Perfect smiles are no longer just for Hollywood movie stars. If you are unhappy with the appearance of your teeth, don't despair - today there are many options for people who want whiter, brighter smiles.

If you are considering tooth whitening, the first step is to speak to your dentist to determine which procedure is best for you. Often, the appropriate method will be dictated by the cause of your current discoloration.

According to dentist Anthony J. Tabone, DDS, of Auburn, there are several reasons for discolored teeth.

“They could darken due to trauma - someone gets hit with a baseball in the tooth and the nerve goes dead. Or it could be some kind of an internal stain,” he said. “Sometimes expectant mothers need to be put on antibiotics, specifically tetracycline, and if the baby's forming teeth, the tetracycline will lay down a dark layer in the tooth and you can't get it out by brushing or scraping or anything like that.”

Although many patients do have hard-to-remove internal stains, most people's teeth are discolored because of extrinsic factors such as coffee drinking or smoking. For these patients, one of the most popular cosmetic options is at-home whitening. Often referred to as bleaching, this procedure involves applying a tooth-whitening gel in a removable mouth tray for several hours each day for a specified period of time.

“What we do is make an impression of the patient's mouth, and we fabricate a tray out of that impression,” Tabone explained. “Then we dispense the whitener to the patient in the form of a syringe.”

According to dentist John G. Carlile, DDS, of Skaneateles, most whitening gels rely on an active ingredient called carbamide peroxide. Because carbamide peroxide comes in several different concentrations, the amount of time tooth whitening takes varies according to the strength of the whitening agent being used.

The timing is also dependent on how much lighter a patient wants their teeth to be.

“We take an initial shade of what the teeth are,” Tabone said, “and we take a final shade of what the patient ultimately wants the teeth to be. Then we can determine, based on that dichotomy, how long we need to whiten.”

“In our office, we've found that whitening takes about two weeks,” Carlile said, “and the lightness should last from about one to three years. Then there's typically a touch-up phase, which might take a fraction of the original time that it took to whiten one's teeth.”

Although the health risks associated with tooth whitening are minimal, some patients do experience mild side effects.

“In a small percentage of patients, there might be some tooth sensitivity or irritation to the gums, but these symptoms typically resolve when the treatment is stopped,” Carlile said.

Tabone agreed. “It usually lasts for a day or two if it happens at all, and the bleaching itself has gotten sophisticated enough where we as dentists have different options as far as concentrations are concerned to minimize that for the patient.”

Despite these drawbacks, tooth whitening is a great option for people whose teeth have been stained by coffee, tobacco, or tea. According to the American Dental Association, 96 percent of patients with these kinds of stains experience some lightening effect.

An additional bleaching technique is laser whitening or “power whitening.” During this procedure a rubber dam is placed over the teeth to protect the gums, and a bleaching product is painted onto the teeth. Then a light or laser is shined on the teeth to activate the chemical.

This light is believed to speed up the chemical reaction of the whitening product and the color change can be achieved quicker.

Carlile pointed out, however, that teeth with existing fillings will stand out after tooth whitening. “When dentists put fillings in front teeth, they try to match them to a patient's natural tooth color. These fillings do not bleach, so once you get done with the whitening program, all of a sudden you have fillings that are showing.#”

Teeth with intrinsic stains will not respond reliably to bleaching either. Therefore, many patients consider other cosmetic whitening options such as veneers.

Porcelain veneers are shell-like facings that are cemented onto stained teeth. According to Tabone, the beauty of veneers is that they can also be used to reshape teeth.

“It's very artistic,” he said. “We have a lot of options with veneers as far as fixing other problems that a patient might come into the office with.”

“One of the other nice things about porcelain veneers is that they are more resistant to external staining,” Carlile added, “and the porcelain closely resembles one's own natural tooth enamel.”

Unfortunately, veneers do have some downsides.

“Porcelain is a very brittle substance,” Tabone said. “It's great aesthetically, but if the patient has a heavy bite or if they bite on something the wrong way, there is a possibility of the porcelain fracturing.”

Because veneers are also expensive, many patients turn to bonding, a procedure during which a composite resin is molded onto the teeth.

“The advantage to bonding is that it's typically a chair-side visit, so the cost factor is maybe half of what a porcelain veneer would be,” Carlile said.

Although it is less expensive, bonding requires even more maintenance than veneers.

“The problem is that they tend to stain over time,” Tabone explained, “so there's more of a likelihood that they will need to be replaced.”

While bonding, veneers and bleaching are all common procedures, over the counter whitening products have also become popular. Tabone recommends, however, that you speak to your dentist before trying one.

“There are a lot of variables to consider. That's why I prefer doing in-house whitening rather than telling patients to go out and get something off the counter. With the in-house bleaching, you have a professional who can guide you as to what you need to do.”

“While my preference is that whitening programs be done under the supervision of a dentist,” Carlile agreed, “I do feel that there is great value out there to many of the over the counter whitening products. For example, Crest has come up with their Whitestrips which use the same active ingredient as most of the professional products, the carbamide peroxide.”

“If you're going to get something over the counter,” Tabone said. “I recommend using a low-abrasion whitening toothpaste such as Rembrandt. It's expensive relative to other toothpastes, but it works more naturally and doesn't use abrasion.”

Although there are many ways to whiten teeth, Tabone urges his patients to keep their teeth from becoming discolored at all by brushing regularly with fluoride toothpaste.

“Make sure that your oral hygiene at home is up to snuff,” he said. “As always, prevention is the best medicine.”