How to Whiten Your Teeth Like a Dentist
Guest Post from BowTiedGator, DDS
I made my own whitening strips! Pick up PRISM Whitening Strips today:
Here we go again - another installment of Misc. Aesthetics!
In this series, I explore various avenues to improve your appearance outside of skin and haircare.
In the first installment, we learned about hypertrophy from BowTiedHeifer.
Today, I’m delighted to introduce a new Jungle member to you all today - Gator DDS.
He’ll take it from here to teach you everything you need to know about teeth whitening.
Background
Let’s start off by acknowledging the elephant in the room; I’m a dentist, the person you probably have deep-seated psychological trauma from when you were a kid.
Maybe you had some infection that took you to another dimension, maybe you got some crazy 5 figure quote from a dentist, or it could be that one dentist told you that you have 47 cavities but another one told you that you have one.
Regardless of your thoughts of dentistry and dentists as professionals, here’s the bottom line…
Your teeth fucking matter.
Smile, and people make snap judgments about your teeth.
Don’t smile, and people will make subconscious assertions about your personality and character.
Remove smiling from the equation, your teeth are visible even as you speak.
So your options are to wear an N95 mask for the rest of your life, or stay a while and maximize the teeth you’ve been given.
Don’t believe me?
Take a look at this [redacted] Facebook meme below:
Let’s disregard the cheesy-ness of this picture and focus on the message because it’s true.
A healthy, bright smile demonstrates vitality to those you interact with.
Bad teeth signal to others that you are unwell and slovenly.
Harsh but true.
The focus of today is not going to be drilling into your head (see what I did there) the importance of dentistry in general, but now that I have your attention and maybe elicited a bit of awareness of your teeth, let’s talk about teeth whitening aka bleaching.
We’ve been seeking white teeth as far back as 3,000 B.C when the ancient Egyptians abraded their teeth with ground pumice stone and vinegar.
Even the Egyptians knew white teeth signaled health and wealth, still with me?
Then, a few thousands years later, the Ancient Romans gargled human urine to whiten their teeth, because the ammonia in the urine gave a whitening effect.
Luckily for you, you don’t have to crush up stone and scrub your teeth with liquid sandpaper to get white teeth (unless you use charcoal toothpaste, but that’s for another time), nor do you have to swish with your own urine.
Here you are, in the year 2022 with lots of technological advances at your disposal to get those pearly whites to become *actually* white.
Whitening products are almost all peroxide-based.
This was discovered by accident in the 80’s when some periodontist was trying to get an antiseptic effect on the gums and noticed the surrounding teeth got whiter.
Alright enough about the history of whitening, let’s get into how it works.
Understanding the Stain
You have two kinds of stains: extrinsic and intrinsic.
Extrinsic stains mean the stains are on top of the tooth whereas intrinsic stains are embedded within the structure of the tooth itself.
Intrinsic stains
Intrinsic stains are pretty tough to treat with whitening.
It’s usually seen with the prime example of tetracycline staining (meaning your pregnant mother took tetracycline and your enamel was formed with chromogens), or with a tooth that has “died” and the non-vital tooth darkens.
Check the images below for reference.
Exhibit A: Tetracycline staining.
This is pretty individual, as some patients have very mild amounts and others have severe staining.
This example is moderate-severe but they all have this component of “layering” to the color gradation of the stain, like the lines on an oak tree (that could be a completely wrong analogy but I’m not going to check if it’s true, you get the idea).
Exhibit B: A dark tooth from a dead nerve (non-vital), likely due from trauma or a tooth that received a root canal and never got a crown.
Tetracycline staining is pretty resistant to whitening, but I’ve seen examples of it providing an aesthetic result.
Non-vital darkened teeth need to be whitened from the *inside* of the tooth, rather than the outside.
You can almost see in that dark tooth photo that the outer layer is white, but the inner layer is what’s causing the darkness. Whiten at your own risk.
Extrinsic staining
Extrinsic stains stubborn stains and can range from colored food items like coffee and red wine to something like cigarette smoke.
These are the stains you want compared to intrinsic staining as they are easier and more predictable to resolve.
All this really begs the question: How do teeth get stained though?
Look, it’s complicated.
Teeth are kind of like bones, but not really.
They’re mouth bones, just deal with it, ok?
They have a pretty unique structure that forms a lattice of a mineral called hydroxyapatite.
This can be analogous to the way a cotton tee shirt is woven and has little spaces between the threads.
Stains get in between this lattice network of “threads” and visibly appears as stain.
With that said, anything that will stain a white cotton T-shirt will stain your teeth over time.
That means red wine, berries, coffee, cigarette smoke.
Everyone has different propensity and risk factors to staining, but this is just how it works.
You’ll see all these buzzfeed style articles that will tell you:
“Drink with a straw!”
“Brush your teeth after eating!”
“Oh wait, don’t brush your teeth after eating!”
“Rinse with water after you eat!”
I’m not going to be some kind of denta-nazi and tell you to deprive yourself of any semblance of a normal life, but keep these things in mind if you find your teeth stain at a different pace than the average population.
