Say "cheese!" Now, go look in the mirror. What do you see? A pearly white smile or teeth that look like, er, yellowcheese? If you're not happy with the image looking back at you, you're not alone.

These days, the perfect smile goes beyond orthodontics and fresh breath. Today, people are looking for that glowing, shiny, bright white smile. The kinds of smiles babies have when their teeth are sparkly and new.

If you're looking for that "Hollywood smile," we can help.

The Dark Side

What exactly causes our teeth to lose their luster? While the question may be simple, the answer is not.

Most of us know that drinking coffee or carbonated soft drinks can dim the color of our teeth. But certain medications, such as tetracycline (an antibiotic often used to treat acne) also can be culprits.

Factors out of our control also can be at fault. "As we get older, our teeth get darker," says Richard H. Price, D.M.D., consumer advisor for the American Dental Association. Price says that simply because teeth aren't pearly white doesn't mean they are unhealthy. "There is nothing unhealthy about teeth getting darker from aging. The color of teeth is determined by heredityas we get older, it is very natural for teeth to get darker," he says. "White teeth do not make a healthy mouth. You can have disease all over the place and have white teeth," Price adds.

Price says there are other variables that can cause teeth to discolor. Too much fluoride can cause teeth to discolor. If a person had a very high fever when the tooth was developing, the color can become irregular. If a tooth is injured, for example, banged on something, that tooth may become and stay black. Anything that can cause a breakdown of the blood vessels supplying the tooth, Price says, can cause discoloration. Disease, such as cavities, also can result in a less-than-pristine smile. These causes are known as intrinsic, or internal.

Extrinsic causes of tooth discoloration, Price says, can best be explained this way: "Whatever you put in your mouth, if it stains the carpet, it will stain your teeth." Some examples are red wine, coffee, tobacco, and soft drinks. "[Extrinsic] stains will come off when you clean the teeth," Price says.

Most people think that bleaching the teeth will make them white and sparkly. But it's not always as simple as that, Price says.

On the White Path

There are a host of options for getting teeth whiter. Price says that consumers should always check their dental products for the American Dental Association's Seal of Acceptance. "It's the only safeguard that the product is safe." The ADA's Seal is present on some 1,300 products, and in order to get the seal, a manufacturer must undergo stringent testing for its product's safety and effectiveness.

He cautions, however, that simply because a product does not have the ADA Seal of Acceptance does not make it a poor product.

OK, so what can you do to get whiter teeth? Let's begin at the beginning:

Brush, Brush, Brush

Believe it or not, just following a good oral hygiene regimen can help. Brushing helps remove surface stains (extrinsic, as Price says). Sonicare electric toothbrushes do the best job. Second Best? Supersmile 45 degree angle Lucite Toothbrush, which is designed to get close to the gum line for optimal cleansing and plaque removal. Flossing (think Supersmile Whitening Floss) regularly helps keep the teeth healthy. Equally as important, Price says, is getting professional cleanings from your dentist. And yes, cutting back on the coffee, soda, tea and smoking make a big difference, too. If this is not possible, GoSmile Touch Up On-The-Go Smile Refresher - Mint may be used as often as needed to help remove surface stains.

When it comes to getting the teeth whiter, Price says, you have to go to the source of the discoloration to find the solution.

He says that teeth stained from extrinsic sources should not be bleached. To get rid of stains from coffee, tea and the like, Price says, you need to have a professional cleaning. Using the carpet analogy: "You have to hire a professional to clean your carpet," he says.

There are loads of whitening toothpastes on the market today, many of which carry the ADA Seal of Approval. For a complete list, go to www.ada.org. These toothpastes contain abrasives that help clean the surface of the teeth, helping to remove stains and improve the color of the teeth.

If your teeth are discolored from other, or intrinsic, factors, bleaching might be a good option. Here, you have even more options.

