In the News

Tooth Whitening

First impressions are important, and one of the first things people notice is your smile. Because of this, many consumers are considering tooth whitening to achieve a whiter, brighter smile. However, there are a variety of tooth whitening products on the market today, both in-office and at-home, so how do you know which option is best for you?


Do I need to see a dentist before whitening my teeth?
YES! Whether you chose an in-office procedure at the dentist’s office or an at-home application kit, the first step is to consult with your dentist. They will provide a complete exam, including X-rays, to make sure you are a suitable candidate for tooth whitening and help you select the best option to meet your needs. If even the slightest bit of decay is present, whitening could cause irreversible nerve damage and lead to the need for a root canal.
I want to whiten my teeth, what are my options?

Over-the-counter whitening strips – These typically yield a very subtle lightening of the teeth.

Over-the counter whitening toothpastes – While these will not change the natural color of teeth, some contain a special chemical or polishing agent to help more effectively remove stains from the tooth’s surface.

Prescription bleaching kits – Dispensed by a licensed dentist, these kits contain peroxide(s) that will bleach the tooth enamel. They contain higher levels of carbamide or hydrogen peroxide than their non-prescription counterparts. Peroxide whiteners typically come in a gel and are placed in a tray similar to a mouthguard. By obtaining the bleaching solution from your dentist, he or she can make a custom-fitted tray specifically designed to fit your teeth. Poorly fitting trays can cause gingival irritation and tissue burning.

Zoom whitening (power whitening) – This in-office procedure combines a high concentration of hydrogen peroxide gel with a high intensity light used to whiten the teeth. The cost is approximately $600 and results typically last about three years.

How white can I get my teeth and how long will it take?
Results depend upon several factors, such as the beginning shade of the teeth. Discolored teeth that have a brown, yellow or grayish hue may not yield a full whitening effect. Teeth with a grayish hue also may take more applications to produce a noticeable change. Keep in mind that bonded teeth, tooth-colored fillings, crowns and veneers cannot be whitened.
What are the possible side effects?
Tooth and gum sensitivity can occur, but is more likely when over-the-counter products are used because of the higher pH levels generally found in over-the-counter products. If your teeth become sensitive after having your teeth whitened, a professional fluoride treatment is often helpful in relieving any sensitivity. Though your gums may become sensitive after tooth whitening, this is normally a short-term side effect that will subside within a few days.
There is a tooth whitening kiosk in my local mall. Is it safe?
NO! Tooth whitening procedures, outside of those readily available for over-the-counter purchase by the consumer for self-use, should be performed only by a licensed dentist within a registered dental office. The Pennsylvania State Board of Dentistry is developing a policy statement that will help provide more guidance by clearly defining tooth whitening as the practice of dentistry. This approach will ensure that the patient’s specific dental needs are being properly addressed by an individual who is trained and licensed to diagnose and identify possible complications that could occur due to inadequately performed procedures.

Fluoride and Infant Formula Frequently Asked Questions (FAQ)

To whom does the interim guidance apply?
The recommendations apply only to infants (ages birth to 12 months).
What is the ADA’s interim guidance on infant formula and fluoride?

The ADA’s interim guidance contains recommendations to simply and effectively reduce fluoride intake from infant formula:

  • Breast milk is widely acknowledged as the most complete form of nutrition for infants. The American Academy of Pediatrics recommends human milk for all infants (except for the few for whom breastfeeding is determined to be harmful). Babies who are breastfed do not appear to exceed the optimal amount of fluoride.
  • Ready-to-feed formula is preferred over formula mixed with water containing fluoride during the first year of life to help ensure that infants do not exceed the optimal amount of fluoride intake.
  • Powdered or liquid concentrate infant formula can be mixed with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis. Examples are water labeled purified, demineralized, deionized, distilled or reverse osmosis filtered water. Many stores sell these types of drinking water for less than $1 per gallon. Some, but not all, home water treatment systems also remove fluoride from tap water, so check with the manufacturer. Parents and caregivers should consult with their pediatrician, family physician or dentist on the most appropriate water to use in their area to reconstitute infant formula. Since some children may have special medical needs, ask your pediatrician or physician whether water used in infant formula should first be sterilized.
Why was the interim guidance on infant formula and fluoride issued?

Recent developments led the Association to offer interim guidance on infant formula and fluoride while more research is conducted. These developments include the U.S. Food and Drug Administration’s health claim notification October 14 , 2006 allowing bottlers to claim that fluoridated water may reduce the risk of dental cavities or tooth decay, but not make the claim for bottled water products specifically marketed for use by infants, and the March 22 release of the National Research Council (NCR) Report: “Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.”

Studies cited in the NCR Report have raised the possibility that infants could receive a greater than optimal amount of fluoride through liquid concentrate or powdered baby formula that has been mixed with water containing fluoride during a time when their developing teeth may be susceptible to enamel fluorosis.

