Putting The White Back In Your Bite

By Nancy K. Crevier

Americans spend billions each year on health care products, weight loss products, health clubs, hair dressers, tanning salons, and cosmetics to look and feel better about themselves. So it is no surprise to learn that millions of people each year have added the cost of tooth whitening to that list, in the quest for a brighter smile.

Age, genetics, caffeine, cola, tea, medications, illness, and tobacco can stain teeth, but several alternatives exist to bring back the white gleam of yore.

Whitening products can be purchased over the counter (OTC), and whitening treatments can be provided in dental offices. Even chewing gums and mouthwashes have gotten in on the trend to whiten smiles.

Over the counter products include gels and whitening strips that contain peroxide to bleach the teeth. When applied twice daily for a one- to two-week period, or overnight, varying degrees of whiteness are obtained.

Whitening toothpastes contain polishing agents that provide additional surface stain removal, without actually changing the tooth color, as does a bleaching agent. The pastes and whitening mouthwashes usually contain a low percentage of hydrogen peroxide, as well.

The concentration of hydrogen peroxide in professionally applied treatments ranges from 10 to 35 percent, as opposed to the home treatments containing only 2 to 10 percent peroxide. A rubber mouth dam or protective gel prevents gum tissue irritation, a common side effect when using whitening treatments, as is temporary tooth sensitivity in some patients.

Because not all tooth discolorations can be improved through a whitening process, the American Dental Association recommends a dental consultation prior to beginning any treatment. At a cost of anywhere from $30 for an OTC product to $600 at a dentist’s office, it is important to determine the course of treatment that will be most effective. Particularly for patients with very dark stains, or who have had bondings, crowns, or fillings, the course of treatment may differ or not be advised.

“Everyone wants whiter teeth, from teens to senior citizens,” said Dr Mark Renzi of Dental Associates on Church Hill Road. “Teeth whitening is very popular.” Nor is it just women seeking whiter teeth. It is equally popular with both men and women who come to his practice, he said.

A Youthful Appearance

“As we age, teeth just naturally begin to yellow, plus diet is a real culprit in staining teeth,” explained Dr Renzi. “Teeth are very porous. I tell people, anything that will stain your carpet will stain your teeth,” he said, with tea, red wine, and coffee being the three top offenders. Whitening teeth gives a more youthful appearance, said Dr Renzi, and certainly a psychological lift. “It’s easy, it’s fast, and you get quick results,” he said of the cosmetic improvement.

At Dental Associates, the practice offers two methods of teeth whitening. The Zoom! System is a one-hour process in which a whitening gel is applied to the teeth and activated by a UV light. A protective barrier of gel is applied to the gums to protect them from UV damage, and a layer of lotion protects any exposed skin. It is a great solution for patients who need immediate results for a special event, said Dr Renzi. A follow-up custom tray is provided for additional whitening performed a few days later at home.

The other option is tray whitening, in which a patient is custom fit for a tray, and then uses a peroxide solution at home over seven  to 14 days.

The Zoom! System achieves swift results due to a higher concentration of carbamide peroxide, a stabilized form of hydrogen peroxide, than is contained in the tray system gel sent home with the patient.

But why would a consumer opt for a dental application that can cost between $300 and $600 over OTC packages or spa treatments that cost a tenth of that or less?

“In a dental office, the product is applied in a controlled environment. The carbamide peroxide comes in different strengths and a dentist can determine the strength that is best for the individual,” explained Dr Renzi. It is also important to have an oral exam performed prior to using a tooth-whitening product to make sure that there are no gum or teeth issues and that the mouth is healthy. “If there is decay or cracks in fillings, or gum recession, it can be painful to have the product applied,” he said. “Even with the take-home tray process, we monitor it to make sure that the client is getting the results they want and that there are no problems.”

Whitening products used at home generally are used to whiten only the very front teeth, too, Dr Renzi pointed out. Customized trays used in the dental office mean that all of the teeth are whitened.

Overuse Can Damage Teeth

While teeth whitening is not damaging when properly done, nor does it weaken teeth, overuse can damage the enamel, said Dr Renzi. “It’s good to have a dentist oversee the process,” he said, “but if people want to try the OTC items, I don’t discourage it, either. I do caution people, though, that if they have crowns, bridges, or bonding on teeth, whitening will not work. It only works on the natural teeth.”

