"YOUR TEETH WILL NEVER LOOK like those in the ads or the movies," Dr. Sidney Fogelman tells a hopeful patient. "Nobody's can. Those pearly whites are dubbed in later."
But Washington dentists like Fogelman have new weapons for lightening teeth–even if not to supermodel white.
You can try it on the cheap with toothpastes, though the results may not live up to the claims. You can wear take-home trays made by your dentist and filled with bleach, though that can mean a messy mouth and aching teeth. You can get a dazzling smile fast enough for a dinner date by using a procedure called BriteSmile. But it's pricey: $500 to $1,000 for an hour under a light with bleach on your teeth. And whitening isn't covered by insurance.
Whitening is the most popular cosmetic procedure done by dentists, but it's not for everyone: If you're pregnant, nursing, or have gum disease, cracked teeth, or cavities in the surface you want whitened, some procedures are not recommended. And unfortunately, bleaching won't lighten crowns, bonding, or tooth-colored fillings.
The tone of your teeth may affect the outcome. Says the American Dental Association: "Yellowish-hued teeth will probably bleach well, brownish-colored teeth may bleach less well, and grayish-hued teeth may not bleach well at all." But some grayish teeth bleach beautifully–it's hard to predict.
External staining–from coffee, tea, cola, red wine, nicotine, chocolate–is easy to remove, says DC dentist Marc Doctors, and you should be able to maintain those results by using a home-bleaching kit and switching to a straw for soda. Intrinsic staining, whether caused by genes or antibiotics, is harder to get at. "We can lighten that to varying extents," Doctors says, "but often not as much as patients would like."
Over-the-counter products are rarely effective on internal staining. How do you tell external from internal? Even dentists sometimes have to guess. Tetracycline tends to stain in bands, so that's one clue.
"Stains are partly a factor of surface smoothness," says ADA spokesman Dr. Richard Price, noting that paint is easier to remove from glass than from concrete. Ironically, harsh brushing, by causing tiny crevices and uneven wear, can encourage the very problem you're fighting.
We tested several options. Here's what we found. All teeth are unique, so your results may vary.
WHITENING TOOTHPASTES: Get What You Pay For
What's on the market: Makers of regular toothpastes have come out with products such as Aquafresh Whitening Toothpaste, Mentadent Advanced Whitening Formula, and Colgate Total Plus Whitening Toothpaste. Unlike other bleaching products that promise to lighten teeth by five or nine shades, toothpastes make modest claims.
How they work: Aquafresh, for one, says it "helps to weaken and remove the stains that build up on the teeth over time . . . gentle enough for use every day, as it doesn't contain harsh abrasives, bleaches, or peroxides."
Results: Any good toothpaste cleans the surface of teeth. "They're a waste of time in my experience," says Chevy Chase's Dr. George Kesten about whitening pastes.
DC dentist Stuart Ross says that whitening toothpastes can indeed lighten teeth on the color scale, "but you count it in the decimal-point range, not the whole-number range. Some people's teeth are so amenable to whitening that anything will work."
The amount of whitening agent in over-the-counter pastes is negligible. Mentadent's label says it contains "a safe level of hydrogen peroxide" along with fluoride and other cleansers, but Price says, "It's got barely any peroxide–enough to foam, not to whiten."
Several Washingtonian staff members tried whitening toothpastes; none noticed a real difference.
If you want to try a whitening paste, make sure you choose one with the ADA seal of approval–meaning it's tested for safety and truth in labeling. Be careful with "smoker's toothpastes," which contain harsh abrasives.
Cost: Whitening toothpastes can cost the same as regular toothpaste or up to twice the price, depending on the brand.
Bottom line: Since you're going to brush anyway, try a whitening toothpaste, but don't expect a lot.
REMBRANDT DAZZLING WHITE: Not So Dazzling
The pitch: "The first at-home whitening toothpaste and bleaching gel in one," Rembrandt Dazzling White "bleaches your teeth five shades whiter . . . without harmful abrasives or ingredients." The company adds, "the fluoride, Citroxain, and peroxide ingredients also work to prevent cavities and improve the overall health of the teeth and gums." This kit contains four one-ounce tubes of toothpaste and an ounce of Extra Whitening Toothpaste for maintenance later. It is not ADA-approved.
