Before you bite on any whitening method, weigh the pros and cons

kansascitystar
By EDWARD M. EVELD

The Kansas City Star
Posted on Tue, Jul. 08, 2003

Put down that cup of tooth-tarnishing coffee and look around. Teeth are getting whiter and whiter.

Used to be that only sheets, socks and underwear had to be “whiter than white,” for reasons known only to advertising people.

Now it’s teeth.

Adults with what were once considered normal teeth yearn for something else, something many shades lighter than the aging pearlies they see each morning in the mirror.

The number of teeth-whitening procedures performed in the last six years has jumped 300 percent, said Eric Nelson with the American Academy of Cosmetic Dentistry. Whitening is now the most requested and performed cosmetic dental procedure.

How white? Experts feel the need to tell consumers not to shoot for whites that are “unnatural” or “freakish” or to expect the iridescence they see in Hollywood actors and models. Such Day-Glo results are often achieved with caps and other more costly dental procedures (or via the magic of photo retouching).

Ross Headley, a dentist in Overland Park, said that while a few patients want teeth that stand out in a crowd, the vast majority are asking for white teeth that look natural, simply a brighter smile. Which is good, he said.

“Most people are pretty reasonable about how white to go,” he said.

In a survey, the Cosmetic Dentistry group asked members what procedure they most recommend. Of its members who responded, 87 percent said “at-home custom trays.” Patients wear the trays over their teeth nightly as the whitening compound does its job.

Consumers are encountering all sorts of products and procedures, not only at the dentist’s office but at the drugstore and on TV and the Internet. They generally fall into a few categories. Here’s a rundown:

Teeth-whitening toothpastes

What: Over-the-counter toothpastes for regular use at home.

Cost: Several dollars a tube.

Pros: In general, mild abrasives in toothpastes help to remove stains on the teeth. Toothpastes with extra “whitening” agents can provide extra stain removal.

Cons: Toothpastes with whitening agents, even those that carry the American Dental Association’s Seal of Acceptance, are unlikely to actually bleach the teeth. Even if they have bleaching additives, two minutes of brushing isn’t enough time to do the job.

Over-the-counter products

What: Strips applied to the teeth; brush for applying whitening agent; bleaching trays that fit over the teeth.

Cost: From $10 to $50.

Pros: Less expensive than dentist-directed treatment.

Cons: Higher risk of cold sensitivity and gum irritation because the whitening chemicals can make contact with the gums. Ill-fitting trays can also cause jaw problems.

Strips do well with the front six teeth but not farther back in the mouth. People with wide smiles might notice a color variation.

The active ingredient in many over-the-counter products is hydrogen peroxide rather than carbamide peroxide. It’s carbamide peroxide, at a concentration of 10 percent, most often recommended by dentists.

Dentist-directed at-home treatment

What: Dentist takes a teeth impression to create bleaching trays that fit over your teeth. A whitening gel is placed in the trays, and they are worn for several hours, usually at night, for about three weeks.

Cost: $200 to $500.

Pros: Because custom-made trays for the teeth fit better, the bleaching effect may be enhanced and side effects — gum irritation and hot-and-cold sensitivity — are reduced.

Dentists generally use the bleaching solution, at least 10 percent carbamide peroxide, found to be most effective. Dentists can make sure your natural and restored teeth, such as crowns and veneers, have a uniform appearance.

Cons: Side effects aren’t eliminated. About 50 percent of patients notice at least temporary sensitivity. Patients may need a touch-up in a couple of years.

In-office treatment

What: Dentist applies a whitening gel to the teeth and uses heat, light or laser energy about 45 minutes. The process requires one to five visits. At-home bleaching might be recommended afterward.

Cost: $500 to $1,000.

Pros: Whitening is done more quickly during one or more office visits. Patients avoid nighttime tray treatment, which for some is uncomfortable.

Cons: Loss of control some patients feel with at-home method, a more gradual process that allows them to assess their progress.

Doesn’t eliminate the possibility of extra office visits and a home kit.
More whitening tips: • Yellowed teeth, the result of tea, coffee, tobacco and normal aging, are likely to respond well to bleaching. • Brown- or gray-colored teeth are often more resistant to whitening. • Individual teeth darkened by trauma or root canal work also may resist whitening. • Bleaching won’t change the color of most dental work, such as white fillings, bondings, crowns and bridges. An exception: porcelain veneers. The lightened shade of the underlying tooth will show through the veneer. • Teeth with receding gums may have exposed root surfaces that have a naturally darker color unresponsive to bleaching.

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