Teeth Whitening Myths
By Dr Sofia Stavropoulou (DMD)
Myth #1 : Extra White Teeth – 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 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 ricewhite 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 toothcolor 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.
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.
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.
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…
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
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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.
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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 nonmetallic factors causing indirect teeth staining. Women who may be taking metallic salts such as iron supplements –men with anemia may also take these supplementscan 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
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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-extrawhite 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
• Dr Daniel Ravel’s Site: http://dentalresource.org • Publication on Brazilian Dental Journal : http://www.scielo.br/scielo.php?pi d=S010364402009000400008&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 • Publication on Journal Of American Dental Association on “Fluorosis”: http://jada.ada.org/cgi/content/fu ll/140/3/278