​

Evo Terra (Host): This is Jamaica Hospital Med Talk. And I'm your host, Evo Terra. Today, Dr. Harold Biller will talk to me about teeth whitening, covering what works, what doesn't work, and what's safe. Thanks for joining me today, Dr. Biller.

Harold Biller: I want to thank you for having me. I'm happy to be here.

Host: Well, let's talk about teeth whitening versus cleaning. In fact, I think that's where I want to start. What's the difference between just getting my teeth cleaned like I did yesterday by the dentist or by the dental hygienist and actual teeth whitening, which I've never done?

Harold Biller: So, teeth cleaning removes surface stains that are on the teeth, like from food or we go over and we drink colored liquids like wine or Coca-Cola or coffee, that sort of thing. So, it just gets surface stains. While teeth whitening, you're trying to remove food stains that have been absorbed into the tooth structure itself, into the enamel covering of the tooth. So, you're trying to get something that's deeper that a polishing or even a whitening toothpaste is not going to remove. So, teeth whitening, you're trying to get deeper into the tooth to make it bring out more of its natural white.

Host: That makes sense. And I mean, I was going to say, why do people want this? But, obviously, you know what? We want it, we want our teeth to look white and shiny and whatnot. If we avoid things like a coffee and tea and red wine, will we have bright, shiny white teeth forever?

Harold Biller: So, yes and no, because there's no question that even after, let's say you do a professional teeth whitening, you have to go over and be careful about those colored foods to go over and keep them white. But don't forget that the enamel that you're given wears overtime, just the thickness of the enamel that determines how white the tooth is. Enamel tends to be translucent. And underneath the enamel layer is dentin, which is very yellow. So, the thicker your enamel, the whiter your teeth. So, a lot of it has to do with genetics—how you're born—with how white your teeth are to begin with.

But then, over time, as you use them, they tend to get yellower because you get stains, you get stains that are deeply embedded into the enamel, and you also get wear of the enamel, which allows more of the yellowish dentin to show through. So, there's a limit to how white you can get your teeth, based on how you were born.

Host: That makes sense. So, as the enamel wears, you see the yellow is coming. So, let's just put more enamel on the teeth. That's clearly the right answer, right?

Harold Biller: Oh, well, you can't exactly put enamel on teeth. That's the problem. If we could, we wouldn't need filling materials. The answer to that though, sort of is, you know, if you see like the models of the stars on TV who go out these absolutely unbelievably white teeth as white as a piano key, part of that is because you're not looking at their natural teeth. If you're looking at teeth that have replaced enamel, they have what are called veneers that are bonded onto the front of teeth. Those you can make, wow, as white as a piece of paper, okay?

But then, it's an expensive process and you are changing the tooth. And that's different than just trying to whiten in order to go over and bring out the natural color of the teeth with a minimal amount of involvement of changing the actual tooth structure, and also at a reasonable cost.

Host: And I definitely have seen that those brilliant white teeth that just look like they're illuminated underneath. They've really, really gone far.

But let's stick with, you know, getting our teeth to our natural color again. I mean, there's a lot of treatments out there, right? We've talked about, you know, going crazy and adding these veneers to them, but there are professional treatments out there. I can buy a store-bought kit. Every other commercial, it seems to be, you know, for some teeth whitening thing. I guess I can go get this whitening done at the mall now, which is weird to me. Help me understand all of that. How do these things compare both in results and more importantly, I guess, safety?

Harold Biller: So, let's look at that. So, the easiest and least expensive way is to go out and, like, buy something like Crest Whitestrips, okay? Which they go and they say, "Oh, we'll go over and whiten your teeth nine shades," or whatever. The strips are nice. They're relatively inexpensive. They're safe because they're made by a brand that you know. So, you know that Procter and Gamble's not going to give you something that's going to be dangerous. It all works based on using hydrogen peroxide. Hydrogen peroxide, as you well know, is a bleaching agent. So, you're using it to bleach the enamel of the teeth to make them whiter. So, the strips are nice. You put them on and they will whiten somewhat. But the nine shades on the shade guide that Procter and Gamble uses is very little change in white. It's a very choosy shade guide they use. So, that's number one.

