Looking to a brighter future...

Unpacking Truth

…one smile at a time.

Dentistry is a beautiful blend of art and science. Most patients likely view what we do as the mechanical preparation of teeth to remove and repair decayed lesions. But dentists also view themselves as artists. Our teeth have very specific lengths, shapes and sizes that give help to create a fantastic smile. One crucial element to an amazing smile is tooth color…the color of one’s teeth can have a big impact on how a person views him/herself and how they are perceived by others. I touched on the importance of our smiles in an earlier writing by highlighting research indicating that one’s view of his/her smile can have a very strong impact on personal self image. The science behind our smiles also indicates that others may view someone with broken, discolored or missing teeth as less friendly, less successful and less attractive.

As we age, our teeth tend to naturally get a bit darker. This happens for two reasons…tooth color is determined intrinsically by the amount of dentin that is seen through enamel. As we mature the enamel of our teeth can get thinner causing the teeth to have a slightly more yellowish hue. Over the course of a lifetime of consumption of coffee, tea, wine, blueberries and other staining foods, our teeth will develop an extrinsic stain that often adds a yellowish/brown hue to our teeth.

A guideline we often follow to help patients establish the proper level of whiteness for their teeth is to compare their teeth to the whites of their eyes. If your teeth are yellower than the whites of your eyes, whitening your teeth can help give a more youthful appearance. Just like any cosmetic procedure, some people take this too far. When teeth start to have a blueish appearance, it is time to discontinue whitening.

Professional vs OTC

When patients inquire about whitening, I like to explain the difference between ‘over the counter’ (OTC) products and professional treatments. Jokingly, I suggest that if you’re under the age of 40, OTC is the way to go. It seems like after the age of 40, you’re better off trying a professional whitening option. There are two main differences between professional vs OTC whitening. Professional whitening involves the fabrication of a custom fit tray, OTC whitening is a one size fits most. Professional whitening typically contains about 10% hydrogen peroxide, OTC whitening is a 3% solution. Whitening professionally will produce results in significantly less time than products you can buy in stores and online.

Professionally, there are two options for whitening: in-office and take home. Unless you’re getting married and only have a couple of days to whiten, I do NOT recommend in-office whitening. It is more expensive, it needs to be followed up with take home trays and there is often a significant amount of sensitivity that can be felt for weeks after the treatment. My preference is to recommend custom fit trays to be made and we train you as to where and how much material to use. We do this in an effort to not waste product by using too much or whitening teeth that no one will ever see.

Professional take home tooth whitening will involve having impressions made of your teeth. We use these molds to fabricate custom fit trays that serve to deliver the whitening gel exactly where we want it and nowhere that it should not be (like on your gum tissue). Once you have the custom trays made, you will be instructed as to where to place and how much gel to use. You wear the trays for about 20-30 minutes/ day. Typically patients see results after the first few treatments and achieve their goal tooth color in two to four weeks. After initial treatment, I recommend patients whiten their teeth every time they have their teeth cleaned as a maintenance protocol. There is no magic prescription for whitening but I have found this to be effective for most. The ongoing cost of maintaining the beauty you have achieved is on par with purchasing OTC whitening kits.

Side Effects

The number one complaint of anyone embarking on the journey to a brighter smile is acute sensitivity to cold temperatures. Professional whitening products now contain desensitizing materials that have all but eliminated this annoying side effect. For patients that have breakthrough sensitivity, brushing with a toothpaste that contains nanohydroxyapatite such as NoBS or one that uses potassium nitrate such as Sensodyne can help to mitigate trouble enjoying cold foods.

Whitening Toothpastes and Mouthwash

Patients often ask me my opinion about whitening toothpastes and mouthwashes. In general, I DO NOT recommend these products. First, the goal of whitening your teeth is much like trying to get a tough stain out of your favorite shirt. It must first be treated and allowed to sit soaked in stain remover. Teeth stains aren’t far removed from a dirty blouse or t-shirt. Brushing and rinsing do not allow for enough contact time to provide effective improvement in tooth color.

Additionally, whitening toothpastes often contain abrasive additives that are damaging to your enamel and gum tissue. A common complaint from patients is that their teeth are sensitive to hot/cold food. When I inquire about what they are using to brush their teeth, more often than not, they have switched to a ‘whitening’ toothpaste.

Charcoal Toothpaste??

Several years ago charcoal hit the dental marketplace through toothpastes promising to make your teeth several shades whiter. Activated charcoal is composed of wood, coconut shells and other natural ingredients ground into a fine powder. The ability of charcoal to whiten teeth has mixed reviews in the literature.

One thing we do know for sure about charcoal is that it is abrasive and may offer initial whitening due to the ability to abrade/remove stains. But the long term impact of brushing with something that is scratching the tooth surface can lead to thinning enamel and unwanted ridges in your teeth that collect stain over time. From what I have read, I would NOT recommend using activated charcoal in your mouth.

Natural Whitening Alternative

I have previously written on the many wonders of baking soda for cleaning your teeth and helping to neutralize acidity from your diet. Baking soda is also a mild abrasive that can help to remove surface stains naturally. Fortunately, on a hardness scale, baking soda is softer than tooth enamel which eliminates the concerns mentioned about charcoal. If the staining of your teeth is coming from deep within the tooth, you may not find brushing with baking soda alone to provide much benefit.

It is possible to make your own whitening toothpaste using a baking soda and peroxide solution: mixing to achieve a paste consistency. Hydrogen peroxide is found in a 3% solution OTC and can achieve whitening when used daily but may take considerably longer than the preferred method using a custom fit tray.