Verified by 
Regular readers of my blog will know that I am always prepared to look at any claim of any behaviour being an addiction, compulsion or obsession irrespective of how trivial the behaviour might be perceived. One such behaviour is ‘teeth whitening’ which was included in a list of the ‘World’s Wackiest Addictions’ on the Oddee website. The short article claimed:
“Looks like some people can stop whitening their teeth, so much that it's being considered a new addiction. Since bleaching is easy and effective, people can really get hooked. Two possible side effects of this addiction are tooth sensitivity and gum irritation. According to a report, in the US alone, people spent almost $1.4 billion on tooth whitening products and procedures in 2006”.
It will probably come as no surprise that there is no empirical research into teeth whitening as an addiction, compulsion or obsession (although there are some academic and clinical studies looking at other aspects of teeth whitening that I’ll return to later in this article). However, I was surprised to find the Web MD website – a respected reference resource on all things health-wise – actually had an article on whether teeth whitening can become an addiction. The article noted that:
“Teeth whitening treatments are now the No. 1 requested cosmetic dental procedure, having increased more than 300% since 1996, according to the American Academy of Cosmetic Dentistry. At-home teeth whitening treatments have become increasingly popular as well. An array of over-the-counter tooth bleaching kits can be found in most any drugstore, discount store, or even grocery store. But there's such a thing as too much of a good thing. While most would stop short of calling it an addiction, dentists say some people do overdo it in the quest for the perfect smile”.
The same article also quoted Dr. Marty Zase (president of the American Academy of Cosmetic Dentistry) who said: "Yes, there definitely is a tendency of people to overuse [teeth whitening products], although most people don't”. A number of (populist and non-academic) articles that I read online about obsessive teeth whitening mentioned the behaviour in the context of ‘bleachorexia’ or ‘dentorexia’. (The online Urban Dictionary defined a ‘dentorexic’ as “When someone has white teeth but they think that their teeth are yellow so they obsess over brushing their teeth/whitening them. Similar to anorexia but involving an obsession over teeth rather than weight”).
An article on the Farah Queen website examined ‘bleachorexia’ (‘Teeth whitening addiction unraveled’) and claimed that some individuals become “obsessed with the process of teeth whitening…[the] repetitive desire to conduct teeth bleaching”. Typical behaviours of bleachorexics included constantly looking in mirrors at one’s own teeth (looking for signs of stains, spots, and discolouration) and a constant feeling of dissatisfaction with the colour of one’s teeth. The article claims that:
“[Bleachorexia is the term] referred to as the addiction with bleaching or teeth whitening to the extent that their oral dental health is already affected. People with bleachorexia don’t have to be admitted to a hospital to be cured, but it does pose multiple oral health risks in the process. The solution is just to accept that the teeth whitening products don’t really whiten the teeth but just remove the stains in their teeth. It is also recommended to avoid as much as possible the factors that causes stains and discoloration of teeth, such as coffee, red tea, soda, etc.”.
The article then goes on to list some of the “symptoms of bleaching addiction”. This includes hypersensitive teeth (due to tooth enamel erosion), oral irritation (affecting gums, palate, and throat), dizziness (due to accidental swallowing bleaching solutions). This is because bleaching solutions excessively can cause damage to the enamel, or the outer coating of the teeth, which results to sensitivity of your teeth. This appears to be backed up by a US report on ABC News that claimed that when it came to teeth whitening some people simply do not know when to stop, and that excessive teeth whitener use can cause permanent damage to teeth and gums. A New York cosmetic dentist, Dr. Nancy Rosen, said:
"People just want that Hollywood white, bright smile, and they are becoming obsessed with it. When people abuse teeth whitening products, the results aren't pretty. The edges of your teeth will become bluish-translucent in color, and that is irreversible. Your teeth can become very sensitive. You can harm the gum tissue and burn it away. They don't see that their teeth are looking translucent," Rosen said. "They don't see they have a problem. But a dentist can tell. I think most systems are very safe and effective. If you're not going to read the directions, any of these products can be dangerous. And there is no product that you can use, and use, and use that won't harm your teeth. If you are going to bleach your teeth, drink staining liquid through a straw”.
An online article by Dr. Chris Iliades (‘Could you have bleachorexia?’) defined bleachorexia as “an addictive obsession with bleaching their teeth to the point that it’s affecting their dental heath”. However, it did then add that those suffering from it “probably don't need a 12-step program – [but may] need to set more realistic expectations [about] teeth-whitening products”. Addictive terminology appears in almost every article that I have read on teeth whitening. For instance, an article by Sarah Bernard in the New York Magazine began her article with the following:
“Dr. Jennifer Jablow calls them ‘bleaching anorexics’. Dr. Larry Rosenthal prefers ‘bleaching junkies’. Peering into a patient’s mouth, Dr. Jonathan Levine can spot one in eight seconds. Dentists in the city are seeing more and more DIY tooth-whitening addicts who are abusing over-the-counter products…often to the point of pain and permanent damage. Michele Hallivis, 28, a biotech sales executive, began with ordinary whitening toothpaste, then upgraded to strips, paint-on whiteners, and finally a tray-and-gel product (where the solution is squeezed into a retainer like tray and worn for about an hour). She’d marinate her teeth – and inadvertently her gums – in a 6% peroxide solution. And because she kept the solution in too long, her gums became so sensitive”.