If you want to get a more intense whitening process, you can go to the dentist where he is going to make what are called custom trays. The trays are made to fit like gloves over your teeth very, very accurately. And then, they give you a gel to place in the trays. And you go and wear these trays either for an hour at a time, over a night, depending on the strength of the hydrogen peroxide they're using, And that, because it holds the material intimately against the tooth and prevents saliva from diluting it out, it tends to go over and give you a much more intensive white reaction than the strips. But don't forget, there's a limit to how white it can get based on the thickness of your enamel. It's not going to whiten the dentin underneath. It's just going to go over and remove the stain from the enamel. So, that's important. So, those are the two biggest things. Then again, there's some dentists will add light to it. Research has really shown the light doesn't do anything. So, I think that's a waste.

I would not go over and have bleaching done in the mall, because there are some companies out there that sell this hydrogen peroxide with acidic content in it, because they know that if you go over and add acid to the tooth, you'll be able to go over and get a more intense reaction. But the acid could burn your gums and can actually lead to more tooth decay. It actually weakens the enamel. You want to use a neutral-based solution. You don't want to use something that's acidic. So, I don't think the mall is a good idea.

So basically, you know, don't forget also there's whitening toothpastes or all the whitening mouthwashes. They do really pretty much nothing, okay? It's a very nice way to add it, but if you look at the ingredients in the box, it says active ingredients and the active ingredients, there's nothing there about whitening. So, it's just a more coarse way to brush your teeth. It's not going to really do too much.

So when it comes to real whitening, we're talking about more like the strips over-the-counter, or a dentist making custom trays, which simply gets you a much, much better result. But don't forget, the other question we get is, "How long will it last?" So, that's up to you.

So, two things. Number one, if you're a person that goes over and drinks coffee all day long, or has wine every night with dinner or smokes tremendously, their teeth are going to darken down much, much faster than somebody who does not. That's why a lot of models, after they get the veneers, they don't even drink coffee directly in their mouth, they use a straw. They want to protect their investment, they want to make they're not staining the veneers, okay? So, this is not like a one-time thing and you're going to forget about it. You have to do maintenance. It's like coloring your hair. You can color your hair, but then it's going to grow out, it's going to get gray again.

The same way with this, your teeth are going to darken down no matter what you do, because you eat. Not everything you eat is white. That's the way it is. So if you go over and you have the trays around, down the road, you can always just go over and touch it up. And we go over and we tell you to do the home trays. So, we tell them do with 14 applications over two weeks. But then, let's say three months later, your teeth are getting dark again. Do one application as a maintenance just to bring it back to where you were. So, you will always have to be doing maintenance for the rest of your life to go over and keep them where they get to.

Host: But those trays should last.

Harold Biller: Exactly, that's why it makes sense to get the trays. You get the trays, and they'll probably be able to use them for years, okay, before they wear out or they get bent or a teeth movement and they no longer fit. And that's a nice way of doing it. That's why I like doing the trays. A lot of dentists offer this office whitening where they do everything once without the trays. It's nice, it works, but what do you do for the maintenance? So, the custom trays are the way to go, in my opinion.

Host: Let's talk about safety for a second, and I'm remembering back when I was a child—and that's been a while—my mother had this stuff called—I think it was called Pearly White. It might have been the name of this toothpaste. That is what I thought it was, but it turns out it's just an abrasive. And my dentist said, "Why, 12-year-old boy, are you using that? That's not necessary." So, let's talk about safety of some of these kits. Obviously, the trays and doing things at your dentist, that's the safest route to go, but let's talk about other challenges.

Harold Biller: How about some myths about whitening, okay? An example. When you're talking about toothpaste, a number of companies are pushing charcoal-based toothpaste. Charcoal goes over and absorbs different things, okay? So, it helps to absorb some of these colors. Charcoal is extremely abrasive. So if you don't mind brushing your teeth away, it's not really going to work, because it's going to actually brushing the enamel away and your teeth going to look yellower, not whiter. Literally brushing the enamel away. A very, very bad thing to try. All these teeth whitening toothpaste that are out there, that what they count on for this whitening is basically they're a little bit more abrasive. And there are lists you can find online of what's the most abrasive toothpaste, and what's the least abrasive toothpaste.

Then again, there are people depending on what type of toothbrush they use. That's an important thing. Also, you should always be using a soft toothbrush. I cannot tell you how many people I've seen who have damaged their teeth and their gums by brushing grooves into both using a hard toothbrush.

