White Teeth Does Not Mean Good Teeth

By Sadhbh O’Sullivan | Refinery29

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.

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.

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