Some natural and holistic medical practitioners promote the use of items common in the home as a means to whiten teeth, from strawberries, baking soda, orange peel, lemon juice to brushing with wood ash. However, any agent capable of whitening teeth, natural or otherwise, will by default alter the tooth enamel. If used excessively they can have severe side effects given their ability to actually corrode the enamel's surface and furthermore, once enamel has been damaged it is permanent. Compromised teeth will generally be more prone to sensitivity and cavities, so it is imperative to consult a dentist before any whitening procedure.
"When using these everyday household items to lift tooth colour, the slight short-term gain in colour versus the potential lifetime of oral hygiene issues is seldom worth it. There are far safer ways to achieve whiter teeth and with the more refined prescription bleaching agents available, patients now have more choice and do not need to take undue risks with such old-school home remedies. Whitening has also become a lot more affordable and locally we are seeing an unprecedented boom in this field," says Dr Mark Bowes, from the South African Academy of Aesthetic Dentistry (SAAAD).
Bowes explains that whiter, brighter smiles have a remarkable impact on looks and that just by lightening the teeth a shade or two, one appears refreshed and even younger but without it being glaringly obvious that they have had 'work' done. For those who have previously been self-conscious about their smile, the newfound confidence merely adds to their holistic appeal.
Prescription bleaching treatments can be broadly broken down into two categories – in-office (also called in-chair) or at-home, allowing patients to tailor their treatment to budgets and required timelines.
In-office whitening is the common choice for those wanting instant results, for example, a bride with her big day looming. It generally involves a single, hour-long session in the dentist's chair whereby a highly concentrated peroxide gel is applied under controlled conditions.
"In-office whitening might be instant but costing between R4000 and R6000, it is the more expensive treatment option," says Dr Bowes.
For those happy with a more gradual whitening process, the same results can be achieved with a take-home whitening kit. Patients are fitted with bleaching trays that resemble clear mouth guards into which they apply a lesser concentration of bleaching gel than those used for in-office procedures. The trays are worn for two hours a day for two to three weeks or until the desired shade is achieved.
"Costing between R2000 and R3000, take-home kits are just as effective as the in-office alternative. It's merely a more gradual process but far more affordable,"
Perhaps the most common question about tooth whitening is, "Is it permanent or will I need to repeat the treatment to maintain my preferred tooth colour?"
According to the SAAAD, there will be a slight colour relapse over time and patients will need to have intermittent 'top ups', depending on their consumption of staining substances like red wine and nicotine. Every patient differs but whitening maintenance and secondary treatments (if needed) are usually minor and quick.
As with skin tone and hair colour, we inherit tooth colour. During the ageing process, the enamel on our teeth wears down and becomes more transparent, permitting the yellow colour of dentin (a tooth's core material) to show through and cause a darker appearance. Furthermore, regular chewing causes tiny cracks in the enamel and it is these cracks that fill with stains over time. The end result is that teeth naturally become lacklustre and discoloured.
Some of the common side effects of tooth whitening are transitory gum inflammation and tooth sensitivity but these symptoms recede once treatment is complete. It is important to note that fillings and other restorations such as veneers will not be whitened and may need to be replaced depending on the variance in shades at the end of treatment.
"The average age of a tooth whitening patient is getting younger but children under the age of 18 are advised not to consider teeth whitening as their dental enamel will not have fully developed," says Dr Bowes.
Among the common items that stain teeth are red wine, dark cola drinks, berries, dark or red juices and nicotine. A good rule of thumb is that if it can permanently stain your clothes, it will stain your teeth! Stains can also be intrinsic which means that they occur inside the tooth, not on the surface. Tetracycline, an antibiotic, is a known cause of this type of stain. Also problematic are silver coloured fillings that can seep and cause greyish discolouration in surrounding teeth.
"It is one thing to whiten teeth as a reactive solution but the SAAAD encourages patients to understand what causes discoloration in the first place. Avoiding things like red wine is obvious but being sensible and diligent about personal oral hygiene is what really pays off in the long term. Despite the vast amount of education and dental resources available to the public, still few people floss enough or correctly and people are notoriously bad about annual dental checkups," says Dr Bowes.
It is important to be realistic in your expectations of a whitening procedure and to know when to stop, as even the healthiest teeth are not naturally bright white. Hollywood has a high prevalence of over whitened teeth, something that can be as unsightly as stained teeth!
The SAAAD, a recently formed association of accredited dental professionals aiming to educate on aesthetic dentistry and its role in general health and wellness, urges the public to avoid quick fix whitening products at too-good-to-
"Unfortunately, there are a lot of so called instant whiteners being offered at bargain prices, especially online. Always consult a dental professional regarding any whitening procedure, as every person's requirements and dental make up are unique. Bear in mind that these treatments use a potent peroxide base that if not applied correctly can damage or sensitise the teeth. Generally speaking, over-the-counter bleaching kits are less effective than a controlled procedure prescribed by a dentist and have a higher incidence of colour relapse," concludes Dr Bowes.
When selecting any dental professional, first check with the SAAAD to ensure they accredited. If in doubt about the treatment options your dentist has recommended, contact the SAAAD about your concerns.
For more information on tooth whitening and other dental procedures available in South Africa, visit http://www.saaad.co.za.
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The South African Academy of Aesthetic Dentistry (SAAAD) provides a leadership role in the exchange of dentistry-related knowledge and is a trusted source of information for the public and the profession alike.The Academy is dedicated to excellence in the science and art of aesthetic dentistry, aiming to enhance the highest standards of ethical conduct and responsible patient care.