Home-based options include:

• GoSMiLE Smile Whitening System which is clinically proven to whiten teeth in a week. This is a great product for those who find traditional tooth whitening products to be too strong to tolerate.
• Crest Whitestrips Classic - Contains the least amount of tooth whitening ingredient with regard to the Crest line. Tooth Whitening in 14 days, results last approximately 12 months.
• Crest Whitestrips Premium contains more of the tooth whitening ingredient than the Crest Classic version. Tooth Whitening in 7 days, results last approximately 12 months.
• Crest Whitestrips Pro Effects contains more whitening ingredient than Crest Classic and the same amount as the Premium version. Tooth Whitening in 10 days, results last approximately 18 months.
• Crest Whitestrips Advanced Seal is the newest addition to the Crest Whitestrips family. It provides the easiest application, with a stronger grip & form fit, cleaner removal & once daily application. Different formulation, but provides similar whitening benefits to Premium and Premium Plus Crest versions. Results last approximately 18 months.
• Supersmile Professional Whitening System is the only system that will restore bonding, porcelain veneers, crowns and even dentures to their original color.

Going to the Pros

Price says that tooth whitening is a consumer problem. "I would rather people have their whitening supervised by a dentist. Some teeth should not be bleached, and some teeth cannot be bleached," he says. If you are interested in a home whitening method, play it safe and consult your dentist first.

In-office bleaching procedures, what the ADA refers to as "chair side bleaching," involve the application of a special bleaching solution to the teeth. Typically, a protective gel or shield is applied to protect the gums during the procedure. In some cases, this procedure may require more than one office visit.

Some dentists will use a special light to enhance the bleaching effect. This should not be confused with the use of a laser during treatment. Price says that he has seen the laser decrease in popularity in recent years. According to the ADA Web site: "No whitening products using lasers currently are on the ADA list of accepted products."

Dentists also offer the take-home bleaching method. This method requires the patient to wear specially fitted mouth trays containing a bleaching agent for a specified amount of time during treatment. The key here, Price says, is patient compliance.

Before a dentist will administer any tooth whitening treatment, a thorough assessment of the patient's oral health will be taken. Patients with gum disease, cancer or other oral health issues are not good candidates for bleaching. Cavities also raise a red flag (however, filled cavities are OK). Capped teeth or front teeth with tooth-colored fillings will not bleach, Price says. He says that you may be able to bleach the teeth to match the cap, and since caps last about five years, this might be a good option.

Beyond the Laser

BriteSmile boasts results in just one, hour-long session. The system, administered by dentists, uses a proprietary hydrogen peroxide gel. Then a special light is used to "activate" the gel and whiten the teeth.

The company's literature says that with good oral hygiene, the results can last as long as two years. Cost: $500 to $600. Maintain your investment by using BriteSmile products on a daily basis.

Risks and Safety Concerns

Most experts agree that tooth whitening is usually safe for most people. Some people may experience tooth sensitivity to hot and/or cold after some treatments.

As we noted earlier, people with oral health issues are not good candidates for tooth-whitening procedures. This warning is more for those who plan to partake of home tooth-whitening products. In-office procedures include a health evaluation prior to beginning treatment.

Price says that there is no research to suggest that tooth whitening is harmful to pregnant women; however, there also is no research to suggest that the procedures are safe for pregnant women. "Don't do it," he says.

The biggest risk in the tooth-whitening game, Price says, is shattered expectations. "Very often I tell a person we can whiten their teeth, but the patient has to have realistic expectations," he says. Whitening likely will make a difference in the color of your teeth, but it can't work miracles. For severely stained teeth, just a couple of shades of increased whiteness can make a huge difference.

The results from typical dentist-administered treatments can last from one to four years, Price says. However: The longer it takes to bleach the teeth, the quicker the teeth will go back to their color before the procedure. "It's a gradual return," he says, "and you can do touch-ups."

Price says to be careful when selecting a dentist to bleach your teeth. "When you meet the dentist, be sure a complete health history is taken. Be sure he or she doesn't treat bleaching teeth as a 'nothing' procedure," he says. "It is supposed to be a 'nothing' procedure if all of the pre-procedures are done correctly."

Robin Heinz Bratslavsky
DERMAdoctor Staff Writer

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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