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Patient options for whitening

June 1, 2004
Current internal marketing studies by The Levin Group indicate that the two most sought-after smile enhancements are teeth straightening followed closely by teeth whitening.

By Gregory P. Heintschel, DDS

Current internal marketing studies by The Levin Group indicate that the two most sought-after smile enhancements are teeth straightening followed closely by teeth whitening. In addition to that, a survey by The American Academy of Cosmetic Dentistry (AACD) has determined that the demand for in-office whitening procedures has increased by more than 300 percent since 1996, while over-the-counter whitening product sales have increased by more than 160 percent during that same period. In an attempt to capture this growing market, there has been an explosion of products — both professional and over-the-counter — to help the consumer achieve a whiter smile.

It might be a bit idealistic to think that popping in a piece of gum an hour or so each day will lighten darkened teeth. Even vigorous brushing three times a day with whitening toothpaste seems an ambitious plan for fighting yellow teeth. The quest of consumers and dentists alike is finding which products achieve the claims of the promotional hype. It is also important to note that products — particularly over-the-counter products — appear to make little distinction between whitening of teeth by stain removal, and whitening of teeth by an actual bleaching effect. For the sake of this article, whitening will be referred to as a color change by stain removal, and bleaching as a measurable color change of the actual tooth structure.

Today's educated consumer is very interested in the cost effectiveness, i.e. value, of the method employed. The consumer's choices range from the $3 tube of whitening toothpaste, to the several-hundred-dollar in-office light bleaching. With the myriad of options available today, something has to work.

Going from top to bottom, the least expensive "solution" to stained teeth, starting at $3 per tube, is the cornucopia of toothpastes available. Most contain abrasive ingredients to remove superficial stain. Some pastes — starting around $10 per tube — even include a bleaching agent. Some of these products will slightly whiten teeth with the limited superficial stain removal. However, even pastes containing an effective bleaching agent have a minimal chance to effectively bleach teeth due to the limited contact time with the teeth. The reality is that when most people think of bleaching, they are looking for movie star white smiles. That is just not going to happen with these products; the hype should be saved for Hollywood.

In an attempt to increase the contact time of the bleaching agent with the teeth, products are now available in a "paint on" version. These products, available for $10 to $20, curiously resemble the containers of White-Out of the past. While contact time is enhanced, it is still minimal because the tongue, lips, and saliva readily remove and dilute the coating formed on the teeth. In a similar category, products are available in strip form. These resemble bandages applied to the teeth and are impregnated with a bleaching agent. These strips hold the bleaching agent in contact with the teeth over a longer period of time with less dilution from saliva. The products are manufactured both in an over-the-counter version and a professional version available only through a dentist. These products range from $30 to $80 per kit.

Marketers have also developed over-the-counter tray bleaching systems to compete directly with the dental office. With these systems, stock or semi-fit trays are included to contain the bleaching agent against the teeth. While these products use similar bleaching agents found in the dental office, they are often "watered down" versions of the professional agents currently available. These products are largely found marketed through infomercials and at-home TV shopping networks.

Those consumers willing to explore a more professional, and costly, means of teeth bleaching will consider a true professional system. The entry level professional system is generally considered to be the custom fit tray method. With this system, vacuum-formed trays are made from diagnostic models of the consumer's teeth. These trays are then used to contain the agent directly against the teeth. The nature of the true custom fit tray allows much less chance of dilution or wearing off. Depending on the agent used — typically carbamide- or hydrogen peroxide-based — the trays are worn as little as 30 minutes or overnight. With the entry into this level of bleaching, a true and inherent color change of the teeth is demonstrable. Depending on the shading system used by the dentist, 10 or more shade changes are achievable on a regular basis. These systems generally take two to six weeks to effect this change, but the consumer will notice a color change within the first few days of treatment. Current fees across the country will fall into the $200 to $400 category.

For those consumers demanding a more immediate color change, and who can open their wallets a little wider to pay the $600 to $800 price tag, the light bleaching system is for them. This method of teeth bleaching is accomplished in the dental office with the application of a very strong hydrogen peroxide that is light-activated. The light source is different with varying systems, and can be initiated by an ultraviolet curing light, plasma-arc light, or dental laser. These systems generally take one to three office visits of approximately one hour each.

With any system of bleaching, a lifelong commitment to highlighting is necessary to maintain results. Teeth generally will initiate a noticeable change back to their original color in as little as six weeks. Most dentists advise a highlighting one to two times per year to maintain those pearly whites.

While all of these systems offer varying results, at varying costs, it is ultimately the dentist who is best equipped to initiate a program to achieve the results at a cost the consumer is willing to pay. While many choices exist today to achieve whitening and bleaching, more will surely become available.

Editor's Note: This is the third of a yearlong series of articles from the American Academy of Cosmetic Dentistry (AACD). The AACD and Dental Equipment & Materials are working together to provide articles that will help your practice. For more information about the AACD, log on to or call (800) 543-9220.

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Dr. Gregory Heintschel is a dental graduate of The Ohio State University. He is a long-time member and current director for the AACD. In addition, he serves as vice-chair for the Give Back a Smile Foundation. He practices restorative and cosmetic dentistry in Findlay, Ohio. His practice, Blanchard Valley Center for Exceptional Dentistry, has just been awarded the 2003 National Cosmetic Practice of the Year award. Dr. Heintschel has lectured and been published internationally. For more information, Dr. Heintschel can be reached at (419) 427-1500.