Paying the price for pearly whites

Whitening toothpastes might remove surface stains, but only if they contain peroxides.

After years of grinding, chomping, and chewing, your once-pearly whites may have seen better days. Add to that a lifetime's worth of pigments from coffee, tea, red wine and soda that have gotten lodged in tiny cracks in your teeth.

The result: that unattractive yellowish-brown tint that's made tooth whitening one of the most popular cosmetic dental procedures in the United States.

Nearly all cosmetic dentists offer whitening treatments, and the number of procedures they perform has jumped about 50 percent each year since 2005, according to the American Academy of Cosmetic Dentistry.

Cosmetic options abound. To decide which may be right for you, experts say, see a dentist for an evaluation.

"Any tooth decay, cavities, periodontal disease and root or gum recession will have to be resolved before going ahead with whitening," says Matthew Messina, a consumer adviser to the American Dental Association. Sometimes, he adds, just correcting those issues can improve the color and appearance of teeth.

When that's not enough, dentists can make additional improvements using well-tested whiteners or prosthetics. But an informed do-it-yourself approach may be cheaper and, ultimately, just as effective.

Toothpastes

Supermarkets and pharmacies offer a dizzying array of whitening pastes for less than $10 a tube. But do they really work?

"It depends on the active ingredient," says Laura Kelly, president of the American Academy of Cosmetic Dentistry. Only some brands contain a peroxide, and those that do have very low concentrations, usually 1 to 2 percent. That's enough to remove surface stains and give teeth a good outer cleaning but not enough to make teeth shades whiter.

Whitening strips

The best-known OTC whiteners are strips -- thin, cellophane-like tape that adheres directly to the teeth -- and gel-filled trays, both falling in the $15-to-$50 range. The bleaching agent in these products can cause irritation or blotching if it comes in contact with the lips or gums. To minimize that problem, manufacturers keep peroxide concentrations low, which means you should expect relatively slow, modest results.

In-office whitening

You'll fetch the most dramatic improvement in the shortest time with bleaching procedures done at a dentist's office. But convenience and results come at a price --often between $500 and $1,000 and even more in major metropolitan areas.

At-home treatment

Those looking for in-office results at a lower price can use a dentist-supervised "at-home" treatment. Patients get a custom-fit tray and a whitening gel that's about a third as strong as the solutions used in offices. The kits cost between $200 and $400.

Bonding

Made of a pliable composite resin that hardens in place, bonding is a good option for small repairs like fixing chipped teeth, whitening a single tooth, closing gaps, or creating a straighter appearance. Because it's typically meant for touch-up jobs, it tends to cost less -- between $300 and $600 per tooth -- than other cosmetic options, like crowns, bridges and veneers.

Veneers

Extreme cases of discoloration, or misaligned or worn-down teeth, may warrant veneers instead of whitening, crowns or bonding. Usually made of porcelain, veneers are designed to mimic the bright white enamel and shape of healthy teeth and are cemented directly onto the surface of the teeth. They're more expensive than most other cosmetic options, costing $700 to more than $2,000 a tooth, but they last for decades with very little upkeep. And because they come with a stain-resistant coating, veneers will stay white forever.