For teeth, whiter is better

After the Halloween season comes to an end, many candy-lovers will have to deal with the inevitable consequence of consuming too many sweets: Those dreaded cavities.

In years past, having a cavity filled was about the most that the average patient could expect out of a trip to the dentist’s office. But over the past two decades, people have increasingly wanted their teeth to not only be healthy, but look healthy. With the advent of teeth whitening technology, many patients now come to the dentist’s office with the simple goal of achieving a brighter smile.

According to a survey of dentists conducted by the American Academy of Cosmetic Dentistry, aesthetic services grew an average of 12.5 percent from 2000 to 2004, with teeth whitening as the most requested service.

In addition to dentist-supervised whitening procedures, over-the-counter whitening products such as Crest Whitestrips have hit the market and become a major player in the whitening industry in recent years.

“I think that what’s happening nowadays is that people are focusing more on their appearance,” said Dr. Gennaro Cataldo, a professor in Boston University’s School of Dental Medicine. “Patients certainly come in and are conscious of the color of their teeth.”


Cataldo said the stains that cause discoloration of the teeth fall into two categories. Extrinsic stains are produced by outside agents, such as coffee, tea, wine and tobacco. Because they are primarily surface stains, they are usually not difficult to remove.

“Most of these can be removed by simple cleanings and can be maintained by good oral hygiene habits at home,” Cataldo said.

By contrast, intrinsic stains, caused by the natural yellowing process that happens over time, and also by medications taken at a young age, are more difficult to remove. For these, some sort of bleaching process is usually necessary, Cataldo said.

But until about 15 years ago, bleaching was not an option, according to Dr. Marty Zase, president of the AACD.

Before the early 1990s, the only people with very white teeth were children — whose teeth have not undergone the natural yellowing process — or Hollywood personalities, who could afford expensive whitening procedures, Zase said.

But with improvements in the application of hydrogen peroxide in the bleaching process, whitening became available to the general population.

“Suddenly there was a way to whiten your teeth safely … and mainstream people began whitening their teeth,” Zase said.

Since the early ’90s, teeth whitening has exploded into a billion dollar industry, Zase said. Of all the procedures offered by cosmetic dentists, teeth whitening is “by far” the most common.

“Like it or not, we are a society of keeping up with the Joneses,” he said. “Well, right now the Joneses have white teeth.”

What are the benefits of a brighter smile?

“When your teeth are whiter, more people are attracted to your smile…and people think that you’re happier,” Zase continued. “You’re going to be more open and appealing to the people that you meet.”

Zase said these improvements in image can lead to greater self-confidence and even better job prospects.

“Let’s face it, we judge people by how they look,” he said. “We might not like to admit that, but we do it.”


According to Zase, not all whitening procedures achieve the same level of effectiveness, nor are they equally safe.

Both Zase and Cataldo recommended that people seeking to whiten their teeth follow dentist-supervised procedures. These fall into two categories: in-office whitening systems using high-strength chemicals, and trays applied by patients at home over several weeks. The procedures can cost anywhere from $300 to $1,000, depending on which method patients choose, Zase said.

Dr. Matt Messina, a spokesman for the American Dental Association, said the biggest difference between whitening procedures lies in the strength of the whitening agent. In-office power whitening systems use a peroxide solution of about 35 percent, while trays use a 10 to 15 percent solution and over-the-counter whiteners use about a 4 percent solution, he said.

Although they are not as strong as the dentist-supervised procedures, over-the-counter whiteners may be right for some people, depending on their individual needs, Messina said, adding that people using over-the-counter products often try more intensive treatments as they become more concerned about their appearances.

“Even if somebody begins with over-the-counter products…they may seek out their dentist to find a stronger method to get them where they want to be,” Messina said.

Still, Zase said there are downsides to the over-the-counter products, mainly due to the fact that there are no dental professionals overseeing the process.

“On the over-the-counter products, there’s nobody guiding you,” he said. “You don’t know if you’re one of the people who shouldn’t be doing it.”

People whitening with over-the-counter products may actually bleach their teeth so much that that they start to look abnormal, Zase added.

“You can definitely get your teeth so white that they look like Chiclets and don’t look natural anymore,” he said. “The ideal is about the same color as the whites of your eyes or maybe just slightly whiter.”


While Zase prefers dentist-supervised whitening to over-the-counter methods, he acknowledged that over-the-counter products such as Crest Whitestrips have become a major industry and that more people are whitening their teeth with over-the-counter products than with professionals.

Crystal Harrell, external relations manager at Procter ‘ Gamble, which owns Crest, said P ‘ G developed Crest Whitestrips to meet a growing demand among consumers.

“In 2001, P ‘ G knew that 5 percent of consumers were using professional tooth whitening techniques and 50 percent of consumers were saying they wanted whiter teeth,” Harrell said in an email. “P ‘ G saw an opportunity in the marketplace and developed Crest Whitestrips to meet that consumer need.”

Harrell said at-home whiteners “allow consumers to safely whiten to their desired level in the convenience of their own home and at a drastically lesser cost” than professional treatments, noting that the at-home products range from $24 to $35.

Unlike Zase, Harrell said there are no significant disadvantages to at-home whitening. While some people may experience sensitivity, she said this “is temporary and isn’t harmful.”

Another option for consumers is BriteSmile, which offers “teeth whitening spas” supervised by dental professionals in several locations around the country, including one in Boston.

John Reed, CEO of BriteSmile and one of the company’s founders, said the spa’s one-hour procedure, which costs about $400, is painless and customer-friendly. Patients often sleep or watch TV during the whitening procedure.

“We’re there for the customer in an environment which is non-dental,” he said.

For Reed, teeth whitening is the latest development in the “look good, feel good” industry. Just as the advent of mouthwash made it socially undesirable for people to have bad breath, teeth whitening procedures have forced people to brighten their smiles.

“Yellow teeth are becoming no longer acceptable,” he said.

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