Brushing Up on Oral Health
Wrinkles aren’t the only thing that show our age. Over time, the outer layer of our tooth enamel thins, allowing the yellowy dentin (the tissue that comprises the inner structure of the tooth) to show through. Combine that with decades of downing stain-causing food and drink and less-than-stellar dental hygiene habits, and those pearly whites start looking like, well, more of a dingy yellow.
If you’ve been tossing around the idea of (finally) tinkering with those lackluster ivories, consider this. A study reported in the British Dental Journal revealed that people with nice teeth are viewed as being more friendly, trustworthy, happy and self-confident than those with subpar choppers. Another study, this one conducted by Kelton Research — involving simulated job interviews, before and after whitening treatments — found that people were more likely to be hired when they had whiter teeth.
The good news is that there are plenty of treatments available to get the bright back, ranging from over-the-counter (OTC) toothpastes and strips to more intensive procedures done in your dentist’s office. Just keep in mind that more intense doesn’t necessarily mean better. “Our teeth weren’t intended to be toilet bowl white,” points out Mark Wolff, dean of the University of Pennsylvania School of Dental Medicine in Philadelphia. “There’s a point where whiteness looks phony rather than natural.” Here’s a look at your current brightening options.
Over the counter
1. Baking soda
One of the easiest and cheapest ways to whiten your teeth uses something you probably already have in your house: baking soda. “It’s a very mild abrasive, which helps remove stains from the surface of your teeth,” explains Brian Novy, chief dental officer at the Alliance Dental Center in Quincy, Massachusetts, and a lecturer on oral health policy at the Harvard School of Dental Medicine. Since it’s alkaline, it also helps lighten acid-based food stains from coffee, tea and red wine, he adds.
“I encourage all my patients to have a shot glass filled with baking soda on their bathroom counter,” he says. “Every time they brush their teeth, they can wet their toothbrush with water, dip it into their baking soda, then add their toothpaste.” A 2017 review published in the Journal of the American Dental Association concluded that baking soda toothpastes may actually be more effective — and less abrasive and damaging to teeth — then some other types of over-the-counter whitening toothpastes.
2. Whitening toothpastes
These remove surface stains through the action of mild abrasives like calcium carbonate or magnesium carbonate that scrub the teeth, says Matthew Messina, assistant professor of dentistry at Ohio State University and spokesperson for the American Dental Association. Some also contain peroxide or other chemicals that help break down or dissolve stains. But it’s important to use only whitening toothpastes that have earned the ADA Seal of Acceptance for stain removal (it will tell you on the package) to make sure a product doesn’t have any additional abrasives that could wear away the enamel on your teeth. Keep in mind, too, that these toothpastes don’t change the color of your teeth; they only remove stains on the surface. They also don’t appear to be as effective as over-the-counter tooth whitening strips, according to a 2020 review published in Operative Dentistry.
3. Tooth whitening strips
Tooth whitening strips are small pieces of flexible plastic coated with a thin layer of gel that contains peroxide. Each strip is pressed against the surface of the teeth, allowing the bleach to seep into the enamel to lighten the color and lift stains. Though whitening strips don’t use as high a concentration of peroxide as other whitening methods you’d get in your dentist’s office, they can deliver decent results (figure on a shade or two lighter) for people whose teeth aren’t too badly stained for a fraction of the cost of in-office treatments. They’re also no fuss, no muss — since you just press the strips onto your teeth and go — and convenient: You wear them daily, for about 30 minutes to an hour, over a period of two to three weeks. Results last for up to four months. These strips are safe and effective, notes Wolff. But he recommends that you check in with your dentist beforehand, since cavities or broken teeth will be extremely sensitive to bleach.
There are some cons, however. “Unless your teeth are perfectly straight, it can be difficult to get the strip to lay close enough to make contact with the entire tooth surface — particularly in between the teeth — which can lead to uneven results,” says Kimberly Wright, a dentist at Advance Dental Arts Center in West Linn, Oregon. Another thing to keep in mind: Whitening products will work only on “natural” teeth; they won’t change the color of crowns, bridges or veneers. What’s more, whitening can’t work miracles. If you’ve lost a significant amount of surface enamel, veneers may be a better choice. Other types of discoloration that are difficult to tackle with whitening alone: grayish teeth, caused by the antibiotic tetracycline (sometimes given to children whose teeth are still developing) and some antihistamines, or discoloration from high levels of fluoride in drinking water.
If you are thinking about using an OTC bleaching kit, discuss options with your dentist and look for one with the ADA Seal of Acceptance. That means it has been tested for safety and effectiveness for teeth whitening. Expect a kit to cost between $25 and $65 and know that the best time to use one, Wright says, is right after you’ve had a professional cleaning. “The less residue on the surface of your teeth applying the whitening strip, the better the results.”
4. Whitening trays
Whitening (or bleaching) trays are made of flexible material that fits around your teeth to whiten the surface and in between your teeth. They’re usually pre-filled with a peroxide-based whitening gel, or come with syringes of whitening gel that can be dispensed as needed. You can purchase dispensable trays over the counter or be fit with a customized take-home tray at your dentist’s office. Your dentist can also supply bleach refills to take home; when you come in for a cleaning, you can get a few more tubes for touch-ups.
