Have you visited the HSI e-Alert Forum yet? If you haven’t, you should. Members are talking about recent topics, exchanging information, sharing personal experiences, and asking questions. It’s working out just as I hoped it would – another valuable resource for our members.
At the Institute, we’re finding that the Forum is a valuable resource for us as well. It helps us keep our fingers on the pulse of our members and e-Alert subscribers, and it highlights topics that you want to know more about. Today’s e-Alert is a perfect example.
Just a few weeks ago, Bernie K. read the e-Alert from our newest panelist, Dr. Rick Cohan, which explained how prescription antidepressants can cause unexpected damage to your teeth and gums. Pleased to see that HSI added a dentist to the panel, Bernie wrote to the Forum asking for Dr. Cohan’s advice on teeth whitening. Since over-the-counter teeth whitening products are all the rage, many of our e-Alert readers may be wondering about them so we decided to bring you Dr. Cohan’s thoughts on these products. I think you’ll be interested in what he has to say
Straight from the dentist’s mouth
The words ‘safe’ and ‘teeth whitening’ in the same sentence may cause some to shudder – but the fact is that most methods appear to be relatively safe. Today there are more options than ever, both for at-home, over-the-counter, and for professional treatment in a dentist’s office. But not everyone is a good candidate for teeth whitening – and everyone needs to know the potential risks of these products and procedures, however small they might be. Bear in mind that ‘whitening’ and ‘bleaching’ are used interchangeably but really are different terms. The latter term refers to the removal of stains from the enamel (outer) surface using abrasives, whereas bleaching refers to the alteration of pigments which are most often internal (in the underlying dentin).
In a healthy tooth, the enamel coating is almost as clear as a pane of glass. The underlying dentin is what gives the tooth its color. But, over time, various events or chemical exposures can damage and discolor teeth externally and/or internally. Most people notice their teeth getting darker as they age. Smoking cigarettes and drinking coffee, soda, tea, and red wine can also stain the teeth. Other causes of discoloration include use of antibiotics like Tetracycline during tooth maturation, bleeding from the pulp caused by trauma, too much fluoride, or not enough calcium. If you have the garden-variety overall discoloration caused by age and lifestyle habits, the over-the-counter products may be enough to get you the results you want, unless the stains are dark, such as those associated with old fillings.
People with old fillings, especially tooth-colored ones, should probably avoid bleaching. Such fillings are vulnerable to becoming weaker and they do not bleach at the same rate as enamel. Also, if you have a problem with receding gums (dentists call it ‘gingival atrophy’), bleaching agents are likely to make your teeth and gingivae quite sensitive (possibly because of their acidity or alkalinity), at least for a few days.
But if you have healthy gums, and the teeth you’re looking to whiten don’t have fillings, whitening treatments may work for you. Though there are more varieties now than ever before, over-the-counter products have actually been around for years. The whitening toothpastes and mouthwashes usually include carbamide peroxide (CP) in a 3 percent gel or solution. (By contrast, products used by most dentists contain 10, 20 or even 33 percent CP, so 3 percent should not be a concern.) The over-the-counter bleaching trays are usually a bit stronger, with maybe a 10 or 20 percent solution. But used correctly, they are still generally safe, and can deliver good results for a much smaller price than in-office treatments. (In-office whitening treatments can cost as much as $400 for your whole mouth – and most dental insurance plans don’t cover them.)
Whether you get them from your local drug store or from your dentist, bleaching trays work in the same way. The bleaching solution is poured into rubber forms that fit around the upper or lower teeth like a mouthguard. You wear the trays for 30 minutes at a time, once a day for several weeks. (Years ago, when in-office bleaching procedures were first introduced, dentists recommended that their patients wear the custom trays overnight. We now know that the major effects of bleaching occur within the first 20 minutes.) To minimize side effects, don’t wear the bleaching trays any longer than 30 minutes at a time. If you use bleaching trays supplied by your dentist, return to the office for a check-up after a week or two.
Some people do experience side effects from whitening treatments. They can cause teeth sensitivity to cold and heat, and the gums may burn or become ulcerated. Usually, this occurs when the products are overused. The 3 percent toothpastes and mouthwashes can usually be used daily with no ill effects, but for the bleaching trays, whether at-home or in-office, I don’t recommend doing it more than once a year.
If you do experience sensitivity in your teeth after bleaching, stop using the products. If you got the products from your dentist, contact him or her and ask for advice. In my practice, I may tell patients to stop using the product for a week or so, and then start using the products again for shorter periods of time and/or on alternate days.
If you know that your problem was caused by Tetracycline or excess fluoride, don’t waste your time with over-the-counter products. Special procedures may be necessary to treat these kinds of stains. I’ve had a lot of success with a treatment for fluoride stains (we dentists call that ‘fluorosis’) that can usually help in just one visit. The teeth are pumiced with an acid for a very brief time, and then immediately treated with sodium bicarbonate to neutralize the acid. Using a rubber “dam,” certain teeth can be isolated for treatment to make the teeth appear uniform. The results are almost instantaneous and, in my experience, long-lasting.
I explained earlier how most whitening treatments affect stains in the enamel. But even discoloration caused by damage to the dentin (often seen in root canal-treated teeth) can sometimes be treated with more powerful bleaching agents in a dentist’s office. In a surgical procedure, the agents are placed within the former pulp chamber of the tooth. They remain there for a period of time and are then removed. When done correctly, this technique produces rapid results. But again, it is not without risks. Originally, this procedure included the application of heat to accelerate the process. I don’t recommend using heat, because it increases the risk of damage. If this technique is used to excess, the bleach can eventually dissolve the cervix, or base of the tooth, causing the crown to break off.
You may have seen the new outlets like BriteSmile, which markets itself like a LensCrafters, saying you can have white teeth ‘in about an hour’ after treatment with their patented laser approach. I have done some research into this, and don’t feel there is enough information available yet to make a recommendation. I have some reservations about preliminary reports of cracking in the teeth caused by laser treatment. I advise waiting for more results before trying it.
No matter what method you choose, I always recommend doing one area at a time so you can track the changes. Many products come with a “shade guide,” to help you identify what color your teeth are before you start, and how much they’ve changed after treatment. After all, you’ll be investing your time and money into this process and you want to make sure that you’re getting the results you want!
Best regards,
Dr. Rick Cohan, HSI Panelist
Copyright 1997-2002 by Institute of Health Sciences, L.L.C.
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