By Cheryl Alexander
Options abound for anyone who is interested in boosting the brilliance of their
smile. So many choices are available for you to consider if the shade of your
teeth doesn
’t satisfy your desire to dazzle. There is honestly a solution for every budget,
time frame and disposition
—from at-home bleaching kits to sessions in the dentist chair.
Yet despite the plethora of pearly whiteners on the market and the success
stories claimed by all of them, according to the
Consumer Guide to Dentistry, only a slight 15 percent of the population has actually tried this easy
procedure, mostly due to misinformation on the subject. Here, we will offer you
information to clear up some of your most common questions and put a bright,
white smile back on your face.
What is tooth discoloration?
Tooth discoloration refers to the stains that accumulate on teeth. There are two
categories of staining as it relates to the teeth: extrinsic staining and
intrinsic staining.
Extrinsic stains appear on the surface of the teeth as a result of exposure to
substances that stain the teeth. Most of these minor stains can be removed with
brushing and regular trips to your dentist for cleaning. Stubborn extrinsic
stains can be removed with more involved efforts, like teeth bleaching.
Intrinsic stains form on the interior of teeth. Intrinsic stains result from
more profound experiences such as trauma or aging, or exposure to minerals
during tooth formation and/or excessive ingestion of fluoride. Previously, it
was thought that intrinsic stains were too resistant to be corrected by
bleaching. Now dentists believe that even deep-set intrinsic stains can be
removed with supervised take-home teeth whitening maintained over time.
What causes tooth discoloration?
Web MD reports several causes of tooth discoloration, including:
•Foods/drinks. Coffee, tea, colas, wines, and certain fruits and vegetables (for
example, apples and potatoes) can stain your teeth.
•Tobacco use. Smoking and chewing tobacco stain teeth.
•Poor dental hygiene. Inadequate brushing and flossing which will remove plaque
and other stain-producing substances (like coffee and tobacco) can cause tooth
discoloration.
•Disease. Several diseases that affect enamel (the hard surface of the teeth) and
dentin (the underlying material under enamel) can lead to tooth discoloration.
Treatments for certain conditions can also affect tooth color. For example,
head and neck radiation and chemotherapy can cause tooth discoloration. In
addition, certain infections in pregnant mothers can cause tooth discoloration
in the infant by affecting enamel development.
•Medications. The antibiotics tetracycline and doxycycline are known to discolor
teeth when given to children whose teeth are still developing (prior to age 8).
Mouth rinses and washes containing chlorhexidine and cetylpyridinium chloride
can also stain teeth. Antihistamines (like Benadryl), antipsychotic drugs, and
drugs for high blood pressure also cause tooth discoloration.
•Dental materials. Some of the materials used in dentistry, such as amalgam
restorations, especially silver sulfide-containing materials, can cast a
gray-black color to teeth.
•Advancing age. As you age, the outer layer of enamel on your teeth gets worn
away revealing the natural yellow color of dentin.
•Genetics. Some people have naturally brighter or thicker enamel than others.
•Environment. Excessive fluoride either from environmental sources (naturally
high fluoride levels in water) or from excessive use (fluoride applications,
rinses, toothpaste, and fluoride supplements taken by mouth) can cause tooth
discoloration.
•Trauma. For example, damage from a fall can disturb enamel formation in young
children whose teeth are still developing. Trauma can also cause discoloration
to adult teeth.
What are my teeth whitening options and what do they cost?
The Consumer Guide to Dentistry reports that there are three major teeth whitening options available today. All
three rely on varying concentrations of peroxide and varying application times.
In-Office Whitening
In-office whitening offers the most significant color change in the shortest
period of time. This choice involves the carefully controlled use of a
relatively high-concentration peroxide gel, applied to the teeth by the dentist
or trained technician after the gums have been protected with a paint-on rubber
dam. Generally, the peroxide remains on the teeth for several 15 to 20 minute
intervals that add up to an hour (at most). Those with particularly stubborn
staining may be advised to return for one or more additional bleaching sessions
or may be asked to continue with a home-use whitening system.
Southwestern Society of Oral Medicine Past President Dr. Ronada Davis, D.D.S.,
advocates that patients not do the in-office whitening procedure more than once
every two years.
“In my practice, most patients that have it done are so thrilled with the results
they really keep their teeth clean and do not
In-office teeth whitening usually costs $650 per visit (on average) nationwide.
Professionally Dispensed Take-Home Whitening Kits
Many dentists agree that professionally dispensed take-home whitening kits can
produce the best results over the long haul. Take-home kits utilize an
easy-to-use lower-concentration peroxide gel that remains on the teeth for an
hour or longer (sometimes overnight). The lower the peroxide percentage, the
longer it may safely remain on the teeth. The gel is applied to the teeth using
custom-made bleaching trays that resemble mouth guards. This option can cost
from $100 to $400.
Over-the-Counter Whitening
The over-the-counter option is the cheapest and most convenient of the teeth
whitening options. A store-bought whitening kit features a bleaching gel with a
concentration lower than that of the professionally dispensed take-home
whiteners. The gel is applied to the teeth via one-size-fits-all trays,
whitening strips or paint-on applicators. In many cases this may only whiten a
few of the front teeth unlike custom trays that can whiten the entire smile.
The cost can range from $20 to $100.
Generally speaking, the price of tooth whitening increases with the number of
in-office treatments required by the patient. Dental insurance does not
typically cover the cost of the procedure.
What are the risks associated with whitening my teeth?
Tooth whitening treatments are considered to be safe when procedures are
followed as directed. However, there are certain risks associated with
bleaching that you should be aware of:
•Sensitivity: Bleaching can cause temporary sensitivity to temperature, pressure
and touch and is most likely to occur during in-office whitening, where
higher-concentration bleach is used. Some individuals experience spontaneous
shooting pains, called
“zingers,” down the middle of their front teeth. If you have receding gums, significant
cracks in your teeth or leakage resulting from faulty restorations, you may be
at greater risk for sensitivity. Whitening sensitivity is usually gone after a
day or two, and your dentist may recommend a toothpaste containing potassium
nitrate to alleviate sensitivity.
•Gum irritation: Over half of those who use peroxide whiteners experience some
degree of gum irritation resulting from the bleach concentration or from
contact with the whitening trays. This type of irritation can typically last
several days.
•Technicolor teeth: Restorations such as bonding, crowns or veneers are not
affected by bleach and therefore maintain their default color while your
surrounding teeth are whitened. This results in what is frequently called
“technicolor teeth.”
What maintenance is required to keep my teeth white and bright?
To extend the longevity of newly whitened teeth, dentists recommend:
•At-home follow-up or maintenance whitening—implemented immediately or performed as infrequently as once a year.
•Avoiding dark-colored foods and beverages for at least a week after whitening.
•Sipping dark-colored beverages with a straw whenever possible.
•Practicing good oral hygiene by brushing and flossing after meals and at
bedtime.
The long and the short of it is that tooth whitening works. Almost everyone who
opts for this cosmetic treatment will see improvement in the brightness and
whiteness of their smile. However, tooth whitening effects are not permanent
and will require maintenance or
“touch-ups” for a prolonged effect.
