How to get those pearly whites
“We are all evaluated in this culture by so many things -- socioeconomics, education, fitness -- but if you have a jacked-up grill, that’s a bad deal.”— Dr. David Hornbrook
In the looks department, you might feel like you've really got it going on -- thick and shiny hair, a tight and toned body, and skin that is nothing less than smooth and flawless. You take care of yourself and it shows. In fact, perhaps, you never met a mirror you didn't like; that is, until you break into a self-satisfied grin and see a mouthful of stained, yellow teeth smiling back at you. Discoloured teeth can ruin your look and age your appearance. “A shiny smile is a sign that you take good care of yourself overall. It's one of the more appealing elements of attraction to other people. [It] helps a lot with self-esteem and overall confidence,” said Dr. Monica Herdoiza. The good news is that a less-than-sparkling smile is often an easy fix.
Basic chemistry of whitening trays
When it comes to tooth whitening, there’s really a product or procedure to fit almost any budget.
You can purchase over-the-counter, one-size-fits-all dental trays, get them from your dentist or have your dentist customise trays for you. Whatever the case, you typically fill a tray with a gel, containing carbamide peroxide, and wear it for a specified amount of time each day for several weeks.
Dr. Todd Schoenbaum explained how the basic chemical process works: “Carbamide peroxide breaks down into hydrogen peroxide. Potassium nitrate, another chemical in the whitening gel that's also used in Sensodyne toothpaste, helps decrease sensitivity. Potassium fluoride is often included as well, with the idea being that it might help strengthen the enamel.”
The colour of the tooth is affected both on the inside and outside, but the colour truly comes from below the enamel where a substance called dentin, which makes up the structure of the tooth, is located. Dentin has color pigments. The oxygen from the peroxide oxidizes and works its way from the outside, through the enamel and into the dentin, breaking down those colour pigments.
Professional bleaching and home systems
Dr. David Hornbrook notes that teeth whitening dates back 25 years, when it was accidentally discovered that gels and dental trays could do more than just treat sores in the mouth. The whitening process evolved using hydrogen peroxide for bleaching purposes to achieve various shades of whiteness.
While at-home whitening trays, dental strips, whitening toothpastes and whitening rinses are all available over the counter for less than £20 -- and can help you achieve and/or maintain varying degrees of whiteness for varying amounts of time -- there are certainly advantages to opting for professional in-office bleaching with your dentist. Your dentist can remove plaque, take X-rays, do periodontal charting, perform a preprocedure study with digital photography, and provide a shade guide to help you determine your whitening goal. In-office professional bleaching can last from one to three years.
Dentists typically use a strong peroxide-based gel, applied directly to the teeth. Most gels are self-activating, while others are activated with a light. The procedure takes about an hour and offers immediate results -- although it may take more than one session to achieve your desired level of whiteness.
In-office treatments, according to Hornbrook, use the highest level of active chemicals for fastest results; they typically whiten teeth by 35 to 50 percent. Dentists often follow in-office procedures with custom take-home dental trays that can whiten teeth an additional 10 to 25 percent. The cost for a single in-office whitening session can range from £250 to about £600, while the take-home trays can cost anywhere from £80 to £250. Prices vary depending on the product, the dentist, your teeth and the level of whiteness you want to achieve.
Commitment to pearly whites
Regardless of the product or procedure you try, for those seeking advanced whitening, discipline is mandatory and it is an ongoing process.
“The key is commitment,” said Dr. Jonathan Levine. “As we age, teeth darken from the inside out, that’s just a fact of life. Like our nutrition, like our fitness routines, teeth whitening means continual care.”
The inventor of the GLO-Brilliant whitening system, Levine, a long-time researcher in the field of aesthetic dentistry, has refined the basic procedure most dentists use and developed a method for take-home use.
Levine's GLO whitening mouthpiece has heat resistors and an LED light built directly into its design. The whitening gel is applied with the unique G-Vial delivery system, preventing it from migrating to the gums and soft tissue, which can cause sensitivity and discomfort. The cost is approximately £300.
Schoenbaum points out that genetics also play a part in whitening results; some people just achieve a higher level of whiteness more easily than others. He also notes that there’s now a trend where patients are saying, “Well I don’t want it to look like I've had anything done; I just want my teeth to appear more naturally white like they used to.” He says that one way to ask a patient the level of whitening he desires is to say, “Do you want to look Hollywood white or naturally white?”
The high end of teeth whitening
Regardless of shade level considerations, all teeth-whitening procedures require touchups and maintenance; however, there are more “permanent” forms of teeth whitening.
At the high end of that spectrum, you find porcelain veneers. With a price range varying from £300 - £500 per veneer, they're a comparatively big investment. "With veneers, there’s a slight amount of enamel removal from the tooth. But we can change colours, shapes, fill gaps making them bright white or natural white," said Herdoiza. "Veneers are about 1/2 millimeter thick. A custom-made veneer looks like a porcelain contact lens; it's permanently bonded to the front of the tooth.”
In between porcelain veneers and basic whitening, there’s the bonding option, or what dentists call "composite veneers." “We take white filling material -- composite resin -- and lay it in thin layers on the teeth to improve their aesthetics,” said Herdoiza. The cost of cosmetic bonding ranges from about £400 - £800 per crown, depending on the dentist and individual situation.
Before plunging in and deciding which teeth-whitening process to pursue, consider that certain lifestyle choices can discolor teeth -- but they're often merely superficial stains. If you drink a lot of coffee, dark teas, red wine and use tobacco, greying or yellowing of the teeth can occur. However, in many cases, a dental hygienist can polish these types of problems away, says Hornbrook.