Best and Worst Teeth Whitening Products!
Below are my recommendations for the best (and worst) types of over the counter teeth whitening / bleaching products. If you are interested in faster or more significant results see my page on professional whitening to see if any of those options are a better fit for you.
Teeth whitening is dependent on just a couple of factors.
- How much and what type of stain you have on your teeth
- Concentration of peroxide
- Time the peroxide is contact with your teeth
That’s it! The better you can seal the peroxide against your tooth, the better and faster results you will get. Keep that in mind as you look through the following options. Those products that look like they will seal better, will work better.
The Best Teeth Whitening Products
Custom Bleaching Trays (Approximately 2-8 shades lighter)
You will get the best results from at home whitening if you have custom whitening trays made by a dentist or dental lab. The most cost effective solution for custom whitening trays is to use a self impression kit from a dental lab. As long as you take an accurate impression, the custom trays will work great for you. Click on the banner below to go to the lab we recommend for making custom bleaching trays.
Buy whitening gel to go along with your custom trays…
If you already have your own custom trays or clear Invisalign style retainers you can just buy whitening gel and use it. Personally, I like buying Opalescence whitening gel from Ultradent (this link will take you to their Amazon store). Many dentists use these same products in their office and you know the product is good quality. Generally it is cheaper to order it online yourself rather than purchasing from your dentist. Concentrations vary based on your sensitivity and how you will use it. I’ve broken it down into a couple of different types…
Overnight Use – This is a lower concentration formulation than daytime use products. In order to see results it is best to use this overnight. If you can tolerate the 15% you’ll get the best results. If you find that are developing significant sensitivity or it seems to be “burning” your gums, you might want to use the 10%.
Opalescence 10% bleaching gel
Opalescence 15% bleaching gel
Daytime Use – This is a much higher concentration product that you can use during the day. I usually recommend wearing them from 30 minutes to an hour each day.
Opalescence 35% bleaching gel
White Strips (Approximately 2-5 shades lighter)
The best brand of white strips is Crest 3D White Professional Effects. All other white strip products work but this one generates the quickest results. I’ve found that these strips form to your teeth and stay in place better than many other products. Bleaching is all about how long the bleaching / whitening chemical is in contact with your teeth and so the products that seal better generally work faster.
Single use trays (Approximately 2-5 shades lighter)
These are disposable trays that you bite into and leave on for 30 minutes to an hour. You can usually get slightly better results with this over white strips because you get better adaptation of the material to your teeth. The biggest thing they have going for them is that they are super easy to use. If you’re willing to put a little more effort in, the other options will give you better results. The product I recommend is Opalescence GO 15%, also by Ultradent.
Kit to Create your own “custom” trays at home (Approximately 2-5 shades lighter)
There are many different options out there for creating your own custom trays. They are all essentially the same. It has material that you can heat up in hot water and mold to your teeth. This will not get the same adaptation that you would get with lab fabricated custom trays, so it will take longer to see results with this method. I recommend the kit below because it is one of the most cost effective kits available. Also, you don’t need to use the light while bleaching. It is just a gimmick.
The Worst Teeth Whitening Products!
Whitening Pens
Whitening Pens are a terrible investment. Sure, they contain hydrogen or carbamide peroxide which you can apply to your teeth. Without anything to keep it on your teeth your saliva will wash it away almost immediately.
Gimmicky LED Lights
I’ve seen a lot of new products that contain LED lights and claim that they get amazing results from the combination of heat and bleaching product. Guess what? These lights don’t do what they claim. The amount of heat generated is minimal. I took apart one of these products to see what was inside and it was just your basic LED light that you could buy for a dollar or so from Radio Shack. Don’t waste your money!
Homemade Whitening Products
Homemade whitening products can range from ineffective (brushing with baking soda) to damaging (formulations that contain heavy acids such as lemon juice). Acids can literally soften the enamel of your teeth and brushing immediately afterwards can remove the surface layer. You might actually get some whitening as a result of this effect but you really don’t want this type of whitening. There are a lot of methods that actually whiten your teeth without damaging your teeth.
Whitening Toothpaste
Whitening toothpaste works by being highly abrasive. This high abrasiveness removes very surface stains better than less abrasive toothpaste. This isn’t really true “bleaching” or “whitening”. Over time these abrasive toothpastes can be very harsh to your tooth enamel. I’d stay away from any toothpaste that has “whitening” in the title.
Whitening Mouthwash
Whitening mouthwash is another one of these headscratching type products. You literally can’t leave mouthwash in your mouth long enough to have any effect at all on your teeth. If the concentrations were enough to actually whiten your teeth it would also burn your gums to shreds. Don’t waste your money on mouthwash that claims to whiten your teeth.
Whitening Kiosks in the Mall
They’ll usually use some variation on the whitening pens which we’ve already established don’t work very well. They can’t do the type of professional whitening that can be accomplished in the dental office. The chemicals used in a dental office setting are very high concentration and dangerous to gum tissue. They’ve got to be handled carefully and monitored. This is what allows professional whitening to work so much quicker. You’re just not going to get this in a mall kiosk.
Sports Mouth Guard Reviews and FAQ
Reviews:
We’re going to get right to the good stuff here in case you just want to know what is the best overall sports mouth guard…
Shock Doctor Gel Max (My Overall #1 Pick For Over the Counter Products)
This mouth guard surprised me quite a bit (in a good way). The Shock Doctor Gel Max design is their basic mouthguard product. This mouthguard will provide some of the best protection of any of the boil and bite mouthguards. It also has a small piece that goes slightly over the front bottom teeth providing some level of protection there as well.
