Oh, the never-ending quest for perfect teeth, healthy teeth but most of all -- white teeth.
In the past few years, a proliferation of products promising to help consumers have the whitest teeth possible -- sold by everybody from dentists to beauty salon owners -- has entered the market.
Welcome to the era of "toothpaste wars," says Dr. Howard Strassler, an associate professor at the University of Maryland's department of restorative dentistry.
"Just take a look at store shelves today," says the dentist and researcher who has studied the industry since the mid-'80s. Besides the usual toothpaste with fluoride, there's baking soda toothpaste, tooth whiteners, tooth bleaches, smokers' toothpaste, tooth polishes and "upscale" toothpaste in fancy boxes that costs about $10 a tube.
But the ever-expanding spectrum of tooth products occupying shelves and competing for consumer dollars has gotten a little confusing -- and controversial.
So much so, that the U.S. Food and Drug Administration is currently investigating over-the-counter tooth products, particularly those containing peroxide and acid, a spokesman says.
"The FDA at one point issued a warning letter to companies that their products were being reviewed for safety concerns," says FDA spokesman Mike Shaffer.
"Although they are under review, companies can still legally market the products," Mr. Shaffer says.
In the meantime, the one consistent opinion from dentists and researchers is: Consult a professional you trust about what product -- if any -- is best for you.
On the other hand, manufacturers of tooth whiteners and bleaches argue that dentists who disapprove of their products are only concerned about losing business.
In grocery stores, department stores and beauty salons around Baltimore there are stain-fighting brands to be found such as Rembrandt's Whitening toothpaste and Carter Products' Pearl Drops tooth polish.
And consumers are hurrying to whiten up. Beauty salon owner Cindy Kirby, of Hair Today For Tomorrow in Towson, has recently added toothpaste -- a whitening brand that contains no peroxide or acid -- to other beauty products she sells.
"It certainly ties in with the total look. I use it all of the time and I have quite a few customers buying it who are pleased," she says.
Some professionals, such as Dr. Strassler, believe that some whitening toothpastes sold over-the-counter are safe for home use. But misuse -- or using one with harmful ingredients -- could damage tooth enamel or tooth fillings, he says.
If you plan to use an over-the-counter whitener, he says, "look for one that removes stains from teeth but that does not bleach teeth."
Whitening toothpastes, he explains, use a mild abrasive to remove stains. Bleaching brands, on the other hand, use a high )) level of peroxide and/or acids to lighten the teeth by removing deep stains.
And although there are over-the-counter tooth bleaching products, Dr. Strassler strongly recommends against them. "These are dangerous and have been known to harm the enamel on teeth," he says. "I wouldn't recommend people using them."
He believes people interested in tooth bleaches would be better off going to a dentist where they will be prescribed an individual treatment and monitored. Dentists have been doing some form of teeth bleaching for more than 50 years. Today, the process usually involves the patient's wearing a mouth guard -- or shield -- that has a small concentration of peroxide gel in it.
The patient wears the mouth guard for about one hour a day for roughly six to eight weeks, says Dr. Strassler.
One of his patients, who asked that her name not be used, began bleaching her teeth about two months ago. "I have some stains from using [a medication]," says the woman who is in her early 40s. She says she is happy with the overall results. "I am pleased," she says. "I see a definite improvement."
People who might benefit from bleaching are those who have stains from some medicines or who have discoloration from the long-term use of coffee, tea or cigarette smoking. People with brownish stains on their teeth could be helped by bleaching, Dr. Strassler says.
But there are professionals who discourage the use of toothpaste whiteners and bleaches either at home or in a dentist office.
"We don't do tooth whiteners or bleaching here," says Dr. Carmen Luquerosales, a chief resident of dentistry and oral surgery at Johns Hopkins Hospital. "It is very controversial. People will say, 'yes, my teeth are brighter' but they are wearing away tooth enamel."
Stop drinking coffee, tea and smoking cigarettes, she says, and see your teeth brighten naturally.
The American Dental Associations' Council on Dental Therapeutics gives thumbs down to tooth whiteners and bleaches.
"These products contain various types of oxygenating agents as the whitening or bleaching ingredient," according to a statement released by the Chicago-based association.
The statement, which calls for further study of the products, continues: "The Council is concerned about product safety because published scientific studies on oxygenating agents show their regular use may damage temporarily the soft tissues of the mouth, and may delay the healing of already damaged tissue."
Baking soda, another abrasive which has been around for years, is showing up in more brands of toothpaste, Dr. Strassler says.
"The perception is that baking soda is good for fighting periodontal disease," he says. Baking soda is mildly abrasive and has a "minimal effect" on reducing plaque, he says. "But if you are concerned about using baking soda for periodontal disease, talk to your dentist about what the benefits would be."
While baking soda is "not as coarse or harmful" as whitening and bleaching tooth products, "It is still wearing a little bit of the tooth enam
el away," says Dr. Luquerosales.
Finally, dentists say, for healthy, white teeth no product will ever substitute for regular, routine care which includes flossing and correct brushing.
* Plaque: Bacteria that adheres to teeth.
* Tartar: Rough, hard deposits that form on the teeth.
* Whitening toothpaste: Toothpaste that removes surface stains from the teeth. Will not change the basic color of the teeth.
* Tooth bleaches: Products sold over-the-counter and administered by dentists. Generally, over-the-counter bleaches contain an acid mouth rinse and/or high concentrations of peroxide. Some over-the-counter brands have damaged tooth enamel.
* Baking soda: Sodium bicarbonate used in the dental industry as a mild abrasive effective for reducing plaque.
* Fluoride: Chemical compound present in most toothpastes that strengthens the enamel and dentin of the teeth by making them harder and more resistant to decay.
* Peroxide: Substance dentists use in varying concentrations to lighten tooth shade and heal gum inflammation and irritation. High concentrations can inflame or irritate gums.