How to Brighten Your Smile with Anne Clemons, DMD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host.

How important is a brighter smile for people? Let's put it this way, the ancient Romans mixed goat milk with urine — yes urine — in their quest for whiter teeth. So it has been a big deal for a long time. Thankfully, teeth whitening products have advanced a bit over the past millennia. You'll now find numerous products on store shelves promising the pearliest of whites. But what's the option that brings the most sparkling results? We'll try to answer that question today with the help of dentist Anne Clemons. Dr. Clemons is one of the many experts at Cleveland Clinic who visit our weekly podcast to offer tips you can use to live better. With any luck, you'll be able to increase the wattage on your smile after hearing what she has to say.

Welcome to the podcast, Dr. Clemons. Thanks for coming in to talk teeth.

Dr. Anne Clemons:

Thanks for having me. I'm always willing to talk about teeth.

John Horton:

And our topic today is how to make those teeth whiter. And it seems like that's the human quest that no doubt began with the invention of the mirror. I guess, we've always been consumed with the idea of getting a more perfect smile.

Dr. Anne Clemons:

I mean, I think it's a pretty obvious reason. One of the first things … if you go in to meet someone or look in the mirror, one of the first things you're looking at is that smile. It can make such a wonderful first impression or a not-so-great first impression. So naturally, we want to be at our best, and one of the cool parts about what I get to do is I get to help that. I get to help people look their best, feel their best, and getting a nice, beautiful smile is a big part of it.

John Horton:

All right, well that's what we're going to work toward today. But before we get into all those ways that people can whiten their teeth, let's spend a few moments going over how our chompers get so discolored over time. Is this just like a natural byproduct of life?

Dr. Anne Clemons:

In some ways, it is. A lot of the things that naturally happen can contribute to teeth getting darker or changing color. With time, we tend to use our teeth … the teeth can wear down. As we wear down that outer surface of the tooth — your enamel tends to be the nice, beautiful, pretty part of the tooth — if we wear that down, then we start to see a darker or yellow or shade to the tooth. It's because we're starting to see that dentin in the inner part of the tooth. So it can happen with time and with age. The other thing is the things that we do every day, like eating and drinking can stain our teeth. A lot of the best things, like coffee and tea and red wines, are the big offenders.

John Horton:

Yeah, that's not good.

Dr. Anne Clemons:

Some of the not-so-great habits also like tobacco can have a big part in darkening our teeth. Even some medical conditions, some medications or some developmental disorders. There's so many different things that can change or affect the color of your teeth.

John Horton:

Just once, I want to hear that aging brings some giant health perk, where everything gets better and it never seems to work that way.

Dr. Anne Clemons:

I know. Maybe wisdom, we get more wisdom, but-

John Horton:

…Well, there we go. We can hope.

So now, we've kind of gone over how our teeth start looking a little bit dingy. Now, let's figure out how we're going to fix that. So it seems like most teeth-whitening products on the market kind of have a bleaching mechanism of some sort.

Dr. Anne Clemons:

Right. The sort of bleach that we see, the sort of product that's really doing bleaching, the whitening of the tooth, isn't the same sort of bleach that you would use to like whiten your clothes. What it really is, is called hydrogen peroxide. Sometimes, you'll see it in your bleaching product is actually called carbamide peroxide, but that carbamide peroxide breaks down to hydrogen peroxide. So that's really what we're talking about. That hydrogen peroxide actually has the ability to break down these molecules, these stained molecules inside of your teeth, they break them down to kind of smaller pieces. As it does that, that color gets less concentrated and the net effect is that your teeth get brighter.

John Horton:

That's amazing how it gets in there and it just kind of breaks down, I guess, the colors or the molecules. You don't think of it as molecules causing the discoloration.

Dr. Anne Clemons:

You don't.

John Horton:

It's kind of a weird way to think of it.

Dr. Anne Clemons:

You think about the coffee or the tea…

Yeah, it is very cool. It can get very technical, but the bottom line, we're just breaking down these big, discolored compounds into smaller ones that end up looking nicer.

John Horton:

Now, I always hear that baking soda gets tossed in there, too. Is that kind of like in the same realm?

Dr. Anne Clemons:

It's not doing quite the same sort of thing as something that's truly bleaching the tooth. Baking soda can be helpful. One of the ways that baking soda can help, though, is a little bit different than this bleaching and really changing the color of the tooth. It can actually be kind of a mild abrasive. So some of the tooth whitening that we're doing isn't really bleaching the tooth, it's just making the tooth look whiter. Baking soda is one of the sorts of things that does that by removing what we call an external stain. So a stain that's on top of the tooth, not really inside of the tooth.

