Most people want to look their absolute best at the holidays, and for some, that may mean getting their smiles in tip-top shape.

Tooth whitening procedures used to gain a mouth full of pearly whites are popular and widely used, but local dentists say there are risks involved in getting that prized megawatt smile.

Immovable stains and root resorption, not to mention cost and convenience factors, are among the considerations individuals must make regarding professional, and especially over-the-counter, bleaching procedures.

"They should really talk to the dentist or the hygienist and then go online and get information on it," said Dr. Robert Gordon, who has practiced dentistry for 38 years and operates a general dentistry practice in Orangeburg.

Tooth sensitivity is one concern, Gordon said.

"Whitening can cause sensitivity, and it comes from around the root," he said. "The whitening takes some of the sealant from the enamel. That allows the tooth to become sensitive, but there is a way around it. You could always use a desensitizing toothpaste. That should reduce the sensitivity."

Whitening agents decalcify enamel, as it has to penetrate the enamel to be effective, Gordon said.

"That opens up the tubulars, and that allows for the sensitivity," he said. "But, the toothpaste is a fluoride toothpaste. It has a predetermined amount of fluoride in it, and that is to counter that. It puts the sealant back in, and that should reduce the sensitivity."

Root damage, particularly in individuals who have already had root canals and are considering tooth whitening, is another risk factor, said Dr. Michael E. Salley, who operates a family and cosmetic dentistry practice in Orangeburg.

"You can have what's called root resorption," Salley said. "That's most common in teeth that have had root canals. We don't really know exactly why."

Often requiring tooth extraction, root resorption is a condition where the root of the tooth starts to dissolve either from the inside or outside. This is caused by living body cells attacking part of the tooth.

Salley also said some stains may not lighten well or at all, including teeth with multiple colorations, bands, splotches or spots due to tetracycline use or fluorosis. Teeth with many fillings or cavities are also included in this category and are usually best treated with other non-bleaching alternatives, he said.

"Stained teeth can be lightened some, but tetracycline, or antibiotic, stains in children are very difficult stains," Salley said. "It's kind of a blue-gray stain. It's very difficult to remove. Children used to take tetracycline for cystic fibrosis ... . Tetracycline is still used for people with acne and things like that, but usually later in life, they will see wisdom teeth stains like that."

Gordon said whitening treatments are also not intended to lighten artificial teeth, caps, crowns, veneers or other restorative materials, cautioning individuals with such dental work that lackluster results may occur.

"So, if you already have caps in there, and you want to whiten your teeth, then the caps are not gonna change because they're made of porcelain," Gordon said. "If you want uniformity, you must consider what's there already. But, biologically, I don't think there's anything else you'd have to be too concerned about."

Gordon said he uses the tray whitening system ,which includes the use of hydrogen peroxide gel.

"The tray looks like a mouth guard, and the ingredients are placed in the tray. It's snapped around the teeth and confined to the teeth," he said, noting that the presence of a white oral fungal growth from too much peroxide in the mouth, or "secondary flush," is a possible bleaching risk, but very rare.

"If you use peroxide over too long of a period of time -- people sometimes use peroxide for rinsing -- it can cause that," he said. "It takes a longer period, like three weeks or continuous use of it. But normally when you use whiteners, it's in a tray pretty much confined to the teeth."

In addition to the tray system, Salley also uses an in-office tooth whitening procedure that uses a combination of a hydrogen peroxide gel and a specially designed ultraviolet lamp.

"We use an ultra-violet light to drive the process, so the patient stays in the chair for three 15-minute sessions," he said. "What it does is actually oxidizes the stains within the tooth. The patient has a custom-made tray that fits their teeth so they can touch up ... later on and keeping the material against their teeth for however long they keep the tray in."

Salley said patients usually see about nine shades of whitening when the ultraviolet light is used.

"You can get the same result with the tray system, but it just takes a longer time," he said, cautioning individuals to use over-the-counter whiteners carefully for the best results.

"Over-the-counter methods do work if the person can keep the material against their teeth long enough," Salley said. "The best over-the-counter products are the ones that have a delivery system that can keep it against the teeth longest. In my opinion, whitening toothpastes are a waste of money, because you can't keep them on the tooth long enough."

Cost is also a factor in making the decision to whiten your smile.

Oak Brook, Ill.-based Delta Dental Plans Association is a national network of independent, nonprofit dental service corporations specializing in providing dental benefit programs to 47 million Americans in more than 81,000 employee groups nationwide.

They report that most dental benefit plans do not cover bleaching and may not reimburse enrollees for bleaching costs. This lack of coverage arises from the federal tax code, under which many services considered "cosmetic" cannot be purchased with pre-tax contributions to an employee's income or reimbursed through flexible spending accounts.

"Bleaching is cosmetic. Just like any other enhancement of body parts that people do, insurance doesn't cover it unless there's a medical reason for it," said Salley, noting that whitening costs vary. "It varies in the geographic area you might live in, which is about anywhere from $600 to $700 to even $2,000 in some places for the same procedure."

He said the best course of action, if a person bleaches their teeth or considers any other procedure, is to continue to maintain a good, healthy relationship with their dentist.

"That relationship's important because small things are easy to fix," he said. "If you wait a long time, you make things really hard to fix. When it's harder to fix, the higher the cost."

T&D Staff Writer Dionne Gleaton can be reached by e-mail at dgleaton@timesanddemocrat.com or by telephone at 803-533-5534. Discuss this and other stories online at TheTandD.com.

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