How to make your teeth white and take away stains?

Have you ever considered how to make your teeth white but do not know the right way to go about it? There is a myriad of options available to combat staining teeth from simple whitening toothpaste to more expensive clinical whitening sessions. But obviously, the results may vary and so is the time taken to achieve the colour change.

How did my teeth get yellow and stained?

Before knowing how to get rid of those stains, it is best to understand how those stains came in the first place and made teeth look dull and lost their bright, white sparkle. The stains are internal and external in nature or a combination.

External stains: They are also called extrinsic stains; appear due to the consumption of certain food items and beverages over time; such as tea, coffee, wine, and food with red and green spices. Also, habits such as smoking and tobacco have an effect. They can stain your enamel, the outermost layer of the teeth. 1,2 Additionally, plaque buildup on your teeth can cause them to look yellow. The good news is these types of stains or discoloration in the outer layer of the enamel can be removed with regular cleaning and whitening remedies. 4

Internal stains: No matter how much you follow the teeth cleaning regime, do your teeth still look yellow? That is because of internal stains, which are also called intrinsic stains. These occur much deeper in the tooth. It can be caused by multiple factors like tooth infection; a high percentage of fluoride use; medications (particularly tetracycline), and genetics may also play a role. 3 These types of stain is harder to treat because they deal with the dentin on the inside of your tooth. 3, 4

Age-related tooth stains are a combined result of both external and internal tooth discoloration. Teeth become darker as a physiological age changes because the dentin, the core tissue of the teeth naturally yellows over time, and extrinsic stains and gradual wear of enamel allow a greater influence on the color of the underlying dentine. 5

Ways to whiten teeth: Tooth whitening options for you

How to get white teeth? People often wonder if the most expensive option is the most effective, but not necessarily! A host of options are available from less-priced over-the-counter teeth whitening products to expensive in-clinic teeth whitening treatments. It is important to note; that some teeth whitening options are suitable to manage extrinsic stains, while intrinsic stains require extensive dental treatments. Further, each teeth whitening option will not bring the same results and the time taken to show a difference will also vary based on the treatment type and intensity. The best option is to consult a dentist informing your requirement and who would be able to recommend to you which method or a combination of them, in particular, will be the most beneficial option to brighten your smile.

Here are some commonly used teeth whitening options available in Singapore.

Whitening Toothpaste

Oral care product manufacturers are well aware of the consumer’s strong desire for whiter, brighter teeth and, in response, a vast choice of contemporary toothpaste have come to market; although, most of them contain basic functional ingredients such as abrasives to remove surface stains, plaque and food debris and additional chemical agents to augment the abrasive to aid removal of external stains. 6

Do teeth whitening toothpaste work? Whitening toothpaste contains abrasive particles that can remove surface staining. In truth, the toothpaste has a polishing effect rather than achieving a true shade change. Whitening toothpaste removes surface stains only through the polishing effect of the abrasives they contain. 7 So be careful to have realistic expectations as opposed to the overrated marketing advertisement.

Is whitening toothpaste bad for teeth? Whitening toothpaste can be obtained over the counter. As per the Ministry of Health in Singapore (MO) directives, only the products that contain the stipulated concentration of chemicals can only be sold to the public. Therefore, whitening toothpaste is generally safe for daily use. However, one should adhere to the instructions of daily usage as over-usage and prolonged time of use may increase enamel roughness and decreases enamel hardness, which in turn may result in unwanted teeth issues. 8

Natural Teeth Whiteners

Natural teeth whiteners are inexpensive and easy to use such as baking soda, charcoal, hydrogen peroxide, and apple cider vinegar. The natural acids and abrasives in them help to remove stains that are on the surface of the enamel. These are good solutions to add an extra sparkle to your teeth, however; overuse can lead to irritation, sensitivity and aging of your teeth. Therefore, natural teeth whiteners are recommended only for occasional use as they can do more harm than good, also they will not drastically whiten your teeth.

Scaling at the Dental Clinic

A scale and polish are not primarily designed to whiten teeth, yet it is advantageous to scale and polish as it will help to take off the extrinsic stains 10 (external stains) from tea/coffee, smoking, food, red wine etc. These stains can be easily removed by scaling. This procedure can also get rid of plaque and calculus (tartar) harden minerals. The dentist can also use a powder spray at the dental clinic to clean your stains more thoroughly. They won't necessarily whiten teeth in the way that a teeth whitening treatment could, but most dentists recommend a scale and polish before teeth whitening treatments.