John Horton:

So it kind of rubs it off, I guess, for lack of a better word.

Dr. Anne Clemons:

Yeah, exactly.

John Horton:

A little sanding going on.

Dr. Anne Clemons:

Yeah, gentle sanding.

John Horton:

So, I mean is one of those agents better than the other?

Dr. Anne Clemons:

That's a really good question, and one that is going to be individualized. We talked about there's a lot of different reasons that your teeth can be stained or that your teeth can look stained. Sometimes, teeth are stained because there's plaque and there's tartar buildup. Sometimes, teeth are stained because of a medication, sometimes, they're X, Y, Z. So knowing what's going to work the best, you kind of have to know what's causing the stain, and sometimes, it's both. Sometimes, it's getting the outside stain removed maybe with a mild abrasive, like a baking soda-type toothpaste. But if we really want to change the color of the tooth, we really want to be bleaching that tooth. So something like a wide number of these bleaching products may be more effective for that.

John Horton:

And I feel like we need to mention this here, but I take it you shouldn't just use 100% hydrogen peroxide or baking soda on your teeth.

Dr. Anne Clemons:

Exactly.

John Horton:

This isn't where you go rummage through your cabinet and pull that out and start brushing it on, right?

Dr. Anne Clemons:

Exactly. Even with our ADA-approved, really, really well-developed products, there's some risks with those. But they're carefully formulated to make sure that they're safe to use on your teeth, they're effective to use on your teeth. Something like just grabbing an ingredient from the cabinet is going to have a lot more risk involved and probably won't be as effective. You definitely want to look for a product that's designed for the purpose you're trying to use it for to make sure that you're going to get the most out of it and do it safely.

John Horton:

And obviously, anyone who's been in the dental aisle at the store recently, you see whiter teeth claims on products just on every shelf. How effective are those sorts of products?

Dr. Anne Clemons:

Yeah, so depending on what the source of the stain is, they can have varied effects. So one of the big ones that you tend to see is a lot of toothpaste now, like I mentioned, say whitening or stain removal sort of things, and they can be helpful. A lot of toothpaste, really most toothpaste, have some level of abrasiveness, some level of that kind of grit to help scrub away some of that staining. And it can be helpful depending on what your stain is. If you've got a decent amount of stain on the outside of the tooth, regular use of a toothpaste like that, you can start to see and notice a difference over time.

The other thing we tend to see are things like whitening rinses that may have some of those bleaching products in there. This is something that you're just rinsing over the tooth. It isn't going to be in contact with the tooth for a lot of time, but if you really stick with it and you really use it regularly, you start to see, again, a shade, or maybe two, difference in the tooth, but it tends to be a while before you see that.

John Horton:

And how drastic can the results be? I mean, are you going to go from really discolored to pearly whites? Or is it just kind of, you'd make it a little bit better?

Dr. Anne Clemons:

When we're talking about those kinds of just over-the-counter toothpaste, mouthwash sort of things, we're looking more at gradual sort of changes. Typically, you'll see a little bit of a difference. The teeth will look a little bit cleaner, it'll look a little bit brighter, but we're typically not making those drastic changes from a pretty dark tooth to a really nice bright one. Tends to be more gradual.

John Horton:

What about whitening strips? Because I know that's another type of product that you hear about a lot. Are those worth giving a shot?

Dr. Anne Clemons:

Yeah, so whitening strips are a little bit different. The whitening strips tend to be more in that category of products that are looking to really whiten, really bleach the tooth, and so tend to contain your carbamide peroxide or your hydrogen peroxide. The way you use them varies based on the concentration in that specific strip. So it's really important to read the instructions on that box and follow them really carefully. But if you're persistent with those and you're reusing them regularly, you can get some real shade difference in the teeth. Something important to note is that what you can get over the counter — the sort of whitening strips that you can just buy at the store — are going to tend to be a lower concentration of that type of bleaching product versus something that you may see at your dentist's office or that you may get from your dentist.

John Horton:

And in searching online, I saw references to something called “oil pulling.” What is that and does it work?

Dr. Anne Clemons:

So oil pulling is something that has become more popular recently but isn't something new. Oil pulling is really an ancient traditional folk remedy most commonly associated with places like India or Southern Asia. Essentially, what oil pulling is, is taking some form of edible oil, most commonly sesame, olive, sunflower or coconut oil, but putting maybe a tablespoon or so of that oil in your mouth and then swishing it around, rinsing around the mouth, for some kind of prescribed period of time. That amount of time can vary a lot. Sometimes, it's … you see recommendations for just a couple minutes, but it can be 20 minutes or even longer. And-

John Horton:

…That's a long time.

Dr. Anne Clemons:

It is a long time.

