Who doesn't want perfect pearlies? But how far should we push our obsession for sparkling white teeth? What are the pros and cons of teeth-whitenng treatments, for example? Ritu Raizada finds out.
You have had a refreshing shower, donned your best suit, dabbed on a little of that lovely perfume ... You are all set for the party. You pirouette one last time before the mirror, move in close and practise your million-dollar smile ... and eeeargh! What's with your teeth? Why can't they dazzle like the rest of you?
You brush, brush, brush ... after every meal, after dinner. And yet ... Perhaps just look dazzling but don't smile.
There are no instant fixes to white teeth and, of course, your smile must not be remembered for the wrong reasons. So, what's the solution?.
Cosmetic dentistry, that's what.
Says Dr A. Amer, dentist, The Dental Spa, Dubai, "(Cosmetic dentistry) is the art and science of creating an attractive smile.'' State-of-the-art aesthetic materials and techniques are used in a natural, artistic and painless manner to achieve the best smile possible for an individual, he says.
According to a survey done by a leading toothpaste manufacturer, 90 per cent of the people polled said that white teeth were considered a sign of good health and attractiveness. The colour of your teeth also influenced factors such as professional development and relationships, the poll revealed.
When you meet a person for the first time, "there is a subconscious way our brains and eyes interact with the person'', explains Dr Linish Sagar, dentist, Noa Dental Clinic, Dubai.
"Your eyes scan the person's face - from their eyes, to their nose and then to their smile. If you have stained, missing or chipped teeth, this will be held in memory and will be used to construct that First Impression!
"A healthy smile improves more than your looks. It also reflects good dental health, which can contribute to good general health and a personal sense of well-being."
Why teeth stain
Over a period of time, your teeth start getting discoloured because they absorb stains from almost everything that you consume - tea, coffee, colas, grapes ... if you are a smoker, you are at even greater risk of getting discoloured teeth.
Calculus or tartar can also affect the colour of the teeth. Some people may have staining under the surface, which can be caused by certain antibiotics. Tiny cracks in the teeth, too, can be perfect stain residences.
Realising the importance of pearly whites to make a good impression, dentists across the world have come up with varous ways of whitening teeth. Today, you can brighten your smile either in the dentist's chair or at home using DIY teeth-whitening methods.
But whatever method you choose, it is important to use teeth-whitening products that will provide lasting results, are clinically proven to be safe, effective, use low concentration of hydrogen peroxide and are approved by your dentist.
A note of caution: there are a number of teeth bleaching products on the market sold over-the-counter that can end up doing more harm than good.
Most stains are basically harmless, but many people find them unattractive.
Before proceeding with any form of teeth-whitening treatments, the first step is to consult your dentist. He will be able to guide you on the best treatment option, depending on the extent of discolouration.
Yellow-ish teeth respond well to teeth bleaching while grey-ish teeth don't respond at all! If you have porcelain veneers or other dental bonding, whitening will not help them at all. You may need to change them if they are really discoloured, so they match your real teeth.
What are tooth stains?
Before we answer that, let's get to know a little about teeth. A tooth has an inner dentin layer and a hard outer enamel layer. When you eat or drink, a layer of tartar or plaque forms on the enamel.
In the case of smoke, a film of residue from the various components in the smoke gradually forms on top of the enamel layer. The foreign material accumulates to form a pellicle film over the enamel layer.
A dentist can clean away this film, through scraping or by the use of certain chemicals. Even brushing your teeth can displace some of this muck. But a point to keep in mind is that brushing with an abrasive toothpaste cleans the tooth in the same way as scrubbing with an abrasive pad cleans a dish.
If not cleaned regularly, this pellicle layer remains on your teeth for years. But because the enamel layer is porous, the staining agents begin to slowly seep into the tooth, where it may be almost impossible to remove.
Basically, teeth whiteners use bleaching chemicals to get down into the tooth enamel and set off a chemical reaction (specifically, an oxidation reaction) that breaks down the staining compounds.
Most tooth whiteners use one of two chemical agents: carbamide peroxide or hydrogen peroxide (the same stuff that is used to bleach hair). When used in the mouth, carbamide peroxide breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active whitening ingredient.
What is tooth whitening?
Whitening is any process that will make your teeth appear whiter with a product can bleach the tooth. In other words, it changes the natural colour of the tooth. Bleaching products contain peroxide(s) that help remove deep (intrinsic) and surface (extrinsic) stains.
By contrast, non-bleaching whitening products contain agents that work by physical or chemical action to help remove surface stains only. These include whitening toothpastes, also known as dentifrices.
A few years ago, there was only one way to whiten your teeth. Your dentist would make a mould of your teeth, send them off to a lab, and in 5-10 days a custom-made mouthpiece would be created.
Then, you would have to sit in the dental chair for about two hours with these plastic moulds filled with peroxide (at a very low concentration) pressed against your teeth and gums.
