As a plastic surgeon who regularly does procedures to enhance and improve the perioral region of the face, the color of one’s teeth can also make a significant impact on these results. Smiling is an expression that is framed externally by the face and internally by one’s teeth. Full lush lips that move to reveal dungy and yellow teeth is an aesthetic distraction. I encourage my patients to consider teeth whitening as part of their facial rejuvenation process.
Having a dental degree and training, patients frequently ask my advice on dental issues including teeth whitening. Many teeth whitening products are available from the drugstore to a dentist. Strips, trays, toothpastes, mouthwashes, and even light systems are available to improve tooth color. But how effective are they and which is best?
An important concept to understand is why teeth discolor? Time and what you eat are the main causes. As you age, the outer layer of the teeth (enamel) becomes thinner and easier to see through. Like glass, one can see through to the second layer known as the dentin. Since the dentin is naturally darker, our teeth begin to appear less white. In addition, the enamel has tubules which can absorb color from food and drink such as coffee, red wine and tobacco, further contributing to a dull and yellow appearance. To get teeth whiter, one essentially has to get the glass (enamel) cleaner.
The key ingredient by which all forms of whiteners work is peroxide. By releasing oxygen, it bubbles away stains in the enamel like wiping a glass window clean. The higher the concentration of peroxide and the longer it can remain in contact with your teeth, the better the result will be. The bleaching action of peroxide solutions can make some teeth temporarily sensitive after treatment as it opens up the tubules down into the sensitive dentin and nerve tissues of the tooth.
For at-home whitening, trays and strips can be effective. These “barrier method” whiteners keep the peroxide solution against the teeth until the solution becomes ineffective. While no single treatment session (usually 30 minutes) produces a dramatic whitening effect, daily use over weeks can improve tooth color up to four or five shades. The highest concentration of peroxide in strips or trays may be up to 9 to 10%. These methods are popular because of their ease of use and low expense. They are not perfect as they are not custom fit. Whitening strips can slip and slide around and may become wrinkled or folded. Disposable trays do not fit everyone well as they are designed for the average-sized mouth.
Paint-on whiteners have become well-marketed and they allow one to apply the peroxide solution to specific teeth or spot areas of teeth. Because there is no barrier for the peroxide, however, it quickly becomes diluted and loses any significant contact time. Some products have a longer application time due to holding agents but they are still inferior to strips and trays. These whitening brushes have gained some popularity because they are portable, not messy, and cause no tooth sensitivity.
Whitening toothpastes can produce a mild brightening effect of maybe a shade over time. They work by mainly by a light abrasive effect. Some do have peroxide action. Again, duration of contact is important and several minutes of brushing per session are needed if any significant effect is to be seen. Some whitening toothpastes also have ingredients that prevent new stains from sticking to teeth. Whitening mouthwashs have more recently become available. While they have good foaming action, they don’t stay in contact with teeth very long. But the combination of a whitening toothpaste and rinse does give teeth several minutes of whitening action every day. At the least, their use may be able to get rid of any stains that are acquired by food and drink on a daily basis.
Professional whitening done at your dentist uses one of three treatment methods. The fabrication of custom bleaching trays for at-home use with differing strengths of peroxide solutions. In-office strong peroxide gels with an applied gum barrier. And light treatments which have accelerated whitening up to 6 or 7 shades in a single session. The light helps intensify the effects of an already high strength peroxide. With such accelerated whitening, tooth sensitivity is common and persistent. However, any dramatic whitening can fade quickly without at-home maintenance (usually a tray, whitening strips or toothpaste). You also have to watch what you eat and drink for a couple of days after, since tooth enamel is very receptive to new color from food or drink for the first 48 hours after a bleaching treatment.
Not everyone can really whiten their teeth significantly. If your front teeth are crowns or veneers, they can not be whitened at all. If your teeth appear more gray than yellow (commonly caused by antibiotics taken as a child), they will not lighten. A simple method to test your whitening potential is to hold up a white piece of paper or 3 x 5 card next to your teeth. If your teeth appear yellowish, they will get whiter. If they appear gray, they will likely not get lighter.
Teeth whitening is an important part of making one’s smile more aesthetically pleasing. It is frequently overlooked in the plastic surgery patient who can get get caught up in lip enlargement, wrinkle reduction, and other methods or perioral rejuvenation. Numerous effective methods of tooth whitening exist. They fundamentally differ based on how long they take to work, how much lightening can be achieved, and their risk of temporary tooth sensitivity.
Dr. Barry Eppley
Indianapolis, Indiana