Teeth Whitening Myths

By Dr Sofia Stavropoulou (DMD)

 • Myth #1 : Extra White Teeth
Contents – Teeth Whiteness
– Tooth Structure
– Natural Smile
– Artificially Beaming Teeth
– Teeth Discoloration
• Myth #2 : One Whitener for All
– Internal Discoloration
1. Enamel
2. Dentin
– External Discoloration
1. Direct Staining
2. Indirect Staining
• Myth #3 : DIY Teeth Whitening
– Internal Discoloration Treatment
– External Discoloration Treatment
1. Deep Enamel Discoloration
2. Superficial Enamel Discoloration
Myth #1 : Extra White Teeth

Extra White Teeth are not necessarily the best

aesthetic option for the unique YOU…
 How White Is White Enough?
The first myth I’d like to dissolve is that
Teeth Whiteness about extra white shinning teeth. It looks like
in most cultures shinny white teeth are closely
related with nobility, higher social status,
exceptional beauty and attractiveness.
Poems and songs have been written for rice-
white teeth or pearl like ones.
But our DNA’s designer, a top class artist if
we judge by the results, had wisely devised a
norm of harmony and affinity between one
trait and another. There are as many white
teeth shades as people on the planet, and
on one person’s mouth we will find many
different shades of teeth colors - canines are
always a tad darker than incisors for
example- and even on a tooth alone there
are different zones of dental tissues’ density
and transparency that cause a visual
manifestation of gradient opacity in most
cases.
These deviations from a uniform
appearance, practically are the ones that
define BEAUTY and UNIQUENESS in every
person’s smile. And again, us Dentists, -and
more often Cosmetic Dentists- take a series
of steps prior picking the most suitable tooth-
color when using cosmetic restoration
materials. An empirical rule has been -apart
from the adjacent teeth’s color- the exact
shade of patient’s eye’s white.
Tooth Structure Having a look at our tooth’s anatomy,
we can see that the outer white visible
part of it, -the crown- is built by two
layers of slightly different materials :
enamel (the external one) and dentin
(beneath enamel, the internal one).
Both substances are consisted of
micro-tubules and have a “crystalline
architectural structure”. On the outer
surface of enamel, a protective “film”
seals the enamel tubules and enhances
its smoothness.
So, you can imagine enamel, which is
the outer substance of our teeth, having
a micro-porous surface which allows to
external agents to enter once they are
incorporated in its protective “film” or if
the “film” is destroyed. Also at the
enamel-dentin junction border, agents
can move through enamel or dentin
tubules to any of the two directions.
Dentin, the inner substance of tooth’s
crown, through its tubules allows the
entrance of internal agents that come
from an infected or traumatized pulp to
its zone or even their further diffusion to
enamel.
Natural Smile White teeth are synonymous to a
bright smile, and smile is the absolute
distinction between human beings and
animals, on a primary level. On a
secondary level –and more essential
one- it is a universal communication
friendliness-key.
Nobody can resist the charm and
attractiveness of a beautiful smile. In a
truly heartfelt smile magic lies into the
eyes. Eyes can smile too ☺
A nice smile with a “good morning”
or a “hello” are more than enough to
make someone’s day, while what
makes or breaks a major business deal
may be a simple smile.
Smile on a psychological level signifies
acceptance and invitation to connect.
Although aesthetic standards may
vary from culture to culture and on an
individual basis, we all agree that the
most natural the smile, the better ☺
Artificially Beaming Teeth
On the other side of a natural smile
stands an eye-popping artificially
beaming one.
Sometimes, when I see celebrities
carrying around a smile like this, I don’t
know if I should laugh or feel pity for their
poor sense of aesthetics. Because I’m
sure that they are the ones who push their
Dentist to do such a horrible job.
This kind of ULTRA-WHITE in perfect order
teeth, is a stylish crime I would never do
even to a horse.
Each tooth in a mouth has its own
unique beauty and even if it deviates a
bit from being perfectly aligned or if it’s
lightly more twisted around its axis than it
should be, if its color reflects the light
through diverse tones and shades of white
or white-ish crème, it may as well be the
tiny part of your smile that adds the most
to your personal allure.
Teeth Discoloration
I tried hard to keep this report as
understandable as possible, and I
also tried to include the least ugly
and disgusting images on the topic.
But believe me, teeth discoloration
can be a very scary image in
certain cases.
To understand when and how we
can actually try to whiten our teeth
alone, we need to comprehend
TEETH DISCOLORATION, its types and
their causes.
In Medicine, it is a fact that
treating the cause instead of the
symptom, is the ONLY right way to
go. Aesthetic (Cosmetic) Dentistry is
not the exception to this rule.
So lets see one by one the types
of the problem and their true and
sometimes deeper causes.
 Myth #2 : One Whitener for All

