White Teeth Does Not Mean Good Teeth

If you’ve watched any season of Love Island, including the current one, then you’ve definitely seen them. Even if you haven’t, you’ve probably seen them – they gleam out from our social feeds and wink at us from ads and TV screens. Impossibly straight, rectangular teeth that range from a natural brightness to shades so white they are almost blue. If I were trying to show my age, I’d reference Ross’s glow-in-the-dark teeth in Friends. Or the blinding charm of Rylan and his gnashers.

White teeth are the best teeth, or so we’re led to believe. Discolouration is the devil, as is wonkiness, but a little character in your jaw can be forgiven provided your teeth are still bone white (just ask Kirsten Dunst).

This belief – the whiter, the better – is delivered in many ways. Though teeth whitening has been part of human history for centuries, the practice was really cemented with the accidental discovery of the bleaching effects of Gly-Oxide (an antiseptic oral cleanser) in the 20th century and played a key part in the development of cosmetic dentistry. White teeth came to be another signifier of beauty and effortlessness, with desirable looks varying from 'so natural, they just look lucky' to the American preference for a blinding white, Hollywood smile.

Veneers and whitening were originally out of reach for the majority of us but innovations in the industry and increased exposure through social media have made cosmetic dentistry more accessible — and more visible — to 'normal people'. For us Brits, there is also the impulse to reject the still-pervasive myth that our teeth are inherently 'bad' (compared to other nations) and therefore we should fix them.

It’s no surprise, then, that teeth whitening in particular, and cosmetic dentistry in general, is booming. According to a 2020 survey, 22% of people (including 40% of 18 to 24-year-olds) said they would probably whiten their teeth and 10% said that they definitely would or already had. As with other cosmetic industries, the pandemic has prompted more people than ever to seek out straightening and whitening as part of the so-called 'Zoom boom'. Now, British people are eclipsed only by Americans in how much we search for 'teeth whitening' annually.

Healthy teeth, and access to proper dental care and hygiene, should be a right and not a privilege. Unfortunately this isn’t the world we live in. Even in countries that have otherwise socialised medicine, like the UK and Canada, dental care is separate from general healthcare and has to be paid for in some capacity. This creates a society where access to dental care is determined by class and your financial situation. In the UK, people from deprived backgrounds are twice as likely to be hospitalised for dental work that could have been caught by routine checkups.

Teeth don’t have to be white to be healthy. As is often the case, what we now believe to signify health in people is actually an aesthetic preference (such as the constantly shifting but always slim definition of a 'healthy' body type). Treating tooth whiteness as a primary indicator of health encourages people to spend large sums of money on sometimes dangerous whitening procedures while ignoring basic dental hygiene.

If you’re talking about healthy teeth you need to look for a few basic things, according to Dr Sahil Patel, dentist and founder of Marylebone Smile Clinic. You want an absence of decay, healthy gums, absence of illnesses that can affect your oral health (like oral cancer) and to monitor the wear on your teeth. You counteract these with proper daily cleaning (including regular flossing), finding ways to lessen or manage any grinding, and regular dental checkups to catch any sign of decay or disease before it gets worse.

Even though the shade of the tooth isn't an explicit part of that list, Dr Patel says there’s a reason we see whiter teeth as healthier. "White teeth show that you might be cleaning your teeth, and research shows that it has a measurable effect on how likely you are to want to work with that person, be friends or even be in a relationship with that person. As unfortunate as it may be, humans are social animals so we seem to unconsciously extrapolate from the first impression and that tends to be from a visual perspective of what the teeth look like, in addition to other aspects of the face."

It is important to note that teeth staining can be a sign of disease or neglect. Dr Aneka Khaira, cosmetic dentist and founder of Vogue Dental, explains that staining is usually lifestyle- and dietary-related, and can be defined by two categories: intrinsic or extrinsic staining. "Intrinsic staining is internal within dental tooth tissue and can be due to trauma and pulpitis [when your dental gum becomes inflamed]. Extrinsic stains usually result from accumulation of [staining substances] which build up on the external tooth surfaces." The latter can come from food or drink, some medications, and habits like smoking.

Extrinsic stains have the potential to attract plaque but they don’t inherently. Additionally, staining can result from genetics as well as age, with the whiter enamel (the outer layer of the teeth) wearing away to show the yellower dentine underneath. Without proper oral hygiene and monitoring, this yellowing could indicate potential damage but equally it could be superficial. The important thing is to have a hygienist and dentist regularly examine your teeth to ensure there are no active dental diseases. Dr Khaira adds: "If the tooth surface is clean and the tooth appears darker or more yellow, this isn’t necessarily unhealthy. You can have a perfectly healthy tooth as long as you maintain your oral health."

