November 27, 2014

The Perfect Smile

The scent of fluoride, pastes and compounds permeates the tiny room. But Adam Piatt's attention is elsewhere as he reclines in an office at the Aesthetic Dental Centre in Fort Myers. Piatt, a financial manager from Fort Myers, listens as Dr. Robert Hendry explains the procedure: four 20-minute sessions involving a painless but effective combination of peroxide-based gel and a plasma-type blue light positioned directly above the patient's teeth.

And the results? "I would recommend it to anyone," says Piatt.

Piatt is hardly alone in his quest for a whiter smile. According to the American Dental Association, dentists answer more questions about whitening and bleaching than any other procedure. With so many over-the-counter products and in-office procedures available, there are plenty of options to choose from. Dentists typically begin with a comprehensive examination complete with photos and X-rays to determine if you're a good candidate for whitening. If so, you'll likely be offered one of three options: enamel microabrasion, tray whitening or light whitening.

With enamel microabrasion, a rotating instrument is used in conjunction with an abrasive compound; but because it's used to remove specific stains from teeth, it really isn't the most practical solution. "Abrasion only removes really tiny stains, and it does remove some tooth structure," says Dr. Thomas Hale of the Advanced Dentistry Center of Naples.

Tray whitening has been around since the 1980s. Patients are fitted with a tray that's filled with a peroxide solution; they wear it for six to eight weeks, two to three hours a night. "The custom fit of the tray keeps the material in close contact with the teeth," says Naples dentist Dr. David Clary.

If you want a brighter smile faster, light whitening expedites the process. The relatively new technique yields impressive results in 90 minutes or less, using a peroxide solution and a plasma-type light. Patients sit for three to four consecutive 20-minute sessions, between which the solution is removed and reapplied. "Light whitening is more costly but more immediate," Clary says.

With any of these procedures, the only real drawback might be some initial tooth sensitivity, which can last for up to 72 hours. Dentists often administer prescription-strength fluoride in an effort to make teeth less sensitive.

"I haven't seen any negative side effects outside of transient sensitivity," Hendry says. "There's no enamel deterioration."

How long your teeth stay white is largely up to you. Patients who want their smile to stay whiter longer should avoid red wine, dark colas, coffee, tea and smoking. That said, the results from in-house whitening procedures can last anywhere from one to five years, during which time touch-ups with whitening trays are recommended.

Whitening procedures using peroxides aren't for everyone. Patients with bondings, crowns or fillings should be wary of these procedures. Restorations don't lighten with whitening, which can leave a less-than-desirable smile. Patients with grayish hues or Tetracycline stains may also experience unfavorable results. And people with receding gum lines, extremely sensitive teeth or reduced salivary flow are not ideal candidates.

Alternatives to peroxide include bondings, porcelain veneers and crowns. For bonding, a mixture is shaped and placed on the teeth to obscure cracks and chips, or to cover undesirable teeth. But it has its drawbacks.

"Bonding is more susceptible to stains because there are particles within the bonding that will stain," says Hale. "Bondings also have to be replaced more often."

A better option is porcelain veneers, all the rage of late. In this procedure, the teeth are slightly filed down and a thin porcelain covering is bonded to each tooth. "Veneers are a good option for people with chips, cracks or poorly functioning teeth," Hale says. "We can make everything work better as we are getting things to look better."

And veneers don't stain, so your smile will stay white as long as the veneers last-anywhere from 10 to 40 years.

While veneers only cover the front portion of the tooth, crowns cover the entire tooth. Another benefit of crowns is thickness; veneers are so thin as to be almost translucent. So if your teeth have dark stains, crowns may be the answer.

Like any cosmetic procedure, all of the above solutions can be expensive, so it's important to carefully weigh your options.

"The most conservative restoration that meets the patient's needs is the best restoration," says Clary.

Do It Yourself

A whiter smile doesn't have to mean a trip to the dentist. There are dozens of over-the-counter whitening products available, from abrasive pastes to bleaching agents.

Pastes-or whitening toothpastes-have stronger chemical agents and polishers than traditional toothpastes to more effectively remove surface stains from teeth. Products containing peroxide or other bleaching agents change the intrinsic coloring or hue of the teeth. They come in several forms, from strips to gels to wands, and most take up to 14 days to work, fading after about six months. All have received mixed reviews from dentists and the American Dental Association, which has withheld its seal of approval, maintaining that such products shouldn't be used without a professional consultation.

Still, Dr. Hendry has noticed a "marked improvement" in over-the-counter bleaching products. He recalls too well the days of patients coming in with stripped teeth and enamel damage.

Adds Dr. Hale, "Most patients have tried over-the-counter products, and their chief complaint is that their teeth are not where they want them to be."