The craze to whiten teeth in Ghana in recent times is unbelievable. Everybody wants teeth as white as snow. Several home remedies such as the use of baking soda, coconut oil, charcoal powder, apple cider vinegar, sea salt, lemon juice and wood ash are being marketed to whiten teeth on various social media platforms. But do they work? Is there any evidence-based literature to support these claims?

Tooth whitening is defined as any process that makes teeth appear whiter. This can be accomplished through the physical removal of surface stains or through a chemical process called tooth bleaching. In some literature, the terms tooth whitening and tooth bleaching are used interchangeably.

To commence the journey of tooth whitening, one must appreciate the natural color of teeth and understand the causes of tooth discoloration. A tooth has 3 parts: The outer-most layer termed enamel, followed by an underlying layer termed dentine and an innermost layer termed pulp. The enamel is translucent, meaning light can pass through it but one cannot see through it. Dentine is slightly yellowish and this color is revealed through the enamel. This generally gives the tooth an off-white, light yellow or light grey color depending on the thickness and translucency of the enamel, as well as the density of the underlying dentine.

Tooth discoloration could be as a result of an accumulation of stains on the tooth surface over a period of time (extrinsic discoloration) or due to an absorption of pigment particles into the tooth structure (intrinsic discoloration). Extrinsic forms of discoloration include poor oral hygiene, accumulation of dental plaque and calculus, deposition of tannins found in coffee, tea, wine and certain beverages unto the teeth, tobacco stains from cigarette, pipes and cigar and topical staining from the long-term use of certain mouthwashes such as chlorhexidine gluconate-based types. Intrinsic forms of discoloration include the use of certain dental fillings (eg. amalgam restorations), tooth decay, trauma to a developing tooth which produces a subtle grey-to-black color, infections during childhood, long-term use of medications such as tetracycline, minocycline and doxycycline during childhood, nutritional deficiencies during childhood (vitamins C and D, calcium and phosphate), genetic and hereditary diseases, and also the excessive ingestion of fluoride during childhood (fluorosis).  

Dental treatment of tooth discoloration involves identifying the cause of the discoloration through a thorough history and examination at a dental clinic. One treatment option may not suit all the causes, so it is very important to seek a professional opinion from your dentist first. Professional teeth cleaning (scaling and polishing) is one of the major modalities to remove extrinsic stains from the teeth followed by effective toothbrushing and flossing twice daily. To prevent further staining, a diet and habit change approach is very necessary since some foods, beverages and habits such as smoking can discolor the teeth. Other modalities of treatment for tooth discoloration include the use of tooth-colored dental fillings (composite), use of dental veneers or crowns and bleaching of teeth.

In the next part of my teeth whitening series, I will take you through the types, process, indications and contraindications of tooth bleaching.

Thanks for reading.

Stay connected to the Vine. Stay Gorgeous and Stay Professional.

Credit: Dr Michael Awua-Mensah

(@Dr_Awua on Instagram)

A member of the Ghana Dental Association (GDA)