So, you’ve decided to seek the glamour of a movie star…
Years of drinking coffee, tea, or other dark colored beverages — or even smoking — have darkened your teeth, and spurred the urge to get them whitened.
According to the American Academy of Cosmetic Dentistry, it’s the single most requested cosmetic dental procedure by people of all ages… and the numbers are growing by a staggering 25.1% a year. The Academy also notes that the number of whitening and bleaching procedures has increased more than 300% during the 5 years from 2002 to 2007.1
So it’s popular, for sure. But is it good for your health? We looked into it. . .
Two processes for whitening your teeth
A “whitening” process can work in one of two ways…
- It can bleach the tooth, meaning it actually changes your natural tooth color. Bleaching products contain peroxides that help remove both deep and surface stains.
- Non-bleaching products contain agents that help remove surface stains only — by either physical or chemical action.
Whiteners can either be administered by dentists or purchased over the counter (OTC).
Do-it-yourself OTC whiteners, as you might assume, are a lot less expensive, but require more effort. They consist of very thin, almost invisible, strips coated with a peroxide-based gel. You apply these strips for 30 minutes twice daily over the course of two weeks. Final results last about four months. These strips contain 10 percent carbamide peroxide.
Professionally administered whiteners are the quickest route to whiter teeth, and are sometimes combined with heat, light or laser treatment. You can get dramatic results during a single one-hour appointment, though it’s often repeated several times.
This kind uses a hydrogen peroxide solution ranging from 15 to 35 percent. The practitioner protects your gum tissues with a rubber dam, or a protective gel.
There are also whitening toothpastes available on the market. They contain polishing or chemical agents (instead of bleaches) to remove surface stains.
The ADA ‘Seal of Acceptance’ — should you trust it?
All whitening products carrying the American Dental Association (ADA) Seal of Acceptance contain 35 percent hydrogen peroxide. However, there is no requirement demanding this concentration.
In water, carbamide peroxide breaks down into hydrogen peroxide and urea. Other ingredients may include glycerin, carbopol, sodium hydroxide, and flavoring agents.
A couple things to note here…
First, the ADA is reluctant to give its seal of approval to do-it-yourself OTC products. The association’s viewpoint is that only dentists should administer tooth whiteners — “because professional consultation is important to the procedure’s safety and effectiveness”.
Their “Seal of Acceptance” should perhaps make you as a consumer just a bit skeptical when coming from an organization that has been promoting poisons like mercury fillings and fluoride for more than half a century. We published our opinion on their shenanigans in a Special Report called The Secret Poison in Your Mouth.
Big dangers, little dangers…
According to the ADA, the most common side effects from either hydrogen or carbaminde peroxide are tooth sensitivity and gum irritation.
Tooth sensitivity is likely to occur mostly during the early stages of bleaching… and tissue irritation is often from a poorly-fitting tray that holds the whitener. Both are said to be temporary and to cease after treatment.
On rare occasions though, irreversible tooth damage has been reported. And the treatment is often ill advised for patients with many fillings, crowns, or very dark stains.
In sum, this is the ADA position: There have been a few problems, mostly minor, and the procedure is generally safe. As you may have guessed, there are other opinions.
Drugs.com advises that all medicines may cause side effects — and while whiteners typically cause no side effects, potential severe side effects are possible with carbamide peroxide solutions — rashes, hives, itching, breathing difficulties, chest tightness, and swelling of the mouth, face, lips, or tongue.
But wait… it may be worse than that. Not to imply that breathing difficulties, chest tightness, or uncontrolled swelling or hives are minor…
Britain warns of the dangers of whiteners
It seems to have been kept hush-hush in the States, but four years ago, Britain warned all dentists and beauty salons in Gateshead of potential dangers from tooth whitening products… after discovering that many of these products contain dangerous chemicals such as hydrogen peroxide and carbamide peroxide far in excess of permitted levels.
That level in the UK is only 0.1%. But some products were found to have levels as high as 10.0% — a staggering 100 times the permitted level. Another product was found to be 60 times the permitted level.
Officials are very concerned about finding products that breach safety guidelines by 60 to 100 times.
It’s a cosmetic, not a drug. . .so they say
Meanwhile, in the United States, tooth whiteners are classified as a “cosmetic”, not as a drug (even though they contain chemicals), and are therefore unregulated. So it’s “buyer beware”.
Dentist Martin Fallowfield — spokesperson from the British Dental Association — warns that some home tooth whitener kits contain the same acid used to disinfect swimming pools, chlorine dioxide.
And, it’s not always listed on the label.
He says the chemicals destroy your tooth’s protective enamel… they obtain their whitening effect by etching your tooth’s surface.
This causes sensitive teeth, and in extreme cases can lead to tooth loss. It can also lead to chemical burns on your gums (furthering your risk of tooth loss).