After three to four such visits, your teeth would end up whiter ... and you would end up with a lighter purse. Thanks to technological advances and innovation, dental office whitening has come a long way.
Now the most popular dental whitening procedures are Laser Bleaching, Plasma Teeth Whitening Method, Zoom Technology, Power Bleaching and Argon Bleaching. In most of these methods, a concentrated peroxide gel is applied onto your teeth.
An hour later, a special light (usually laser or argon) is shone on to the paste. The light reacts chemically with the peroxide to complete the bleaching process in a short period.
"One must take enough care to shield all the soft tissues in and around the mouth and a de-sensitising treatment should be given to complete the procedure," adds Dr Sagar.
The whole procedure could set you back by Dh3,000 or more. You also may still need to return to the dentists six months later for a 'touch-up'. Your dentist might also give you some DIY at-home bleaching trays.
Fortunately, as with most other things in life, technology has made teeth whitening easier and more affordable! And "at-home" teeth bleaching has, for sure, taken a bite out of the "in-office" power bleaching systems.
Treatments on offer
In the UAE, there are several options available but Dr Amer recommends Plasma Power Whitening, which is the "safest, fastest and the latest technique for teeth whitening".
"The procedure is done in one hour and the results are due to the reaction of a light source (plasma) and a whitening gel, which releases oxygen radicals to cleanse the teeth deeply," he explains. "The results are an average of 7 to 10 shades lighter, depending on your existing teeth colour and structure."
For maximum whitening, experts agree that peroxide is usually the way to go.
At-home procedures, sometimes called nightguard vital bleaching, consist of placing a bleaching solution, usually a peroxide mixture, in a tray (nightguard) that has been custom fitted for your mouth by an oral health care professional.
The bleaching solutions may vary in potency and may be worn for an hour, or throughout the night. Your oral health care professional can advise you on the appropriate type of application and the length of time needed to whiten your teeth, based on the severity of tooth discolouration and your specific needs.
What's available in the market
There are several types of in-office treatments that you can take advantage of, ranging from professional tray treatments and laser treatments. While tray treatments are less expensive, these can be quite messy, make your gums sore for a number of days afterwards and literally leave a bad taste in the mouth for a while.
Tray treatments also require several sessions, or a take-home kit that allows you to whiten your teeth without having to see the specialist more than once.
The second type of treatment is the one in which laser is used. It is much quicker and has a much more noticeable effect. However, a laser treatment is expensive. One session can cost more than Dh3,000. Most sessions will take roughly 30 minutes to an hour, making it the quickest type available today.
However, once you begin laser treatments, if you do not take care to keep your teeth white, you will need to return to the dentist's after a few months for another treatment. Daily brushing and careful hygiene is mandatory to keep your teeth in good colour and condition.
At-home bleaching kits
These are the most popular whitening option. Mouth trays are usually made in one office visit, and your oral health care professional will provide a whitening brand suitable to your needs. Some trays are worn for an hour, others through the night.
Whitening strips
The second most common type of home teeth whitening. The strips are easy to use and no preparation is necessary.
Trays with bleaching gels
Trays with bleaching gels still provide the best combination of the most affordable and most efficient tooth whitening treatments available. In fact, most of the bleaching gels available at your dentist are almost the same.
Besides, most of the bleaching gels available at retail stores are low cost and also have low concentration levels of active ingredients.
The one thing in common between dental bleaching gels and OTC gels is that they both use glycerine as a carrying agent and this causes the most common side-effect: sensitive teeth!
Bonding
A composite resin that is moulded on to the teeth to change their colour and to reshape them. The resin material can stain and chip over time. Bonding can usually be done in one office visit.
Porcelain veneers
These shell-like facings can be bonded on to stained teeth. They are used to reshape and lengthen teeth as well as to whiten them. Veneers require at least two visits.
Whitening toothpastes
If you cannot deal with the pain and sensitive gums associated with most whitening processes, you can choose from among a variety of toothpastes (dentifrices) available OTC. These will help whiten your teeth without breaking down the enamel.
But yes, it will take a much longer time and will also require brushing your teeth twice daily. These toothpastes contain polishing or chemical agents. They remove surface stains through gentle polishing, or through some other non-bleaching chemical action.
Several whitening toothpastes available OTC effectively keep the teeth cleaner and, therefore, looking whiter. Some are more abrasive than others. The stronger toothpastes rely on abrasion to remove external stains. The key is to study a product's ingredients. Consult your oral health care professional for customised advice.
"While these whitening toothpastes may be somewhat effective, they can destroy tooth enamel in the process, particularly if used for extended periods of time," warns Dr Sagar.
"No toothpaste is effective on teeth that are discoloured on the inside."
How effective is TW?
Bleaching is effective in lightening most stains caused by age, tobacco, coffee and tea. Other types of stains such as those produced by the antibiotic tetracycline or the excessive use of fluoride respond to bleaching less reliably.
