A: We wish we could offer some comforting palliative like "Don't worry: Grossly discolored teeth make you look distinguished." Unfortunately, there's no way to put a positive spin on your Austin Powers choppers.
Tooth staining occurs in many ways. Extrinsic stains result when substances like red wine, coffee, tea, or tobacco leave a colored residue on the surface of your teeth. For the most part, regular brushing can remove the discolorations. But if you're a heavy smoker or a coffee or tea drinker, goo can lodge itself in the micro-crannies of your tooth enamel to the point where stains become resistant to scrubbing.
Intrinsic stains, on the other hand, originate inside the living portion of your teeth and can't be eliminated by any form of scouring. Taking the antibiotic tetracycline or consuming too much fluoride at an age when your teeth are still developing, for example, can interfere with normal growth and convert once snow-white teeth into little Jackson Pollock paintings, streaked with yellow, brown, blue, and even black.
Similarly, most of us experience some yellowing of the teeth with age, and untreated cavities, silver amalgam fillings, and dead spots inside a tooth's soft living pulp can give teeth a gray appearance.
Scrub 'Em Yourself
Happily, you can fix all of this. Start with one of the half-dozen whitening toothpastes that carry the American Dental Association's Seal of Acceptance. The products use mild abrasives to make your whites whiter. Another self-help option is do-it-yourself bleaching kits. They're available over the counter for $10 to $40 per kit, but none has yet received the ADA's blessing.
If those options don't work, see a dentist experienced in bleaching – the fastest-growing dental procedure in the United States. If your dentist determines that bleaching makes sense, you'll have two basic options: at-home or in-office bleaching. With the at-home option, the dentist custom-fits your mouth with a plastic "tray" (similar to an athlete's mouth guard), then sends you home with a supply of a bleaching agent – either hydrogen peroxide or carbamide peroxide gel. Depending on the kit, you'll have to wear the tray for a couple of hours per day or overnight, for up to several weeks. Total cost: from $200 to $400.
The in-office procedure employs a stronger bleach solution and an activating agent—a heat lamp or lasers (lasers are not yet accepted by the ADA)—to accomplish the same job in a matter of hours for $350 to $700 typically. Generally speaking, an hour of office bleaching equals four to seven days of home bleaching. Which way you go, dentists say, is purely a lifestyle choice. With either approach, expect some short-lived tooth sensitivity and some possible gum irritation. The whitening effects should last anywhere from a year to four years, then you'll need a touch-up.
Bleaching, mind you, is hardly the court of last resort. If your teeth are Stephen King-scary, more radical options include bonding and porcelain veneers. With bonding, a dentist molds a composite resin to the surface of the teeth to change their color. Veneers are just that—little synthetic covers for the teeth. Both bonding and veneers, though more permanent solutions, can cost thousands of dollars. Of course, if your shiny new choppers win you a shiny $1 million settlement, the cost will be well worth it.