The Absence of Color Isn’t Everything
This weather has been so amazing for October in Northern Ohio…
So amazing that you find yourself making excuses for reasons to go walking outdoors or just sitting on a rock and absorbing the meditative powers of the sun. It’s hard to believe that we are not cold-blooded! I used to have an iguana that would always be found in the house by a window with southern exposure. As it nears the holiday season, those who have spent a few winters with lake-effect, as I have, know this tropical vibe can’t last. Speaking of seasons…
Over the years as an orthodontist, I have noticed seasonal trends in preparation for family and friends’ get-togethers that appear quite cyclic.
These preparations go beyond table decorations and outdoor lighting. I’m talking about the preparations designed to make one look younger and more attractive. I will stick to dental procedures and not address Botox or body sculpturing. We all know these procedures are out there but, as with tattoos, it takes a stronger conviction and thicker wallet to pull the trigger.
I will stick to more conventional personal preparations for the holidays…
Every September, we get an influx of individuals who would like to clean up and rearrange their dental smile by Thanksgiving Eve or, at the latest, Christmas Eve!
We could never achieve this with braces. Invisalign can get a 20% improvement in three months and, just by wearing the trays, a patient looks another 10-15% better. But you will invariably need to take them out some time during the party.
So what is a dentally-challenged individual to do for improving their smile for the holidays?
Since grandma’s time, if you can’t move them, then with baking soda or charcoal, let’s whiten them! I’ve already been asked this year, almost on a daily basis, “Dr. Pfister, I want to whiten my teeth. What do you recommend?”
To answer this, we must look at what darkens teeth and then evaluate the proper procedure or procedures that are needed to reverse the current darkening direction. However, I must throw out a clarifying statement that may sound unprofessional; but after 37 years in the mouth, I feel I’ve earned the right to put out a fire or two started by Vogue or Cosmopolitan magazines and potentiated by Hollywood…
Hold onto your hats… dentally-speaking, pearly white teeth are not often found in Nature.
Most humans have teeth with some yellow hues and mottled striations of gray; and a few have poorly formed chalky enamel that looks dull white. Since enamel is a porous substance, some teeth are more porous than others and a lot of off-white teeth are due to staining created in many ways by our lifestyles.
So let’s look closer at staining…
There are basically two types of stains - intrinsic and extrinsic. Intrinsic staining comes from within (usually due to trauma) and is a result of the tooth nerve dying and depositing hemosiderin, a protein compound in our blood that stores iron and is deposited in the calcium lattice of enamel. Light travels unimpeded through the normal calcium lattice of healthy enamel, giving us the much sought after pearly white coloration. But the iron of hemosiderin blocks the light rays, causing shadows and a darkening of the traumatized tooth. Over-the-counter products have no effect on intrinsic staining. One needs to have a root canal procedure and internal bleaching by a dentist. The results are usually unpredictable and, in the end, crowning the tooth may be the best way to return the tooth to an acceptable color by the patient.
We have seen several football injuries in our practice this fall. Once struck in the tooth - even if it wasn’t knocked out - one should have the tooth checked by a dentist, even if there is no pain. It usually takes 6-10 weeks, sometimes longer, before a tooth may begin to appear less white than the one next to it. The sooner the root canal is initiated, the lighter the end crown color will be after internal bleaching procedures by the dentist have been completed to remove the hemosiderin. Intrinsic staining is a bad stroke of luck for a tooth and smile, in general, due to our inability to treat it ourselves.
So now let’s focus on the type of staining that we can personally do something about - extrinsic staining.
Extrinsic staining of a tooth comes from outside the tooth in many forms, some of which include medications, food, drink, tobacco, cannabis, and even chemicals in our workplace. These extrinsic stains are what the entire bleaching industry focuses on with a myriad of products.
But how do these products work and what is the research backing up their claims to successfully lighten your teeth several shades?
The two most popular bleaching chemicals are hydrogen peroxide and carbamide peroxide - neither has enough research to make it overwhelmingly better than the other. Toothpastes, mouthwashes, paint on gels, whitening strips, and professionally delivered gels in custom trays have varying concentrations and combinations of hydrogen and/or carbamide peroxide.
The latest study in Dental Abstracts, February 2021, ran 24 studies, with 22 being randomized clinical trials (this is to reduce skewing the data for some company’s benefit). The results were interesting and fairly predictable from a dentist’s point of view. One of the overriding conclusions was that the longer the bleaching chemical was in contact with the tooth, the more effective it was in reducing the stain. This is not a nuclear science finding, but it showed that bleaching toothpaste, though able to scrub off some stain with its abrasiveness, didn’t approach the effectiveness of gels in trays.
The findings also showed bleaching rinses were the least effective over-the-counter product, due in part to their short contact time with the tooth. Paint-on gels faired a bit better; but those individuals with excessive saliva flow achieved poor results due to reduced tooth contact time.
Whitening strips (personally I have used them and agree) are the best over-the-counter product when purchased, with the highest 14% of the bleaching agent.
This leads me to the differing factors of the top three bleaching techniques…
The top three bleaching techniques are OTC whitening strips utilized for 30 days, your dentist’s custom tray with professional-grade bleaching peroxide for 14 days, and Zoom whitening which utilizes extreme concentrations of professional-grade, light-activated bleaching peroxide in 30 minutes.
But hold on, before you go running out to knock 20 years of latte indulgence off your teeth, we need to talk about the limiting factor in bleaching.
I hear it time and time again… a patient remarks that they were doing well with 9% peroxide, so they moved up to 14% OTC or 18-24% from their dentist. OMG, they couldn’t drink anything colder than lukewarm and if they opened their mouth and a cool breeze hit their teeth, they experienced piercing pain from their teeth that radiated into their jaws and head.
Nerve sensitivity from gums and teeth is the limiting factor on how white you will be able to get your teeth! That is why the phrase of “start low and go slow” is so important in teeth whitening. Some people like hydrogen peroxidase and others prefer carbamide peroxidase. You may need to give your teeth and gums a rest day or two before you go back at it.
Not everyone can go two weeks straight without their nerves letting them know that teeth bleaching is a not a naturally healthy procedure and that a lot of white teeth are crowns or veneers. While you are bleaching, you are actually opening up the surface porosity of your teeth, allowing temperature to be more quickly transmitted to the pulp, causing sensitivity and also making them more susceptible to staining. That’s right, I have had patients drinking merlot wine, coffee, or tea while bleaching and after several weeks had teeth darker than when they started!
If you’re bleaching, do yourself and your teeth a favor - use a straw.
Let me summarize by saying that a little bleaching is fine and yes, we all look better with whiter teeth. But we also have to accept our gene pool. I’m sure with my great head of hair and looks I was supposed to be six-foot-two. You know what, I’m not even five-eleven. But that’s ok, I’m happy to be living in Medina with a great wife and two terrific boys.
So if you must bleach your teeth, go with OTC strips or, better yet, have a heart-to-heart discussion with your dentist to see what’s an achievable goal in the color lightening of your teeth.
The absence of color isn’t everything.
Just look at the beautiful colors of Fall to get schooled by Nature.
Now get out with those almost-white teeth of yours, enjoy the leaves changing, and spot a deer or 2.
Have a happy and healthy autumn,
- Dr. Pfister