Design: It is a very solid design with an outer hard layer and an inner soft layer. The mouthguard itself extends up over your teeth pretty far providing good protection. Most other “basic” boil and bite mouthguards are only a single thin layer of material that won’t provide good protection from contact. The multi-layer design allows the hard outer layer to protect from hard contact while still cushioning your teeth and other oral tissues from any blow.
Tether: It does have a removable tether.
Speech: Talking was slightly more challenging than with the Nano 3D or single layer mouth guards but I could still be understood while spelling “MISSISSIPPI” out loud.
Ease of Fitting: Fitting was easy (boiling water for 90 seconds) and after molding it stayed in place really solidly.
Pictures of completed mouth guard…
Overall if you are playing a light to medium contact sport and want a boil and bite mouthguard that provides a good combination of protection, good fit, ability to talk, and affordability, the Gel Max is your best option.
For more information on some of the other mouthguards I’ve tested and reviewed including a couple of specialty types such as for braces read on…
There are three main types of mouth guards you’ll find.
Stock Mouth Guards:
Stock mouth guards are mouth guards that can basically be put in place with no to minimal fitting and adjustment. They generally don’t fit well and are pretty uncomfortable. They only thing they’ve got going for them is that you really don’t have to put any effort into making them. The only situation in which I recommend stock mouth guards are when you have braces as you need to have room for movement of the teeth during the orthodontic process.
Shock Doctor Double Braces Mouth Guard (Best For Braces)
This is the Shock Doctor double braces mouth guard. While I’ve got it under the stock mouth guard section it is actually somewhat customizable. What I like about this one is that it fits around your braces and covers both your top and bottom teeth. A lot of people will tell you that you only need one mouthguard on the top because those teeth stick out further. I can tell you from experience as a dentist that plenty of athletes injure their bottom teeth even with a top mouth guard in. When you are in braces you have to be especially careful because any blow to the face can cause your braces to cut the inside of your mouth. You will definitely have trouble speaking with this in place and you will have to breathe through more through your nose as you generally need to keep your mouth closed with this in place. It does have breathing channels but nose breathing works out better. Notice on the photos below the area circled in red. This is the part you can customize to the back side of your teeth (where the brackets aren’t at). This gives it a bit more retention than a typical stock mouthguard for braces.
If you would prefer a mouthguard that isn’t double sided they also make a single sided version. You can just wear this on top or buy two and wear one on the top and bottom. Wearing two at once would definitely be challenging in terms of total bulk in your mouth but would allow you to breathe through your mouth.
Boil and Bite Mouth Guards:
These are exactly like they sound. You place them in hot water for a set amount of time and then mold them around your teeth. Some only go over the top or bottom teeth and some cover all your teeth. These mouth guards are always bigger and bulkier than custom made ones, but some can fit pretty well and provide decent protection. With some home made customizing you can make these work pretty well. There are several options that can work depending on what you need it for.
Under Armour Athletic Mouth Guard (Best For Talking)
The first is made by Under Armour. For LIGHT contact sports it is a no frills, relatively low cost option. I DO NOT recommend it for heavy contact sports. Fitting is easy. You microwave it in a wet paper towel for 45 seconds and then mold it to your teeth. It extends up high enough to provide protection to the teeth and gums. It stays in place without having to bite on it but isn’t quite as stable as some of the other options. You can see in the pictures below that it doesn’t mold to the teeth as well as some of the other options. That said, it stayed in place well enough for me. My biggest concern with this one is that the material isn’t terribly thick and wouldn’t provide great protection for any heavy collisions or blows to the mouth. It also doesn’t have a tether in case you need one for your sport. This is by far the easiest mouth guard to talk in.
Shock Doctor Nano 3D
Another option for light contact sports is the Shock Doctor Nano 3D. It is light and slim but I found this one the most difficult to mold correctly and get a good fit. You have to boil water and place it in the hot water for 40 seconds before fitting. It also has breathing channels to allow more air in. Talking with this one is more difficult than the Under Armour mouth guard but still very doable. The biggest advantage of this mouthguard is that it is made of several different layers of materials. There is an outer layer and an inner layer that molds to your teeth. This allows the mouthguard to maintain a consistently thick layer of material which is one of the most important factors in providing protection. It does have a removable tether. My biggest concern with this design is that it doesn’t extend up very far, just barely covering my teeth (which are about average size).
Shock Doctor Nano Double (Best for Heavy Contact)
The exception to this is for people who play heavy contact sports with a high risk of collision or facial injury (such as boxing and MMA). If you’re one of these people I recommend the Shock Doctor Nano Double. This will cover both your top and bottom teeth at once. Fitting again was very easy (boiling water for 60 seconds) and it stayed in place the best of all the products I’ve tried. It is comfortable, extends everywhere it needs to and has the double layer that is important for protection. It does have a removable tether.The only aspect of this mouthguard that is challenging is that you literally can’t talk with it in place. I attempted to say “Mississippi” with all the different mouth guards in place. With the Under Armour one I slurred just slightly, with the Nano 3D and Gel Max I slurred moderately, and with the Nano Double it came out something like, “mrhghgh hhieirr pii”.
Still confused? Here is a photo of them all lined up to compare their profiles.
