After years of grinding, chomping, and chewing, your once-pearly whites may have seen better days. The gloss of lustrous white enamel has faded, exposing the natural yellow layer beneath. Add to that a lifetime's worth of pigments from coffee, tea, red wine, and soda that have gotten lodged in tiny cracks in your teeth. The result: that unattractive yellowish-brown tint that's made tooth whitening one of the most popular cosmetic dental procedures in the United States.
Nearly all cosmetic dentists offer whitening treatments and the number of procedures they perform has jumped about 50 percent each year since 2005, according to the American Academy of Cosmetic Dentistry. More people are also turning to cosmetic enhancements beyond whitening, such as bonding and veneers, which can improve both the function and appearance of crooked, chipped, or worn-down teeth.
Cosmetic options abound. To decide which may be right for you, experts say, see a dentist for an evaluation.
WHITENING TOOTHPASTES. Supermarkets and pharmacies offer a dizzying array of whitening pastes for less than $10 a tube. Crest alone boasts seven varieties of toothpaste whiteners. Colgate has eight. And that's not even counting the number of different flavors (Caribbean cool, anyone?), gels, baking sodas, and 2-in-1 paste/mouthwashes that promise to brighten your smile. But do they really work?
"It depends on the active ingredient," says Laura Kelly, president of the American Academy of Cosmetic Dentistry. Only some brands contain a peroxide, and those that do have very low concentrations--usually 1 to 2 percent. That's enough to remove surface stains and give teeth a good outer cleaning but not enough to make tooth shades whiter. "They're more effective at maintaining your shine after you've undergone stronger in-office or at-home whitening treatments," says Kenton Ross, a spokesperson for the Academy of General Dentistry.
OVER-THE-COUNTER WHITENING PRODUCTS. The best-known OTC whiteners are strips--thin, cellophane-like tape that adheres directly to the teeth--and gel-filled trays, both falling in the $15-to-$50 range. The bleaching agent in these products can cause irritation or blotching if it comes in contact with the lips or gums, says Ross. To minimize that problem, manufacturers keep peroxide concentrations low, which means you should expect relatively slow, modest results.
IN-OFFICE WHITENING. You'll fetch the most dramatic improvement in the shortest time with bleaching procedures done at a dentist's office. But convenience and results come at a price--often between $500 and $1,000 and even more in major metropolitan areas.
Some products, including Zoom and BriteSmile, make use of a high-intensity blue light or laser that purportedly activates the highly concentrated hydrogen peroxide solution and speeds up the process, but it's debatable whether such flashy extras make a difference.
With minimal home follow-up care, in-office bleaching can last for up to five years. However, teeth are vulnerable to re-staining shortly after the procedure.
AT-HOME WHITENING. Those looking for in-office results at a lower price can use a dentist-supervised "at-home" treatment. Patients get a custom-fit tray and a whitening gel that's about a third as strong as the solutions used in offices.
"Most at-home kits need to be worn once or twice a day, about an hour each time, and up to two weeks," says Ross. Costing $200 to $400, the kits work as well as or better than in-office treatments, according to Matis. In studies, he has found that at-home treatments outperform all tested in-office products.
The most common side effect of all whitening treatments--tooth sensitivity--will usually resolve within a day or two, says Ross. In rare instances, the discomfort can cause a dentist to cut short a treatment.
BONDING. Made of a pliable composite resin that hardens in place, bonding is a good option for small repairs like fixing chipped teeth, whitening a single tooth, closing gaps, or creating a straighter appearance. The bonding material, says Kelly, will "match the exact color shade of your tooth, blending into the natural structure." Because it's typically meant for touch-up jobs, it tends to cost less--between $300 and $600 per tooth--than other cosmetic options, like crowns, bridges, and veneers. And unlike veneers, bonding is often covered by insurance, especially if it corrects a structural, rather than merely cosmetic, problem. But just as teeth can stain, so can bonding material.
VENEERS. Extreme cases of discoloration, or misaligned or worn-down teeth, may warrant veneers instead of whitening, crowns, or bonding. Usually made of porcelain, veneers are designed to mimic the bright white enamel and shape of healthy teeth and are cemented directly onto the surface of the teeth. They're more expensive than most other cosmetic options, costing $700 to more than $2,000 a tooth, but they last for decades with very little upkeep. And because they come with a stain-resistant coating, veneers, at least, will stay white forever.
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