Oral Health Group

How White is White??

March 1, 2004
by Janice Goodman, DDS

I was having a great day. I just finished tray bleaching my teeth post-ortho, and I demo-ed a shade scanner. The results came back that my front teeth were now basically A1-B1 from the original C3 shade. This made me feel just great about them, and since I was going to the Crown and Bridge Study Club that morning, I was all smiles. At lunch I sat down at a table beside two high profile cosmetic dentists who knew I had just completed orthodontic treatment. “Let’s see your new smile”, one of them said. I proudly complied, and they both said the same thing, in unison, “now, you just have to bleach”. OUCH! “Are you kidding, I just had them scanned and they’re already A1-B1”. “Janice, you need to bleach more”.

It turns out that they were right. The two scans are shown on page 4, after an additional in-office power bleach with the Saphire light, I have removed the bit of chroma that was remaining at the cervical collar and there is no question that they look better. But this got me thinking about how and why the standard of white with respect to tooth colour has changed in the past few years. The evidence is overwhelming that the status quo is getting whiter: companies are scrambling to create new porcelain bleach shades (more than 30 that I found–although some look similar), the new small particle hybrids all have bleach shades, higher value shades or colour enhancer components. Bleaching systems are ubiquitous and their costs are coming down. All, these developments have allowed dentists to be able to render this whiter smile, but I think the movement is largely being fuelled by outside forces that the dental profession has no control over.


The bar of “natural beauty” is being raised across the board by advancements in technology at a record pace. The “look of perfection” is an illusion that people are trying to attain. Plastic surgery, dermatology, laser eye surgery have all developed new technologies to keep up with market demands. The cosmetic industry has introduced airbrush-on makeup for that flawless look. The dental profession has new materials, veneers, bleaching and Invisilign.

I think the media-TV, print and movies-are the driving forces behind the increased cosmetic demands we experience in the office. Television shows such as Extreme Makeover, Nip/Tuck, Skin Deep for the way you look, Facelift, Queer Eye for the Straight Guy, all these new reality and dating shows are not being shown on the Learning Channel or The Women’s Network, they are on prime-time cable. They’ve taken over from the sit-com genre and if you’re watching TV you are getting saturated by shows that affect your ideas about how you want to look.

Magazines and advertising are even bigger culprits than television. They create impossible, digitally enhanced images that the public then interprets as an acceptable standard. You are not seeing real people in ads anymore. Photo enhancement is big business and there are agencies that specialize in this. Close to 100% of all media print pictures have some photo-enhancement. This technique goes beyond whitening the eyes and teeth. They can smooth the skin, erase errant hairs, deepen shadows or add high lighting to create contours, intensify shine and colours, soften lines and enhance eye colour to name a few commonly used tools. Bernadette Morra in a December Toronto Star article claimed that magazines were not altering body parts beyond shading, but Crystal Siemans, a Canadian clothes designer, says she saw a New York photo-enhancement company actually shaving off bodies to slim them further. Skinny models being made even slimmer on a routine basis? Eating disorder professionals must be cringing. La Senza, Victoria’s Secret, Abercrombie, the cosmetic industry…these companies have the formula down pat. What man can wander into these stores without considering purchasing one of their posters? They are absolute works of art. (And they are absolutely not for sale–my husband tried to buy one for my son’s college dorm.)

You know most of this, so what’s my point? I think that a majority of patients would consider dental aesthetic enhancement, but in a fashion that is not too obvious, there are also patients who wish their enhancements to be obvious and still others that have next to no interest in their looks. Most patients are aware of photo-enhancement and media manipulation, but not all of them. When your patient asks for “white, white” teeth–you’d better think twice before prescribing the “toilet bowl” white that is in the picture they brought in from the whitening strips ad. I know a dentist that had a “white, white” request from a patient, who had to redo the entire case of bleach shade porcelain restorations, after the patient saw it in her mouth. There is a new spectrum of white available and each individual patient will have their own idea of where they want their teeth to fit into it. It will take a lot of talent to satisfy each individual patient on this issue, and I can see it being a challenge for many dentists.

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