Custom Made Mouth Guards: (Best Option If Price and Time Isn’t An Issue)
With custom mouth guards you get the absolute best fit of any of the options. They also end up being slimmer and lighter. The downside is that they are always the most expensive option.
Your dentist can make you a custom mouth guard. These work great and can be very customizable but end up being the most expensive by far of any option.
Another option for a custom mouth guard is an online lab that sells you a kit where you can take your own impressions, send them off in the mail, and they will make a custom mouth guard for you. These are also relatively expensive compared to the over the counter options but will be less expensive than the ones made by your dentist. The link below will take you to our recommended direct dental lab. Their prices for a custom mouth guard range from $140 to $160.
If you’re still not convinced you need a mouthguard, take a look at this story of one of my patients.
He is a nice young guy who enjoys playing basketball. He was at practice and got elbowed in the mouth. One tooth broke in half and another was knocked out entirely. Unfortunately, sports accidents like this happen all the time! In his case, if he had been wearing a mouth guard to protect his teeth, he’d likely have gotten a busted lip as the worst of the damage. Instead, he will end up with a root canal, a crown, and an implant to replace his missing tooth. Total cost – $5000. It could have been prevented with a relatively inexpensive mouth guard.
Please don’t make his mistake. Wear a mouth guard when you are playing any type of contact sport.
There are a lot of different options for athletic mouth guards out there but sometimes trying to figure out which one to get can be overwhelming! The best kind is the one provides adequate protection for whatever sport you are playing, fits well, and one that is comfortable enough that you will wear it consistently.
How about top teeth or bottom teeth? It depends on the level of contact in your sport. Any sport with a lot of physical contact and you should really consider a mouth guard on both top and bottom. A lot athletes only wear them on the top teeth as these teeth are more likely to be damaged. The lower teeth are attached to your jaw which is able to move more freely when something hits it. This makes the risk of damage to these teeth less likely but as you can see from my patient, not a guarantee. Some mouthguards that fit on the upper teeth do provide some protection for bottom teeth.
Athletic Mouth Guard FAQ
Some mouth guard products make claims that they can increase athletic performance. Is this true or is it just hype?
Their explanation for how it helps is that these mouth guards move your jaw into a better position for breathing. The science however doesn’t back up their claims. Wear a mouth guard because it protects your teeth and gums, not because it you think it will make you run faster or jump higher.
Do mouthguards protect from concussions?
This is another one of those benefits that some products claim. A concussion happens when you have a traumatic blow to your head causing your brain to bump into your skull. This causes some reversible (and likely some non-reversible) damage to your brain. There is some thought that a mouthguard tends to reduce how quickly your head accelerates and thus reduces concussion severity in some cases. So far there isn’t a whole lot of evidence to support these claims but it is something that is actively being studied.
Can I / How do I wear a mouth guard with braces?
Yes, you should definitely wear a mouth guard when you are in braces. The teeth are actually quite a bit looser during orthodontic treatment and as such, much more likely to be displaced if you get hit in the mouth. Plus, imagine what it would feel like to have your lip smashed into those brackets and wires! It doesn’t feel good. A custom mouth guard usually isn’t an option when in braces because the teeth are moving. Use one of the stock mouth guards that I recommend above or a similar one.
What type of mouth guard should I use for which sport?
Boxing / MMA – I personally like the double mouth guards specifically for boxing. There are two specific benefits. It provides great protection to both your top and bottom teeth. It also forces you to keep your mouth closed which reduces the risk of having your jaw broken. A broken jaw generally means you have to have your jaw wired shut for 6 weeks and can cause significant long term TMJ problems. The big downside is that they are bulky and it’s harder to breathe in them. If you can get used to them, they will provide superior protection.
Hockey – There is a huge risk for teeth damage in hockey. There is a reason why most professional hockey players don’t get their teeth fixed until they are finished playing. As usual a double mouth guard is going to provide the best protection but will be harder to get used to and breathe / speak in.
Basketball – Most basketball players use a single mouth guard on their top teeth. If you saw the story of my teenage patient at the beginning of the article, you’ll realize that this isn’t always going to be adequate. The Gel Max provides some slight protection for the lower teeth as well so I’d recommend that mouthguard (or a custom one) for basketball.
Football/Rugby – While football and rugby has a lot of contact, we generally don’t see a whole lot of teeth related injuries as with some other sports as a result of helmets. A comfortable upper mouth guard tethered to your helmet is your best option in most cases.
Racquetball – This is a surprisingly dangerous sport. You can get hit in the face by a racquet, run into a wall, or get hit in the face with a racquetball. One of my friends knocked out his front tooth a couple of weeks before his wedding while playing racquetball. At a minimum, I think people should wear an upper mouth guard and ideally wear a double.
What is the best way to fit a boil and bite mouthguard?
Fitting a boil and bite mouthguard well takes some patience and attention to detail. The first thing you want to do is read the instructions given by the manufacturer (I know, I know… common sense right?). After doing that here are the key things to do…
If they tell you to heat the water to a specific temperature, make sure you heat it to exactly that temperature. Some mouth guards require water that isn’t actually boiling. You’ll also want to put it in the water for the exact specified time. Too long and it will be too soft, too short and you won’t be able to form it well.
