Smile Like a Star Teeth-whitening Procedures Gain Popularity Through Word-of-Mouth referrals

The flashbulbs of the paparazzi fire and your favorite actor flashes a dazzling white smile, the same one that will also look good in a close-up on a huge movie screen.


Camera tricks? No, just the result of one of the most popular procedures in dentistry today — tooth whitening.

Dr. Lisa B. Emirzian, D.M.D., of Emirzian, Mariano & Associates in East Longmeadow, and a specialist in esthetic dentistry who has been doing this procedure for 15 years, said more and more people are opting for this simple process every day.

“It changes the way people see their smiles. We all know how important a smile is to one’s self-esteem,” she explained. “It’s a general trend throughout the country.”

TV is doing its share to popularize the procedure, too, and not just for actors. Shows such as Extreme Makeover are spreading the word about tooth whitening to the general population. Says Dr. Gary H. Goodman, D.M.D., of Springfield, “I can’t even tell you how much whitening material we go through.”

How it All Happens

Teeth yellow for a variety of reasons: tobacco, red wine, coffee, tea (though “not as bad as coffee,” Emirzian notes), and just plain aging. Also, the tetracycline family of antibiotics can cause yellowing, particularly in the teeth of children who are still developing. Because of this, physicians today avoid prescribing these antibiotics in children when they can.

But when yellowing does occur, there are essentially two methods that dentists use to whiten teeth. One procedure uses carbamide peroxide and is begun in the dentist’s office, and continues mainly at home. The dentist prepares a ‘whitening tray’ somewhat similar to the mouth guard that athletes wear, but far thinner. It holds the whitening gel and the patient must wear it at home for up to four to six hours for 10-14 days. Most people do this at night. Some manufacturers, though, suggest times that are far shorter and much less frequent.

The second method uses hydrogen peroxide that is light- activated. It is done in one session, usually around two hours, in the dentist’s office. Both methods require brief ‘touching up’ sessions at home with a tray six months to a year later.

Which method a patient chooses is generally a lifestyle choice.

“My patients tend to prefer the office procedure,” noted Emirzian. “Two hours is more convenient than the several hours that the take-home procedure requires. The end result is the same.”

Goodman takes a different approach. “I prefer the take-home method,” he said. “I feel the procedure is more effective the longer the tooth is exposed to the whitening agent.”

Goodman has an interesting perspective — he spent much time during the period 2001-2003 testing various bleaching agents for the manufacturer of laser devices designed for the tooth whitening process to find out which one worked best.

One thing Emirzian and Goodman agree on is that patients should see their dentist first. It is important to clear up any pathology issues and make sure their mouth is healthy before starting. Tooth decay can cause problems with the procedure. Whitening also works better after a cleaning, because the bleach can oxidize the surface of the tooth better.

From one standpoint, it would seem that tooth whitening is basically vanity-driven. Emirzian dispels this myth, noting that tooth whitening is often not a “stand alone” procedure; it is often a part of more general tooth restoration.

“For instance, a patient may need to have some white fillings replaced that have yellowed over the years, or perhaps they have had porcelain veneers inserted. Maybe they need a crown. Maybe they need to have an old silver filling replaced and the dentist uses new white filling. They will want to have their teeth match the new, brighter fillings, crowns, or veneers.”

Side Effects Few and Minor

Another reason the procedure is gaining in popularity is that it its affordability; Goodman noted a price of around $600 for the in-office procedure and $199 to $400 for the take-home. However, since the procedure is considered cosmetic, it is not covered by insurance, even if some of the associated restorative procedures are covered.

There are few side effects to the procedure, the most common being a slight sensitivity in the teeth that quickly fades. Emirzian said most of her patients describe it as “a little zing, like a cold drink hitting your tooth.” At first, it can last about half an hour. After a few treatments, even this little bit disappears all together.

Also, how soon and how frequently touch-ups will be needed depends on the patient’s lifestyle and how much staining material they use – smoking is by far the worst culprit. A heavy smoker’s teeth can stain so quickly that the procedure may not be practical.

While the American Dental Association (ADA) has deemed the procedure safe, and states that it does not damage the teeth in any way, it is not recommended for children under 16.

Goodman said teenagers are precisely the people who benefit the least from whitening anyway.

“Only if they smoke or had bad hygiene while wearing braces should they need tooth whitening,” he said. “Under normal circumstances, 18 would be ideal.”

He also points out that the procedure, for all of its current publicity, is not a panacea for all people. The results will vary for almost everyone, mostly because of something no one can change—genetics.

“Some people just have teeth that are more naturally gray. They will still get benefits from the procedure, but their teeth will not get as white as people whose teeth are not so naturally gray.”

Further, patients that have had root canals often discolor on their own, and require a totally different procedure called ‘interior bleaching.’

Should I Try This at Home?

What about those over-the-counter kits that anyone can pick up at the local drug store and take home? Are they really effective? A patient can choose to do the procedure at home with OTC kits, but Emirzian said there are efficacy issues that hamper their effectiveness.

“The whitening agent isn’t as strong and people may not follow the directions correctly,” she said. “The White Strips® will help, but they won’t give you the results a dentist can give you. And they only do the front six teeth.”

Emirzian has some further advice for do-it-yourselfers. “Use a regular, non-abrasive toothpaste. Abrasive toothpaste can pit the teeth and leave them looking dull.”

And in today’s world, when the camera flashes, only a dazzling smile will do.