Not all discoloration conditions are created equal,

and most of them require special dental
treatment…
Internal Discoloration

Numerous systemic or external

factors ranging from metabolic
disorders, systemic syndromes,
dentin defects, tetracycline stains,
fluorosis, enamel hypoplasia and
trauma, to Dental malpractice
when an endodontic treatment
has not taken all necessary
measures to protect the dentin
tubules from getting stained by
the residues of therapy, may be
responsible for causing Internal
Teeth Discoloration.
1. Internal Enamel Discoloration
Don’t get confused by the medical
terms I’m listing below. There was no
alternative way to name these special
conditions. Just keep in mind that,
enamel can get discolored either
during its formation at the fetus stage,
or later on due to metabolic systemic
disorders or trauma.
• Amelogenesis imperfecta
• Enamel hypoplasia
• Trauma (capillary vessels of the tooth
are broken and blood substances such
as hemosiderin and hemoglobin enter
dentinal and enamel tubules)
• Systemic syndromes causing pitting of
the enamel
• Fluorosis due to excessive fluoride
intake
• Alkaptonuria
• Congenital erythropoietic porphyria
• Congenital hyperbilirubinemia
• Tetracycline Staining can affect both
enamel and dentin
2. Internal Dentin Discoloration
The conditions affecting Dentin, can be
either common with those affecting
Enamel, such as :
• TRAUMA
• Tetracycline
Or they can be categorized into
Dentinogenesis Imperfecta Classes, and
Dentinal Dysplasia Classes.
• Dentinogenesis imperfecta I, is a
congenital condition associated with
osteogenesis imperfecta, the teeth are
opalescent, but the aesthetic problem may
not be as severe.
• In Dentinogenesis imperfecta II, both the
primary and permanent teeth are affected
being opalescent when trans-illuminated,
and have a brown or bluish color.
• In Dentinogenesis imperfecta III, teeth are
also opalescent.
• In dentinal dysplasia type I, the primary and
secondary teeth may have an amber
translucency.
• In dentinal dysplasia type II, a brown
discoloration is sometimes observed.
External Discoloration

Tooth-decay (dental caries)

caused by plaque acids and the
demineralization effect they have
on the enamel are among the
main reasons of teeth discoloration.
But here we will focus on
discolorations where dental
substance is not actually lost.
External discoloration can be
caused by an array of external
factors. Foods we eat, hot or cold
beverages we drink, medicines we
take, habits like smoking may have
a gradual discoloration effect of
various degrees on our teeth.
1. Direct Staining

Direct Staining is usually caused

by substances –usually food or
drinks- containing organic
compounds that get incorporated
in enamel’s outer protective “film”.
Typical example of such type of
staining is coffee, tea or smoking
discoloration.
This type of discoloration can easily
be treated by Dental Cleaning.
Systematic oral hygiene, with
diligent brushing using toothpastes
with whitening ingredients –such as
baking soda etc- and flossing can
help prevent this type of staining.
2. Indirect Staining