John Horton:

That's a very long time.

Dr. Anne Clemons:

It's a very long time, and unfortunately, we don't really have any evidence that it's effective at all. Certainly not for whitening the teeth or really any big noticeable difference in oral health. We don't really have any evidence that it's harmful but don't have good evidence that it's really going to make a big difference in the sort of things we're looking for.

John Horton:

Well, it sounds like that kind of falls in this whole DIY remedy category, which I know there's always things, when you go online, you see people talk about apple cider vinegar. And you eat pineapple or strawberries or activated charcoal. I mean, there's a lot of these sorts of things that are thrown out there. Are any of those effective or are they just kind of online myths that just exist?

Dr. Anne Clemons:

They tend to be more in the category of a myth. They tend to not be effective but can go even further and can really be harmful. Some that you mentioned, like the apple cider vinegar or other sort of fruit-based acids, can be pretty harmful. If we're eating fruit regularly or having vinegar in a salad dressing or something like that, that can be great, and can be super healthy. But if we're applying that fruit or that acid to the tooth, especially for a long period of time, that acid's going to break down the tooth structure. And specifically, it's going to attack the enamel first. And as we mentioned earlier, the enamel is that nice outer beautiful white coloring of the tooth. That acid is going to break down that enamel and thin it out and then, you're just going to start to see the darker yellower dentin underneath, and it's going to be less healthy for your tooth, but it's actually going to make it look worse, too.

Something kind of similar can happen with the charcoal sort of things that you mentioned. And we don't have good evidence that activated charcoal is going to be healthy or helpful in oral care, oral health, but it can be abrasive, it can be something that can also be pretty aggressive to the tooth structure. And in a different way than acid, but to a similar effect, it can wear down the enamel and thin the enamel out. So now we're, again, less healthy and with a less aesthetic tooth.

John Horton:

Yeah, I'm so glad you brought up those dangers because I think, all of us, you think of your teeth, and they really seem pretty indestructible. I mean, we chew on a lot of stuff. We've all had those hard candies, things like that, and you don't think of them as being harmed or something eating away at them. But it sounds like if you put the wrong stuff on them consistently, you're going to have some issues.

Dr. Anne Clemons:

Yeah, you really can. And those kinds of natural or DIY sorts of things can seem harmless because it's something that you may just have in your cabinet or have around otherwise. But yeah, with time, it can be something that can be really impactful.

John Horton:

Now, so far, we've been talking about the things you can do at home to try to make your teeth a little whiter. Let's shift to your office. And if we come in and see you, what kind of magical things do you have to get our teeth a little better? I'm guessing you have some better products than what we have available to us.

Dr. Anne Clemons:

Yeah, we have some similar things and kind of similar methods but kind of bumped up. The first thing is that we are going to do a really thorough, really good, investigation of everything that's going on with the teeth. And that has to be No. 1 because you got to know, are the teeth healthy? Are the guns healthy? What's going on? Are things like cavities going on or other really big health conditions that may be part of why the teeth don't look good? So we can get that baseline first. We can get the teeth healthy, we can do a professional cleaning. So really, getting all of the outside stain off, the plaque, the tartar, all of those things, get those off of there. Even just those first two steps can be a really huge change to how the teeth look and how white they look.

Though, after those first steps, if we find that the teeth are still not the shade that we want them to be or the shade that they could be, we want them to be whiter, now we're going to be looking at really bleaching those teeth. And the sort of approaches that we have in the office are similar to what you might be able to do at home, but again, are kind of bumped up. So the tooth bleaching that we'll do in the office is a higher concentration of that peroxide than you would get over the counter. So the steps for that process are a little bit different. The first thing that we're going to do is either the dentist or the hygienist that's doing the bleaching for you is going to protect your gums. That higher concentration of peroxide can be pretty uncomfortable and cause some pretty significant sensitivity and irritation to the gums.

So there are a number of different things that they can use depending on the bleaching product we're using. But a gel or like a rubber shield will go over the gums. Then, we'll apply the bleaching product to the teeth and we'll let that sit for ... it kind of depends on the amount of time based on the product — maybe 30 minutes, could be longer. That bleaching product will go on there, then we'll clean everything off, and that may be it. Sometimes, after an in-office bleaching, you may be done. Often, we'll send you home with some kind of touch-ups sort of strips or bleaching trays that you would use to kind of continue that process a little bit.

John Horton:

So I take it these results with this sort of treatment are going to be a little more dramatic than what we're going to get at using the at-home products.

Dr. Anne Clemons:

Yeah, this can be because it's such a significant increase in concentration, it's a much more dramatic and much more instantaneous sort of result. So we can walk in one shade and walk out … and it can be a pretty significant change in the tooth shade.

