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Bleachorexia: When White Is Not White Enough

With the advent of do it yourself teeth whitening products that you can use in the comfort of your own home, "whitening junkies" were born. Prior to OTC whitening products, you had to make a trip to the dentist in order to obtain them. This provided a level of safety due to limitation of availability of the products.


hismile whitening toothpaste pen strips

However the flood gates were opened and all hell was let loose once OTC options were readily available. Individuals can purchase them whenever they wanted and however much they wanted. The limits on teeth whitening were lifted and the sky became the new limit. Everyone was now bleaching their teeth without any professional supervision.


Of course as you may have guessed when there is a lack of control for using products that have side effects, problems arose. That was how bleachorexia was born.


What is bleachorexia?

Bleachorexia is an unhealthy obsession with whitening your teeth. Rather than being a dental problem it actually falls under the category of body dysmorphic disorders.


The term is a blend between the words "bleach" and "anorexia". According to ABC news, it was first coined in 2005 by Dr Jennifer Jablow, a dentist in NYC. Whether or not that is true, we're unsure to be quite honest. The news article was written in 2011 and we could not find any information circa 2005 in regards to Dr Jablow mentioning the term. Her personal website also yielded no information about it either.


Therefore we cannot say with any degree of certainty that bleachorexia was coined by Dr Jablow due to insufficient evidence. Nonetheless, we'll just say that she did for now...


Anyway, this is not a dental problem because when whitening is used as directed and intended, the adverse effects are limited. The two most common symptoms from bleaching are sensitivity and gum inflammation. However these symptoms are usually mild and transient in nature. In other words they will subside on their own in about 4 days after stopping treatment at least according to the ADA.


Thus when teeth whitening is used in moderation, it is typically not a problem. However when individuals are left to one's own accord, some of them take it too far. Some people will attempt to whiten their teeth beyond what is recommended.


An example would be bleaching their teeth everyday for a few months straight. They also can't stop because they've grown addicted to having whiter teeth. When this happens, it is definitely a psychological problem because the product is being abused by the user. For that reason, bleachorexia is considered a body dysmorphic disorder and of course there are unwanted side effects that come with it.


Adverse effects from excessive whitening

The two most common side effects from whitening in general are teeth sensitivity and gum inflammation. However when it becomes excessive such as for individuals who are bleachorexic, other symptoms start to emerge.


whitened gums from teeth whitening

This can be see in a case report of a 55 year old female who was using teeth whitening products twice a day for months. Apparently the day that she started whitening was the day that her teeth are never white enough. (There are before and after photos of the symptoms in the case report link).


Symptoms from excessive teeth bleaching:

  • Sensitive teeth

  • Gum inflammation

  • Sloughing of oral mucosa

  • Spontaneous bleeding gums


Despite the scary symptoms, all of them resolved after two weeks of discontinuing her self-prescribed whitening treatment. That should be plenty of evidence of how too much whitening can be harmful to your mouth.


Another point to keep in mind was that she was ONLY using OTC products which were lower in concentration from professional ones. She was using 6-10% hydrogen peroxide and in due time that resulted in all of her symptoms above. The concentration pales in comparison to professional in-office products that can be as high as 40%. Imagine the damage that can be done if she somehow managed to abuse the higher concentration products.


40% peroxide teeth whitening gel

Also if you're curious as to how does hydrogen peroxide whiten your teeth, we've an entire article dedicated to it! It is one of the few ingredients in this world that can oxidize tooth stains. But basically how most teeth whitening products work, they all do so in a similar fashion by using peroxide.


How do you treat bleachorexic patients?

The first thing that should be done is the dentist counseling and advising the patient to cease the whitening due to its harmful oral consequences. After that they should be referred to a primary care physician for further counseling since this is a psychological disorder.


First and foremost the patient needs to discontinue all self-prescribed whitening. There are a lot of adverse oral effects that may result from excessive bleaching. These will not go away until they stop using all of these products. As evident in the case report, all of these adverse symptoms resolved after two weeks of discontinuation.


If they don't stop using it, the symptoms will persist and that is not healthy for their mouth. Therefore they must be persuaded to stop so that they are no longer inflicting self harm.


OTC whitening toothpastes with peroxide
OTC whitening toothpastes with peroxide

Secondly they should be referred to a physician because this incidence has unearthed a problem that was not previously known. The whitening products are innocent because they're merely being abused. The root of the problem stems from a body dysmorphic disorder which will need to be addressed.


The condition may even be affecting other parts of their lives but we don't know. That is why it is important to refer them for professional counseling. That is beyond the scope of dentistry. However you can still consider this condition a multi-disciplinary disorder.


Takeaway

White teeth is certainly desirable and can be a good thing since it improves your aesthetics and raises your self-esteem. It is certainly amazing that technology has advanced enough that there are OTC solutions which permit you to whiten at home. The affordability and accessibility of it has definitely improved the quality of life for everyone around the world.


However like most things in this world, there can be too much of a good thing. Excessive bleaching is not only harmful to your mouth but also to your mind. We're not proponents of self-harm so you should definitely seek to address this issue.


Sometimes white is white enough and you need to just accept it and be happy with what you have. If you think you have a whitening problem, you should definitely seek out professional help whether that be from your dentist or your physician.


Just so that you know, there IS a limit to how white your teeth can get so it is senseless to continually continuing on your journey for even whiter teeth. If you've been doing it for a long enough time, you've most likely reached the end anyway. If you really wanted to brighten them even further, the only option would be to get dental veneers.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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