Whitening toothpaste, gum, brush-on gels, plastic trays, strips… What’s available over the counter and a professional opinion of what works and what doesn’t
America’s obsession with flawlessly white teeth has companies smiling.
While bleaching done by dentists continues to be the most effective procedure available, few can afford the high price tag that comes with it. Custom-made trays and professional gels cost upwards of $300. Zoom Laser whitening, the ultimate system that can whiten teeth in a little over an hour, runs about $1,500.
In the search for an affordable alternative, customers have turned to over-the-counter products, and companies are eagerly responding. In the last five years alone, over 130 new teeth-whitening products have hit the market.
But, with so many options, how do you know what works and what falls short of its promise? Here is a review of the options available.
How Do they Work?
Teeth whitening products work in two distinct ways. They can either remove surface stains, or they can bleach the tooth, changing its natural (intrinsic) color.
Once applied to the tooth, the bleaching agent (hydrogen peroxide, carbamide peroxide, or sodium perborate) penetrates the surface, releasing free radicals and oxidizing (bleaching) stains.
What is Available?
Toothpaste
Cost: $3 to $10
Sample Brands: Colgate’s 12-Hour Multi-Protection plus Whitening Gel, Aquafresh’s Triple Action Whitening, Rembrandt’s Extra Whitening with Tartar Protection
How to Use It: Simply brush with this type of toothpaste instead of using regular ones.
The Truth: Teeth whitening toothpastes basically work by abrasion. The paste may contain hydrated silica, calcium carbonated, or other similar coarse substance in tiny particles. As you brush your teeth, these particles act as sandpaper, grinding down superficial stains. Some toothpaste may contain hydroxide peroxide. However, the concentration is so low (less than 1 percent) that the results are negligible.
Results: While brushing with whitening toothpaste may minimize discoloration of the teeth, this only occurs on the surface of the tooth.
Drawbacks: “Long-term use of excessively abrasive toothpastes may […] be counter-productive, since they may eventually cause thinning of tooth enamel, permitting the darker dentin layer beneath the enamel to shine through more conspicuously,” says Mark Bornfeld D.D.S., a dentist in private practice in Brooklyn, New York.
Professional opinion: “In general, toothpastes are ineffective in changing the intrinsic coloration of teeth,” says Bornfeld. “Instead, these toothpastes are intended to brighten teeth by adding abrasive materials that can remove adherent extrinsic stain from tooth surfaces. The removal of food and tobacco-derived stain from teeth can indeed whiten teeth, but in my experience the effectiveness of a patient's oral hygiene depends much more on his manual technique than his choice of toothpaste.”
How to Use It: Chew 2-3 times a day as you would any other gum.
Results: No studies have been done to study efficacy.
Drawbacks: None, especially if you chew gum anyway.
Professional opinion: “I am unaware of any reliable studies that deal with this question,” says Bornfeld. “My personal observation, intuition, and experience with what it takes to keep teeth clean tell me they do not. Also, just as is the case with toothpastes, there is no effect on the intrinsic coloration of the teeth from the use of whitening chewing gums; if a change in intrinsic color is how you define the term "whiten," then most assuredly these gums do not work.”
Brush-on Gels
Cost: $15 to $20
Sample Brands: Colgate’s Simply White and Simply White Night, Crest’s Night Effects
How to Use: As the name implies, these products are designed to be brushed or “painted” on the tooth a minimum of twice a day and a maximum of four, depending on the bleaching concentration of the product. The pain-on gel then dries to form a film. No food or drinks should be consumed for at least 30 minutes after application.
Results: With a peroxide concentration of only three percent (six for overnight products), results are minor. To give you a straightforward comparison, professionally applied bleach whiteners offer concentrations of up to 35 percent. It is also hard to avoid friction of the lips or saliva against the teeth, which means the products dilutes fairly quickly.
Drawbacks: Although easy to use, it requires frequent re-applications.
Professional opinion: “These products cannot maintain contact between enamel surfaces and a sufficient amount of active bleaching material for a sufficient period of time, and are less effective than tray/strip systems,” says Bornfeld.
Strips
Cost: $45 to $60
Sample Brands: Crest’s WhiteStrips
How to Use: Polyetheylene (a type of transparent plastic) strips coated with hydrogen peroxide are stuck on the teeth twice a day, 30 minutes at a time, for 14 days. Each strip is used only once and then discarded. The bleaching concentration is higher than in most products (up to 10 percent) and because it’s condensed on one side of the strips (the one that touches the tooth), contact with saliva does not interfere or diminishes the bleaching process.
Results: Teeth can whiten up to five shades if the strips are used properly and for enough time.
Drawbacks: The strips only cover the six front teeth. As with other bleaching methods, it can cause gum irritation and teeth sensitivity.
Professional opinion: “As opposed to brush-on gels, strips can hold a greater amount of bleaching product, and protect it from dilution and dispersal from saliva and lip/cheek/tongue movements,” says Bornfeld. “Of the OTC products, the Crest WhiteStrips can achieve comparable levels of whitening as the professional systems, but the patient must use proper technique and must persevere longer to get the same level of whitening.”
How to Use: Carbamide peroxide gels are placed on a plastic dental tray, which is then inserted in the mouth and worn for 30 minutes twice a day. The tray helps the gel stay in constant contact with the teeth for enough time to allow the bleach to penetrate the tooth’s surface.
Results: Teeth can whiten 2 to 5 shades.
Drawbacks: Uncomfortable. Can cause uneven whitening of the teeth. The major problem is that the shelf life of the product is very short. “All bleaching systems, whether over the counter or professional, rely on some type of oxygenating bleach,” says Bornfeld. “What distinguishes them is the way they are transported, stored, dispensed, and disposed. All these chemicals are quite unstable, and have a very short shelf life. Professional systems are shipped to dental offices in refrigerated canisters, which permit higher and more reliable concentrations of product.”
Professional opinion: “Professional systems are best-- conventional bleaching trays and gel that are provided by the dentist and taken home by patients to use over a one-or two-week period, and repeated as necessary,” says Bornfeld.
Keep in Mind
Bleaching does not work on crowns, fillings, or bonding. If one of your front teeth consists of any type of artificial surface, you may need additional dental work after the bleaching to make sure colors match.
Products can cause temperature sensitivity, gum inflammation, soreness and discoloration of the gum and inner lips. “While […] sensitivity usually goes away quickly on discontinuation of product use, the inconvenience of such unpleasant side-effects may serve as a deterrent to continued use,” says Bornfeld. “This is significant, since the whitening effect of these products is temporary, and their use must be repeated to maintain whitening. In my experience, many patients use these products once or twice, and eventually lose interest.”
Results are not permanent. Professional work can last for many years, but OTC products usually require that you repeat the process every six months or so. Smokers and heavy coffee drinkers may need more frequent “touchups.”
Results depend greatly on the color of the teeth before using the product. Stains caused by smoking, coffee, or use of tetracycline (antibiotic) can easily lighten up to five shades with the use of strips or gels. Grey stains, such as those caused by pigments inside the tooth rather than outside discoloration, may not respond well to OTC bleaching products and may require professional help.
Experts also recommend avoiding no-name bleaching kits and buying only well-known brands with a history of dental products. “OTC bleaching products are unregulated, and as such present some danger of faulty formulation,” says Bornfeld. “This can introduce any of a number of risks-- whether one of over-concentrated product, unsanitary product, or extraneous ingredients that may provoke irritation or allergy.”
All tooth decay, to the smallest cavity, should be dealt with before bleaching is attempted.
Pregnant or nursing women should avoid these products.