John Horton:

That's amazing that you can have that in, it sounds like, 30 minutes or hour-long visit and just completely change your smile.

Dr. Anne Clemons:

Yeah, it's really cool. It really is. And one of those instant gratification sorts of things we get to do sometimes.

John Horton:

So we've been talking about the good things, which is that brighter smile. Can these whitening efforts cause any dental issues or concerns?

Dr. Anne Clemons:

The big things to be aware of that are really common to happen with any sort of bleaching in-office or at home are some temporary sensitivity to the tooth and some irritation to the gum. Both of those tend to go away pretty quickly, within maybe a few days, and are really pretty darn reversible. Beyond that, we don't really have evidence that there's going to be any long-term damage to the teeth, but with anything, we want to exercise caution.

There are some studies that are done in the laboratory — so not something that we necessarily have measured in the mouth — but some lab studies that show that if you do enough bleaching over time, we may get some changes to the tooth. Some kind of roughening of the tooth surface, maybe increasing the risk of that tooth breaking down kind of demineralizing, some changes to dental restorations and some sorts of things. So with anything, we want to be aware of what we're doing and have caution with the bleaching.

John Horton:

Does that fit into — because I swear I heard at some point that if you whiten your teeth or do that, they're more prone to get discolored again. I mean, does that ... or am I just repeating an urban legend that really shouldn't be uttered a lot?

Dr. Anne Clemons:

Yeah, not necessarily, really, but I think what happens is, maybe as you're whitening your teeth, you kind of become more aware of the color of the teeth and then changes in that tooth and the sorts of things that tend to get a tooth stained to start or the teeth pain to start, unless you change those habits and like I say, stop drinking the coffee, stop drinking the tea, it's just going to come back again. So you may notice that and you may notice it happen quicker than it happened the first time because you're more aware of it now.

John Horton:

Is there anybody who should avoid going in for teeth whitening?

Dr. Anne Clemons:

The first step really for thinking about whitening teeth really should be checking in with your dentist. If you don't have a dentist, getting established with someone and getting a good baseline, really want to make sure that if we're doing something like bleaching for teeth, that they're healthy, they're in a really good place, and they're ready for bleaching. If people have really sensitive teeth, like we mentioned, that bleaching can make even a tooth that feels OK to start to feel sensitive. If your teeth are already sensitive, that can be tough to add bleaching on top of it. If people have active gum disease or have teeth that have already got worn down enamel or untreated cavities, those sorts of things make you not a candidate for bleaching. Need to make sure that those are taken care of ahead of time.

John Horton:

So if someone wants a brighter smile, and I think we all do, what steps would you recommend we take?

Dr. Anne Clemons:

It can all start at home. The first things that are going to make the teeth look better and either remove some staining or prevent staining are keeping the teeth really clean. So brushing the teeth twice a day, cleaning in between the teeth, typically with floss once a day. You can try some of those ADA-approved products like the toothpaste or the mouth rinses, but making sure you're limiting foods that we know cause some staining, like those coffees, teas, wines, really kind of heavily pigmented foods, and especially not smoking or using tobacco.

Beyond that, get in with your dentist, visit your dentist for checkups, cleanings, and tell your dentist, "Hey, I wish my teeth were whiter. This is what I want to change about my teeth." Your dentist wants to have that conversation with you. They'll be able to tell you what products might work best for you or what other sort of suggestions they may have.

John Horton:

You make that seem like a pretty doable game plan, Dr. Clemons, and it's just a great note to end on. But before we do say our goodbyes, do you have anything else to add about teeth whitening and whether it's worth pursuing?

Dr. Anne Clemons:

I think teeth whitening is something that can be so impactful, can be such a big part of giving you a bright, beautiful smile. But white teeth should be a sign of really good healthy teeth. So hopefully, that's something that's going to inspire you to take care of your teeth. Have a great relationship with your dentist to help maintain your teeth, maintain that beautiful smile and maybe improve it, if we can do a little bit of bleaching, a little bit of whitening, too.

John Horton:

All right, well I'll tell you, on that note, I'm going to promise you I will floss tonight. It'll be a big step. We'll make sure we get that in and don't put it off till tomorrow.

Dr. Anne Clemons:

Today, tomorrow, every day. It's perfect.

John Horton:

Dr. Clemons, thank you so much for joining us today and I look forward to having you back on.

Dr. Anne Clemons:

You're welcome. Thanks for having me.

John Horton:

Focusing on your oral health a few minutes every day won't just help your gums and teeth, it can protect your whole body, including your heart. So invest the time, and you may brush away some big-time health worries.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

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