Infants (ages birth to 12 months) need less fluoride than everyone else because of their size. While more research is needed before definitive recommendations can be made on fluoride intake and reconstituted formula, the American Dental Association issued interim guidance so parents, caregivers and health care professionals who are concerned have some simple and effective ways to reduce fluoride intake from reconstituted infant formula.

Why do we need fluoride?
The proper amount of fluoride throughout life helps prevent and control tooth decay. Some fluoride exposure to developing teeth also plays a long-term role in preventing tooth decay.
What is enamel fluorosis?
The appropriate amount of fluoride throughout life is essential to prevent tooth decay. But it’s possible to get too much of a good thing. Fluoride intake above the recommended level for a child’s age creates a risk for enamel fluorosis, a condition that affects the way teeth look. In the vast majority of cases, fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel and does not affect the function of the teeth.
When are teeth at risk for developing enamel fluorosis?
Enamel fluorosis occurs only when the teeth are under the gums and still developing.
Does enamel fluorosis worsen after the teeth erupt?
No. Once teeth are fully developed and erupt into the mouth they are no longer susceptible to enamel fluorosis.
Can I use my tap water, which contains fluoride, to mix infant formula?
Water can contain fluoride in varying amounts. Consult with your family physician or pediatrician to see if this is the most appropriate water to use. After their first birthday, children can drink infant formula mixed with water that contains fluoride because they weigh more and formula is no longer a primary part of their diet.
What about “ready-to-feed” formula?
Babies who drink “ready-to-feed” infant formula do not appear to exceed the optimal amount of fluoride. For infants who get most of their nutrition from formula during their first 12 months, ready-to-feed formula does not appear to increase the risk of enamel fluorosis.
What if my child occasionally received formula mixed with water containing fluoride?
If your infant was fed formula mixed with water containing fluoride, it doesn’t necessarily mean that the child will develop enamel fluorosis. Occasional use of water containing optimal levels of fluoride should not appreciably increase a child’s risk for fluorosis.
Is fluoride present in breast milk?
Breast milk is very low in fluoride and does not appear to contribute to enamel fluorosis even if the mother uses oral care products that contain fluoride and drinks water containing fluoride.
What if my pediatrician recommends bottled water?

The U.S. Food and Drug Administration Link opens in separate window. Pop-up Blocker may need to be disabled. (FDA) announced in October 2006 that it will allow bottlers to claim that fluoridated water may reduce the risk of tooth decay. The ADA agrees with the FDA that this health claim is not intended for use on bottled water marketed to infants for whom lesser amounts of fluoride are appropriate. The right amount of fluoride is essential to help prevent tooth decay. But fluoride intake above optimal amounts creates a risk for enamel fluorosis as teeth develop before they erupt through the gums. The ADA’s interim guidance contains recommendations to simply and effectively reduce fluoride intake from infant formula reconstituted with water containing fluoride.

Water labeled as purified, distilled, deionized, demineralized, or produced through reverse osmosis is known to be low in fluoride. Most other types of bottled water contain low fluoride concentrations but variations exist and some brands may contain optimal or higher levels. If you have questions about the fluoride content in the bottled water you use, check the label or contact the bottler. Because some children may have special medical needs, ask your family physician or pediatrician whether water used for infant formula should be sterilized.

How can I help my children benefit from fluoride use while keeping an eye out so they won’t get too much?

The ADA has long-standing recommendations concerning fluoride use. One of the most important things to remember is that if children are younger than six years old, an adult should supervise their use of fluoride-containing dental products.

Fluoride Toothpaste
When children’s teeth start to appear, brush them with a child’s size toothbrush. Do not use fluoride toothpaste until the child is two years old unless advised to do so by a dentist or other health professional.

For children age two and older, place only one pea-sized amount of fluoride toothpaste on the toothbrush at each brushing. Young children should always be supervised while brushing and taught to spit out, rather than swallow the toothpaste. Many children under age six have not yet fully developed their swallowing reflex so they may be more likely to accidentally swallow fluoride toothpaste.

Fluoride Mouthrinse
Unless advised to do so by a dentist or other health professional, the ADA does not recommend the use of fluoride mouthrinses for children under six years of age. Many children under age six have not yet fully developed their swallowing reflex so they may be more likely to accidentally swallow fluoride mouthrinse.

Where can I find more information about fluoride?

You can find extensive information in “Fluoridation Facts,” the ADA’s comprehensive publication with facts from over 350 scientific references. Fluoridation Facts includes information from scientific research in an easy to use question and answer format on the topics of effectiveness, safety, practice and cost-effectiveness of fluoridation.

Additional Resources

A-Z Topic: Fluoride & Fluoridation

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