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New Year has arrived!! Hope you all had a great vacation. I had a great New Year’s Eve party, invited a few of my friends and their families. I invited my friend Maya, who is not a stranger to Saathee readers. I wrote about her children’s dental health issues two months back. Maya brought along her parents, who are visiting from India. In addition, she had a very special visitor. Her younger sister, Tara, works for a MNC in India, visited RTP on a short business trip. Tara is indeed a very good looking girl. However, my dentist eyes couldn’t help noticing the yellowish brown hue that made her smile look dull.

The evening moved quite nicely. After dinner, we wanted to while away the time to greet the New Year. Maya, a great fan of Madhuri Dixit, wanted to watch a movie. As we were watching, the topic invariably turned around Madhuri’s great looks, her dancing ability and, of course, her gorgeous white, sparkling, “Hollywood Smile”. Maya had this perception that it takes a fortune to maintain this bright white smile that only celebrities can afford. Our conversation from Madhuri turned to sparkling smiles.

Hollywood Smile: White teeth are subconsciously associated with youth and people like to look young. Whitening is a modern phenomenon and contrary to Maya’s perception, whitening is one of the most common cosmetic procedures done today.

Teeth have varying degrees of extrinsic and intrinsic stains ranging from yellow to brown to gray influenced by a variety of factors such as medicines, injury, disease, aging etc. Habits such as smoking, coffee, tea, and wine drinking can cause different degrees of stain depending on the severity of the habit.

The science behind whitening is quite simple; it is the bleaching/oxidation of colored pigments. Most common bleaching systems contain hydrogen peroxide or carbamide peroxide. Hydrogen peroxide diffuses through the stains on teeth and oxidizes colored compounds which are then rendered colorless, giving a white and bright appearance to the teeth. I will be using the terms ‘bleaching’ and ‘whitening’ interchangeably as they are one and the same process.

Your options for teeth whitening depends on various parameters including the extent of teeth discoloration, the available time needed to get the desired result and the cost. Faster processes typically require a high dosage of the whitening agent and are generally expensive. Slower process takes several weeks as lower dosage of the gel is applied to get the desired results.

The different options are as follows

In Office Whitening: This is done in the dental office under direct supervision of the dentist and involves proprietary gel and light. In office whitening is fast, takes an hour to complete and works well in most cases. However this is more expensive than other methods of whitening.

Custom Trays - Professionally dispensed whitening agents to be used at home:The dentist makes custom trays similar to mouth guards after taking molds of your teeth. These trays are used as a vehicle to carry the whitening agent. The trays are worn anywhere from 30 minutes to overnight for 2-4 weeks. Carolinians should be proud to know that UNC School of Dentistry did the pioneering research on at-home bleaching that is widely used today.

Over-The-Counter (OTC) whitening products such as gels, strips and trays. Whitening gels are applied directly on the teeth with a brush. Whitening strips are thin invisible strips coated with the gel. The trays purchased OTC do not fit as well as the professionally made trays. OTC systems are the cheapest option. Please follow the instructions carefully to avoid applying the gel to your gum, causing increased irritation.

Custom trays works well in most cases because the model is made by a dentist to specifically fit your mouth, delivering maximum contact with your teeth, but minimizes contact with gum tissues reducing irritation. This procedure is cheaper than the in-office whitening systems. Custom trays will be a good option if you are not in hurry and looking for a low-cost, gradual and progressive process.

The two most common side effects of bleaching which are temporary are sensitivity and mild irritation of the gums. Both these conditions resolve after stopping or completing treatment. Irritation of the gums is mainly because of contact of the gel with gums. Sensitivity can be reduced by using a fluoride containing product.

Once whitening treatment is done, whitening toothpastes and power toothbrushes can be used to prolong the whitening effect. Fillings and crowns do not bleach and may need to be replaced to match up with the rest of teeth after whitening. For tough stains a combination of in office and take home trays need to be used for better results.

I should point that whitening is not permanent. Touch-up treatments are needed depending on the type of whitening method used and dietary habits. When teeth are exposed to food and beverages that cause staining touch up treatments are needed more often. From what I have seen, whitening is not covered by most dental insurances.

The ADA recommends a consult with your dentist if you are considering whitening your teeth. The dentist will do an oral exam and decide the type of bleaching method to be used depending on the type and extent of stain and the number of restorations on the teeth. Bleaching is not recommended for children under 16 and for pregnant and lactating women.

As I completed explaining the options, I could see several faces lightning up. Tara, being a high roller and short of time, asked me if I can schedule her for an immediate in-office whitening consultation that can be completed before her trip back to India. Maya, who likes a gradual process and being budget-conscious, thought she and her parents will be good candidates for Custom-trays.

As we watched the New Year crystal ball dropping in Time Square, I could already see bright ‘Hollywood Smiles’ welcoming the New Year!!! 

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Dr Meena Chelury, a long time resident of the Triangle, is a graduate of University of North Carolina Dental School and with advanced degrees in Public Health and Oral Pathology. She balances her life between two demanding but wonderful children and her family friendly practice of dentistry. You can reach her at meenac@yahoo.com or soon to open www.AmberlyFamilyDentistry.com

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