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What options are there for teeth whitening and bleaching?


Published by
SmileLabs, LLC
Written by
Zachary Hilgers, DDS (Retired)
January 13th, 2010
© All Rights Reserved

ABSTRACT

It is frequently asked, “What are the options available today for consumers that want to whiten their teeth safely and effectively, and how does SmileLABS™ accomplish this for their clients?”  This paper reviews the literature to cite examples of currently accepted methods of teeth whitening or bleaching, and shows how SmileLABS™ uses the best of these techniques to accomplish its goal of safe, easy, and effective teeth whitening.

INTRODUCTION

Today, in 2010, there are three basic options available to the consumer for cosmetic teeth bleaching. The first option is whitening that is performed by a dentist in a dental office, or by a hygienist or dental assistant at the dentist’s office under his or her supervision. There are a few variations as to how the dental office does the actual treatment, and those options will be discussed in detail.

The second choice available to health- and beauty-conscious consumers is the Over-The-Counter (OTC) option. There are a few examples of these alternatives available to today’s consumers that we will explore. Some of these appear to work and some do not, and some are downright novel in their approach to whitening.

The third and final alternative is a what many believe to be the best of both worlds method; this would be cosmetic teeth whitening or bleaching using some the same techniques and materials that the dentist would use, but without the bother and expense of having to go to the dental office to have the procedure quickly, affordably, safely, and effectively accomplished. This is how SmileLABS™ does its teeth whitening treatments.

THE DENTIST OPTION

In a landmark study some twenty-one years ago, VB Haywood and HO Heymann described what they called “Nightguard Vital Bleaching” to dentists in Quintessence International, a popular dental journal at the time.[i] It consisted of using dentist-fabricated custom bleaching trays, which were made of a material that was then used as a nightguard for people that ground their teeth. These trays were given to the patient for use at home while they slept.

The patients would usually treat their upper teeth first. The patients were instructed that before going to bed, they should brush their teeth, apply a small amount of 10% carbamide peroxide bleaching gel to the inside of the tray, insert the tray to cover the teeth, wipe off any excess that flowed out, and then to sleep with the tray inserted in their mouth all night long. Upon arising, they would remove the tray, rinse it and their mouths with water, and then repeat the same process every night for 14 days. Then, they would do the same thing with the tray for the lower teeth for another two weeks to complete the treatment regimen.

The results were usually very good, with shade changes reported of 5 to 8 shades whiter as measured by a dental shade guide. Today, this type of bleaching is sold to the patient for $200-$400. This method was so effective that it is still used by many dentists today. Even my own dentist still uses this technique. Other dentists have modified it somewhat by changing both the strength of the bleaching gel placed into the tray, as well as changing the amount of time the appliance is worn daily. Most dentists, however, do not use the same “nightguard” material because, unless the patient actually does also need a nightguard, they feel it is too thick, and they have opted for a thinner type of silicone tray material. This technique, done almost exclusively by dentists, is commonly known as the “Custom Take-Home Tray” method of bleaching. The safety and efficacy of this tooth-whitening method has been well documented in clinical studies.[ii]

Table of Some At-Home Bleaching Products Dispensed by Dentists:2.1

  NuPro Gold

  Carbamide peroxide

 Crest Whitestrips Supreme

  Hydrogen Peroxide

 Colgate Platinum Overnight

  Carbamide peroxide

 Colgate Visible White

  Hydrogen Peroxide

 Sapphire Home Whitening

  Carbamide peroxide

 Opalescence

  Carbamide peroxide

 Très White

  Hydrogen Peroxide

 TiON

  Carbamide peroxide

 Night White ACP

  Carbamide peroxide

 Day White ACP

  Hydrogen Peroxide

 Vivastyle

  Carbamide peroxide

 Perfecta REV

  Hydrogen Peroxide

 White and Brite

  Carbamide peroxide

The other technique that dentists use to bleach vital teeth is known as “In-Office, One-Hour Whitening.”[iii] This method can be done with or without the use of an accelerator light. This treatment modality is also known as Power Bleaching. The cost to the patient is typically $500-$800 per session.

In this procedure, all of the bleaching is performed by a dentist or supervised assistant in a dental chair at the dentist’s office. The procedure usually takes one to two hours to complete. The results are generally good, similar to the take-home trays method, but are much faster but also more expensive to the patient.