Here, the use of the word ‘junkies’ and a case study showing what appears to be tolerance (i.e., the needing of more and more, and stronger and stronger teeth whitening products to get her ‘fix’) implies some kind of addiction. However, I have yet to read any case study (even anecdotally) that fulfils my six criteria for addiction. However, the psychology of some aspects of teeth whitening have been investigated.
A 2013 paper in the Journal of Korean Society of Dental Hygiene by Dr. Kyeong-Hee Lee and colleagues examined awareness towards tooth whitening among 395 Koreans. They found that the majority of the participants wanted to whiten their teeth and most (65%) had whitened their teeth because it was easy to do (with 50% having done it themselves). They also reported that smoking and drinking coffee had no significant influence on the intention to whiten teeth either by gender, age, and marital status.
However, having white teeth doesn’t appear to influence attractiveness. A study published in a 2003 issue of the psychology journal Perceptual and Motor Skills by Dr. Alexis Grofosky examined whether having whiter teeth affected people’s perception of attractiveness. In their experiment they manipulated the colour of male and female teeth in photographs. They found that participants in their study found no difference in attractiveness between those with brilliantly white teeth and those that were not brilliantly white. However, they did note that having really white teeth might increase the self-esteem and confidence of those with such teeth (but this was not a variable examined in their study).
This does appear to be the case as a 2013 study by Dr. Corina Cristescu and colleagues in the Journal of Romanian Medical Dentistry assessed dental patients’ attitudes towards dental somatoform disorders damaging facial aesthetics, and how they felt after dental treatment. They surveyed 230 patients (92 females and 138 males; aged 20-63 years). They found that those with a poorer educational background were less preoccupied with their physical and anatomic appearance, and that people felt better about themselves after aesthetic dental treatment (including teeth whitening).
Another area where teeth whitening has been examined from a psychological perspective has been in the area of body dysmorphic disorder (BDD). BDD is a psychiatric condition that affects about 1-2% of Western populations and in the American Journal of Orthodontics and Dentofacial Orthopedics, Dr. M. Pole wrote an awareness-raising paper for orthodontists about the disorder, as it is believed that BDD concerning perceived dental imperfections is on the increase. A recent paper in the journal Behavioral Dentistry by Dr. A De Jongh also made the same point that one of the many types of BDD include those people who feel that their teeth are not white enough and need cosmetic surgery to improve their psychological condition.
A short 2010 article by Dr. M. Ali and colleagues in the British Dental Journal reported that they encounter patients with many psychiatric conditions including dental anxiety and phobia, obsessive compulsive disorder, hypochondriasis, psychogenic facial pain, eating disorders, drug and alcohol misuse, depression, schizophrenia and bipolar disorder. However, they singled out BDD as an important disorder that dentists should be aware of. They noted:
“From a dental point of view, patients present with disproportionate concerns about relatively minor cosmetic or aesthetic lesions, or the delusion that a normal part of their body is abnormal. A delusion is a fixed, false belief out of keeping with normal cultural and educational values…Such patients are more common than perhaps realised, and are very difficult to treat successfully as their visions of the anticipated results are not always realistic. They often display narcissistic personality traits, and there is a link with depression and anxiety. Often they have had multiple interventions…Patients with BDD may seek conventional dental treatment, for example cosmetic dentistry, implant surgery, [and] tooth whitening”.
However, Dr. A. De Jongh and colleagues published a 2008 study in the British Dental Journal and claimed there ws no reason to assume that BDD plays a significant role in the majority of people who seek cosmetic dental care. They surveyed 879 Dutch citizens for characteristics of BDD. Only one BDD feature (i.e., a preoccupation with a defect of appearance) was reported as a significant predictor of undergoing cosmetic dental treatments. Patients with such preoccupation were nine times more likely to consider tooth whitening, and six times more likely to consider orthodontic treatment. They were also five times more likely to be dissatisfied about their most recent treatment. The authors concluded that a preoccupation with physical appearance was a motivating factor for undergoing certain types of cosmetic dental procedures (including teeth whitening).
References and further reading
Ali, M., Elrasheed, A., & Cousin, G. C. S. (2010). Dysmorphic disorder. British Dental Journal, 209(5), 198-198.
Cristescu, C., Apostu, A., Virvescu, D., Apintilesei, A., & Burlui, V. Study on the psychological impact of dental somatoform disorders. Journal of Romanian Medical Dentistry, 13, 54-59.
De Jongh, A. (2013). Cosmetic Dentistry: Concerns with Facial Appearance and Body Dysmorphic Disorder. Behavioral Dentistry, 109.
De Jongh, A., Oosterink, F.M.D., Van Rood, Y. R., & Aartman, I.H.A. (2008). Preoccupation with one's appearance: a motivating factor for cosmetic dental treatment? British Dental Journal, 204, 691-695
Grosofsky, A., Adkins, S., Bastholm, R., Meyer, l., Krueger, l., Meyer, J., & Torma, P. (2003). Tooth color: effects on judgments of attractiveness and age. Perceptual and Motor Skills, 96(1), 43-48.
Lee, K-H., Park, C-H., & Kim, S-K. (2013). Awareness and satisfaction on tooth whitening. Journal of Korean Society of Dental Hygiene, 13, 605-613
Oddee (2008). World’s Wackiest Addictions. November 5. Located at: http://www.oddee.com/item_96496.aspx
Polo, M. (2011). Body dysmorphic disorder: A screening guide for orthodontists. American Journal of Orthodontics and Dentofacial Orthopedics, 139, 170-173.
