i.Dentali.Dental

Are You Still Wasting Money on Whitening Toothpaste that Doesn’t Work?

Everyone wishes for something. For some, it is to be an inch taller. For the rest of us, it might be to have teeth a shade whiter. It didn’t take long for household brands to capitalise on that – the promising whitening toothpaste that allows us to keep our teeth clean and whiter at the same time. Tubes after tubes, nothing changed. How come?

First, we need to know the causes of teeth discolouration. These are as follows:

1. Extrinsic stains – These are, broadly speaking, anything that we ingest. It can be from our diets such as coffee, or also tobacco smoking. These stains are best removed with polishing and whitening.

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Figure 1:Photo source: http://www.prestige-dental-care.com.my/blog/oral-surgery-oral-pathology-oral-medicine/teeth-discolouration.html

2. Intrinsic stains – Some teeth are born naturally darker in shade. It usually involves the whole dentition. Other situation involves isolated teeth. This turns darker due to internal breakdown of the pulp. This is commonly on a dead tooth where often only an isolated tooth is darker. This tooth will require root canal treatment followed by internal whitening and/or crown/veneer to appear normal again. Internal whitening involves dentist placing whitening gel inside the tooth after root canal treatment before sealing the cavity again. The gel will be replaced as many times as necessary. For generalize teeth whitening, one can either go for laser chair-side whitening or tray system take home kit.

3. Fluorosis – Fluoride is beneficial for teeth, until it passes its optimum level. Too much of it causes brown and white spots on teeth. Spot whitening and/or micro-abrasion will better target the affected areas. Micro-abrasion works by gently removing the discoloured regions, and spot whitening focuses the whitening effect on the brown areas only to make the teeth even coloured.

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Figure 2: http://www.fluoridation.com/fluorosis.htm

4. Decay – While big obvious cavities are easy to spot, tooth decay begins way before a cavity appears. Decay often causes teeth to look more opaque or dark on the sides of front teeth. The solution for this is to remove the decayed teeth and restore with a tooth coloured filling.

5. Dental restorations – Any existing dental work such as filling, crowns or veneers does not whiten easily with any forms of whitening treatment. They can also pick up stains or discoloured over time. They will usually require replacement.

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Figure 3: Photo source: http://www.prestige-dental-care.com.my/blog/oral-surgery-oral-pathology-oral-medicine/teeth-discolouration.html

6. Receding gums – Over brushing is arguably worse than not brushing at all. Over a period of time, gums can be brushed off leading to roots of teeth exposed. They often appear darker than teeth above them. To protect and improve the appearance will usually require gum grafting surgery or masking it by filling or prosthesis.

7. Medications – Children who took antibiotics such as tetracycline or doxycycline while teeth are forming usually have teeth that appears anything from grey to red on the bottom half of their teeth. Previously, the treatment was to mask the discolouration with veneers but studies have now shown that with sufficient professional whitening, the discolouration can be improved.

8. Medical conditions –Porphyria, amelogenesis/dentin oogenesis imperfecta are some of the rarer conditions that affect teeth appearance. Individuals with these conditions have teeth that looks fine initially but can quickly break down. Treatment is multi-disciplinary and requires early attention.

Of the aforementioned causes of tooth discolouration, whitening toothpaste can only potentially work on extrinsic stains. Professional chair-side or custom-made whitening trays are much more effective and safer than whitening toothpaste although whitening toothpaste maybe suitable for an extra form of maintenance after professional whitening. Therefore, it is best to have an examination and a proper diagnosis by your friendly dentist before lathering excessive whitening toothpaste on your teeth!

Dr. Pua Hong Ping

BDS London, MJDF (RCS England)