Teeth Whitening turns more heads than facials or tattoos – professionals agree.
Worldwide, especially the baby boomer generation, are obsessed with youth. The popularity of televisions Extreme Makeover is a testament to this infatuation. The show has featured tooth whitening one, relatively inexpensive procedure to make people look younger and that has fueled a consumer-driven need for tooth whitening.
It seems the number of whitening products increases daily. Consumer-whitening products began with gels in trays and now include whitening strips, paint-on products, and felt-tip applicators with whitening substances. In fact, in a recent e-mail survey* of dental hygienists conducted by Hygienetown, nearly all respondents (95%) recommend home-use whitening to patients and 70% said oral hygiene products were sold in their offices. The market is growing, the products are selling and the number of choices keeps increasing.
With all of the attention to tooth whitening today, it seems odd to think that it wasn’t too long ago dentists discouraged their patients from wanting white teeth, saying: “Teeth are shades from yellow to gray;’ Pure white teeth just aren’t natural; and Really white teeth are probably dentures. With no solution being offered by the dental profession, consumers decided to take matters into their own hands, using Ajax or Comet cleanser to whiten their teeth.
There is no denying it, tooth whitening is big business. Over-the-counter whitening product sales were projected at $351 million last year in the United States, up from $38 million in 2001. Sales of whitening products dispensed from the dental office were $2 billion in 2005, up from $435 million in 2000, according to Mintel International.
When professional whitening products first entered the market, dentists were reluctant to offer the procedure because it was considered cosmetic rather than therapeutic and therefore was unprofessional. The perception of tooth whitening changed with the public’s desire for whiter teeth.
In fact, my first experience with whitening was done to lighten an endodontically (root canal) treated tooth that had darkened. The tooth was opened up from the lingual, a cotton pellet soaked with hydrogen peroxide was placed inside, and a photo flood light was used to speed the bleaching process. The high concentration of peroxide used destroyed the interdental papilla in the process, even with the use of a rubber dam. (It looked awful for weeks!) From those crude beginnings, bleaching has evolved into whitening and with it has come a revolution of change and the number one “head-turner.”
Although, 70% of respondents to Hygienetown’s e-mail survey* reported whitening was done by other staff members in the office, we know hygienists routinely field questions from patients about tooth whitening. Patients undergoing whitening procedures either in the office or at home want very white teeth, with no sensitivity, in the shortest time possible. Understanding the dynamics of whitening will help you answer your patients questions.
Whitening: How does it work?
Just as peroxide products lift color from hair, peroxide whitening products lift stain from tooth surfaces. Hydrogen peroxide is a combination of hydrogen and oxygen. There is an extra oxygen molecule that hunts for another molecule to attach to, in this case molecules of color within the enamel. The oxidation reaction breaks down the color trapped in the enamel surface into smaller particles that are released from the enamel.
Carbamide peroxide is a combination of hydrogen peroxide and urea. Adding urea to hydrogen peroxide stabilizes the formulation, produces a longer shelf life and improves taste. According to the research, both products whiten comparably, since the whitening is achieved by hydrogen peroxide in both cases.
Although the concentrations for hydrogen peroxide products appear to be lower than carbamide peroxide products, carbamide peroxide consists of one-third hydrogen peroxide and two-thirds urea. Therefore, a 10% carbamide peroxide product contains only 3% hydrogen peroxide and 7% urea. From the other side, a 9% hydrogen peroxide product is equivalent to 27% carbamide peroxide.
Whitening is achieved with a time/concentration approach. The shorter the time, the higher the concentration needed. The higher the concentration, the shorter the time needed. In-office products generally use peroxide at concentrations of 20-35% for short periods of time. At-home products are generally lower concentrations used over a longer time period.
Most in-office whitening is not sufficient to achieve the desired results in a single visit. According to a study reported in the February 2006 issue of Quintessence International, one to four visits are needed to achieve patient satisfaction with whitening results. Home-use products are provided to supplement and extend the in-office results and for touch-ups later. The primary advantage of in-office procedures is time. However, according to research published by Dr. Van Haywood of the Medical College of Georgia, whitening achieved with a lower concentration over a longer period of time is more stable than that achieved with a high concentration applied for a short time.
Can tetracycline stain be treated?
Even tetracycline staining can be altered with whitening over an extended period of time, or deep bleaching. Researchers have shown significant effects when the home-use whitening process is extended to six months or more. Other clinicians have found that preconditioning the teeth with several weeks of home-use whitening followed with a high concentration, in-office treatment effectively lightens tetracycline staining and/or fluorosis. According to Dr. Marshall White, the slow preconditioning of enamel with home-use whitening makes the enamel surface more receptive to greater color change later using a higher concentration, in-office procedure.
How white will the teeth be?
Teeth can be lightened from one to several shades. Patients should be prepared for some rebound as whitening procedures often dehydrate the enamel, leaving it lighter than it will be when again saturated with saliva. Explaining this to patients will prevent disappointment later.
How does the light work?
The heat from the light will speed the effect of the peroxide and also will dehydrate tooth surfaces. According to the research, the lights and lasers provide very little, if any, advantage over the whitening products used alone. More recently, whitening products have incorporated photo-activating substances to enhance the effect of the light or laser. The lights and lasers provide a psychological stimulus that patients find trendy and therefore desirable in this competitive world of sole mates.
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