How it works: You're told to brush with Dazzling White two to three times a day for three to five minutes and to not rinse for at least 20 minutes.
Results: The product predicts a "dramatic" outcome, and that's what one of our testers got. For the first three days, the product irritated the 26-year-old's gums and, initially, left white spots on them: "It's like pouring hydrogen peroxide in your mouth." (The fine print suggests that white spots show the product is working but says nothing about pain.) By contrast, our second tester felt only a tingle.
Dazzling White was "gloppy and inconvenient"–it was hard to keep the gel on the teeth, and it's almost impossible to not swallow during all that time. But the minty taste wasn't bad, and both testers' teeth looked shiny for an hour or two after each use.
Bottom line: Too annoying for very little result. "If you're spending extra money on whitening toothpastes, I advise spending a little more and getting Crest Whitestrips," says Reston dentist Sandra Varney.
CREST WHITESTRIPS: Newest on the Shelf
The pitch: "Whiten teeth ten times better than the leading whitening toothpaste . . . guaranteed in just 14 days." You're asked to use the strips only on your top teeth at first; if not pleased with the change you see, you can send back the rest for a refund. The package promises "whiter teeth for at least six months," though the company acknowledges that "dark, gray-blue stains" caused by medication won't lighten as well. The company is applying for ADA approval.
How it works: Apply strips to your teeth for 30 minutes twice a day for 14 days. Crest says its product is more effective than toothpastes because "Whitestrips hold whitening ingredients against your teeth long enough to get at stains beneath the surface." That whitening ingredient is peroxide, same as in office and tray treatments.
Results: Whitestrips are effective only if you use them for the prescribed period. One of our testers, in her fifties, dropped out. "They were messy," she says. "It was hard to find the right time to wear them. You don't want to eat right away. You can't talk well. And your tongue can dislodge it, so you have to be careful." But it's more efficient to use strips than to try holding toothpaste on teeth for the same length of time.
Our other tester, age 29, had the opposite experience: She wore the strips in the shower and while reading at night–so she didn't feel inconvenienced–and saw results. The strips cover about six to eight teeth at a time, so if you have a big smile you might have to alternate the strips on the right and left side of your mouth to cover all your visible teeth. "But for so little money," says our tester, "I'm pretty happy."
Cost: $45 for 56 strips.
Bottom line: If you can use this product as directed, it's effective for the price. To start with healthy teeth free of plaque and tartar, see your dentist first.
NATURAL WHITE 5-MINUTE: Awkward But Cheap
The pitch: "Fast results . . . easy . . . guaranteed to whiten teeth shades lighter in one week."
How it works: This over-the-counter kit contains bleaching gel, mouthwash, and one tray–like an athletic mouthpiece that fits over both upper and lower teeth. Fill the tray with gel from a tube, then squish it into place. Leave the mouthpiece in for 5 to 15 minutes, twice a day, for seven to ten days. After each wearing, rinse with the mouthwash "to restore pH balance and leave your teeth feeling fresh and minty." It is not ADA-approved.
Results: Our thirtyish tester used Natural White ten minutes each morning and evening for a week. Her teeth did become lighter, at least enough for people she knew to comment on. The taste was "bleachy," but mouthwash took care of that.
The fine print inside warned, "Avoid prolonged contact of the bleaching agent with the gums." The bad news: That was nearly impossible. The mouthguard isn't customized to users' teeth, so gel is likely to leak. The good news: Our tester had no ill effects.
Cost: $11 for 25 applications.
Bottom line: A bit awkward, but not bad for modest results. Easier on the budget and less time-consuming than Whitestrips.
TAKE-HOME TRAYS: The Dentists' Choice
What it is: Whiten your teeth using an at-home procedure that's safe and under a dentist's supervision.
How it works: A dentist makes a mold of your teeth, then creates flexible plastic trays that fit on each arch and hold the bleaching gel–usually carbamide peroxide in concentrations of 10, 16, or 22 percent–against the enamel.
Some patients use the trays twice a day for 30 to 90 minutes over two weeks, others overnight for one to two weeks. Many dentists check during that time for changes and sensitivity.
Results: One of our testers calls her take-home trays "a royal pain." Her teeth became temporarily more sensitive to heat and cold, and results were not outstanding.