When you place it in your mouth, you first want to form it around your teeth with your fingers. Apply some pretty good pressure. Then you’ll want to use your tongue to continue to form it especially on your palate (roof of your mouth). At the same time pucker your lips and create some serious suction.. Don’t take it out until the material has hardened somewhat. Stick it in ice water to cool it down sufficiently afterwards. You won’t get good retention until you’ve done this step. If you’ve done it right, it should stay in place securely without any help from you.
Don’t be afraid to trim excess material off if it is rubbing, gagging you, or is too long in certain areas. You want this as comfortable as possible so you won’t be tempted to take it out all the time.
If all else fails, start over from the beginning. Most boil and bite mouthguards can be reheated multiple times. Even I had to take multiple attempts to get a good fit from a couple of these mouthguards. Look at my pictures of them for a good idea of what you want them to look like when done.
How do I take a good impression for a custom mouth guard?
So once you’ve sprung for a custom mouth guard from a mail order service, you’re going to need to take a good impression of your teeth. Dentists have a saying about dental impressions… “Garbage In, Garbage Out”. Simply enough, this means if you take a terrible impression of your teeth, you’re going to get a terribly fitting mouth guard back.
As with boil and bite mouth guards, please make sure you read the instructions they provide with the self impression kit. The instructions are not just “guidelines”. You should follow them exactly as directed. Most kits have two different putties that you’ll mix together, place in a tray, and form around your teeth. You need to do this in the time frames specified in the directions. If you wait too long to place it on your teeth, it will become too hard and won’t mold well. If you don’t leave it in place long enough, you can distort the material when it comes out and the mouth guard won’t fit correctly. You’ll also want to make sure you adapt the material as well as you can around ALL of your teeth. Again, if you don’t get all the teeth, it is not going to fit well. Once you take the impression out of your mouth, look at it to make sure there aren’t any large bubbles in the material and that it adapted well around all your teeth. If it is a bad impression, get more impression material from lab instead of sending them a crappy impression. For more tips see our page on self impressions.
Professional Whitening Options
(If you just want to know the best possible option available, and what I recommend, just skip down to the section on KoR Whitening below!)
If you’re on this page, my guess is that you want better whitening results than you’ll get from some kiosk at the mall or out of a box of Crest White Strips. You can get them too, even if you have heavily stained teeth. I’ll break down the differences between all the different professional and other over the counter options so that you know what is best for you.
So who needs professional whitening? It depends on what your goals are. If any of the following apply, then you should seek the advice of a dentist for whitening options.
- You want the whitest smile possible
- You want to accomplish it as quickly as possible
- You have heavily stained teeth, especially if it is medication induced
- You have had dental work done on front teeth. Fillings and crowns will not whiten!
There are three main types of whitening that dentists perform, oftentimes in combination with each other.
Take home custom trays
The dentist takes impressions of your teeth and makes trays that fit specifically to your teeth. This allows the bleach to remain in contact with your teeth for longer and you get better results. The dentist can give you different concentrations of peroxide depending on whether you are going to wear it overnight or during the day. Generally, overnight wear gives you the best results as long as the trays seal well.
In office whitening
In office whitening allows the dentist to use a much higher concentration of peroxide than you can use at home and whiten the teeth more quickly. They paint the material on your teeth and let it work over the course of several hours. This is often times used in conjunction with a special light, as with Zoom whitening. Many studies have been done and it appears that light has very little effect on the actual whitening process. It is mostly a marketing tool.
KoR Deep Bleaching
If you want the whitest teeth possible…Find a dentist who does KoR Whitening and get it done right. It might be more expensive than their other whitening services. It’ll probably take more time than other methods, BUT, it is the absolute best whitening system out there, bar none.
It is the gold standard in professional teeth bleaching. This service is only available through a dentist. The method provides impressive results, even on heavily stained teeth. This includes people who have staining from antibiotic use as a child which was previously thought to be out of reach of whitening.
This was a patient of mine who did KoR Deep Bleaching. He had deep staining on one of his front teeth (it came in like that) and he wanted the best possible results to help blend the stained area in. As you can see, his teeth were brilliant white after treatment with significant lightening of the stained area. A little bonding over the stained area and you won’t even know it was there!
For more information visit the KoR website. They have a ton of before and after photos as well as a search function for dentists who perform this.
KoR works the best because it has meticulous instructions on how impressions are taken, how the whitening trays are fabricated, what materials they use (they come to my office packaged in dry office unlike every other product out there), and how the treatments are carried out. They’ve revolutionized whitening and I’m one of their biggest fans.
Over the Counter Whitening Options
There are a lot of over the counter whitening products out there now! The thing to realize is that most products will work moderately well, as long as you use them consistently over the course of several weeks to months. This excludes whitening toothpastes/pens/other novelty items. Don’t bother with those products because they are a waste of money.
The first option and one many people try is using a white strips product. You place the adhesive strips on your teeth for 30 minutes to an hour a day. One of the big downsides of the white strips is that most products don’t seal well. As described in our Science of Whitening page, the efficacy of whitening is mainly dependent on the concentration of the bleaching product and how long the tooth is exposed to it. As soon as saliva starts to water down the bleaching material, you get less effect.
The second is a disposable tray that you bite into. The material has bleaching material in it. You wear it for the specified amount of time and then throw away the tray. It has a set number of trays.
The third is whitening kits where you heat the whitening trays and mold them to your teeth. You place gel in these trays and whiten similarly to how you would use custom made trays from a dentist. These trays generally don’t seal as well as professionally made products and as such, don’t work as quickly.
If you’d like to know what the best products are for all of these over the counter options, see our whitening / bleaching product review page.
