Shopping Cart (0 items for $0.00)
Sign Up Now For
February 16, 2010
Time for tooth whitening?
Over time, your pearly whites can start looking a bit dingy. Dentists can perform or supervise various whitening procedures, and over-the-counter whitening products are available at drugstores and supermarkets. What’s best for you depends on several things, including the type of discoloration and the amount of time and money you’re willing to spend.
There are two main types of whitening products. Some, chiefly whitening toothpastes, remove surface stains by polishing with chemical agents or mild abrasives. These don’t alter the tooth’s natural color and can only lighten its appearance slightly. The other type of product contains a peroxide bleaching agent (carbamide peroxide or hydrogen peroxide) that changes the color of the tooth and can lighten it by several shades.
Getting help from a dentist
The American Dental Association (ADA) recommends that you consult your dentist before using any bleaching product, even an over-the-counter one. Bleaching can be uncomfortable for people with sensitive teeth or gum recession. Also, most products will bleach only natural tooth enamel, so if you have tooth-colored fillings, crowns, veneers, or partial dentures, bleaching may yield uneven results.
Your dentist can evaluate whether bleaching is right for your teeth, since different kinds of discoloration respond differently to whitening. For example, bleaching works for most stains caused by age, smoking, and regular coffee or tea drinking, but it may not be effective against discoloration that results from tetracycline use in children under age 8. (Tooth discoloration can also occur in a child whose mother took tetracycline while pregnant.) Finally, even if you choose the over-the-counter route, your dentist can advise you on the relative merits of the products available.
Dentist-supervised procedures include the following:
In-office bleaching. A neutralizing gel or a rubber shield is placed on your gums to protect them. Your dentist then applies a peroxide bleaching agent to your teeth and exposes them to a bright light or laser to hasten the lightening. Achieving the color you want usually takes three to four sessions, each lasting 30 to 60 minutes. A new technique, called power bleaching, uses a highly concentrated form of hydrogen peroxide and requires only one session. In-office bleaching costs $500 to $1,200 for the whole mouth. Results generally last for one to three years.
Dentist-prescribed home bleaching. Your dentist takes an impression and makes a custom-fitted mouthpiece to hold the peroxide bleaching gel. You wear the gel-filled mouthpiece for an hour or two every day, or overnight, for a week or two. Some users experience tooth sensitivity, but it usually subsides once the treatment is complete. Dentist-prescribed home bleaching for the whole mouth costs $300 to $600. Currently, 10% carbamide peroxide tray-applied gel is the only home-use whitener that carries the ADA Seal of Acceptance, which means that it meets ADA standards for safety and effectiveness.
Bleaching teeth with pulp damage. If your tooth has darkened because the pulp (the soft interior of the tooth) is dead or injured, your dentist can treat the pulp chamber with a bleaching agent during root canal therapy.
Over-the-counter bleaching products
All of the following over-the-counter products contain peroxide as their active ingredient. The concentration is lower in these agents than in the products dentists use, and the cost is substantially lower, ranging from $20 to $150.
Whitening strips. You apply these thin, flexible pieces of plastic directly to the teeth, usually for a half-hour once or twice a day for five days to two weeks. (Strips used for a shorter time have a higher concentration of peroxide and may cause greater tooth sensitivity.) The effects can last for up to 12 months.
Gels. All gels are similar, though some are applied with a small paintbrush and others come in a penlike applicator or are placed in a mouthpiece. Gels are typically applied daily before bedtime and left on overnight, usually for about two weeks. Effects may last up to six months.
Whitening rinses. Whitening rinses are swished through the teeth for 60 seconds twice a day before brushing and are used on an ongoing basis. (A 16-ounce bottle — about a one-month supply — costs $6 to $8.)
Safety and effectiveness
There’s very little evidence on the long-term safety and effectiveness of tooth-whitening products or procedures. No over-the-counter bleaching product carries the ADA Seal of Acceptance, and the organization recommends consultation with a dental professional before using them. An analysis of clinical trials by the independent Cochrane Collaboration concluded that whitening products appear to be effective, but consumers should be better informed of side effects such as tooth sensitivity and gum irritation. Noting that the products’ manufacturers sponsored most of the studies, the reviewers recommended more independent research.
Whitening products aren’t recommended for children under age 16, for women who are pregnant or breast-feeding, for people with sensitive teeth or an allergy to peroxide, or for those with gum disease or worn tooth enamel. If any whitening product causes irritation or mouth sores, you should stop using it immediately and see your dentist.
| More information | |||
Get your copy of Hearing Loss: A guide to prevention and treatmentIf you think you might need a hearing checkup, you probably do. This special health report describes the causes and cures for hearing loss. You’ll learn about the latest advances in hearing aid technology and find out which kind of hearing device may be best for you. This report contains in-depth information on the causes, diagnosis, and treatment of hearing loss. You'll learn how to prevent hearing loss and preserve the hearing you have now. |
Could aspirin cause hearing loss?
Q. I am 85 and have taken an 81-mg aspirin each day for decades for heart attack prevention. Recently, I noticed these words on the label: “Stop using if you get ringing in your ears or loss of hearing.” Should I be worried?
A. In a word, no.
In the body, aspirin gets converted into a chemical called salicylic acid, so the side effect that the label is referring to is sometimes called salicylism, or more simply, aspirin poisoning. Very high levels of aspirin in the blood can have toxic effects. Tinnitus — a ringing or whistling noise in the ear — and hearing loss are among them. But there’s no risk of that happening at an 81-mg dose.
People have been taking aspirin for more than a century, and I think it’s still the most widely used medicine. Like you, many people take small doses daily for cardiovascular health. But large doses used to be prescribed much more often, partly because we didn’t have nearly as many other medications to choose from. Doctors have also learned that many drugs, including aspirin, work just as well at lower doses as at higher ones, and — no surprise — lower doses are often associated with fewer side effects.
Aspirin for rheumatoid arthritis, an inflammatory condition that damages joints, is an example of what I am talking about. Today, if someone with rheumatoid arthritis is treated with medication, there are several choices among the disease-modifying antirheumatic drugs, or DMARDs. But when I was in medical school, aspirin doses of 1,500 milligrams (mg) a day or more were often prescribed for rheumatoid arthritis. Taking that much aspirin on a daily basis can have toxic effects, including tinnitus, and I saw cases of salicylism early in my medical career.
Your 81-mg dose is about one-twentieth of 1,500 mg. You really don’t have to worry about salicylism. The evidence for cardiovascular protection from small, regular doses of aspirin is solid. So congratulations on reaching 85, and I think there’s a good chance that your aspirin habit might have helped you get there.
— Anthony L. Komaroff, M.D.
Editor in Chief, Harvard Health Letter
