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Today's Daily Health Tip
Extreme Teeth Whitening
by Hiyaguha Cohen     A few weeks ago, we wrote in our natural health newsletter about the problems associated with teeth-whitening toothpastes, including the fact that they don't work. Most adults take the quest for white teeth seriously, with 74% believing that an unattractive smile hampers career success. As we noted in the previous article, Americans spend $1.4 billion each year on over-the-counter teeth whitening products, and that's without counting the money spent on dentist-administered whitening. So clearly, the public wants an effective way to restore teeth to their pearly hue. The two questions we want to consider today are whether some of the other products out there--over-the-counter whitening strips, prescription whitening systems, and in-office dental whitening--actually do the trick, and are there many downsides.
Dentist-supervised in-office whitening procedures constitute the top rung of the whitening methods. Having your dentist do the whitening for you provides certain advantages, such as the fact that it takes just an hour or two in the office versus weeks at home using over-the-counter strips. At the end of your single session, you'll have a smile from two to eight shades lighter. The effectiveness depends somewhat on the condition of your teeth at the start. It's possible that you'll only lighten a few shades, in which case you'll have to do some follow-up work at home using a tray fitted to your mouth. On the other hand, the results should last about a year.
The in-office treatments involve having a high concentration of hydrogen peroxide--anywhere from a 25 to a 40 percent solution--directed right at your teeth, and often combined with laser therapy. (Your dentist will, hopefully, protect your gums with a gel or rubber shield.) The cost for the whole shebang usually runs about $650 out-of-pocket dollars, depending on where you live. And it should be noted that insurance usually doesn't cover the cost. You can also try one of the specialized "drive-by" clinics that only do teeth-whitening. Technicians rather than dentists do the work at these locations, and the cost comes in a lot lower--anywhere from $150 on up.
If you want to save a few dollars, you can also have your dentist make a cleaning tray for you. It's a take-home device, molded to your mouth. You squirt a cleaning solution into the tray and then wear it for about half an hour at a time, several times a day, for a week or two. You get results equal to that with the laser treatment, and it runs an average of about $400. Again, you might have to wear a tray as a follow-up measure even if you have the in-office whitening.
Far down the scale in terms of cost are the strips you can buy in the store and stick on yourself. If you haven't yet had the joy of trying these, you peel adhesive off the back of perioxide-soaked strips and then adhere them to your teeth. They can slip and slide in your mouth and feel a bit uncomfortable, but the strips do often lighten teeth several shades. The advantage is that they use a lot less bleach than the professional alternatives--usually a 10-15 percent carbamine peroxide solution, which breaks down to about 3-5 percent hydrogen peroxide; the disadvantage is that they don't lighten teeth as much as professional methods and the results only last a few months. Of course, they cost far less than in-office dental procedures, starting at about $20. And finally, there are now in-home kits that use light, and those run about $200.
All of these methods will likely lighten your teeth to varying degrees, but are they safe? Do they cause side effects? Are there any downsides? As it turns out, a surprising number of users experience tooth pain after bleaching. Studies at the University of Southern California's School of Dentistry found that a full half of all users experience some mild discomfort, and one in 25 has spells of debilitating, shooting pain that lasts several minutes at a time. The pain can come hours or days after using the whitener, and the spells can persist for several weeks or months even after discontinuing treatment.
Other issues that can come from bleaching include irritated gums, bleached gums, and seriously discolored enamel. In-office treatments can cause chemical burns to the gums, tongue, and other soft tissue areas if the patient isn't properly protected. And if that's not bad enough, on a more serious note, if the peroxide leaches into a crack or cavity in the tooth, it can cause damage that requires a root canal. That's why dentists recommend using products only with dentist supervision. Also, not all darkening can be bleached away. For instance, if the darkening comes from an antibiotic like tetracycline, bleaching won't always lighten it.
The American Dental Association sums up the research with this rather somber cautionary note: "On rare occasions, irreversible tooth damage has been reported. Patients should be cautioned that not enough information is available to support unsupervised long-term and/or repeated use of bleaching products." In fact, the ADA hasn't approved over-the-counter products, in part because it's harder for home users to protect their gums, and also, because if users begin the process with damaged teeth they can encounter problems.
The sensitivity problems tend to arise more often in frequent bleachers--and apparently, there are many of them. Bleaching can be somewhat addictive. None of the products are intended for use more than a few times a year, and that's a problem because soon after a whitening session, the teeth start returning to their former dingy state. The retreat progresses even faster if the person drinks coffee, tea, or wine regularly. In fact, the bleaching process compromises a protective layer on the teeth called the pellicle, making the teeth more vulnerable to stains right after treatment. The average person relapses two shades within a week of bleaching, according to a study conducted by the Tufts University School of Dental Medicine. When the relapse occurs, many people rush back to bleach again--and they end up overdoing it.
According to New York City dentist John W. Siegel, "There's anorexia nervosa among certain people who desperately want to be thin, and there's also a similar syndrome for people whose teeth are never white enough."
Beyond the concerns about the effects of bleach on teeth and gums, there's also the question of how safe it is to swallow peroxide. While the American Dental Association and most experts say there's no real worry at the low concentrations used, at least in home bleaching, the European Commission on Health and Consumer Protection completed a study on hydrogen peroxide in bleaching products, focusing on concerns that peroxide might trigger oral cancer, particularly in smokers and drinkers. The Commission concluded that at concentrations less than 6 percent, hydrogen-peroxide based bleaches are safe when used by people who do not have gingivitis, tooth decay, and who don't abuse alcohol or tobacco. That means that if you do have gingivitis, tooth decay, or you indulge in smoking or drinking, bleaching is not necessarily safe. Oh! And the report did note that leave-in strips can cause mercury to leach from fillings and bonding agents to leach from restorations.
In short, bleaching is a low-risk undertaking, but it isn't risk free.
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