Over-The-Counter Whitening Products

Whitening Stripes: A popular method as they can be purchased from most pharmacies and are cost-effective and generally considered safe. The Ministry Of Health in Singapore directs that no whitening product can be sold over the counter, unless it contains less than or equal to 0.1% of the whitening agent (hydrogen peroxide), Therefore, as the concentration is less, it may even take a week or more time to see the results thus teeth whitening strips are only a good solution for a planned event or a special occasion and also the teeth whitening results are usually short-lived. 11

Over-the-counter Teeth Whitening Kits: Over-the-counter teeth whitening trays are one-size-fits-all and have a restriction of less than 0.1% use of whitening agents by law, thus may not be effective as dentist whitening kits and the gel can come in contact with your gums, causing irritation and sensitivity to develop.

The common side effects experienced with at-home methods: The most common ones are soft tissue irritation and tooth sensitivity. These side effects are usually mild, transient, and dose-related. Reducing the gel concentration and duration of application generally reduces these side effects. The application of potassium nitrate gel either before or after each session can also help lessen these side effects. It has been shown in several studies, that the side effects disappear once the treatment is terminated.

In-Office Tooth Whitening

The most effective and successful method to get your teeth whitened within a shorter duration. 12,13 This is carried out under the supervision of the dentist while the patient is seated on the dental chair. The gums are protected with a resin barrier. The whitening gel is then applied to the teeth. Strong light or laser is applied to activate the gel. Treatment can be carried out on both upper and lower teeth at the same time.

Advantages are:

• lightening effect can be seen after one treatment visit
• gum is protected from the bleaching agent

Disadvantages are:

• Possible seepage of the bleaching gel under the gingival barriers
• Possible adverse effects on the pulp with resultant post-treatment sensitivity
• Treatment fees are higher.
• There can be greater colour relapse as the tooth-lightening result is due to both tooth dehydration and the bleaching effect.

Dentists are now prescribing at-home bleaching as a follow-up to in-office bleaching so as to maintain or improve the lightening result

Dentist Teeth Whitening Kits with gels and custom-made trays: Dentist teeth whitening kits come with a custom-fitted plastic tray with a recommended concentration of hydrogen peroxide or carbamide peroxide to be worn for a few hours. Results can be seen 3-4 days after the start of treatment. Trays and gels purchased from your dentist are safer and will give faster results as trays from the dentist are custom-made to fit your teeth and the gels have stronger teeth bleaching agents.

The success rate with at-home methods has been reported to be more than 90% and the colour maintained for 2-3 years without any observable changes, after the initial colour relapse 14. Colour relapse does occur with most of the relapse occurring within the first four weeks after cessation of treatment.

Advantages are:

• The ease of application
• Reduced chair time
• Fewer side effects
• Lower treatment cost

Disadvantages are:

• The patient will need to do treatment regularly and follow the instructions carefully
• Side effects like soft tissue irritation and tooth sensitivity. These usually stop after treatment is completed. However, patient compliance is necessary to achieve a satisfactory result.

Conclusion:

The demand for teeth whitening has expanded significantly in Singapore as well as globally. As a result, the market has made different oral care products and solutions to meet this growing demand. The basic question of how to whiten teeth has so many answers with varying degrees of success. This article brings out various teeth whitening options, ranging from over-the-counter teeth whitening products to professional in-office dental teeth whitening treatments. Each method has advantages and disadvantages, as well as side effects if not followed precisely. Additionally, not everyone is a suitable candidate for teeth whitening, so it is strongly urged by the Ministry of Health in Singapore that you contact a dentist and acquire the right suggestions and instructions beforehand.

Reference:

1. Zhao, X., Zanetti, F., Wang, L., Pan, J., Majeed, S., Malmstrom, H., Peitsch, M. C., Hoeng, J., & Ren, Y. (2019). Effects of different discoloration challenges and whitening treatments on dental hard tissues and composite resin restorations. Journal Dentistry, 89,103182. https://doi.org/10.1016/j.jdent.2019.103182
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3. Nathoo, S. A. (1997). THE CHEMISTRY AND MECHANISMS OF EXTRINSIC AND INTRINSIC DISCOLORATION. The Journal of the American Dental Association, 128, 6S 10S. https://doi.org/10.14219/jada.archive.1997.0428
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