Time for teeth whitening?

The American Dental Association recommends consulting your dentist before using any teeth bleaching product.

Premium Health News Service

September 30, 2010


Harvard Health Letters

The eyes may be the windows to the soul, but the teeth may also be the first thing others notice.

Maybe it was your 35th high school reunion photograph— or perhaps an innocent remark by a grandchild— but now you're self-conscious about your dingy teeth, and you're thinking about whitening them. Dentists can perform or supervise various whitening procedures, and over-the-counter whitening products are available at drugstores and supermarkets. What's best for you depends on several things, including the type of discoloration and the amount of time and money you're willing to spend.

There are two main types of whitening products. Some, chiefly whitening toothpastes, remove surface stains by polishing with chemical agents or mild abrasives. These don't alter the tooth's natural color and can only lighten its appearance slightly. The other type of product contains a peroxide bleaching agent (carbamide peroxide or hydrogen peroxide) that changes the color of the tooth and can lighten it by several shades. Our focus here is on these products.

Getting help from a dentist

The American Dental Association (ADA) recommends that you consult your dentist before using any bleaching product, even an over-the-counter one. Bleaching can be uncomfortable for people with sensitive teeth or gum recession. Also, most products will bleach only natural tooth enamel, so if you have tooth-colored fillings, crowns, veneers, or partial dentures, bleaching may yield uneven results.

Your dentist can evaluate whether bleaching is right for your teeth, since different kinds of discoloration respond differently to whitening. For example, bleaching works for most stains caused by age, smoking, and regular coffee or tea drinking, but it may not be effective against discoloration that results from tetracycline use in children under age 8. (Tooth discoloration can also occur in a child whose mother took tetracycline while pregnant.) Finally, even if you choose the over-the-counter route, your dentist can advise you on the relative merits of the products available.

Dentist-supervised procedures include the following:

Over-the-counter bleaching products

All of the following over-the-counter products contain peroxide as their active ingredient. The concentration is lower in these agents than in the products dentists use, and the cost is substantially lower, ranging from $20 to $150.
Safety and effectiveness

There's very little evidence on the long-term safety and effectiveness of tooth-whitening products or procedures. No over-the-counter bleaching product carries the ADA Seal of Acceptance, and the organization recommends consultation with a dental professional before using them.

An analysis of clinical trials by the independent Cochrane Collaboration concluded that whitening products appear to be effective, but consumers should be better informed of side effects such as tooth sensitivity and gum irritation. Noting that the products' manufacturers sponsored most of the studies, the reviewers recommended more independent research.

Whitening products aren't recommended for children under age 16, for women who are pregnant or breast-feeding, for people with sensitive teeth or an allergy to peroxide, or for those with gum disease or worn tooth enamel. If any whitening product causes irritation or mouth sores, you should stop using it immediately and see your dentist. - Harvard Women's Health Watch