Whiter Teeth

Problem: My teeth are in need of a smile tune-up! What can I do to make them whiter?

Solution:  Making teeth whiter is easier than you think! Let’s look at how you can turn that frown upside down and begin smiling again with confidence.

First, keep in mind that no one’s teeth are naturally white, at least not the “Hollywood-white” smiles many celebrities have. There are many reasons why someone may have yellow or stained teeth. Beverages like coffee, tea, red wine, and foods such as berries can cause stains. You can cut back on the food and drinks causing the problem, but who wants to give up their coffee in the morning, much less fresh berries and red wine (nothing like a beautiful pinot noir or cabernet sauvignon at the end of the day)? Genetics can play a role too; some people just have teeth with a yellowish or off-white appearance. Smoking is perhaps the worst offender because it not only discolors teeth but it kills healthy gum tissue, causing serious health risks for your mouth. Serious staining and discoloration (natural or otherwise) cannot be corrected with toothpaste no matter what the claim says on the label, but teeth whitening/lightening/bleaching products at the drugstore in the form of strips, liquids, or gels or from a dentist work miracles.

The whole subject of improving the color of your teeth gets complicated because the terminology has been regulated, but the regulation is too confusing to be of help to consumers. According to the FDA, the term "bleaching" is permitted for use on products that can “whiten” or “lighten” teeth over and above their natural color. Plus bleaching products must contain “bleach” (not the kind for your laundry), but the kind that “bleaches” teeth making the color lighter, with the typical ingredients being hydrogen peroxide or carbamide peroxide.

Now here is where it gets really confusing: the term "whitening," can only be used on products that clean teeth, meaning toothpaste. So any product that cleans the surface of a tooth can be labeled a whitener. However, because the term whitener sounds so much better than bleaching (which we think of as Clorox and something used for laundry, not on our teeth), “bleaching” products call themselves whiteners or whitening to sound more appealing to the consumer. Yet as mentioned, the term whitening is only about cleaning your teeth, not changing the color.

Before you jump in with any choice for teeth whitening there is a risk of mild to painful gum sensitivity. Mild to moderate isn’t bad, but when it’s painful, believe me, it isn’t pleasant. However, one way to resolve that problem is to brush your teeth with a toothpaste containing potassium nitrate. Research shows that this desensitizing, teeth-friendly ingredient can make a huge difference in reducing some of the side effects.

Dentists would like you to believe that they are the only solution for teeth whitening but that isn’t the case. Almost all teeth whiteners (“bleaches”) work incredibly well so you can choose by cost or just start with the easiest availability which would be those at the drugstore. All teeth whiteners use the same type of ingredients, either carbamide peroxide or hydrogen peroxide, but with different strengths to lighten teeth. The higher the percentage of the active ingredient and the type of ingredient determines how fast you see improvement. Results will be seen in 1-14 days depending on the product you buy. Although there are several very good at-home whitening products, some of my favorites include Crest Whitestrips Pro Effects Dental Whitening Formula, Aquafresh Whitetrays Disposal Pre-Dosed Trays, and the iWhite Advanced Teeth Whitening Kit (available at CVS stores).

If you choose the in-office dentist procedure it would cost on average about $500 per visit. Dentists can also give you a take home kit that you can only buy from them (though there are Web sites such as www.aplussmile.com selling the exact same product to consumers). The cost for the dentist-sold kits ranges from $100 to $300 (and about half that from most Web sites selling the same products). At the drugstore the “bleaching” kits cost between $20 and $100.

Teeth-whitening kits at the drugstore or from various Web sites come in many different forms from strips and paint-on liquids to gels that are used with a mouth guard. Choosing is all about your own personal preference because they all pretty much work as claimed when they contain the same active ingredients, and you follow the ratio of effectiveness I explained above.

No matter the claim on the label, there are pros and cons to each type of application. Strips can slip off the teeth creating uneven results. Some people don’t like the feel of dental trays. Paint-on products are more time consuming to evenly cover the surface of each tooth. Strips are also limited because they can only cover the front teeth, which means only those teeth will be affected, leaving the others as they were.

Another problem is that bleaching kits of any kind cannot change the color of dental crowns, bonding material, porcelain veneers, fillings, or any other material in your mouth other than your natural teeth. You can imagine how strange an appearance you can end up with if each of your teeth were a significantly different color from the other. None of these treatments is very effective if your teeth are grayed rather than yellowed, or if they are completely yellowed. Teeth-bleaching systems work best for partially yellow or food-stained teeth.

Keep in mind that bleaching products have a short shelf-life. This is because the active ingredient is a form of peroxide and it is an exceptionally unstable ingredient. It can happen that by the time you find, buy, and start using your whitening strips the peroxide may have become inactive. If whatever method you try doesn’t provide noticeable results then that could be the reason why.

Other than bleaching, if the yellow or dull color of your teeth is from tartar buildup, get your teeth professionally cleaned, and have them cleaned regularly. If you can, avoid or minimize consumption of foods that can grab onto teeth and make them look darker, such as chocolate, dark-colored berries, red wine, and coffee. Milk can also bond onto front teeth and cause a yellow tartar buildup. Clearly, it would be best to brush immediately after eating these foods, but if that isn't possible, rinse your mouth well with water and then chew sugarless gum. Many dentists recommend using the Sonicare automatic toothbrush to prevent tartar or plaque buildup. You definitely cannot manually brush your teeth as well as the Sonicare can, so it is a worthwhile option to check out.

(Sources for the above information: Operative Dentistry, July-August 2008, pages 379-85; Dental Materials, May 2007, pages 586-596; Journal of Dentistry, February 2008, pages 117-124; Cochrane Database Systematic Reviews, October 18, 2006, CD006202; Journal of Contemporary Dental Practices, February 2004; pages 1-17; Compendium of Continuing Education in Dentistry, June 2003, pages 461-464: Journal of Clinical Dentistry, 2002, volume 13, number, pages 91–94; Journal of Esthetic and Restorative Dentistry, 2001, volume 13)