At the end of the day, these “tips” are the same as every headline that says “Wait, eggs are killing you!”.
Followed by an article titled “10 reasons why the oldest living man in history attributes his long life to eating eggs every day”.
The media will do anything for clicks, and it’s in your best interest not to get caught up in the nonsense.
Keep it simple: if your teeth are chronically getting stained and you’re tired of using whitening products, search your diet and habits for things that are contributing to staining.
If you have to whiten your teeth once every few years, don’t waste the mental real estate trying to carry a straw with you at all times. Don’t let click-hungry media outlets feed your OCD.
Before we get into whitening methods, let’s all be on the same page about something: your teeth can be stained before whitening but they HAVE TO BE CLEAN.
Otherwise you’re just going to be minimizing the real estate in which the whitening interacts with the tooth.
Any superficial gunk or plaque on the teeth have to be removed. The image below is considered “dirty” rather than stained.
Peroxide-based Whitening Systems
Peroxide based whitening systems are effective because the stains bonds get broken up.
The chromogens (aka stains) get attacked by the peroxide molecule, and the stains wash away.
We understand this mechanism, but we actually don’t understand much in the grand scheme of things why certain people have phenomenal results and others can sit there with a peroxide gel for hours and barely bump up a single shade.
Now, there are two types of peroxides these whitening systems use: the classic hydrogen peroxide we all know and love and carbamide peroxide.
The latter is a modified version that’s a bit more stable.
Hydrogen peroxide packs a stronger punch and exerts the majority of its whitening power within the first hour.
Carbamide peroxide on the other hand has about half of its whitening power in the first two hours and can continue to whiten for up to six hours. One is not better than the other; they are just used differently.
If you have stained teeth, you really want a peroxide based product. Whitening toothpastes, despite their advertising claims don’t really whiten the teeth via peroxide, but we’ll get to that later.
You pretty much have two types of peroxide whitening systems: At-home strips/gel (i.e., Crest Whitening Strips) and in-office whitening, which functions similarly to the at-home systems but with way more strength.
The brands below are simply the more popular names.
At the end of the day, if it’s got hydrogen peroxide or carbamide peroxide, it’s more or less the same stuff.
There are certain disciplines of dentistry that swear by a specific product, but I’ve used most of them, and the difference in efficacy comes down to the individual rather than the product.
I would personally choose a product based on strength and price rather than brand.
Here’s the mental framework for understanding tooth whitening formulas:
In Office Systems
Philips Zoom - 25% hydrogen peroxide gel placed on the teeth in 20 minute intervals accompanied by a blue light (the blue light does absolutely nothing)
Opalescence Boost - 40% hydrogen peroxide gen placed on the teeth in 20 minute intervals
KöR - 34% hydremide peroxide (we didn’t talk about this one). Let’s take a minute to talk about KöR. There’s a bit of a cult regarding this whitening system. Dentists that use it are very adamant about it and have a bit of a superiority complex. The system claims to have “dual activated tai-barreled hydremide peroxide” and has a strict at home protocol that follows the in office treatment. They have special trays that are apparently better at keeping your saliva out of the way for the at home portion. They claim that the production process is superior in every way to preserve the unstable peroxide material, and that it’s designed to provide the highest strength with the least amount of sensitivity. Basically, it’s your dentist’s dentists whitening system. Prepare to pay up for this stuff. Look, I’m sure there are people out there consistently getting results with a slight edge on whitening power and reduced sensitivity. For me, it’s not worth the hassle for a minor edge. People may disagree with me and that’s fine. If you want the “on paper” best possible product, this is the one for you.
Sapphire - 25% hydrogen peroxide placed in 30 minute intervals.
Basically, you go into a dental office and pay anywhere from $300-1,500. Park your ass in the chair, ideally with headphones in.
A dentist, hygienist or assistant will come in and put some stuff on your gums to prevent the gel from going on your soft tissue (it burns).
And will paint on the whitening gel on the teeth.
They will likely use a blue light, but you don’t need it.
Every study that claims the blue light helps is a study you should use to start a fire in your backyard.
The blue light doesn’t work, you don’t have to read the science because I did it for you.
You may notice that your teeth are sensitive towards the end (the visit usually lasts around 2 hours).
That’s normal.
In fact, it’s the only real world side effect of tooth whitening.
This is what blasting your enamel with peroxide does.
It feels like little lightning bolts in your skull.
It’ll pass.
No pain, no gain.
There isn’t really a rule of thumb for avoiding sensitivity when it comes to whitening.
Some people get it, some don’t, some get it really bad, others have mild sensitivity.
Either way, treat it like a hangover: pop a Motrin and ride it out.
It’ll last a day or two.
They make some hydroxyapatite toothpastes which will provide some sensitivity relief, but don’t be a baby, it’s not that bad.
After your visit, you really want to avoid those food/drinks that will stain a white T-shirt as mentioned earlier.
In the 3-5 days after a whitening, your teeth are pretty susceptible to staining, so avoid things like berries, smoking, red wine and coffee.