Whitening FAQ
Does whitening damage your enamel?
The Science of Whitening
There are two main ways that your teeth become whiter.
Abrasion
Over time your teeth pick up surface stains. Whitening toothpastes as well as the polishing they do in dental offices removes these surface stains from teeth and results in a slightly lighter appearance. In general, most people shouldn’t use whitening toothpastes. They are much more abrasive than regular toothpaste and can actually lead to you brushing away your enamel over time! You can’t replace lost enamel. If you want whiter teeth, stick with bleaching products instead…
Bleaching
Bleaching uses various peroxides to remove surface stains as well as deeper stains within teeth. The two main ingredients that are used are hydrogen peroxide or carbamide peroxide in varying strengths. The peroxides in these chemicals are very unstable and break apart into highly reactive oxygen molecules. These oxygen molecules react with the complex organic molecules that are responsible for the stains in your teeth. As they break apart and lift away these stain molecules, your teeth whiten. The temporary sensitivity that results from whitening is also a result of these peroxide molecules lifting away some of the material (dentinal plugs) within the microscopic tubules in your teeth. This doesn’t damage the teeth in any way and the tubules accumulate these dentinal plugs again about a week after finishing whitening. You can speed along this process by using prescription strength fluoride toothpaste, fluoride rinses, or sensitivity toothpastes for several weeks before whitening.
Generally the higher the concentration, the shorter amount of time you need to use it. Some products are left on the teeth for 30 minutes to an hour and others are left overnight. If you have trays that seal well, overnight with a lower concentration bleach is recommended. This reduces the risk of causing peroxide burns on your gum tissue and generally gets better results.
The difficulty in whitening teeth is that your mouth is constantly producing saliva. This saliva washes away and dilutes the bleaching solution and makes it ineffective over time. This is the reason that at home whitening products take more time to work than professional products. The at home strips just don’t seal as well around your teeth and the bleach is washed away more quickly. Custom dental trays help seal the bleach in and allow it to work longer. The better sealed the trays, the better the results.
Sleep Apnea
Sleep apnea is a serious condition in which a person stops breathing multiple times an hour. The number of times you stop breathing can range anywhere from 5-60 times an hour. There are very significant health problems related to sleep apnea one of which is death. One study of people with severe sleep apnea, found that nearly 40% were dead within 18 years. One of the scariest things about sleep apnea, is that approximately 95% of people who have it, don’t even know. If you snore and have daytime fatigue you should consider seeing a sleep medicine physician.
There are two types of sleep apnea…
- Central Sleep Apnea – Your brain forgets to tell your body to breathe. Treatment includes management of the health conditions responsible, certain drugs, continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP), and supplemental oxygen. Oral appliances do not help with central sleep apnea!
- Obstructive Sleep Apnea – The airway becomes obstructed from the tongue or other excess tissues in the area. The usual treatment includes management of weight (if excess weight is a suspected factor), CPAP, and oral appliance therapy (OAT).
If you have been diagnosed with obstructive sleep apnea, your doctor likely recommended CPAP. It is a device that blows air into your airway with enough pressure to keep it open. Unfortunately, CPAP is very poorly tolerated. Some studies show that half of people stop using it within the first year. For people who fail CPAP therapy, the next best option is to use oral appliance therapy (OAT). Similar to people who snore, the goal with OAT is to pull the lower jaw forward with a mandibular advancement device (MAD) in order to open the airway enough that the person is able to breathe. It re-positions the lower jaw more forward which helps to move the tongue out of the airway. Another device uses suction to hold the tongue in more forward position. The kind of device that is required is based on your specific situation. Compliance rates with OAT are much higher than CPAP as it is not as burdensome as using a CPAP machine.
For people who suspect or have sleep apnea, I highly recommend seeing a sleep doctor and dentist prior to commencing any treatment. Sleep apnea can be FATAL and is not something to take lightly. I recommend following their directions about treatment.
Snoring
Snoring is caused by the vibration of tissues in narrowed airways in the mouth, nose and throat. Estimates are that nearly half of people will snore at some point in their lifetime. Approximately 40 percent of men and 25 percent of women snore on a routine basis. Some of the reasons for snoring are:
- Allergies and colds
- Nasal obstruction
- Large tonsils, uvula, or excess tissue around the throat
- Tongue falling backwards while sleeping
- Lying on your back
- Being overweight
- Certain medications, tobacco, and alcohol before bed
- Age
Health Problems Associated with Snoring
Generally people who snore have disturbed sleep. Multiple studies have shown that disturbed sleep can lead to daytime sleepiness and contribute to many other health problems.
Snoring doesn’t affect just the person snoring! Studies have shown that snoring causes bed partners to have more broken sleep as well. In fact, we’ve found that many of the people seeking solutions to snoring, aren’t actually the snorers. They’re the people who have to listen to it!
Snoring can sometimes be a sign of sleep apnea, a condition in which you stop breathing multiple times at night. It is associated with significant health issues including heart disease, stroke, and even death. I think everyone who snores should be evaluated for sleep apnea. Please do not ignore the warning signs for yourself or someone you love! We have more information about sleep apnea here.
Treatment of Snoring
Since snoring is a result of narrowed airway spaces, most treatment is aimed at creating more space in those areas through various techniques.