Have you ever thought that your

mouthwash could be a teeth
discoloration factor? Yes, that’s
true for chlorexidine rinses, which
are quarternary ammonium
compounds characterized as non-
metallic factors causing indirect
teeth staining.
Women who may be taking
metallic salts such as iron
supplements –men with anemia
may also take these supplements-
can have their teeth indirectly
stained as well.
Myth #3 : DIY Teeth Whitening

Unless you visit and consult your Dentist FIRST,

don’t try to use any “At Home Teeth Whitening”
System…
Internal Discoloration Treatment
In most cases of Internal Teeth
Discoloration, a Dentist has to remove
external tooth substance and
proceed with aesthetic (cosmetic)
restorations, or perform a thorough
endodontic treatment (root canal
treatment) using chemical agents that
clean dentinal tubules.
Composite or porcelain veneers are
a premium cosmetic option when
prosthetic is necessary.
Internal “bleaching” using a
Hydrogen Peroxide solution for
dentinal tubules cleaning, is the other
way to go when an endodontic
therapy –root canal- or the repetition
of a failed one is considered
mperative.
External Discoloration Treatment

To a great extent, External Teeth

Discoloration can be treated
ONLY by the Dentist.
But in this type of Discoloration,
especially the Superficial Enamel
Discoloration, the huge
technological and scientific
advances embraced by Major
Dental Materials Brands, have
brought quite remarkable and
reliable solutions right to the
consumer’s hands.
At Home Teeth Whiteners are a
new trend in personal-care, but
you should ALWAYS consult your
Dentist before you experiment with
any of them.
1. Deep Enamel Discoloration

The Dentist can proceed with a

range of options in case of Deep
Enamel Discoloration. Each one
has its special indications,
advantages and disadvantages.
• Etch-Bleach-Seal Technique : Can’t
remove very deep stains.
• Microabrasion With Dental
Bleaching: Goes deeper, but a
small amount of the stain may
remain unremoved.
• Composite Veneers /Porcelain
Veneers: A thin layer of enamel
needs to be removed and replaced
by the cosmetic restoration
materials.
2. Superficial Enamel Discoloration
There is a good reason why I left this
Chapter to be the last of my Report.
Superficial Enamel Discoloration is
the ONLY type of Teeth Discoloration
where you might try to whiten your
teeth at home. But please, do it
AFTER you discuss the whole thing
with your Dentist.
So, here are the Treatment Options
for the conditions that fall into this
category:
• In Dental-Office or In-Home
Whitening
• In-Office Vital Bleaching
• Overnight Vital Bleaching
• Whitening Strip / Whitening Gel/
Whitening Pen
A few words I hope you’ve got a clearer idea on teeth
whitening now, and the next time you’ll
decide about your smile’s brightness you’ll
know better what can be done by you and
what can’t.
In any case, my best advice – the one I
would give to my dearest friend- is to talk to
your Dentist before you do anything by
yourself. Us Dentists have a more “artistic”
view of a smile because we’ve learned to
recognize natural beauty and have an
“eye” for harmonious perfection. You may
be surprised to hear that your not-so-extra-
white teeth are absolutely stunning and their
color is ideal for your face.
The last thing you want is to damage your
teeth enamel, or to waste your money and
time over a futile purpose.
Smile A Lot ☺
Dr Sofia Stavropoulou (DMD)

http://DentistSays.com
http://DentistSays.com
Resources

• Dr Daniel Ravel’s Site: • Publication on Journal Of American

http://dentalresource.org Dental Association on “Fluorosis”:
• Publication on Brazilian Dental http://jada.ada.org/cgi/content/fu
Journal : ll/140/3/278
http://www.scielo.br/scielo.php?pi
d=S0103-
64402009000400008&script=sci_artt
ext
• Article on “Dental Fluorosis” at
http://fluoridealert.org :
http://www.fluoridealert.org/health
/teeth/fluorosis/
• Wikipedia Article on “Tooth
Bleaching”:
http://en.wikipedia.org/wiki/Tooth_
bleaching