Thoughts on teeth whitening

[neutropeniaboy]

Can anyone out there offer me some advice regarding the various teeth whitening products out there? There are three that stand out to me: the Crest Whitestrips, Rembrant's stuff (tray and gel), and another peroxide-based gel and tray).

As far as I know, 16% carbamide peroxide is what is commonly used in the offices. I don't think these products contain specifically that.

Are these OTC brands worth the cost? Can they damage the enamel? Any effect on gingiva?

Thanks.

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[DrJeff]

Here is whitening broken down in a nut shell for you. Essentially first you have to look at the type of stain that it is. Many stains are extrinsic in nature (i.e. food, smoking, beverage stains) these can with limited success be treated to some extent with over the counter whitening tooth pastes. But after the extrinsic staining is gone, you're left with the natural color of your tooth. Intrinsic stains are those that make up the natural color of your teeth as well as those caused by various genetic conditions and/or antibiotic treatments during tooth formation/ maturation. You can use as much whitening tooth paste as you want and it won't touch these intrinsic stains. This is where whitening gels (essentially carbamide peroxide and to a limited extent hydrogen peroxide) come into play. To sum these gels up, yes they all work, certain stains and underlying tooth colors are more susceptable to the effects of whitening gels. How they work is simply a matter of time and gel concentration. A low strength product such as crest whitestrips with 7.5% carbamide peroxide as I remember will take twice as long to achieve the same result as the standard office delivered gels which are in the 15% range. In my office, we will commonly jump start the bleaching process with a one hour treatment of 30% carbabmide peroxide followed by sending my patients home with syringes of 18% gel. Some of my sensitive patients get treated with 5% gel(generally Colgate Platinum extra sensitive formula) over a longer period of time.

The OTC products you mentioned do work. I've found in my practice that the whitestrips are quite successful and popular, although my patients like the results on their maxillary arches(upper) than the mandibular arches since the strips are easier to conform to the upper arch. Some patients will have a small area at the gingival margin where the whitestrip doesn't reach The with the home formed trays, you need to be careful in their contour at the gingival margins, extened bleaching gel exposure to the attached gingiva at the margins can lead to gum irritation and potentially gum recession.

Bleach away, it works, but you need to have some patience with the lower concentration gels.

 

[UofM01]

Dr Jeff,

I read in a recent study that I read at the dental office I work at...It stated that the strength of the gel is not what leads to the sensitivity but yet it is the wear time(amt. of hours) that you have the bleaching trays in.

In other words, it is better to put a stronger percent gel such as 22% in for a half hour to a full hour instead of using the 16% for a whole night like it is recommended with a product such as NITE WHITE.

Dr Jeff IM sure you have a much better understanding than me on this matter, I just wanted you to clarify what I have been reading thats all. My Dentist told me that what I read was true. Please reply...I do not want to give my friends wrong info

 

[DrJeff]

In the 5 years that I've been administering bleaching trays to my patients (I'd estimate that I've done 250 or so cases in that time) the incidence of sensitivity that my patients report to me have been in the 10 to 15% range. Most of the sensitivity was reported by my patients to be in the moderate range. Most of these have been on folks with exposed root surfaces that were non sensitive before treatment. In these folks I have done everything from starting them on carbamide peroxide concentrations of 5, 7.5, 10, 15, 18 and 22%. You can see by the range of concentrations that I've used that the science of bleaching is an evolving facet of dentistry. I've had folks that I wouldn't have expected to become sensitive become sensitive on the higher concentration/ lower time exposure protocols, and folks not get sensitive that I would have expected to get sensitive on the lower concentration longer time protocols. The biggest advance that I've seen in the bleaching of my patients lately is the Colgate Platinum line of bleaching gels. They've reformulated the gel and buffered it in a fashion that just seems to avoid sensitivity in patients. I'm actually at the point that when the remaining few kits of Night White/Day White and Opalescence are gone that all I'm going to stock is the Platinum products. What really sold me was when one of my hygenists who basically has extreme sensitivity to most situations was able to use the sensitivity version of the platinum for 2 weeks straight with a result of A3 to a post bleach of B1 with no sensitivity

On an aside of what I did above, when you're running an office, offer free bleaching/free dentistry, especially cosmetic procedures to your hygenists, assistants and staff. They will talk about it to patients very frequently and it will sell more dentistry. Case in point, since the hygenist above had her teeth bleached last July, she's been averaging selling 2 full cases of bleaching a week! Thats roughly 60 cases who are now telling their friends about it, who in turn are calling up and scheduling appointments. Word of mouth marketing is the best type that you can have!

 

[UofM01]

So I guess there is NO black and white answer. I will have to research this on my own when I finish dental school. By the way I bleeched my teeth for free along with the rest of the staff at the clinic. You are right we do talk about it a lot to patients

 

[vixen]

hmmm...interesting. Dr.Jeff, do they really teach you the business skills you need in dental school, or do you just kind of pick it up along the way?

 

[neutropeniaboy]

Thanks, DrJeff. I always find it funny that I can use all my medical knowledge to investigate products/medicine, but still seem skeptical or weary without the clinical experience.

Anyway, thanks for the input!

 

[DrJeff]

•••quote:•••Originally posted by simseema17:
•hmmm...interesting. Dr.Jeff, do they really teach you the business skills you need in dental school, or do you just kind of pick it up along the way?•••••Ah the business side of things. This is honestly the topic that I take most of my continuing education in. Most dental schools will barely brush on the practice administration side of things, and frankly its no suprise with trying to cram all the medical sciences and dental sciences and clinical experience into 4 years. I've picked up (and am still picking up) my business skills/philosophies from mentors that I have come to know through dental school/residency, from CE courses, from talks with my local dental society members, and frankly from a little common sense and/or dumb luck . I think the thing that puts it in perspective about how the business side is an on going learning process for most of us in this profession is that in the past when I would get together with friends who I graduated with we would talk the clinical side of dentistry about 80-90% of the time. Now when we get together we talk about the business side of dentistry about 80-90% of the time (Note of the remaining 10 to 20 percent almost all of it is about our families now and almost never about the clinical side of things ). You learn by experience and you'll likely end up changing more things about how the business works than how the practice works.

 

[Centrum]

I will bump this one up for everyone also.

 

[SeaBass]

I have just started (1 application) using a 10% Carb. Per. product (Opal.) and noticed significant whitening where some of my ortho brackets used to be. Are this likely areas of decalcification and do they tend to whiten more than the rest of the enamel? Has anyone else experienced/seen this...will it likely return to the colour of the remainder of the tooth (it's in my lower arch so i'm not too concerned about it).

Also, could anyone recommend a schedule for a 10% product. The kit only came with vague instructions. Thank you kindly