One type of snoring can be attributed to nasal congestion or nasal spaces that are anatomically too small. Treating the nasal congestion or helping to open the nasal passages can help these people. Consider trying breathing strips first if you suspect that your snoring is coming from your nasal passages. I’ve included a link to one of the more popular nasal strip products below.
Oral Appliances:
A large proportion of people who snore do so because their airway (passage from their throat down to the lungs) becomes more narrow while sleeping as the tissue in the area relaxes. One way to address this is to pull the tongue forward using what is called a mandibular advancement device (MAD). It repositions the lower jaw more forward which helps to move the tongue out of the airway. See your dentist for options for these types of devices.
Myofunctional Therapy:
There have also been some promising studies involving myofunctional therapy. Myofunctional therapy seeks to create more healthy muscular patterns through repeated exercises. In many cases this is just as effective as oral appliances for both snoring and mild to moderate sleep apnea, although it does require more effort on your part up front. If you need professional guidance on this specific type of therapy, you’ll need to find a speech therapist or dentist who has training in this field.
Surgery:
The last type of treatment for snoring is surgery. Various types of surgery focus on removing excess tissue or creating better tone in the tissues so that they don’t obstruct the airway as much. If you’ve tried all the other options without success, consider having a consultation with an ear, nose, and throat surgeon to see if you’d be a good candidate for surgery.
Understanding the TMJ
The temporomandibular joint (TMJ) is one of the most complex joint structures in the body. When you open and close your mouth, many muscles, ligaments, and joint structures have to all work in conjunction to create a smooth and pain-free movement. Researchers are just now starting to understand exactly how it functions and the best ways to treat pain coming from the area.
TMJ pain and dysfunction (also known as TMD) is an extremely common issue. Some estimates say that close to 15% of the population in the United States suffers from some type of oro-facial pain, including joint pain, muscular pain, headaches, or earaches. In many cases this pain is directly linked to some type of TMJ disorder. Women seek treatment for TMJ pain at a much higher rate than men (especially during the child-bearing years). It isn’t entirely clear whether they have a higher rate of TMD or whether men just don’t seek treatment as often.
For many people, TMJ issues will resolve on their own without any treatment. Unfortunately, a large number of people will also develop chronic or recurring pain associated with the joint that requires some type of treatment. Usually a combination of dental appliances, exercises, and lifestyle changes will create significant relief for these people.
How the TMJ Works (and doesn’t work)
We usually break the TMJ into two major areas when we are discussing it. The first is the joint itself, which consists of the condyle of the mandible, a disc that cushions the condyle as it moves, and the bone of the skull in which the condyle sits and moves. The second is the muscles that move the joint during opening and closing. A large majority of TMJ pain is muscle related and can be managed with simple reversible treatments. This can manifest itself it many different ways including headaches, earaches, soreness, or pain on opening or closing. A much smaller percentage of people develop TMJ pain associated with some type of disorder within the joint itself. There is usually (but not always) clicking, popping, or grating of the joint itself.
Before we get into all that let’s talk about how the joint functions normally. As you start to open the condyle (ball shaped end of your jawbone / mandible) starts to rotate, cushioned by the disc. Once you have opened approximately half-way the joint starts to move forward and down following the bone of the skull. The disc moves with the condyle down this slope. When closing the process just happens in reverse until the condyle is seated back into its home position.
Now that we understand how it should function, let’s take a look at what can go wrong…
Muscular Problems
The majority of TMJ problems are related to the muscular system associated with the joint and jaw. For various reasons the muscles get overworked and end up becoming so irritated that they go into a spasm. Each muscle creates different symptoms when in spasm.
Temporalis – This is a large muscle that extends from the TMJ, up the side of your head. The most common complaint with this muscle is headaches.
Masseter – This large muscle goes from the bottom of your jaw and and ends on the zygomatic process connected to your skull. It is the main muscle for closing your jaw. A common symptom when this muscle is in spasm is mild-moderate pain when you try to open your mouth. Oftentimes you’ll have an ache in your cheek area that is worse when you wake up.
Lateral and medial pterygoid muscles – These smaller muscles are also very important in proper functioning of the TMJ. When having problems with these muscles, you’ll generally feel a more localized pain behind your very back molars towards the TMJ joint. If take your finger and apply some pressure in this area you’ll also have some generalized soreness.
Other Muscles – There are quite a few other muscles that provide a supplementary support in opening and closing your jaw. These include multiple muscles in the front and back of your neck. These can also contribute to some amount of TMJ pain if overworked.
Joint Problems
Less commonly there can be physical problems with the joint itself on top of muscular issues.
The first and most common type of joint problem is when the disc that cushions the joint is “dislocated” in a position where it shouldn’t be. Most of the time it dislocates forward of the condyle. When you open your mouth you hear a nice “pop” sound as the disc pops back into the correct position. When you close again, it oftentimes dislocates back to its forward position and you’ll hear a second “pop” as it dislocates. This is known as dislocation with reduction. The disc can also be displaced in several other directions, each causing a unique pattern of pain and noise as the joint moves.
Occasionally, someone will have a disc that is displaced / dislocated forward of the joint and even when opening and closing, the disc never goes back to the correct position. This is known as disc dislocation without reduction. Sometimes this will present where you can open partially but at a certain point are unable to open any wider even if you put significant pressure on your jaw. This is one scenario when you should see a professional ASAP. Generally they will create a splint that attempts to recapture the disc into the correct position. If the disc is out of place for too long of a period, adhesions and scar tissue can develop and simple, conservative treatment will no longer be a viable option. These are some of the cases that end up needing surgery.