There is a further point to be made here, though. A person's inability to maintain their oral health often doesn’t come from 'laziness' but from a lack of access to dentistry, which is a much wider problem. Teeth that show signs of disease or decay, which are obviously unhealthy, are grouped together with all discolouration as 'bad teeth'. And this idea of 'bad teeth' is loaded with class assumptions. Yellow teeth are associated with poverty, laziness and neglect, while gleaming white teeth are associated with health and wealth.

Unlike the various points in history when people would use acids or even urine to bleach their teeth, we understand far more about dentistry nowadays. 'Good teeth' don’t have to be pearly white. But the idea persists because of the sale of the Hollywood smile worldwide, made more visible through social media and more accessible through dental innovation. We buy into the idea that big, white smiles are inherently 'good' and so we do what we can to chase that association of wealth, health and discipline.

But it is not a one-time investment. It requires constant maintenance. Even the best whitening will fade over the years, requiring regular top-ups as well as general dental hygiene. And if you have other cosmetic work like caps or veneers, they need additional monitoring and commitment. Once you have chosen to spend money on whitening your teeth, you have to maintain it with constant investment. It is another mark of 'middle class maintenance'. Shortcuts can be ineffective or, worse, dangerous.

In the 2015 BBC documentary The Truth About Your Teeth, Dr Wyman Chan, an expert in tooth whitening, said that the chemicals used in over-the-counter whitening products are nowhere near strong enough to change the shade of your teeth. EU regulations restrict access to chemicals in quantities that are effective to medical professionals like trained dentists, who can use chemicals that are 60 times more concentrated. This is why over-the-counter treatments are so often ineffective. There are ways in which these products pretend to work instead. Newer systems, for example, rely on using the contrast of heavy pigments or charcoal to trick the eye into seeing a whiter tooth when the coloured paste is removed.

That said, there are still risks associated with these products, like increased sensitivity and gingival irritation (inflammation). These are increasingly likely when whitening is done outside of registered medical settings. Hydrogen peroxide- and carbamide peroxide-based tooth whitening is safe and effective (when you follow the manufacturer’s instructions or it’s done by a professional) but there is a risk that acid-based whiteners can thin your enamel, says Dr Patel. "More of the underlying tooth structure will shine through as time goes on. You might see a short-term uplift in colour but if you continue long term, you may have your teeth get dramatically more yellow, which can be difficult to fix." Equally, high-concentration solutions of bleach would be very effective if used in a controlled environment, says Dr Patel, who adds that they could be extremely painful if not used correctly with well-fitting whitening trays.

If you're paying someone else to whiten your teeth, they must be a registered practitioner. Dr Khaira tells R29: "It is illegal for anyone not registered with the General Dental Council (GDC) to perform tooth whitening so if you are visiting a salon, it is illegal. This is due to the potency and toxicity of the whitening gel, which can only be prescribed by a dentist."

If whitening is done outside of a dentist setting without confirming your teeth are healthy, it can have big consequences. Cosmetic dentist Jennifer Jablow told Reader’s Digest: "Teeth whitening that is peroxide-based is meant to whiten the enamel layer, not the structure inside the tooth near the nerve. If the enamel is not intact, because of cavities or other damage, the whitening gel can leach into the nerves tissue and cause irreversible damage."

As pearly whites are sold as more and more attainable for everyone, it’s important to know the risks of pursuing brighter teeth. Especially when the mundane maintenance of dental health is neglected. Changing the shade of your teeth is not quick, cheap or easy. If you are lucky enough to afford it, money is better spent on the less appealing parts of dentistry: regular checkups, trips to the hygienist, getting into the habit of flossing every day and, of course, brushing properly.

And like every other hierarchy where good = healthy, bad = unhealthy, the pursuit of white teeth above anything else encourages dangerous practices, divides people along class and body lines, and embeds shame about what are, in essence, our outside bones. We need them to work much more than we need them to shine bright.

If you do want to whiten your teeth, more power to you. The forces impacting our self-esteem and exacerbating our insecurities don’t disappear when you acknowledge them. There are real life benefits to having teeth that look 'good'. But it’s worth considering before you click on the whitening mouthguard advertised on Instagram whether this is what you really want — or if you’d be better off flossing instead.