Either type of tray will do the job. But a customized “tray and gel” treatment from your dentist will probably contain a higher percentage of bleach than over-the-counter kits do, delivering faster results. As with strips, it’s all about getting good contact with the teeth, says Wright: “Custom-made trays fit snugly, so the gel seeps into every nook and cranny, for the most even results possible.” A close fit also minimizes the amount of bleach that can dribble onto (and potentially irritate) your gums, while preventing saliva from coming into contact with the bleaching agent, which can dilute its strength. Basically, though, “It all comes down to what fits into your lifestyle,” notes Betsy Bakeman, a Grand Rapids, Michigan–based dentist and former president of the American Academy of Cosmetic Dentistry, who’s a fan of prefilled disposable OTC trays for traveling. She suggests Opalescence Go, which has whitening gel in pre-filled trays, worn for about 15 to 20 minutes a day for 5 to 10 days. It contains potassium nitrate to reduce sensitivity, plus fluoride to help strengthen enamel. (Ten trays cost about $63.)
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Store-bought trays come with a few caveats. There’s a limit to the percentage of peroxide in kits sold over the counter, so you’ll probably need to bleach longer than you would if you had a professionally made tray with a higher percentage of bleach. (Figure on about an hour or two a day, for 5 to 10 days, depending on the degree of whiteness you’re aiming for.) What’s more, with a one-size-fits-all tray, there’s a better chance that gel will get on your gums and possibly irritate the tissue, though it typically heals in a few days. “A dentist can trim the trays that she or he dispenses,” says Wright, “so there’s less of a chance the bleach will come in contact with the gums.”
OTC kits can cost $100 and up, while in-office kits are pricier — from about $200 to $600. Tip: If you prefer to wear a tray overnight, as you sleep, try a product that contains lower-strength carbamide peroxide (10 percent to 16 percent). “Carbamide peroxide, which gradually breaks down into hydrogen peroxide, releases about half of its whitening power in the first two hours, then remains active for up to six additional hours,” says Wright. “Some people experience less sensitivity, because it’s a slower process.”
5. In-office bleaching
This procedure is called chair-side bleaching and usually requires only one 30- to 60-minute office visit. To protect your gums, the dentist will apply either a protective gel or a rubber shield. A peroxide-containing gel is then applied to your teeth. Another in-office option is “power bleaching,” which uses concentrated solutions of hydrogen peroxide in water. (These treatments don’t work on crowns or veneers.) These are the same products you’d use at home; the difference is that since this process is done in your dentist’s office, they can use much higher percentages and you’ll see results much faster, explains Anabella Oquendo Parilli, director of the Advanced Program for International Dentists in Esthetic Dentistry at the NYU College of Dentistry. The cost is usually around $600.
6. Laser whitening
With this high-tech in-office procedure, a peroxide-based gel is brushed onto each tooth, then hit with light from a laser, which activates the bleach. It’s touted as a way to deliver dramatic results relatively quickly (either a single hour-plus visit or a few 15- to 60-minute visits spaced one to two weeks apart). But it’s expensive — typically about $1,000 out of pocket — and critics say the procedure isn’t worth it. “There’s some controversy, because research shows that it doesn’t really improve or accelerate the process, and in fact may cause more tooth sensitivity,” says Oquendo Parilli. The fact is, it’s not the high-tech gizmos that deliver the amazing results. The whitening is simply the result of using a much stronger concentration of hydrogen peroxide, which bleaches teeth more intensely, more quickly. “The results won’t last longer than those of an at-home bleach,” says Wright. “If you think you can be compliant and put forth the time and effort to bleach with a tray at home, you’ll get the same great results.”
What’s more, using bleach in such high concentrations increases the chance of sensitivity. “As we age, the nerves in our teeth actually recede, making teeth less sensitive, so people over 55 can probably tolerate a high concentration of bleach with little or no tooth sensitivity,” says Wright. Still, she notes, if the bleach gets on your gums, it will burn the tissue, though it typically heals after a few days.
What Not to Try for Whiter Teeth
The following home remedies are often touted as ways to brighten up your choppers, but research shows that they don’t work, and may even put your teeth at risk.
- Charcoal-containing products. Products like charcoal toothpaste not only don’t help, they may make your yellowing worse, since they can be very abrasive, says Messina. A 2019 review published in the British Dental Journal found that these products were not only ineffective, they can cause gum damage (charcoal can get stuck in the gum pockets, which can damage and discolor gum tissue).
- Oil pulling. There's no evidence that this home remedy, which involves swishing a teaspoon of coconut oil around in your mouth, is effective, according to the American Dental Association. There is evidence, however, that it can cause lipoid pneumonia (a type of pneumonia that develops when oil enters your lungs) as well as upset stomach and diarrhea.
- Apple cider vinegar. It’s used as a mouthwash, but since it’s highly acidic, it can erode tooth enamel, says Messina. A study published this past August in the Journal of Medicinal Food found that daily vinegar ingestion significantly wore away tooth enamel after just eight weeks.