Dr Joshua Baum of Baum Orthodontics on Church Hill Road steers his orthodontics patients to the family dentist by and large when they request teeth whitening services, but his practice does offer it as a convenience for some of his patients. “Whether we are doing it or are referring a patient to a dentist, whitening should only be done once the braces are off,” said Dr Baum. That is when most patients also notice any staining or discoloration that they want whitened, he said.

“A lot of patients are asking about teeth whitening,” Dr Baum said. “A smile is one of the biggest things we’re judged by.” For most, however, they are comparing their teeth to Hollywood stars’ teeth, said the orthodontist, which undergo regular professional whitening or have veneers applied. “Most people have a natural, normal color that they are comparing to unnatural, white ‘super smiles,’” he said. “I get 13-, 14-, and 15-year-old girls asking about teeth whitening, and I gently steer them away from bleaching,” said Dr Baum. Because the nerve and blood vessels in teeth are still developing in young people under the age of 16, he does not recommend it for those young patients.

Dr Baum’s practice uses a custom-fitted bleaching tray, with a gel of 10, 16, or 22 percent carbamide peroxide, depending on the severity of the staining. The patient applies the gel at home, but is rechecked in the office at one- and two-week intervals to monitor the shade of the teeth and to make sure there is no damage to gums or to the mouth, explained Dr Baum. Once the color has stabilized after a couple of months, patients can expect to retain that brilliant white smile for a year or more after treatment, depending on diet habits, he said.

“I’m not offended by people trying OTC or spa products,” said Dr Baum. “As a matter of fact, I think it may get them excited about teeth whitening and then they get talking to me.” He has even suggested to patients with mild staining to try the inexpensive OTC products first. “Sometimes, they are perfectly happy with those results,” he said.

A newer niche for those seeking to whiten smiles is that of the spa or salon environment.

Salon service for teeth whitening, however, has come under scrutiny in several states. According to a February 25 Associated Press report, a Montgomery, Ala., judge has ruled that “whitening constitutes the practice of dentistry and requires a license,” preventing spas and salons from providing that service to customers. Because employees in white coats oversee some services, the ADA is concerned that customers may think that the salon or kiosk employees are health care professionals.

The Tennessee Board of Dentistry also ruled in January that mall kiosks and spas offering teeth whitening services were performing dentistry without a license, according to a March 4 National Public Radio report, despite arguments by the Council for Cosmetic Teeth Whitening that teeth whitening is administered by the customer to his or her own teeth.

Nicole Golden of Golden Glow at 71 South Main Street had not heard about the national flap over teeth whitening, but said that she was largely unconcerned and that Connecticut does not require any special licensing to offer the service. She has offered teeth whitening as a package option to tanning since opening the doors in September 2007, and while it has been steadily gaining in popularity, it is still a relatively small percentage of her clientele that selects that option.

Clients can buy a $30 add-on to a tanning package of the UV light-triggered “Hollywood Smiles” product that Ms Golden carries in her store. The product is designed to be used while in a tanning bed.

The customer inserts a mouth guard and applies the whitening gel to their own teeth. The guard keeps the mouth open and the teeth exposed to the UV light during tanning, and provides protection to the gums, said Ms Golden.

“I’m not doing any hands-on,” she said. “It’s just like buying an over the counter product. All I really do is provide the light,” she said. She questioned how Alabama and Tennessee could ban salons and spas from providing teeth whitening services, without also banning the over the counter products. “This is no different than what people can buy in any drugstore or on TV,” she said, and pointed out that systems for teeth whitening that use a handheld light are even available online and in stores.

The advantage to using Hollywood Smiles as part of a tanning experience, said Ms Golden, is that she can track when a client bought the product and how often it is being used. One of the biggest problems with over the counter products applied at home, she said, is that people tend to overuse them. “When the product is right there in their home, people will think that doing it more often will give better results, and that can cause hypersensitivity in teeth. No one has ever complained here about sensitivity to this product,” she said.

People are definitely asking more frequently about the service than when she first opened her salon, said Ms Golden. “When people have whiter teeth, they tend to smile more. It’s part of the whole look good, feel good experience that people want.”