Ironically, it also can cause further discoloration due to the destruction of your protective enamel, making those teeth more easily stained by food or drink.
Furthermore, if the mouth guard containing the bleach fits poorly, your gums will be exposed for an extended time… causing soft tissue burns, irreversible gum recession, tooth decay and sensitivity.
If you swallow the chemical while the trays are in your mouth — which is very easy to do — you can also burn your throat, stomach and gut.
Whitening toothpastes may seem like an harmless alternatives to the procedures I’ve just described. But they often use abrasive ingredients such as sand to polish stains off. They’re less risky in one way — no chemical burns or gum recession — but they can damage teeth.
New warnings about long-term damage to teeth
Unfortunately, no one quite knows the long-term effects of the popular bleaching products, regardless of where they’re administered.
Andrew Eder, professor of restorative dentistry and dental education at UCL Eastman Dental Institute (UK), says, “Teeth are porous, so whatever you put on the enamel, and especially on the deeper dentine, may have an effect deep inside the tooth over many years.”2
He suggests using products short term only, never on an ongoing basis — and only if you feel you must.
On top of all the other problems,
whiteners may cause cancer
In 2004, WebMD ran an article suggesting the possibility of tooth whitening products leading to oral cancer.
They pointed to Georgetown University Hospital researchers who say the active ingredient in popular whiteners may be the reason two young people in their 20s with no other markers for cancer developed advanced tongue cancer. This is very speculative, and one case doesn’t make a conclusion.
But whiteners are one of several possible explanations for an increase in oral cancers among young people. Under normal circumstances, almost all victims of oral cancers are older folks with bad habits that clearly contributed to their disease.
Ninety percent of oral cancers strike people over age 45 who are long term smokers or drinkers.
But still, some doctors question whether the blame should be pointed at tooth whiteners or to some other exposure.
Bruce Davidson, MD, FACS, chairman of otolaryngology-head and neck surgery at the Georgetown hospital, suggests it may be linked to the carbamide peroxide — one-third of which is composed of hydrogen peroxide. Further, carbamide peroxide changes into hydrogen peroxide when used as a whitener.
Peroxide was shown to promote cancer growth inside the cheeks of rodents and to cause GI cancers when ingested. I found no reports of human testing on this.
So, the theory goes that when hydrogen peroxide gel leaks from the trays into your mouth, it releases free radicals.
At least one doctor says, “Think twice”
Dr. Davidson told WebMD, “If I was in the market for teeth whitening, I’d think twice about it.”3
Davidson reported at the 6th International Conference on Head and Neck Cancer the cases of two patients who developed advanced tongue cancer decades earlier than would be normal… after repeatedly using tooth whitening products.
Both patients drank only occasionally. One was a light smoker; the other didn’t smoke at all.
They were part of a group of 19 oral cancer patients (of all ages) studied by Davidson’s team of head and neck cancer surgeons.
Two of the six patients who developed oral cancer prior to age 40 used tooth whiteners. And both had more advanced cancer than the others, despite not smoking or drinking more heavily. A middle aged man with tongue cancer also used tooth whitening polish. But the others did not use any bleaching products.
The medical community’s opinion…?
Terry Day, MD and director of head and neck oncologic surgery at Hollings Cancer Center at the Medical University of South Carolina and spokesperson for the American Academy of Otolaryngology-Head and Neck Surgery, says we should pay attention to this study… because of the huge spike in consumers seeking a movie star smile, and the rise in oral cancers in young people, especially cancer of the tongue.
However, the small size of the study doesn’t provide enough support for a final conclusion that tooth whiteners are carcinogenic.
Davidson’s study is believed to be the first to consider a link between cancer and tooth whiteners.
Meanwhile, the ADA says there’s no evidence that tooth whiteners increase cancer risk or cause other problems (though they admit that some people do abuse them).
Of course, dentists have much to gain if whiteners can be proclaimed as “safe”, given the huge boon in their whitening cosmetic dentistry business.
Whiteners applied by dentists cost upwards of $200. A customized tray is used, theoretically reducing the risk of hydrogen peroxide leakage. But Davidson reports studies that show that less than 50% of the whitener is still in the tray one hour after application, representing significant leakage. It’s a clear hint that customers are ingesting the stuff.
Until we get more data indicating whether or not whiteners are definitively linked to oral cancer, I’m inclined to stick to my toothbrush and organic toothpaste. Just for the record, my dentist advised me against whiteners long ago because of the damage they do to the enamel, and I’ve followed his advice. I just live with my yellowed, old-dude teeth.
Your addiction to glamour could have unwanted consequences — and it may be years before we can say for sure.
Meanwhile, industrial society keeps producing other wonders. Our last issue wrote about one of them — a prostate cancer treatment for which you need the most expensive medical machine ever made, one that requires a building as large as a football field. If you missed this doozy, click here to read it now.
3From WebMD Medical News, Friday, August 06, 2004.