If you have a tooth-colour filling when your teeth are bleached, the filling will stay yellow - dental restorations do not change colour when tooth whitener is applied.
Those planning to undergo a teeth-whitening treatment should have a dental cleaning treatment done at least four months prior to that, says Dr Amer. "You should have no cavities which need filling and it is very important to have healthy gums and teeth."
Dr Sagar is quick to point out that there is a big difference between dental cleaning and a tooth-whitening treatments.
"In a dental cleaning treatment (costing about Dh200), the dentist cleans the tartar, plaque and visible stains on the surface of the teeth. But in a whitening treatment, the teeth are cleaned of all stains, even those that are on the inside."
Duration of treatment
While Dr Amer insists that he takes just an hour to complete the treatment, Dr Sagar says it takes him two to three sessions during which he also assesses your teeth. "Zoom procedure usually takes about two hours," says he.
"When the treatment is started, you will need to continue to do touch-ups at home. You will also need to visit the dentist once every six months for a touch-up."
However, Dr Amer does not believe in recommending touch-ups due to the "harmful effects of at-home kits".
"On an average, the Plasma Power whitening should last anywhere between 12 and 18 months depending on how meticulous you are about your oral hygiene as well as how much coloured food and drink you consume," he says.
Side effects
Different professional whitening systems employ a variety of concentrations, depending upon the condition of your teeth. On an average, the concentration of hydrogen peroxide (the chief ingredient in many tooth whiteners) can range from 25-38 per cent.
According to a UK-based report, the sale of tooth-whitening products containing more than 0.1 hydrogen peroxide should be limited. But it is too little to make much difference to the shade of the tooth. Cosmetic dentists administer higher-intensity gels and solutions in their treatments.
However, overuse of over-the-counter home bleaching products can wear away tooth enamel, especially when using solutions that contain acid. Therefore, bleaching is a procedure best done under the care of an oral health care professional.
What you need to know
Hydrogen peroxide can increase temperature sensitivity in the teeth, particularly at higher concentrations, and may cause gum irritation. Thus some people find their teeth becoming sensitive to cold foods/drinks during or after the treatment. Others report discomfort in the gums, a sore throat or white patches on the gum line.
"These symptoms are usually temporary and should disappear within a few days of the treatment," says Dr Sagar.
If any of these side effects continue, you should consult your dentist.
"At The Dental Spa, we use an ingredient which utilises potassium oxygen radicals that are effective and ensure sensitivity-free teeth after the procedure," assures Dr Amer.
The dark side of teeth whitening
Tooth colour, like hair colour, is genetically determined to complement skin colour. White teeth can enhance appearance but teeth which are extremely white can look artificial if they do not match your overall face tone.
"Perceptions of what looks artificial or natural are an individual preference," Dr Sagar is quick to point out. "It is your choice to go for a Hollywood white or a naturally light smile."
Like everything else, teeth whitening should also be done in moderation. "These days, with the advent of OTC whitening products, attaining that perfect mega-watt smile has become seemingly simpler and more affordable," says Dr Sagar.
"Those obsessed with bleaching - called bleachorexics - may not even notice the damage that over-bleaching can cause. Teeth can turn chalky, the edges of their teeth may turn bluish-translucent in colour and in certain cases can also cause damage to the gum tissue."
A word of caution
According to Dr Sagar, whitening is not a good solution for people with untreated tooth decay or gum disease: "Not only are whitening agents ineffective in people with certain internal problems, but they can also cause over-sensitivity in the teeth. So a dentist will need to work on improving the health of the teeth and gums before he can turn to purely cosmetic matters.
"For most people, however, the passage of time and particularly the consumption of coloured foods, coffee, tea and cigarettes, are responsible for the discolouration," adds Dr Sagar.
"Yellowish teeth are thought to bleach the best, followed by brownish-coloured teeth and then greyish teeth. Others who might need an alternative solution are those with teeth darkened by antibiotics such as tetracycline or affected by fluorosis.
"If whitening only improves the base colour of the teeth, options such as porcelain veneers may have to be suggested to the client."
When you are going through any tooth whitening process, you will need to make certain that you are very careful with the supplies.
The chemicals associated with teeth whitening can be very dangerous if they are not handled with care. These products should never be used on children, nursing mothers and pregnant women.
There are a few things that you should be aware of when opting for any of the OTC kits. Remember, not all products are alike and some may have to be used for longer periods of time than others to produce the same results.
Also, some whitening agents can irritate an individual's mouth, especially if the individual has pre-existing conditions like sore gums, cavities or sores.
Therefore, visit a dentist and get a full check-up done before embarking on the use of whitening products. It is very important to follow directions when using whitening products.
Also, for those products that provide a tray for consumers to use, it is important to keep in mind that not all trays fit everyone's mouth properly. An ill-fitting tray can be a major
source of irritation for the mouth.
(Note: Before using any whitening procedure, dentists recommend that you first be evaluated by an oral health care professional to determine which application and programme is best for you).