Some people feel their teeth are not really clean unless they scrub them tremendously. It really is quite damaging. It is amazing. You can be strong enough, you can actually brush the tooth away, so you don't want to go crazy like that. You just want to try and remove the bacteria and some of the stain. So, the hydrogen peroxide is going to whiten much, much better than, let's say, a toothpaste or a mouthwash.

Host: Got it. Are there certain people who are not good candidates for teeth whitening?

Harold Biller: Well, that's questionable. I would say that almost anybody is a candidate. There's discussion about the fact that, in theory, it doesn't work on crowns or on bridges or on veneers. But yet, I did have this one patient. There's like 10 veneers on his front teeth. And he felt they had turned the yellow and he insisted that I do the bleaching on him. And I said, "Listen, let's try it. There's nothing to lose. It can't damage it." And it worked. It actually did whiten the veneers brought it back to the original whiteness.

So, I don't think there's anybody who's really not a candidate for it, except—I should say there is one thing, there is a side effect that comes along. Everything has side effects, right? Okay. So even with a whitening, you are going to get tooth sensitivity for a while afterwards, anywhere from like a day to a week to even two weeks. Your teeth get very, very sensitive to cold. I tend to go over and have my patients use sensitivity toothpaste for two weeks before they whiten their teeth just to try and prevent that sensitivity.

So, that is one thing you should be aware of. You might have some sensitivity after the whitening, because the hydrogen peroxide also dries the teeth out a lot, and that leads the tooth to be very sensitive.

Host: Okay. Got it. Now, earlier you mentioned that we have to do maintenance, right? Even if we get them done the right way with these trays and doing the bleach whitening, the hydrogen peroxide bleaching in the dentist's office, at some point in time, they're going to darken again. What's the timeframe for that? Are we talking weeks, months, years?

Harold Biller: Again, it depends on the person's eating habits. Most people, it'll be months. There are certain people, the people who smoke two packs of cigarettes a day, they're going to be doing maintenance once a week.

Oh, the other thing I forgot to mention is this, when it comes to the trays—so we recommend, let's say, doing 14 treatments over two weeks. But let's say at the end of those 14 treatments, you're saying, "Oh, I'd like to know if I get the teeth a little whiter." You can keep doing it. Do it for 21 treatments over three weeks. Well, maybe your teeth will get whiter. So, you can push it and see how white it is. It's not going to damage the teeth if you decide to do more, okay?

But getting back to our maintenance, it depends on what people eat. Really, what it comes down to how much staining they're going to tend to go over and put themselves to. You know, like I mentioned before, the models drink everything through a straw, anything has color, just to make it so they don't have to do the maintenance, okay? But it's up to what you do, okay? It's sometimes some people just want to do it, let's say, have a wedding coming up. So, they'll go in and whiten their teeth because they want just for the wedding. And it's good to have—let's say, you can do this maintenance whenever you want to.

Host: Yeah, that is kind of handy.

Harold Biller: One person's yellow is another person's white, and one person's white is other person's yellow. That's the other thing, you know? I mean, how white do you want your teeth? It's up to you. So, some people want them whiter, some people just want them a little bit whiter.

Host: All right. So, we've covered a lot of ground here. And it's been a great conversation. I want to ask you this last question. And it's just overall, right, for everybody who's been absorbing everything we've been talking about, what advice do you want everybody to kind of take away from this and remember before choosing any of these methods?

Harold Biller: So before choosing anything matters, first of all, make sure your mouth is healthy. Make sure you don't have cavities. Make sure you don't have gum disease. It's more important than getting your teeth white, okay? Because you don't want to keep your teeth for a lifetime. That's the most important thing. So, going over and doing that.

After that, if you have healthy teeth, you don't have any cavities, you don't have gum disease, whiten, okay? No question. Everybody wants to look good, especially in today's society. Why shouldn't you also? There's no reason why not. And if you feel really enough about it and you want to invest money, go for the veneers. Go over and make your teeth really super white, okay? It's what's going to help your ego, what's going to help yourself feel good about yourself. Why shouldn't you feel good about yourself and your appearance? But at the same time, stay healthy.

Host: Always exceptional advice. Dr. Biller, thank you very much for all of this information today.

Harold Biller: Thank you so much for having me, Evo. I really appreciate it.

Host: Thanks once again to Dr. Harold Biller for his time today. That concludes this episode of Jamaica Hospital Med Talk. For more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts. Thanks for listening.

All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnoses, or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast episode.