Some people also eventually develop arthritic or deformed joints from constant bone on bone contact. Sometimes you can hear a grating type sound when you open and close your mouth. At this point it is rare to have any type of clicking or popping sound as the disc has usually degenerated. Some people learn to function with little to no pain and others develop significant pain and dysfunction. For those people who are unable to learn to function, surgery is oftentimes the next step.
TMJ Treatment
Things to Do:
Effective treatments for TMJ problems have been a hotly debated topic for many years now. There are many different types of treatment for TMJ problems and most people will need to use several different techniques in order to gain long term relief. The first thing to understand with TMJ treatment is that you should attempt every type of reversible (non-permanent) treatment that is available before doing anything that will cause permanent changes. Examples of permanent treatment include “bite equilibration” from a dentist or surgery on the joint itself. Except in some very limited situations, these permanent treatments generally aren’t recommended by the most current expert recommendations. See our section on “Things Not to Do” at the bottom of this page. The worst thing that will happen with reversible treatments is that you will have a spent a little bit of money and/or you won’t get any relief (although this is pretty rare). You generally can’t make the problem any worse than it already is with all these reversible treatments. The permanent treatments on the other hand can very well cause long term damage and sometimes make the problem worse. That is why we don’t recommend them until all other options have been attempted!
It is also helpful to remember that the types of treatment also partially depend on what kind of TMJ issue it is. The following are suggestions that are helpful for most people with TMJ problems.
Dental Appliances – There are several different types of dental appliances that can help quickly resolve acute (short term) TMJ problems. See your dentist or local TMJ specialist for options in this area.
Hot compresses – The heat helps relax the muscles and speed the repair process.
Myofunctional therapy and exercises – This is a set of exercises and behavior modification techniques that are designed to help re-educate oral and facial muscles into more positive patterns. Some people attempt these treatments by themselves and other people will need the help of a speech therapist who has specific experience with TMJ problems.
Cognitive behavioral therapy – Many times there is a psychological component to TMJ problems. Cognitive behavioral therapy helps re-orient your thinking. Many studies have shown this to be an effective treatment for reducing the symptoms of TMJ. You can learn CBT techniques on your own, but some people need the help of a licensed psychologist to guide them through this process. I am not a licensed psychologist, but I do have some experience with the process and can give some insight on how to apply these techniques.
Things That May or May Not Help:
Chiropractors. Many people swear that chiropractic treatment has helped significantly with their TMJ issues. There is limited evidence that certain types of chiropractic care can help with some types of TMJ dysfunction. The chiropractic treatment often is similar to physical therapy or massage of the area. People also get some relief as a result of the placebo effect. Because they believe it will help, it actually does reduce pain.
Things NOT To Do!
There are some dentists who will recommend something called “equilibration” in order to treat TMJ issues. Equilibration is when a dentist “adjusts” your bite in order to eliminate any issues with how your teeth come together and function. There are some schools of thought in dentistry that believe that bite problems are the cause of most grinding and TMJ issues. Current research suggests that equilibration is not an effective treatment for TMJ or grinding. It is also an irreversible change to your teeth. Most major organizations involved with TMJ and bruxism recommend that most people should not have irreversible procedures (equilibration or surgery) done unless all other options have been exhausted.
Surgery is also sometimes done for people with TMJ issues. Generally the only people who need surgery are those whose joint/s have physically deteriorated. This can present in several different ways and you need a TMJ specialist to make that recommendation. Again, this is always the last option to consider as there are significant issues with recovery and the results are not consistent.
Teeth Whitening
I ask all of my new patients, if they would like to change anything about their smile, and if so what would that be? Overwhelmingly, they say that if they could change one thing, they’d like whiter teeth. As you eat, drink, and generally get older, your teeth are constantly picking up stain. These foods and habits are some of the biggest contributors to staining of teeth:
- Coffee
- Tea
- Dark Soda
- Red Wine
- Smoking
- Tobacco
- Tomato sauces
Some people also have teeth that are more intrinsically stained or colored which usually requires professional whitening or different restoration options such crowns or veneers:
- Tetracycline (antibiotic) use while the teeth were forming
- Fluorosis (too much fluoride in the water) while the teeth were forming
- Decalcified white or brown areas from pre-cavity areas
- Worn enamel letting the underlying yellow color of teeth show through
The good news, is that there has never been a greater abundance of options to whiten your teeth. Before you whiten though, it is important that you understand how the process works. A lot of people waste time or money on products that will not work in their particular situation. Before you go any further, read through the following sections which will guide you through the best options for your particular situation.
Whitening Options Including Over the Counter and Professional Treatments
Whitening Frequently Asked Questions (FAQ)
Bruxism (Teeth Grinding)
Bruxism is a destructive process where a person involuntarily grinds their teeth either at night or during the day. The large majority of people who grind their teeth, do so at night and are unaware they do it until their bed partner tells them or the wear becomes evident on their teeth. Conservative estimates are that at least 10% of the population grinds significantly enough to cause damage. From my personal experience as a general dentist, I’d estimate that the percentage is even higher than that. Left unchecked, bruxism has the potential to cause serious damage to teeth, muscular pain, and irritation of the temporomandibular joint (TMJ).
