For December 2005 Health column:
The Independent
Brightening Your Pearly Whites:
The Facts on Tooth Whitening
By Tareq Khalifeh, DDS

Have you noticed the growing array of whitening toothpastes and tooth bleaching products in the toothpaste aisle at your local grocery or drugstore? Do you know someone who’s had tooth whitening treatments at their local dentist? Have you wondered whether these products or procedures can work for you, and if they’re safe?

Here are some answers. Tooth whitening has been around for over 40 years, but has been growing in popularity in recent years. The American Dental Association has approved certain tooth whitening procedures, which can truly lighten the color of the tooth’s enamel coating. But not everyone is a candidate. And you need to know your options to safely whiten your teeth.

Bleaching Solutions Work Best, But…
The most effective procedure for tooth whitening uses a whitening product containing carbamide peroxide, which actually bleaches the tooth enamel over a series of treatments. These products come in the form of a gel that is placed into a tray, or “mouthguard,” and applied twice a day for two weeks or overnight for one to two weeks. The concentrations of peroxide in home-use bleaching products vary from 10 percent to 22 percent. But only the lowest percentages are approved by the American Dental Association for home use, and only if they are dispensed by a dentist. This is because bleaching can create tooth sensitivity during the treatment period. And if the gel comes in contact with the soft tissues in your mouth – a common problem if the mouthguard is not properly fitted – you may experience painful gum irritation.

Many dentists prefer to do the bleaching in their office – sometimes over a series of visits, each taking from 30 minutes to an hour. This is not because they want to charge you more for the procedure. It is because they want to minimize side effects and prevent damage to your gums.

In this chairside procedure, the dentist first applies a protective gel to your gums, or uses a rubber shield to protect them. He or she then applies the bleaching gel, which typically contains a higher concentration of the bleaching agent than products approved by the American Dental Association for home use.

The dentist may also use a special light to speed the whitening process. Some dentists use lasers as this light source. According to the American Dental Association (ADA), this technique may be safe, but it has not yet seen published, peer-reviewed data on the safety and effectiveness of laser whitening.

Whether you choose chairside bleaching in your dentist’s office or at-home bleaching under a dentist’s supervision, be sure to discuss the appropriateness of bleaching with your dentist before you begin. You will not get good results if you have had many fillings – especially those using a tooth-colored enamel – or if you have tooth replacements, such as bondings or crowns. These products will not bleach, and you will end up with different shades of white. Extremely dark stains may also be resistant to bleaching. In these cases, alternative cosmetic dental procedures, such as veneers or dental bonding, may be your only option.

The American Dental Association considers the use of carbamite peroxide safe for the tooth enamel. Exposure to soft drinks and fruit juices causes comparable or greater changes in tooth enamel than properly used whitening products. And no carcinogenic risks have been established from these products.

“Whitening” Toothpastes Polish
The many whitening toothpaste (“dentifrice”) products sold over-the-counter do not contain bleaching agents. Instead, they employ polishes that gently remove surface stains, or chemical agents that work through a non-bleaching action to brighten teeth.

All toothpastes, even those without these extra “whiteners,” help remove surface stains through mild abrasion. But none of them really change the color of your teeth. The American Dental Association has approved the following over-the-counter dentifrice products for use:

Colgate-Palmolive Co.
For Dentifrice, Fluoride, Whitening, Tartar Control: Colgate Tartar Control Plus Whitening Gel
For Dentifrice, Fluoride, Anti-Plaque/Anti-Gingivitis, Whitening, Tartar Control: Colgate

GlaxoSmithKline Consumer Healthcare
For Dentifrice, Fluoride, Whitening, Tartar Control: Aquafresh Whitening Tartar Protection Toothpaste

Procter & Gamble Co.
For Dentifrice, Fluoride, Whitening, Tartar Control: Crest Extra Whitening with Tartar Protection Toothpaste, Crest Multicare Whitening Toothpaste
For Dentifrice, Fluoride, Desensitizing: Crest Sensitivity Protection Soothing Whitening Mint Paste

Where to Go for More Information
You can find the ADA’s approved whitening products, both professional and consumer, at the www.ada.org/ada/seal/sealsrch.asp. The site also contains useful facts, including some presented in this article, in its Oral Health Topics library, http://www.ada.org/public/topics/whitening_faq.asp.

Dr. Khalifeh owns the Philmont Family Dentistry located on Rte 217 in Philmont, NY. A graduate of the New York City School of Dentistry, he completed his residency at Albany Medical Center and practiced in Albany until 2004. For more information, call 672-4077.