Sparkling Teeth: A Bright Promise or White Lie? : Dental care: Over-the-counter products, including $150 million worth of special toothpaste, were sold last year. But objective data is hard to come by.

Youth, health and beauty.

Americans have believed for more than a century that sparkling white teeth would bring these attributes, and more. And we’ve endured much to get them.

In the 1800s, we risked poisoning, allowing dentists to paint our “pearlies” with caustic potions of ammonia, chlorine or even cyanide to bleach out stains.

By the 1950s, it was safer, but still unpleasant. We had our gums wrapped in protective rubber while the dentist smeared peroxide on our teeth, then baked them for up to an hour under a 150-degree Fahrenheit lamp.

Today the biggest problem is confusion.

Research done in the late 1980s has led to dozens of do-it-yourself bleaching systems and toothpastes, but objective information on their safety and effectiveness is hard to come by.

The American Dental Assn. scorns over-the-counter methods, telling patients they should entrust their teeth only to a dentist. The association says the chemicals in many of these products either don’t work or could damage tooth enamel, nerves and gums if used improperly.

“There’s no way for the consumer to know at the drugstore what’s OK and what’s not,” said Dr. Kenneth Burrell, an assistant director for science at the ADA. “These products are not for everyone and a lot of people should not be using them, because they’re not going to do any good.”

Manufacturers scoff, saying the chemicals have been used by the dentists themselves for decades. The dentists are simply trying to protect a lucrative business in which they charge anywhere from $400 to $2,000 per mouth, the companies say.

“There should be no reason why consumers, at a lesser cost to them, can’t do the same thing at home,” said David Edell, president of CCA Industries Inc., the East Rutherford, N.J., company that makes Plus-White products. Over-the-counter products cost as little as $7 to $30.

Government regulators, who could act as arbiters, mostly have been silent.

In 1991, the Food and Drug Administration tried to regulate tooth whiteners as a drug. That would have required makers to conduct exhaustive tests on humans.

The corporations sued, the FDA backed off and hasn’t been heard from since.

Meanwhile, over-the-counter tooth whitener sales are rising fast.

Research conducted by A.C. Nielsen for SmithKline Beecham PLC’s Aquafresh brand shows sales of whitening toothpastes alone--not including more potent bleachers--has grown 68% since 1991 to $150 million last year.

Den-Mat Corp.’s Rembrandt brand has risen from nowhere to the No. 5 toothpaste in five years, largely on the strength of whiteners. Colgate introduced its Platinum line of whitening products last year. SmithKline brought out Aquafresh Whitening toothpaste in January.

Celebrity endorsements add a dose of Hollywood hype. Vanna White hawks The Perfect Smile on infomercials, and Morgan Fairchild smiles out from magazine ads for Dr. George’s Dental White.

Drugstores love it. Whiteners costs two to three times more than plain old toothpaste and have double the profit margin--about 25%.

Despite the debate over safety and cost, the science of tooth whitening is relatively simple. Just as in the 1950s, most products use hydrogen peroxide--the same thing your mother daubed on your scraped knee as an antiseptic, or that might have been used to bleach your hair.

The fastest method is still the in-office treatment, involving high-potency peroxide, rubber gum protectors and heat lamps.

The peroxide oxidizes, creating a tingly bubbling action. This process bleaches deep into the teeth and can be finished in a couple of visits.

This procedure is especially good if a patient is short of time--”you’re getting married on Saturday and you’ve only got four days, or you’re going away on a business trip,” suggested Dr. George Freedman of Toronto, a prominent cosmetic dentist and industry consultant.

An alternative system is dispensed by dentists but used at home. The dentist creates a customized rubber mouthpiece, which looks like the mouth guards worn by boxers or football players. Every night for about three weeks, the patient squeezes a medium-potency bleaching gel into the mouthpiece and wears it for several hours or overnight.

Before using either of these systems, the dentist first evaluates the patient’s teeth--a step the ADA says is critical to ensure success and safety.

“He’s going to make sure you have no cavities or gum diseases, receding gums or areas of sensitivity,” said Dr. Jonathan Scharf of Exton, Pa., past president of the American Academy of Cosmetic Dentistry.

The dentist assesses the strength of chemicals to be used and monitors your progress. For instance, yellowish stains from coffee, tea or red wine are relatively easy to clean, but congenital discolorations or stains from drugs like the antibiotic tetracycline can be difficult. Crowns, veneers and porcelain fillings probably won’t bleach at all.

Some over-the-counter bleaching systems also use rubber mouthpieces. Others require users to paint acid on their teeth to etch lines in the enamel, followed by bleach and a chemical called titanium dioxide--essentially white paint--to fill in the etched lines. Whitening toothpastes and rinses use mild forms of peroxide or other stain removers and are usually good for surface stains only.

Dentists cite these risks:

Some products are too weak, frustrating patients who will overuse them, damaging enamel, gums or tooth nerves. The mouthpieces aren’t custom-fit so they may irritate gums or leak. Peroxides in high doses may even enhance the effects of some carcinogens, the ADA says. Acids can permanently damage teeth. The titanium dioxide paint wears off in hours. Some toothpastes contain harsh abrasives.

“With these systems, there hasn’t been any long-term testing or follow up to show whether or not they’re safe and effective,” said Dr. Jacqueline Dzierzak, a Chicago dentist and adviser to the ADA.

“Malarkey,” snaps Plus-White’s Edell, pointing to the FDA’s passive attitude on the industry as evidence.

“If there’s anything dangerous or not safe, or they’re getting an unusual amount of complaints by consumers, that product is off, out, gone. They don’t waste time,” he said.

Bradford Williams, an FDA enforcement officer, concedes the agency hasn’t made tooth whiteners a priority.

“If there were bodies in the street from this stuff, we wouldn’t be sitting by,” he said, suggesting the agency may take up the issue again this year.

“The question is, do they work? Is it an economic rip-off?”