But perception is everything with teeth bleaching. "My dentist put a crown in recently and said, 'Hey, you have pretty white teeth,' " the sixtyish woman reports.
Results can last several years. When teeth begin to darken again, it's easy to touch up by reusing your trays for a few hours.
Cost: Generally $350 to $500 for the whole mouth. Gel refills cost $15 to $40.
Bottom line: Time-consuming, but dentists say the treatment brings noticeable, long-term improvement. More effective than any other home treatment but cheaper than most in-office treatments.
IN-OFFICE BLEACHING: Quick, Painless, But Pricey
What it is: In this procedure, sometimes called chairside or power bleaching, dentists use a solution that's up to 50 percent hydrogen peroxide. As the ADA's Price says, "that'll turn anything white"–including, in many cases, teeth stained by tetracycline. The peroxide is typically used in combination with a light-emitting diode, a laser, or another light source to activate the whitening agent.
The big plus: In as little as one visit–perhaps two for dark tetracycline banding–your teeth look whiter.
The best-known technique is BriteSmile, whose marketers claim it "has been able to achieve an average nine shades whiter, with many clients enjoying results off the chart." Says Dr. Gene Giannini, a Tenleytown dentist and local ADA representative, "BriteSmile has the market identity, but other companies do the same thing for roughly the same amount of money."
What happens at the dentist: He or she uses a protective gel or a rubber shield to cover gums and soft tissues, then coats your teeth with bleach.
For years, dentists used a heat lamp to help the bleach along. While effective, the procedure tended to be uncomfortable, and it isn't done much anymore. Instead, dentists rely on lasers or other light and keep you in the chair at least an hour.
BriteSmile and several similar processes take about 60 minutes–three applications, 20 minutes apiece–using a hydrogen-peroxide gel and a light whose wavelength accelerates the gel's power.
Many local dentists have stopped doing any form of in-office bleaching, citing inconsistent results or "trauma to the tooth." Some dentists say they prefer the safety and control of trays or are concerned by the lack of long-term studies on lasers and lights used in the mouth. But the intense marketing of BriteSmile means more patients are interested in quick, one-visit whitening.
Results: Our late-thirties BriteSmile tester had fairly light teeth to start with, and her results were indeed off the chart. One of the first people to see her afterward called out, "Hey, Hollywood!" Others are equally pleased: "We actually get thank-you notes for this," says Dr. Rena Vakay of Alexandria.
Expect your initial shade to recede slightly after the first day or two, during which you should avoid staining substances; our tester was advised to eat colorless foods for at least a day. The treatment removes the teeth's protective outer layer, a hygienist explained, and ingesting anything colorful during this period can undo the effect.
Results last three to four years, regressing about one shade every six months; you can maintain them with recommended toothpastes and mouthwashes.
Though it's painless, as promised, you may experience sensitivity at the gum line. Our tester spent the rest of the day washing down Tylenol with warm water.
Cost: Though Mike Whan, president of worldwide marketing for BriteSmile, says the Washington price range is $600 to $700, we found dentists charging $550 to $1,000. Higher prices often cover aftercare products like toothpaste and mouthwash.
Similar forms of in-office bleaching, including some using Rembrandt products, usually fall in that range, although we found dentists who charged as little as $400 for chairside procedures.
Ask if your dentist does chairside bleaching–or for a referral, call 800-972-1236 for Rembrandt or see www.britesmile.com.
Bottom line: If you want quick results and are willing to pay a premium, in-office methods are the way to go.
Nearly all dentists do bleaching and other cosmetic dentistry these days; for some, it's a specialty. The American Academy of Cosmetic Dentistry offers a three- to five-year accreditation process. To find an accredited member, call 800-543-9220 or see www.aacd.com. *
PHOTOGRAPH BY ZEPHA ZEITGEIST/PHOTONICA
How They Compare: What Our Testers Liked–and Didn't
Not as effective as bleaching trays made by a dentist, but these are cheap and easy to use.
It's pricey, at $550 or more, but after one visit to a dentist you could have dazzling teeth.
Messy, with little result. And who wants to keep toothpaste in the mouth for 20 minutes?
A little tricky to apply, especially if you have a big smile, but they do work.