Currently, the most popular systems use a high concentration of hydrogen peroxide, as opposed to the mostly carbamide peroxide used in take home trays, and it is usually somewhere in the 25-35% concentration range.[iv] During a lengthy prep time of up to a half hour, the patient’s teeth are exposed using cheek retractors and the gums are isolated using a brushed-on plastic polymer that is hardened by light curing so as to prevent the gums from being exposed to the high peroxide concentration of the whitening gel. The gel is painted on the front surface of the teeth and left to work, usually for a 20-minute period. At this point an accelerator light, such as the ones in the Sapphire™, BriteSmile™, LumaArch™, or Zoom 2™ (the most popular among dentists) systems, may be employed to hasten the chemical reaction of the bleaching process.5,6,7,8

After 20 minutes, the gel is usually suctioned off the teeth using a dental vacuum. The gel is re-applied, the light, if used, is set again, and the treatment is repeated up to two more times for a total of 60 minutes of actual bleaching time. Again, the results are usually very good with a 4 shades whiter or more change occurring. One common very undesirable side effect of this in-office system is post-operative tooth or teeth sensitivity that can last up to two weeks or more. Patients using the popular Zoom 2™ often experience what are known as “Zings,” or quick, sharp, electrical-type, short duration pains that gradually subside with time.

It is my feeling that these “Zings” are due to the fact that while the isolated teeth are being bleached in the open air for an over-long time using very high bleach concentrations, they become desiccated, or dried out, and that, coupled with the oft-times high heat output of the accelerator light, causes a temporary inflammation of the inner tooth nerve, known as a pulpitis, to occur. This pulpitis manifests itself in the form of the painful “Zings.” Interestingly, SmileLABS™ Cosmetic Teeth Whitening System does not have this problem for reasons I will discuss later in this paper.

Table of some Dentists’ One-Hour Whitening Products (with accelerator lights if applicable):8.1

 Sapphire Professional

Whitening

 Hydrogen Peroxide

(Sapphire PAC curing light with with Whitening Crystal)

 TiON

 Hydrogen Peroxide

(Any light for activation)

 Zoom 2

 Hydrogen Peroxide

(Zoom 2 bleaching light)

 White Speed

  Carbamide peroxide

(Any light for activation)

 Opalescence Xtra Boost

 Hydrogen Peroxide

(Any light for activation)

 Opalescence Quick

  Carbamide peroxide

(Any light for activation)

 LumaArch

 Hydrogen Peroxide 

(Any light for activation)

 Illuminé

 Hydrogen Peroxide

(Any light for activation)

 BriteSmile

 Hydrogen Peroxide

(Any light for activation)

THE OVER-THE-COUNTER OPTION

In recent years, manufacturers have developed unique tray-less methods for OTC at-home bleaching. The first of these was Crest Whitestrips™ from Proctor and Gamble. OTC strips from other manufacturers have come out as well, and the concentration of hydrogen peroxide in the strips available have increased significantly from 5% up to 14%.9 The strips are relatively inexpensive, usually costing between $25-$50 per box of strips. Even with their low cost to the consumer, the whitening results with these strips are highly variable because patient compliance is questionable in that many will not complete the treatment regimen of 30 days of daily use. Fifty dollars is not cheap at all when you don’t achieve the desired results.

There are also many other OTC products that have their manufacturers using the catchall phrase of “Whitening” to describe their products. These are not bleaching products per se, and they only minimally remove the outside stains, not the inside ones, on the teeth surfaces. There are various toothpastes, chewing gums, oral rinses, and brush-on products that their labeling claims to have “Whitening” effects. In most cases, if there is no active peroxide in the product and they are merely stain removers. In a recent study, whitening strips performed much better than a so-called “Whitening” toothpaste.10 But both the SmileLABS take home product and our signature chairside solutions are far superior.

THE SmileLABS™ OPTION

SmileLABS Cosmetic Teeth Whitening, offers to the general public what is considered by many to be the best of all options available to the cosmetic beauty-conscious public. They offer two different systems, a light-activated chairside system, as well as over-the-counter take home products.

The flagship product of SmileLABS™ is their $99 15-20 Minute Light-Accelerated Power-Bleaching System that is available from all Authorized SmileLABS™ Dealers. This system uses their proprietary Photosensitive Strength peroxide bleaching gel, their new signature SmileLABS™ Paint-On technique, and their Cold-Light L.E.D. Infinity™ Series Accelerator Lights. This treatment system achieves a 2 to 4 shades whiter result in 15-20 minutes.

