Pulse

Yearning for 'Chiclet teeth'

Our quest for the perfect smile has expanded from the dentist's chair to store shelves, fed by an array of new teeth-whitening products.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published February 11, 2003

If a smile speaks a thousand words, America wants one of them to be "young."

A desire to defy the yellowing and staining of teeth that accompany aging has created a $65-billion industry. Vouchers for teeth whitening were tucked in the $20,000 gift baskets given to presenters and performers at the 2002 Academy Awards. Vogue magazine declared an appointment to "lighten choppers" as de rigueur at the spa. And on CBS's Big Brother 3, house guest Marcellas, dissing roommate Tonya's trashy fashion sense and silicone breasts, delivered this final insult, on her glow-in-the-dark teeth:

"Bad bleaching job."

Teeth whitening has gone from corrective to cosmetic in five years, increasing 30 percent and becoming the most common cosmetic dental procedure in the United States. Driven by Hollywood standards of beauty and baby boomers' refusal to age, it has expanded from the dentist's office to store shelves with dozens of over-the-counter products.

"In our vanity, we want our teeth to look like Chiclets," says James Ferrell, editor of the California-based newsletter Dentalfax.

"It's the same thing driving botox" injections to erase wrinkles. " "I have to have the whitest, brightest smile.' "

"It's independent of age and independent of gender," says Dr. Valeria Gordan, a dentist and associate professor at the University of Florida College of Dentistry. "My first patient was a 60-year-old male."

But though dentist-administered bleaching has received the American Dental Association Seal of Acceptance, there are scant reports on the efficacy and safety of over-the-counter whiteners.

Experts generally agree that do-it-yourself whiteners will not damage tooth enamel or gums if directions are followed. The most common side effect is temporary tooth sensitivity to cold and heat. Some gum irritation also may occur.

Consumers can spend $15 to $600 doing it themselves with marginal results.

"It's very subjective," Ferrell says. "If you feel better about yourself, Crest Whitestrips are cheaper (average price: $45) than a therapist."

Whitening is accomplished by bleaching the tooth to remove surface and deeper stains. A 10 percent peroxide solution -- the concentration found in most over-the-counter whiteners -- is less abrasive to tooth enamel than soft drinks or fruit juices.

The American Dental Association seal, awarded to many toothpastes, has not been given to over-the-counter whitening systems. There are insufficient clinical studies. The Food and Drug Administration focuses on halting overinflated claims, not ranking brand names for effectiveness.

"We are not a regulatory body. And the FDA doesn't consider (whitening products) drugs; they consider them cosmetics," says Clifford Whall, director of the American Dental Association's Council on Scientific Affairs, which oversees which products get the Seal of Acceptance.

"The council believes there are good reasons that you'd want a professional to evaluate you for teeth-whitening procedures" rather than do it yourself, Whall says.

The January issue of Better Homes & Gardens devoted one page to at-home whitening systems, noting they cost about $15 to $45 but making no judgment on which performs best. A University of Florida study comparing Crest Whitestrips and Colgate Simply White declared Whitestrips the more effective but suggested that neither made a significant difference.

In 1998, Consumer Reports rated whitening toothpastes, which remove surface stains through polishing, but it has not reviewed teeth bleaching products, a magazine spokeswoman says.

Teeth whitening in which bleaching gel is placed in trays fitted to teeth was introduced in dentists' offices about 13 years ago. More than 90 percent of dental schools now teach bleaching techniques.

"I really think bleaching will become a routine procedure just like people routinely go to get their teeth cleaned," says Dr. Wynn Okuda, president of the American Academy of Cosmetic Dentistry.

Office and take-home procedures use carbamide peroxide as the bleaching agent. Peroxide is most effective for whitening teeth with moderate yellow or brown discoloration.

Consumers who want to whiten their teeth may:

Visit a dentist: Office whitening procedures use a gel with a high concentration of carbamide peroxide, typically 10 to 30 percent, applied to the teeth for about an hour. Light may be used to create heat and intensify the bleaching action. Guards, or dams, are placed on the gums for protection. Most patients achieve desired results in one visit. Others may require as many as five. Cost ranges from $100 to more than $1,000.

Treat at home with a dentist's supervision: Custom-fitted trays containing whitening mixture are worn on the teeth a few hours each day or overnight for two to six weeks. The tray can be adjusted to whiten individual teeth. Custom fitting helps prevent leaking and gum irritation. The cost is less than an office procedure, sometimes by half, but several checkups are required.

Purchase over-the-counter: Products include kits that can be ordered over the Internet and paint-on gels sold in stores. Some contain as little as 5 percent peroxide. The American Dental Association says that most are minimally effective and lack supervision by a professional to monitor tooth sensitivity and other side effects during the two- to eight-week procedure. The cost is appealing: as little as $10.

The biggest advantage to teeth whitening in a dentist's office is that it requires less time and lasts longer, about three years, dentists say.

"It depends on the patient," Gordan says. "But if discoloration is due to aging, I've seen it last five years."

Those who smoke or drink a lot of coffee and red wine may need to visit their dentist annually.

Whitening systems should be used according to directions. Overuse may damage tooth enamel, but no one is certain. Consumers also are cautioned that cavities and decay can cause discoloration and must be treated, not attacked as stains.

Teeth stained by tetracycline, a prescription antibiotic, are difficult or impossible to treat with a whitener. White spotting caused by too much fluoride also requires special treatment, as do sensitive teeth and those discolored since birth. Children younger than 13 should not use whiteners, Okuda says.

Caps, crowns, veneers or bridgework will not change color.

Bleaching done in a dentist's office can whiten teeth seven or eight shades on the "shade guide," the kit dentists use to match the color of dental work to patients' natural teeth.

The shade guide contains more than a dozen color variations. As a result of Americans' pursuit of whiter teeth, two lighter shades have been added.

"It's not the same in Europe," Gordan says. Despite their best marketing efforts, manufacturers of whiteners and dentists overseas have not experienced a rush to whiter teeth.

Americans, with their new definition of pearly whites, will be happier with their results if they go to a dentist, Gordan says.

"They spend so much money before they come in, and they are disappointed. A dentist can find something comfortable and affordable for each patient."

Your smile's enemies

Coffee

Tea

Red wine

Smoking

Chewing tobacco

Aging

Top toothpastes

Consumer Reports magazine evaluated more than three dozen toothpastes for effectiveness in whitening teeth and preventing cavities, tartar buildup and gum disease in a study commissioned five years ago. (By now, another dozen or so toothpastes are on the market and may bump these on performance.)

Toothpastes claiming to whiten teeth do so by polishing stains away on the surface.

The test was designed to mimic recommended care: two minutes of brushing twice a day.

Here are the magazine's top picks:

--Ultra brite Advanced Whitening: Good all-around effectiveness at affordable price.

--Colgate Baking Soda & Peroxide Whitening With Tartar Control: Tartar protection, reasonable price.

--Crest Extra Whitening With Tartar Protection: Tartar protection, reasonable price.

--Colgate Total: Good cavity protection, plaque and tartar reduction; so-so whitening.

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