Whitening Your Not-So-Pearly Whites

Whitening Your Not-So-Pearly Whites

Reviewed by Cynthia Dennison Haines, MD on September 02, 2005

Your pearly whites not so pearly anymore? That can happen to any of us, for any number of reasons. The good news is that you don't have to live with a smile you're less than happy with. Tooth whitening can restore your teeth to their earlier brightness. But given the number of options and the cost and time involved with each one, how do you know which one is right for you?

As we age, the outer layer of enamel on our teeth is worn away, eventually revealing the darker tissue underneath, at the center of the tooth around the nerves and blood vessels. Our teeth may also become discolored from smoking, from drinking coffee, tea, and wine, and even from taking certain medications as a child such as tetracycline.

"It's like wearing a great outfit or wonderful accessory," says Wynn Okuda, DMD, national president of the American Academy of Cosmetic Dentistry (AACD). "Having your teeth whitened makes you feel good."

Almost everyone wants whiter teeth these days, adds Melissa Ing, DMD, associate professor of prosthodontics at the University of Connecticut Health Center. "It's the number one aesthetic concern of my patients," she says.

Ing is not alone in noticing the upsurge in requests for a brighter smile.

That may be because it's fairly easy to accommodate those requests, says Ing. "Tooth whitening or bleaching works for most people and my patients who have done it are happy with the results."

Tooth whitening can be achieved in two ways. A product can bleach the tooth. That means it actually changes the natural tooth color, usually anywhere from five to seven -- but even up to twelve -- shades brighter, which is how dentists assess tooth color. Bleaching products contain peroxides that help remove both deep and surface stains. The second whitening process uses non-bleaching products that work by physical or chemical action to help remove surface stains only.

A newcomer to the world of tooth whitening is known as chairside bleaching. This may require more than one visit, with each visit lasting 30 to 60 minutes. During chairside bleaching, your dentist applies either a protective gel to your gums or a rubber shield to protect the soft tissues in the mouth. A bleaching agent is then applied to the teeth, and a special light may be used to enhance the action of the agent.

The cost of professional whitening varies -- depending on where you live, what product the dentist uses, and what other services may be offered), but usually starts about $500 per session, says Okuda. If your teeth aren't very dark or very stained, you may need only one session.

Your dentist can also provide you with a tooth-whitening system that you can use at home. At-home products typically come in a gel form that contains carbamide peroxide; the gel is placed in a custom-fitted mouthguard, created from a mold of your teeth. Depending on the product you and your dentist choose, the guard is worn either twice a day for 30 minutes or overnight -- usually for a couple of weeks. The length of time can range from one week to one month depending on how much whitening you need. This procedure usually costs around $400 and whitens the teeth four to seven shades.

Over-the-counter products are less expensive but will not brighten your teeth as much as professional products. The American Dental Association says the products are safe; the range of whitening power they have, though, is usually just a shade or two.

Whitening toothpastes can help remove surface stains through the action of mild abrasives. Some whitening toothpastes have special chemical or polishing agents that provide additional stain removal, but unlike bleaches, don't change the color of your teeth.

Ing and Okuda offer the following suggestions if you're interested in brightening your smile:

  • Have your teeth evaluated by your dentist. "It's important to determine whether you're a good candidate for bleaching," says Ing. "It's not for everyone." In some cases of serious discoloration and pitted teeth, for example, veneers may be more appropriate than bleaching.
  • And crowns, bridges, and fillings do not bleach, so you may need to replace dental work to make it blend with the new color of your bleached teeth. Okuda recommends not only a dental exam, but X-rays as well. "Many dental problems are not visible to the naked eye when they're just beginning. Even if a problem -- such as receding gum lines -- is not very far along, the whitening process could cause you a lot of pain."
  • Choose a dentist who is qualified and experienced. Not all dentists do bleaching, says Okuda. Cosmetic dentists specialize in "smile solutions," he says.
  • There can be side effects. "Occasionally, people experience some sensitivity in their teeth and gums during the bleaching process," says Ing. A study in the Journal of the American Dental Association reported that 50% of people experience temporary tooth sensitivity as a result of home whitening treatment. People with receding gums appear most likely to experience such sensitivity. "The sensitivity usually goes away once the bleaching is stopped though," says Ing.
  • Bleaching isn't permanent. "You may need a touch-up every several years. If you smoke and drink a lot of coffee, you may need the touch-up more often," says Ing.
  • Finally, while the bleaching or whitening process works well, you shouldn't try to get your teeth too white, Ing advises. "Healthy teeth are not pure white, and if you bleach your teeth too much, you may have trouble matching new fillings later on."

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SOURCES: Wynn Okuda, DMD, national president, American Academy of Cosmetic Dentistry. Melissa Ing, DMD, associate professor of prosthodontics, University of Connecticut Health Center.

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