The song “You’re Never Fully Dressed Without A Smile” from the musical Annie said it best: a winning smile can make a huge difference in the face we present to the world. When teeth are discolored, especially noticeably so, who wants to show their non-pearly whites? Let’s look at how you can turn that frown upside down and begin smiling again with confidence.

No one’s teeth are naturally white, at least not the “Hollywood-white” smiles many celebrities have. There are many reasons why someone may have yellow or stained teeth. Foods like coffee, tea, red wine, and berries can cause stains. You can cut back on the foods causing the problem, but who wants to give up their coffee in the morning, much less fresh berries and red wine (nothing like a beautiful pinot noir or cabernet sauvignon at the end of the day)? Genetics can play a role too; some people just have teeth with a yellowish or off-white appearance. Smoking is perhaps the worst offender because it not only discolors teeth but it kills healthy gum tissue, causing serious health risks for your mouth. Serious staining and discoloration (natural or otherwise) cannot be corrected with toothpaste no matter what the claim says on the label, but teeth whitening/lightening/bleaching products at the drugstore in the form of strips, liquids, or gels or from a dentist work miracles.

The whole subject of improving the color of your teeth gets complicated because the terminology has been regulated, but the regulation is too confusing to be of help to consumers. According to the FDA, the term "bleaching" is permitted for use on products that can “whiten” or “lighten” teeth over and above their natural color. Plus bleaching products must contain “bleach” (not the kind for your laundry), but the kind that “bleaches” teeth making the color lighter, with the typical ingredients being hydrogen peroxide or carbamide peroxide.

Now here is where it gets really confusing: the term "whitening," can only be used on products that clean teeth, meaning toothpaste. So any product that cleans the surface of a tooth can be labeled a whitener. However, because the term whitener sounds so much better than bleaching (which we think of as Clorox and something used for laundry, not on our teeth), “bleaching” products call themselves whiteners or whitening to sound more appealing to the consumer. Yet as mentioned, the term whitening is only about cleaning your teeth, not changing the color.

Before you jump in with any choice for teeth whitening there is a risk of mild to painful gum sensitivity. Mild to moderate isn’t bad, but when it’s painful, believe me, it isn’t pleasant. However, one way to resolve that problem is to brush your teeth with a toothpaste containing potassium nitrate. Research shows that this desensitizing, teeth-friendly ingredient can make a huge difference in reducing some of the side effects.

Dentists would like you to believe that they are the only solution for teeth whitening but that isn’t the case. Almost all teeth whiteners (“bleaches”) work incredibly well so you can choose by cost or just start with the easiest availability which would be those at the drugstore. All teeth whiteners use the same type of ingredients, either carbamide peroxide or hydrogen peroxide, but with different strengths to lighten teeth. The higher the percentage of the active ingredient and the type of ingredient determines how fast you see improvement. Results will be seen in 1-14 days depending on the product you buy. Although there are several very good at-home whitening products, some of my favorites include Crest Whitestrips Pro Effects Dental Whitening Formula, Aquafresh Whitetrays Disposal Pre-Dosed Trays, and the iWhite Advanced Teeth Whitening Kit (available at CVS stores).

If you choose the in-office dentist procedure it would cost on average about $500 per visit. Dentists can also give you a take home kit that you can only buy from them (though there are Web sites such as www.aplussmile.com selling the exact same product to consumers). The cost for the dentist-sold kits ranges from $100 to $300 (and about half that from most Web sites selling the same products). At the drugstore the “bleaching” kits cost between $20 and $100.

Teeth-whitening kits at the drugstore or from various Web sites come in many different forms from strips, paint-on, to gels that are used with a mouth guard. Choosing is all about your own personal preference because they all pretty much work as claimed when they contain the same active ingredients, and you follow the ratio of effectiveness I explained above.

No matter the claim on the label, there are pros and cons to each type of application. Strips can slip off the teeth creating uneven results. Some people don’t like the feel of dental trays. Paint-on products are more time consuming to evenly cover each tooth surface. Strips are also limited because they can only cover the front teeth, which means only those teeth will be affected, leaving the others as they were.

Another problem is that bleaching kits of any kind cannot change the color of dental crowns, bonding material, porcelain veneers, fillings, or any other material in your mouth other than your natural teeth. You can imagine how strange an appearance you can end up with if each of your teeth were a significantly different color from the other. None of these treatments is very effective if your teeth are grayed rather than yellowed, or if they are completely yellowed. Teeth-bleaching systems work best for partially yellow or food-stained teeth.

Keep in mind that bleaching products have a short shelf-life. This is because the active ingredient is a form of peroxide and it is an exceptionally unstable ingredient. It can happen that by the time you find, buy, and start using your whitening strips the peroxide may have become inactive. If whatever method you try doesn’t provide noticeable results, that could be the reason why.

Other than bleaching, if the yellow or dull color of your teeth is from tartar buildup, get your teeth professionally cleaned, and have them cleaned regularly. If you can, avoid or minimize consumption of foods that can grab onto teeth and make them look darker, such as chocolate, dark-colored berries, red wine, and coffee. Milk can also bond onto front teeth and cause a yellow tartar buildup. Clearly, it would be best to brush immediately after eating these foods, but if that isn't possible, rinse your mouth well with water and then chew sugarless gum. Many dentists recommend using the Sonicare automatic toothbrush to prevent tartar or plaque buildup. You definitely cannot manually brush your teeth as well as the Sonicare can, so it is a worthwhile option to check out.

