How do I get whiter teeth?

How do I get whiter teeth?

This is undoubtedly one of the most common questions I get asked. There are a lot of different products on the market and a lot of variation depending on which county you come from – the USA have a lot more choice due to the research and regulation of the FDA (Food and Drug Administration). I will discuss what the latest studies recommend, and what I have seen personally be most effective so that you can hopefully wade through the gallons of marketing bumph that surrounds this topic with a bit more knowledge.

I will split this topic into 2 because as always my ability to waffle will no doubt take over and make it far too long for one post. In this section I will explain why teeth are discoloured which will give you some idea of what method of tooth lightening technique will be appropriate for what you dislike about the colour of your teeth.

Why aren’t my teeth white already?

There are a number of reasons – both things to do with natural causes and things that we do ourselves to our teeth.

Small anatomy recap.

Below is not by any means an exhaustive list.

Nature	Nurture
Age As we and our teeth get older, the outer surface gets worn i.e. the enamel becomes thinner and so more of the dentine shows through. For this reason naturally with age, teeth become darker/more yellow in appearance.	Food and drink This is the obvious one. Tannins in things like tea, coffee and red wine can cause staining of the teeth. Similarly coloured food such as curry can also cause staining
Tooth formation Teeth first develop in the womb. It is a very complicated layering process of several proteins and minerals. Of course, as with all aspects of development, many things can go wrong with this process. The same applies for teeth. Various different problems can occur with the enamel or dentine or in fact both leading them to be discoloured, malformed, bumpy, or even missing. The development can also be affected by childhood illnesses particularly measles and chicken pox. Yet another reason to get your child immunised but that’s another matter.	Drugs By this I am mostly referring to medication rather than the “recreational” sort however the less legal types can also cause dental problems which will affect the colour of the teeth. Mostly antibiotics. If you as a child or your mother when she was pregnant had “tetracycline” antibiotics then this can lead to staining of the teeth
Chemicals I have included this in both nature and nurture because chemicals aren’t always things which are commercially produced. The chemicals I am referring to include things like fluoride. While some areas of the country will have fluoride added to the water supply, other areas have naturally occurring minerals such as fluoride in their drinking water. Excess fluoride (and I do mean excess) when teeth are developing can lead to something called fluorosis. “Too much fluoride in the diet during the period of development of the teeth can bring about fluorosis. Fluorosis can cause white, yellow, and brown spots of discolouration on the tooth enamel. Fluorosis can vary from these minor colour changes to irregularities in the enamel surface. After the teeth are present in the mouth, fluorosis no longer develops” (thanks dentalnet.org). The most common form is white spots on the teeth Other things include chlorhexidine mouthwash (Corsodyl) which can cause staining of the teeth if used for extensive periods of time (anything over a week)
Genetics This sort of links in with the tooth formation bit but different “diseases” or conditions including Down’s syndrome, Porphyria etc can affect the colour (and shape) of the teeth	Dental disease/treatment of dental disease This includes decay which obviously will look black/brown/dark. Similarly, metal fillings can cause greying of the tooth purely because I mentioned before, tooth material is not entirely opaque but also because some of the chemicals from the silver fillings will leach out into the tooth. Similarly, root canal treatment can lead to the tooth looking dark because of both the disease process itself and because of the materials we use for the root filling
Illnesses suffered by mother during foetus development Infections like rubella can lead to discolouration of the eventual baby’s teeth – however I am pretty sure the child’s teeth will be of minimal concern at this point.	Smoking The nicotine in cigarettes and things like the dreaded e-cigarettes can cause horrible staining of the teeth (and of course the risk of little things like CANCER)
	Tooth wear Things like erosion and abrasion can make a difference. As with age, anything that wears away that protective enamel layer such as acidic foods and drinks including white wine and orange juice, aggressive tooth brushing, vomiting etc will make the teeth appear darker/more yellow because you are allowing more of the dentine colour to show through.
	Trauma i.e. knocks to the teeth. Both knocks to the tooth itself or damage to the baby tooth that was there before the adult tooth can lead to discolouration. Death of a tooth will lead it to go grey/black, an attempt by the tooth to repair itself will lead to the tooth either looking very pink or yellow depending on how it responds. Both are only solvable by root canal treatment which I have done a blog post on already – gosh I’m good.

The importance of dividing the 2 types of discolouration is that on the whole (again there are always exceptions to the rule) the natural/genetic causes are very difficult to rectify by chemical means for example tooth whitening.

The problems with things like fluorosis is what people see isn’t the white spots on the teeth it is the fact that the rest of the tooth looks yellow by comparison. The problem with this is that you can’t spot treat teeth i.e. if you whiten the teeth, the white bits will get whiter and become more obvious and so there are limitations to what teeth whitening can do.

Similarly, if the problem with the teeth is due to poor formation of the enamel or dentine, then whitening will make no difference because the colour problem is due to the lack of “lamination” from the enamel. As also mentioned above, if the problem is due to dental disease, including tooth decay as well as death of the nerve of the tooth, the colour will only begin (begin being the important word) to be addressed by dealing with the disease i.e. placing a filling or carrying out root canal treatment.

Amusing picture time. I have included this because a) they spelt severe wrong and this makes me feel not so bad for nicking their picture and b) to highlight the fact that smoking whilst disgusting is not the only cause of these terrible teeth. This person is also suffering from tooth wear – from the looks of it tooth wear due to grinding the teeth and due to erosion by acids. If you want to know more about toothwear I am planning to write a blog post on it in the near future if not next so feel free to refer to that.

It is worth noting at this point that I am only going to be talking about natural teeth in these blog posts. If you have a crown/veneer that you dislike the colour of, any of the following methods will have no effect. In order to get a better colour of anything that is not natural tooth, it will require replacement with a new filling/crown/veneer.

There are several ways to address tooth discolouration and because I have waffled on for the equivalent of 6 pages of A4 I will save that for my next blog post.

I will include the list of where I got all my info from in this next post because I am lazy and cannot be bothered to go through both posts and work out which reference was used where!