A little common sense goes a long way on this one.
Certain in vitro studies (aka not real life) will show whitening damaging the internal tooth structure, damage to the nerve of the tooth, and mineral degradation.
These side effects aren’t really seen in “the field” so I wouldn’t sweat it unless you’re getting your teeth whitened once a month.
At-Home Systems
Crest 3D Whitestrips, Snow Magic Strips, Zimba Whitening Strips
Whitening strips work.
It’s not a scam, I promise.
The only difference between the stuff you can buy over the counter compared to the in-office systems is the strength of the peroxide gel.
When the strong peroxide gel gets on the gums or cheeks, it literally burns the tissue.
That’s why the in-office system has your cheeks spread all the way out and you look like you came off the set of a horror movie; it’s by design so the gel doesn’t obliterate your gums.
When using the whitening strips, they make it a little foolproof by dropping down the concentration so when you get some on your gums, it doesn’t burn as much.
Even still, try to keep it off your gums and only on the teeth.
The other consideration with a lower strength at-home solution is that you may need to leave it on longer and do it a few times in a short burst to notice the same effect as in-office treatment.
You may notice a lot of the at home whitening kits come with a light. Same thing with the in-office treatment applies: the light doesn’t do anything but make you feel like you’re doing something extra.
It’s a waste of time and probably money too.
DIY Whitening?
Look, I wouldn’t recommend this route, but given the demographic of people reading it, I decided to include this.
Sure, you can make your own whitening gel/paste.
I wouldn’t do it personally, but you can if you were so inclined.
Take some 3% hydrogen peroxide, make a slurry with some baking soda (not too gritty) and GENTLY brush your teeth, and let it sit for a few minutes before rinsing out.
You don’t want to do this regularly as it’s quite abrasive and will damage the cells in your gums and soft tissues.
Like I said, I wouldn’t do it, but if you’re really on hard times, you could.
“Whitening” Toothpastes
Some whitening toothpastes will have peroxide in them.
I’m not denying that.
However, they have such a low amount.
In addition the peroxide is a naturally unstable component in the toothpaste, and it doesn’t sit on your teeth long enough to have a measurable effect.
The way whitening toothpastes “whiten” is back to the ancient Egyptian method of abrasion.
They increase the grit of the toothpaste and essentially whiten your teeth by scraping off the superficial enamel layer.
Before we move forward, we need to understand the concept of RDA which stands for Relative Dentin Abrasivity.
That’s a fancy term for “this is the scale for how much your toothpaste is like sandpaper and wears away your enamel”.
You really want a toothpaste with a low RDA number, which is low abrasivity.
Check out the chart below:
By taking a quick glance, most of the whitening toothpastes have high RDA.
That’s by design, and the primary method of action.
The problem with this method of “whitening” is that you can only do it a certain amount of times since you’re given a finite amount of enamel.
This is the same method in which charcoal toothpaste “whitens”.
If you took sandpaper to your teeth, they’d be white too, because you’re scraping the utter shit out of your teeth, and while you’re eliminating the stain, you’re taking perfectly good enamel with it.
Now, whitening toothpastes aren’t as abrasive as charcoal toothpaste, or pumice like in Ancient Egypt, but it’s not something you want to do long term.
Generally, I prefer toothpastes with very low abrasivity, and if you want to whiten, take a peroxide-driven route.
The toothpaste is only on your teeth like 4-6 minutes per day if you combine morning and night time brushing, it’s not whitening with that little amount of time on the teeth.
Whitening mouth rinses are similar but without the abrasivity.
There’s just a low concentration of an unstable peroxide molecule.
You may see a whitening effect after 3-6 months, but who has the time for that?
Not me. It’s also a great way to set your hard earned cash on fire.
Non-peroxide but non-abrasive???
There’s this new Australian based company called Hismile, and they use this technology called PAP+.
You may have seen the ads on social media: it’s purple, and they claim it whitens with NO SENSITIVITY GUARANTEED.
I included this brand in its own section because I haven’t decided if it’s genius or the stupidest thing I’ve ever heard.
The ruling is still out.
Either way here’s what they did: It’s pretty simple actually.
There’s no sensitivity because there’s no peroxide….and it’s not abrasive.
What they did was utilize the mechanics of the color wheel and visual illusion.
Let’s say your teeth are yellow. Take a look at the color wheel below…
What’s opposite from yellow?
PURPLE.
These mfers took the opposite color on the color wheel and made a paste/gel out of it.
So essentially, they are staining your teeth kinda purple, hoping it mixes with the yellow to create an optic effect of white.
Apparently people are happy about it, so it can’t be the worst thing. Besides, it’s not damaging to the teeth.
Give it a shot if you like, and let me know how it works for you.
I can’t help but feel that this “technology” is really just a loophole rather than true whitening power.
Anyway, I digress.
There are probably some things that I overexploited in this write up, and maybe a few things I didn’t touch on enough.
You can contact me via DM if you have further questions, and maybe Fawn will accept my insanity and let me write another segment on her fawntastic substack.