The core to this method is the new Paint-On technique, which utilizes a moderate strength hydrogen peroxide gel and only a maimum of 30 minutes total treatment time with adequate rinsing about halfway through the treatment with a re-application of fresh gel. The result is that the teeth stay hydrated; they never become desiccated, and, coupled with the no-heat producing cold L.E.D. accelerator light, they typically never have an issue with pulpitis-caused tooth sensitivity found commonly with Zoom 2™ and other dentist chairside power bleaching systems. SmileLABS clients typically do not get the “Zings!”

SmileLABS™ has also recently added a line of take home whitening kits that can now be purchased from all Authorized SmileLAB Dealers, and soon will be available at many other retail outlets and stores. Two kits are available that come with InstaPression™ trays included. One utilizes an entry level Moderate Strength carbamide gel and another that has an intermediate level Extra Strength carbamide gel. The $39 (MSRP) Moderate Strength kit is used for up to one hour per day for 8 days and the added-value $69 (MSRP) Extra Strength kit can be used up to 30 minutes per day for 16 days. Most people will achieve their desired whiteness level in less than the total number of treatments provided with each kit. SmileLABS™ guarantees that both kits will visibly whiten clients’ teeth or will refund their purchase price (certain restrictions apply).

CONCLUSION

There are more teeth whitening/bleaching options available today to the public than ever before. Today’s savvy consumer needs to research all the available modalities of treatment before making a well-informed decision about cosmetic teeth whitening. The dentist option, in any of its forms, is a viable one, but comes at a high cost to the consumer, and in some cases has some quite painful issues with tooth sensitivity and “Zings.” If using dentist-made take home trays the treatment time can be a month or more. The OTC option, although reasonably priced, many times does not satisfy the consumer as to the efficacy of the treatment or its lengthy treatment time. It is my hope that this paper has helped clarify these options and has shed some light on this constantly evolving cosmetic procedure and treatment.

 

CITED REFERENCES


[i] Haywood VB, Heymann HO. Nightguard vital bleaching. Quintessence Int 1989; 20:173-6

[ii] Sarrett DC. Tooth Whitening Today. J Am Dent Assoc. 2002; Nov., 133: 1535-38.

2.1 Strassler HE. Vital Tooth Bleaching: An Update. Mdental Cont Ed Insert U Maryland Baltimore College of Dental Surgery. 2006; Dec.: 1-12

[iii] Strassler HE. Vital Tooth Bleaching: An Update. Mdental Cont Ed Insert U Maryland Baltimore College of Dental Surgery. 2006; Dec.: 1-12

[iv] Sulieman M, Addy M, MacDonal E, Rees JS. The effect of hydrogen peroxide concentration on the outcome of tooth whitening: an in vitro study. Journal of Dentistry. 2004; 32: 295-299

5,6,7,8 Li Y et al. Effect of Light Application on an In-Office Bleaching Gel. J Dent Res 82 (Special Issue, AADR Abstracts): No. 895: 2003

Luk K, Tam L, Hubert M. Effect of light energy on peroxide tooth bleaching. J Am Dent Assoc. 135(2): 194-201, 2004

De Silva Gottardi M, Bracket MG, Haywood VB. Number of in-office light activated bleaching treatments needed to achieve patient satisfaction. Quintessence Int. 37: 115-120, 2006

Tavares M, Stultz J, Newman M, Smith V, Kent R, Carpino E, Goodson JM. Light augments tooth whitening with peroxide. J Am Dent Assoc. 134: 167-175, 2003

8.1 Strassler HE. Vital Tooth Bleaching: An Update. Mdental Cont Ed Insert U Maryland Baltimore College of Dental Surgery. 2006; Dec.: 1-12

9 Garcia-Godoy F, Villata P, Garcia-Godoy C, Bowman LA, Barker ML, Gerlach RW. Clinical evaluation of 14% hydrogen peroxide strips relative to placebo. J Dent Res 85 (Special Issue A): Abstract No. 1372, 2006.

10 Gerlach RW, Barker ML. Clinical response of three direct-to-consumer whitening products: Strips, paint-on gel, and dentifrice. Compend Contin Educ Dent. 24:458-466, 2003.

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