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SOMETHING TO SMILE ABOUT
The difference between at-home and dental-office tooth-whitening is a matter of degree.

LONG BRANCH, NJ, February 19, 2006 - You used to have a set of blinding pearly whites that would have been the envy of that old shark Mack the Knife.

But now, not so much. Years of coffee, cola, nicotine, red wine and/or other stuff have left their quite literal mark on your teeth.

Or maybe, your teeth have never been sparkling white. The luck of the genetic draw, as it were, has left your teeth, darker than you'd like.

Well, there's a bewildering array of products on the market today that promise the equivalent of snow-blinding whiteness every time you smile.

There are whitening toothpastes, over-the-counter tooth-whitening kits, professional-strength tooth-whitening kits you can get at the dentist's office, and other products and procedures such as laser whitening and bonding.

What to do? What to buy?

Dr. Robert T. Kreutz, chairman of the Department of Dentistry at Jersey Shore University Medical Center in Neptune, would first of all remind people that the much-touted whitening toothpastes are not going to do too much.

"Whitening toothpastes often rely on mild abrasives to whiten teeth," he said.

The differences between the over-the counter tooth-whitening systems, the ones with the mouthpiece trays and the gels, and the dentist's office version of same is a difference of degree, not kind, says Dr. Anthony Sallustio, prosthodontist and section chief of Prosthodontics at Monmouth Medical Center in Long Branch.

"It's a matter of the concentration of carbamide peroxide, a kind of buffered hydrogen peroxide, which can vary from 4 to 42 percent," Sallustio says.

It's the peroxide that whitens the teeth from the surface in, he says. And the concentration is higher with a procedure done in the dentist's office.

Kreutz says that the mouthpiece trays from the dentist's office do the job better than the ones in the over-the-counter products.

"The dentist's trays are individually fitted," he says, "and the one-size-fits-all nature of the over-the-counter products will make them less effective."

Either way, compliance is an issue, say both dentists. If you do not follow the directions about when and how long to use the product, you will not get the desired result and may, in fact, irritate surrounding gum tissue.

The fastest way to whiten teeth is what is commonly called a "laser" treatment.

These one-hour treatments may or may not use an actual laser. But in all cases, a light source is used to activate the strong hydrogen peroxide used to bleach the teeth.

Exactly how much whiter you want your teeth is an aesthetic decision, and dentists often use a "a shade guide" to help patients decide.

"Some people have naturally darker teeth," says Sallustio.

And according to Kreutz, it's not a matter of white, whiter or whitest.

"According to most shade guides, teeth are yellowish, brownish or grayish," Kreutz says. "Grayish teeth are the hardest to whiten. The best you can usually hope for is to brighten those teeth."

The bleaching process is not permanent and may require maintainence or touchups over times.

Rita Torres, 57, noticed a yellowish tinge to her teeth about four years ago.

"I wanted to do something about it," says the Middletown resident. "You get to a certain age and you want to take care of things you have put off."

So she asked her dentist about what could be done.

"He made an impression of my teeth and gave me some gel," she remembers, and I slept with the gel and the mouthpiece for a week or so."

The results she said were striking and dynamic.

"People noticed it and complimented me," she says. "It wasn't inexpensive, but it was worth every penny."

But after four years, she says, the effects are wearing off.

"I'd consider doing it again," Torres says.

The peroxide treatments work by bleaching the tooth from the surface in, but sometimes, particularly after a root canal, it may be necessary to whiten the tooth from the inside through the use of an even stronger peroxide, says Kreutz.

There are other ways of changing tooth color, such as bonding, which involves applying a laminate substance over the individual tooth, says Sallustio, but that can cost hundreds of dollars per tooth.

Both dentists agree that, depending on an individual's particular needs and situation, the most expensive treatments are not always necessary, but one should consult a dentist before attempting any tooth-whitening procedure.

The do-it-yourselfers, says Sallustio, "may be curing the wrong things," overlooking possibly serious dental problems by ignoring them at the expense of having their teeth a few shades whiter.

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