(Sources for the above information: Operative Dentistry, July-August 2008, pages 379-85; Dental Materials, May 2007, pages 586-596; Journal of Dentistry, February 2008, pages 117-124; Cochrane Database Systematic Reviews, October 18, 2006, CD006202; Journal of Contemporary Dental Practices, February 2004; pages 1-17; Compendium of Continuing Education in Dentistry, June 2003, pages 461-464: Journal of Clinical Dentistry, 2002, volume 13, number, pages 91–94; Journal of Esthetic and Restorative Dentistry, 2001, volume 13)

MAX FACTOR Vivid Impact Lipcolor ($8.97). The name for this creamy lipstick is 100% accurate. The colors are vivid and go on opaque with a soft cream finish. Whether you want rich reds, deep burgundies, strong pinks, or bold beiges, there is something for everyone looking for a lipstick that’s bound to turn some heads. Vivid Impact Lipcolor isn’t for the lipstick-shy, but all others should audition this, one of the best cream lipsticks at the drugstore. It is minimally prone to creeping into lines around the mouth, but using an anti-feather lipliner should stop it in its tracks.

Dear Paula, I bought two of your books: Don't Go To the Cosmetics Counter Without Me and the Beauty Bible. I'm very happy that I found these books because they are very informative and save me the unnecessary expenses on products that are allergens and damaging to my skin. I'm 28 years old, and I have a huge problem that I hope you can answer. I used a facial cream sample from L'Occitane. The product's name is Olive Radiance Moisturizing Cream. After using this cream, I got an intense irritation and rash all over my face and under my eye area. Prior to using this sample cream, I had excellent, smooth skin. And now, weeks later, this rash is still there. I went to an aesthetician, and she recommended the Gaylee Neroli Hydrating Cream for Normal to Dry Skin. What do you think about this cream? And what can I do to get rid off the rash that I have? I need your help desperately. I'm panicking! Help! Yolanda, via e-mail Dear Yolanda, When you have a reaction to a product that is severe in nature, the last place you should go is to an aesthetician! Most of them will simply toss more moisturizers or serums at you, without trying to uncover what it was in the offending product that caused this reaction. It would also be extremely rare for an aesthetician to recommend an effective anti-inflammatory product to calm the problem because those are only available over-the-counter at a drugstore or by a prescription from a physician or a physician’s assistant. For the most part, you’d be left experimenting with whatever line the aesthetician’s shop or salon happens to sell—and the products may be just as problematic as the one that caused your skin to react. Chances are good you had a reaction to the fragrance, plant extracts, or fragrance chemicals (such as eugenol) used in the product, but there is no way to know for sure unless you are patch-tested by a dermatologist. The redness and rashy look can be remedied with an over-the-counter cortisone cream, lotion, or gel (whichever texture you prefer), or, if the condition is severe enough, a prescription-only cortisone cream. Apply as directed for 7 to 10 days, and keep your skin-care routine as gentle and minimal as possible. Use a mild cleanser, such as Cetaphil Gentle Skin Cleanser or CeraVe Hydrating Cleanser (no bar soaps or fragranced cleansers) and protect your skin with a titanium dioxide sunscreen (Clinique Super City Block SPF 25 is great, or apply any foundation with a titanium dioxide-only sunscreen). Do not use any scrubs, toners, or astringents, AHAs, BHA, anti-acne medications, washcloths, retinol products, vitamin C products, or fragranced moisturizers. For dry areas, use a bland, unscented moisturizer like Cetaphil (or plain Vaseline would be fine if you have very dry areas). If the redness and irritation do not clear up within one week, or if it gets progressively worse, see your physician—not an aesthetician or cosmetics counter salesperson.

Let Paula take a look at your daily skin-care routine, free! Readers are invited to submit their skin care regimens with the complete names of products they use along with their skin type and skin concerns.  Paula will review your routine and make recommendations for product changes to assist in creating a personalized skin-care plan.
Note: Due to the anticipated high volume of response, Paula will not be able to review every skin-care regimen. Photos or video of products/regimen are encouraged. Please submit regimens to: regimen@paulaschoice.com

Dear Paula,
I know your products are very reasonably priced but do you think their long term effect is just as beneficial as products you would pay big money for? I am using your products now and loving the results, but sometimes wonder if spending more for certain products may net even better results. For example, can your Antioxidant Concentrates really be just as good as serums costing in the triple digits for the same amount of product?
-Samantha, via email

-Dear, Samantha,
When there is a well-formulated product, efficacy is efficacy regardless of price. What counts is the formulary and packaging. If the packaging isn’t airtight key ingredients won’t stay stable and the qualities of the ingredients are not always determined by the product’s retail price (though just to be clear, there are definitely skin-care ingredients that are costly to use compared to alternatives that sell for less but may have reduced efficacy). There are products in all price categories that are well-formulated and in stable packaging and lots that are just pathetically formulated with no merit or great formulas in jar packaging allowing the good ingredients to deteriorate shortly after opening. Relying on price as a determinant of benefit would be wasting your money. You’re welcome to experiment with some of the pricier serums I rate highly, as long as you don’t mistake any perceived benefit as being the result of spending more money than is needed.

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