Lure of the all-American white smile

Regulation of teeth whitening is relaxed in the United States where a bright, white smile is a must-have 

Ask an American to list things they notice about the British and it won’t be long before they mention terrible teeth.

Half of Americans believe a smile is the most memorable feature when first meeting someone, according to the American Association of Cosmetic Dentists (AACD), more important even than what that person says.

And when you pop to the dentist, it’s par for the course to be asked “Are you happy with your smile?” as a question in your health history form.

With so much riding on good teeth, cosmetic dental work has rapidly been turning from an expensive luxury into an everyday essential.

The AACD says one in ten of its members make more than $1 million a year just from cosmetic procedures.

A staggering 45 million Americans – 14 per cent of the population – have had professional teeth whitening, according to data guru Mintel. This is compared to just 3 per cent in the UK.

A white smile is so desirable that even children, or perhaps their parents, have been asking professionals what can be done if you’re under 18.

Dr James Nickman, president of the American Academy of Pediatric Dentistry, says: “It is a fairly common question usually starting in the middle-school years and is likely driven by the interest in aesthetics.

“The main concern from parents is the appearance of the new permanent teeth compared to the baby teeth. The new permanent teeth usually are more yellow in appearance, which is completely normal. The teens usually are concerned about the colour of the permanent teeth and would like the ‘white’ teeth seen in magazines, online or on TV.”

UK vs US regulation

Back in the UK, teeth whitening is tightly regulated. Only a dentist can use bleaching gels with between 0.1 per cent and 6 per cent hydrogen peroxide. These laws are in place due to fears that potent gels can lead to tooth sensitivity and even burn the gums. Anything stronger is illegal and under-18s should not be treated at all. Over in America, the rules are very different.

Whitening kits, strips, lights and gels are viewed simply as a cosmetic product rather than a drug, so they do not need to be approved or tested by the Food and Drug Administration (FDA) before going on sale.

At the dentist, hydrogen peroxide in concentrations ranging from 20 to 40 per cent can be used on teeth for those patients wanting to flash the very brightest smiles.

Kits that allow teeth whitening to be done at home are also popular and can be bought either from the dentist or the pharmacy.

Half of Americans believe a smile is the most memorable feature when first meeting someone

Generally, these contain lower levels of hydrogen peroxide of around 3.5 per cent, but the Council on Scientific Affairs for the American Dental Association (ADA) says some home-use products have been found to contain up to 15 per cent hydrogen peroxide.

“Studies have shown that hydrogen peroxide is an irritant and also cytotoxic. It is known that at concentrations of 10 per cent hydrogen peroxide or higher, the chemical is potentially corrosive to mucous membranes or skin, and can cause a burning sensation and tissue damage,” the ADA says.

In a bid to protect the public, both the ADA and the FDA advise the public to consult a dentist before undergoing treatment.

But such advice may begin to fall on deaf ears. A shift in regulation at state level has meant Americans are increasingly able to get teeth whitening in beauty salons and shopping malls at a fraction of the cost with the dentist.

The Supreme Court has recently ruled that state dental boards in certain states – the dentists who write the rules on teeth whitening – cannot prevent non-dentists from offering the service because it is “anti-competitive”.

While the AACD estimate that dentists charge an average of $357 for treatment, salons and malls usually charge less than half that price, making it an attractive option.

Crest, the top-selling toothpaste manufacturer in the United States, off ers over-the-counter teethwhitening kits with 14 per cent hydrogen peroxide content
Crest, the top-selling toothpaste manufacturer in the United States, offers over-the-counter teeth-whitening kits with 14 per cent hydrogen peroxide content

This raises the question with so much teeth whitening available, who is monitoring the US public for negative effects?

Current laws mean manufacturers are not required to tell the FDA if consumers have complained about adverse reactions.

Although consumers can contact the FDA directly, research by Northwestern University published in The Journal of the American Medical Association last month suggests massive under-reporting. Between 2004 and 2016 there were only 5,000 complaints to the FDA about cosmetic products and fewer than 15 of these concerned teeth-whitening products.

Lead author Dr Steve Xu says no one is collecting robust data on adverse reactions to cosmetics.

Dr John Dodes, a New York dentist and founding fellow of the Institute for Science in Medicine, says that despite this, Americans will continue to want whitening. “In the right hands, it is fairly safe and put simply, whitening is just extraordinarily popular.”