Both children and adults are known to grind. We still don’t know exactly what causes this. A lot of really smart people have studied it and don’t have a great answer. We do know that there isn’t one single cause. It is likely a combination of many different factors. Some of the factors that we believe are involved are:
- Stress
- Anxiety
- Snoring and Sleep Apnea
- Alcohol
- Cigarette Smoking
- Caffeine
- Antidepressants
Consequences of Bruxism
Dentistry is one of the few areas in medicine in which good preventative care can eliminate most major long term issues (excluding TMJ issues). Everyone knows about brushing, flossing, and limiting sugar but what about the need to protect teeth from abnormal wear from grinding? It is estimated that you normally lose 0.3 mm of enamel every 10 years. A severe grinder can wear away nearly 2 mm of enamel in that same 10 year period. It usually isn’t a problem that you can quickly see so most people don’t see it as an urgent need to do something about.
The first and biggest consequnce of grinding is excessive tooth wear and fracture. Notice the chipping at the edge of the teeth, stress fractures, and wear of some teeth at the gum-line. These are very common patterns of wear with mild to moderate bruxism. People who grind severely, will achieve this look much earlier in life and by middle to late age will have multiple fractured teeth and significant shortening of their teeth.
Once it progresses to this point, fixing the teeth becomes very time consuming and expensive. Prevention is key!
In addition to the tooth wear, some people also develop significant muscular pain from the constant grinding. It is usually the worst in the morning, after a night of grinding in their sleep. The primary muscles involved in this are the masseter and temporalis muscles. The muscles work hard as you grind and as they become fatigued you develop muscle spasms and pain. As you can see from the diagram, the temporalis muscle extends high up into the scalp. When this muscle becomes fatigued, it can even lead to significant headaches.
Lastly, some people develop pain either from the muscles directly attached to the temporomandibular joint or from some portion of the joint itself. Please see our TMJ section for more information on how this joint works and how the common sources of TMJ pain are treated.
Bruxism/Grinding Treatment
The challenge with grinding is that we don’t have a way to stop you from doing it. Most people who grind, start doing so in the late teenage years and it continues throughout their life. Some dentists will tell their patients that they just need to get their stress under control to help their grinding. Well, if we could just get rid of our stress, we wouldn’t be stressed out, right? My goal with treatment is to eliminate many of the negative consequences of grinding.
For most people, this means wearing a night guard while asleep. A night guard is a type of dental appliance that covers the chewing surfaces of the teeth. This appliance does several things. First, it keeps you from doing damage to your teeth while grinding. Many people are amazed how much wear they see on their night guard after they have worn it for a couple of weeks. The second thing a night guard can do is help relax the muscles that pull the jaw shut. By opening your mouth slightly, the muscles can’t contract quite as tightly. This helps minimize the problems you can develop with muscular or TMJ pain.
Many drug stores sell “boil and bite” night guards. In general, these appliances are a bad long term solution to grinding. The night guards end up being relatively soft and this softness will oftentimes increase the frequency of grinding. They also wear out very quickly as the material just doesn’t have enough strength to withstand the forces put on it by true grinding.
Custom dentist fabricated night guards generally work very well but can end up being quite expensive. They generally range from $300-500.
One other option, which is a bit more expensive, is to purchase a home impression kit from a dental lab. The kit will have materials to take an impression of your teeth. You’ll send this impression back to the dental lab and they’ll create a custom night guard for you. If you do it right, it will be identical to a night guard fabricated by a dentist. There are a several downsides to this method. The first is that getting an accurate impression of your own teeth can sometimes be challenging. If you mess up the impression, you generally have to purchase more material and try again. The second downside is that they can be difficult for you to adjust. If all your teeth aren’t hitting evenly on the night guard it can cause problems. That said, this can be a good option for someone who wants the process to be as easy as possible.
Bruxism (Grinding) in Children
Teeth grinding in children is extremely common! Many parents come to me with stories of their children grinding so loudly that they can hear it through a closed door! They want to know what they can do to stop it…
Unfortunately, just like in adults, we don’t have a good way to make anyone stop grinding! We also don’t recommend any sort of appliance in children as their jaw is constantly growing and any sort of appliance can modify this process. DO NOT USE THESE GUIDES TO MAKE A GRINDING APPLIANCE FOR A CHILD! If you have a teenager who grinds and you can see wear on the teeth, you can consider a night guard once they have completed most of their growing. This is usually around age 15 to 18. It is earlier for girls than it is for boys. When in doubt, speak with your family or pediatric dentist or orthodontist.
The good news is that the majority of children grow out the grinding habit around the time they start getting their permanent teeth in (approximately age 6-7). There are a couple of things to keep in mind with a child who grinds.
- Occasionally a child will grind their primary (baby) teeth down so significantly that dental work is needed to keep the nerve from being exposed. This is extremely rare. I’ve personally seen thousands of children and have only had one who required this type of work. If in doubt, check with your family or pediatric dentist.
- In children who both grind and snore consistently, studies have shown there is a relatively high likelihood that they have sleep apnea (stop breathing in their sleep multiple times a night). See our section on sleep apnea for more information about this disease. Oddly enough in children with sleep apnea, there are higher rates of attention deficit hyperactivity disorder (ADHD). These children can lag behind in school as a result of getting less or poorer sleep. The most common treatment is removal of the tonsils in order to allow more space for the airway. Any concerns about sleep apnea with a child should be brought to your pediatrician or qualified sleep doctor. This is not something to ignore or attempt to treat at home as there can be very significant long term consequences with untreated sleep apnea.