinking coffee, tea, smoking or even eating a lot of spaghetti sauce or other staining foods.
When the inner structure of the tooth becomes darker or yellowed ("intrinsic" stain), the stain is more difficult to remove or, depending on its cause, may not be able to be removed at all. For example, tetracycline (an antibiotic) causes intrinsic staining, when used by children under age 8 or women in the last half of their pregnancy. These stains cannot be removed by bleaching.
Fluorosis, a cosmetic dental condition that results from overexposure to fluoride during tooth development, also is not always successfully removed by bleaching. Mild to moderate fluorosis, characterized by white lines, streaks or spots, can be made less obvious by using whitening products or methods. However, in more severe cases of fluorosis, when the teeth can become pitted and have brown, gray or black spots, bleaching will not work.
If stains are caused by nerve or blood vessel damage, root canal therapy may be necessary to prevent permanent staining. Even so, the tooth may darken despite the treatment. If bleaching externally does not remove the stain, a bleaching agent can be applied to the inside of the tooth, or veneers can be used to cover the outer tooth surface.
A third type of stain is called "age-related." It's a combination of intrinsic and extrinsic factors. As we age, the dentin (the inner portion of the tooth) gets slightly yellow. This can become visible through the outer enamel as it gradually becomes thinner over time.
Yellow stains are the easiest to remove with bleaching. Gray or black stains tend to be more difficult. Generally, stains that have just formed are easier to remove than stains that have been on your teeth a while.
A. Well, that depends. If you have your teeth whitened professionally in-office or at home, you can choose to make your teeth up to seven shades whiter. Your dentist will show you "shade cards" that are similar to those used for choosing paint, so you can make a decision on which is best for you.
If you use an over-the-counter product (OTC), choose carefully to ensure it is safe, effective and reliable, and follow the directions carefully. OTC products will not produce the dramatic improvements that are available through a professional. Excess exposure to OTC bleaching products can damage your teeth.
There's been a trend in recent years toward whiter, brighter teeth. The shades that were popular a few years ago seem somewhat dingy compared with the effervescent whites that many people are choosing today.
When making a decision to have your teeth whitened, it is important to think about which shade most flatters you and not how white your teeth can get. Keep in mind that your habits also dictate how white your teeth will be. Nonsmokers and people who don't drink coffee or tea will retain their whitening results much better than smokers or regular coffee or tea drinkers. Occasional touch-ups may be needed to maintain the shade you want. This must be done with professional direction.
A. No. It's possible for you to have one or a select number of teeth bleached to match the surrounding teeth. However, this should only be done professionally.
A. When a tooth has been darkened because of root canal therapy, it can be bleached by applying a bleaching agent to the inside of the tooth (also known as non-vital whitening). In this situation, the middle of the tooth (the pulp chamber) is cleaned out, and a bleach-soaked cotton ball is placed into the cavity. It stays in place for about a week and then is replaced with a fresh one. Eventually the tooth will bleach from the inside out.
A. For uniform results, in-office bleaching is best. Before starting a whitening program, your cosmetic dentist will determine the health of your teeth and mouth and remove any surface stains and deposits. To help maintain the results of treatment, the dentist will customize your treatment to your particular needs and advise you of any changes that are needed to your daily oral care routine.
Professional in-office whitening is also more convenient. This is because the bleaching agents are stronger than those that are used in over-the-counter products. Your teeth will get significantly whiter in 60 to 90 minutes. Two or three visits may be required in some cases, but many people can get good results in a single session. Some in-office whitening gets your teeth many shades whiter because the light used in the office activates the whitening agent, making it more efficient. In-office whitening also avoids the use of trays, so you will not ingest any of the whitening agent.
A. There are a variety of peroxide-based over-the-counter (OTC) products that can be effective at whitening your teeth. The ingredients in home kits aren't very concentrated, however, so it may take several weeks to get good results.
OTC whitening products tend to be less expensive than having your teeth whitened by a dentist, but they aren't the ideal method to choose. Some OTC whitening kits contain mouthpieces that aren't custom-fitted to your teeth, that is, they do not fit snugly around your teeth. As a result, some parts of the teeth may be covered by the bleaching agent, while some parts may not. This results in uneven covering and bleaching. The bleaching ingredient also may leak out from the badly fitting mouthpiece and cause gum and other soft tissue irritation.
If you decide to use an over-the-counter product, you should first consult with your dentist. The dentist can offer advice, and can make a mouthpiece that fits properly to ensure the best results from the OTC product.
A. Whitening toothpastes can help the teeth remain cleaner and therefore look whiter. However, the stronger toothpastes rely on abrasion, which can damage the teeth. When you use an abrasive on the outer layers of the teeth, the "newer" layer looks whiter. The problem is that this process causes the teeth to lose shine and luster over time.
These toothpastes do not actually whiten or change the shade of your teeth, but help prevent stains from sticking to your teeth. Results will take some time, and the change won't be very visible. Whitening toothpastes can be used to help preserve the results of professional in-office or at-home whitening.
Before you choose whitening toothpaste, be sure to look at the product's ingredients. Some toothpastes have less abrasive materials. Ask your dentist for advice before you make a decision.
A. In-office whitening is the most expensive. It usually costs between $600 and $1,200.
A more economical approach may be to use the home-bleaching kit offered by your dentist. The cost of home bleaching, which includes the materials and consultations with your dentist, will run about $300 to $500.
A. If you maintain good oral hygiene, and adhere to your dentist's directions for care, you can expect the results to last one to three years. You can maintain your white teeth even longer if you don't smoke, chew tobacco, or drink a lot of coffee or tea.
A. Not necessarily, although it does complicate things. The bleaching agents that are used to whiten teeth don't affect tooth-colored fillings or other restorative materials. After bleaching, these areas may appear darker than the surrounding teeth. However, sometimes the restorative work is whiter than the natural teeth. In these cases, the whitened natural teeth will blend better with the restored teeth.
If fillings or other dental work cause your tooth to appear darker than surrounding teeth, your dentist can use bonding or veneers to make your tooth the same color as the surrounding teeth.
A. It is unlikely that you will have any serious effects from a whitening procedure. However, some patients experience mild tooth sensitivity after bleaching, and minor gum irritation. The sensitivity can be reduced with a prescription fluoride gel, but most people don't need it. The sensitivity usually goes away within a few days after bleaching is complete.
Irritation of gums or other soft tissues in the mouth is more of a problem with over-the-counter bleaching kits because the bleaching agents may leak around the edges of the mouthpiece.
Women are advised to avoid tooth whitening during pregnancy because the effects of bleaching agents on fetal development are unknown.
Original article created by an Aetna InteliHealth writer and Sandra Burkett, D.D.S., of the Columbia University College of Dental Medicine.
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