Part One: Whitening for Teens

Proms, graduations, vacations and other photo-op moments are on the horizon for you – and spurring you to consider a smile makeover. Whitening today is easier than ever, and you may be motivated by those brilliant smiles on magazine covers and even on your friends and schoolmates.

If you’ve mentioned the idea of having your teeth whitened to your parents, you’ve probably heard this question: Is it safe? You may have wondered about it yourself. So is it?

The straightforward answer: It depends. Although teeth whitening solutions can produce good to excellent results, they can also produce side effects, and may not always give you the outcome you expected. Here are some things to consider when making a decision.

You can be too young – and the issue isn’t safety, it’s appearance. According to the American Academy of Pediatric Dentistry, younger teens who don’t yet have all their permanent teeth (unusual, but it does happen) risk whitening that mix of permanent and primary teeth and ending up with mismatched teeth —artificially whitened next to newer arrivals that are naturally colored. Matching them later can be tricky and expensive.

Also, permanent teeth in younger teens often have not fully emerged from the gums. So you could end up with teeth that are noticeably whiter near the biting surface than near the gum line – not an attractive look. Another concern is that whitening kit instructions need to be carefully followed. If you are not fond of reading directions closely, or tend to use whitening treatments more often than directed, you could cause irritation, painful tooth sensitivity—or even damage to the enamel or pulp of a tooth.

For the most part, these problems are usually resolved by the time you are 16 to 18. So, I generally recommend that you wait until that age before deciding whether or not to whiten. I urge my teen patients who are considering whitening first to come in for a brief (and free) exam. During the exam, our team checks the maturity of teeth; looks for problems, such as irritated gums, that should be resolved before whitening; and offers advice on whitening options.

Healthy young teeth are most often naturally white (emphasis on natural) without artificial brighteners. The friends and schoolmates whose smiles you’ve been studying may be doing nothing more complicated than regular brushing and flossing to maintain those bright healthy smiles. At your next dental exam, ask to check your smile against your dentist’s shade guide. You may be surprised to find that your teeth are naturally right up there on the whiteness scale. If beverages or foods that you favor have actually stained your teeth, try giving them up temporarily. After a week or two, if regular brushing hasn’t brightened your smile, try over-the-counter whitening toothpaste, preferably one recommended by the American Dental Association.

Most importantly, be aware that whitening is not a replacement for brushing and flossing. The same habitual care that keeps your hair shiny and your skin glowing works wonders on your teeth. Here is a routine that will keep your newly whitened teeth healthy and sparkling:

• Clean your teeth well twice a day, after breakfast and last thing before you go to sleep at night
• Use a small toothbrush with soft bristles to protect enamel from scratching and dulling, and gums from damage
• Use fluoride toothpaste. Spit, don’t rinse to keep protection working
• Cut back or cut out enamel-staining drinks
• Choose water as your main drink. Tap water is best because it contains fluoride to harden and repair enamel
• After eating, rinse your mouth with water to stop plaque build-up.
• Definitely don’t smoke! It darkens and stains teeth.

Next Time: Professional Whitening

By Robert S. Leland, DMD
You may not be aware of it, but your mouth is an excellent indicator of your overall health. Dental practitioners now know that as many as 90% of serious systemic problems elsewhere in the body, such as heart disease and liver disease, can trigger abnormal conditions in the mouth. In fact,one of the major concerns in dental medicine today, both in research and practice, is diabetes. The American Diabetes Association estimates that currently 25.8 million Americans are diabetics – but that isn’t the whole of it. Statistics from the Centers of Disease Control and Prevention estimate that some 79 million more Americans over 20 years of age have what is called pre-diabetes – blood glucose levels that are higher than normal but not yet high enough to be defined as true diabetes. Many of those people will likely develop a variant called Type 2 diabetes within 10 years.
The interrelationship of oral health to diabetes is vital issue for dentists, since it’s been shown that diabetes and the mouth have a common link in blood sugar. If, for any reason, blood sugar levels are out of control in your body, then blood sugar levels in your mouth likely will be out of control as well. The diabetic body either does not produce enough insulin or produces cells that “resist” insulin. Since insulin enables your body to break down sugars and starches from food into glucose—blood sugar—and transports it from the blood into cells used as energy, any deficiency of insulin is going to cause glucose to build up in the blood.
When that happens and blood glucose levels rise to abnormal levels, a long list of ensuing complications can result. In the dental chair, one such development is rampant tooth decay. With all that uncontrolled blood sugar to feed on, bacteria in the mouth find a receptive home in which to thrive and multiply. They will likely attack a tooth’s protective enamel layer. Eventually, the enamel breaks down, allowing decay to develop. Similarly, uncontrolled blood sugar levels reduce the body’s first line of defense against infection — white blood cells — which puts oral health at risk in another way: glucose-fueled bacteria teeming around the gums opens the gates to periodontal disease. Gum disease produces infection and inflammation that can actually fuel diabetes, making it harder to control.
Tooth and gum problems can happen to anyone, of course, and they don’t necessarily portend diabetes or its predecessor. Our team here in Hanover depends on regular examinations and cleanings to look out for symptoms that may signal budding problems. We check for red, sore, and swollen gums; bad breath; a bad taste in the mouth; loose or sensitive teeth; bleeding gums; gums pulling away from your teeth; a bite that feels different, or
dentures that no longer fit well. Any of these, especially in combination with known diabetes risk factors, are red flags for me, as well as for our team of hygienists. Since statistics show that members of a dental team usually see a patient more often than any other healthcare provider, we are best equipped to monitor you. If your visits are regular enough, our team can often detect oral signs and symptoms of pre-diabetes or diabetes even before blood testing or physical examination has confirmed the diagnosis.
We’ve all heard the drill for good oral-health care: have a dental checkup at least every six months and regular cleanings two or three times a year. Moreover, if you are overweight, underactive, have diabetics in your family or have been diagnosed with pre-diabetes – you have a powerful motivation for checking in regularly. Keeping us updated on your medical history, changes in your condition, and modifications of medications provides us with diagnostic tools to target and treat problems in the early stages.
You can – and should – use regular visits to talk about issues that impact your health. Even some that may seem to be outside the purview of dentistry. Don’t be afraid to ask us questions like these:
What problems should I look for that could signal a systemic problem or disease? What type of information does my dentist need to know about my health history to evaluate my oral health?
How do my oral health habits — how often I brush and floss and with what tools and techniques — affect the rest of my body, not just my gums and teeth?
Your dental team is one of your best allies. A recent study of diabetics in the Journal of the American Dental Association found that those who received regular dental care reduced both their diabetes-related ED visits and hospital admissions significantly.Whether you are pre-diabetic or simply healthy-and-committed-to-staying-that-way, the connection between good oral health and whole body health is one of the most important reasons to maintain a routine of regular dental care. Stay with it and you’ll enjoy not only a healthier smile, but a healthier body as well.