2013 Teeth Whitening Update
Last Updated 1/4/2013 - NEW FOR 2013: ADA Makes Marketing and Practice Information for Teeth Whitening Available to Dentists Nationwide
The American Dental Association announced its publication of both marketing and practice information materials centered on Teeth Whitening. With increasing discussion of the techniques around and the demand for teeth whitening, it's an encouraging sign that the ADA is looking help dentists practice both productively and profitably.
The brochure “Ask Us About Tooth Whitening” introduces teeth whitening options to patients who want brighter smiles but may not understand the limitations or risks of treatment. It explains the difference between at-home and in-office whitening. It details the active ingredients and relative strengths of various products. The brochure also discusses possible side effects and cases when bleaching is not advisable. Patients will also be able to see before and after photos.
Additionally, the ADA has mailed a members-only Practice Techniques Poster on teeth whitening called, “Get It Right. The Safe, Sensible Way to Whiten Teeth.” Intended for both dentists and patients, it details the importance of a visit with dentist prior to whitening, how teeth whitening works, various methods of teeth whitening and the causes of tooth discoloration.
It's encouraging that the ADA is taking a more participatory role in guiding this still-unregulated field; answering the important questions that both dentists and patients often have and ensuring enhanced oral health in the process.
The American Dental Association (www.ada.org) is the grand-daddy of all professional dental groups. Founded in 1859, its mission is to advance public knowledge of oral health issues - and serve as an advisory board to member dentists; providing programs for advocacy, education, research and the development of reliable practice standards.
In keeping with their tradition of exploring and recommending practice standards, the group frequently conducts reviews of dental trends and procedures that are designed to keep its membership up-to-date on recent developments. To help its members know where the art and science of tooth whitening stands today, and which practices and procedures appear to be safest and most effective, they commissioned a report on teeth whitening.
While the paper was entitled "Tooth Whitening/Bleaching Treatment Considerations for Dentists and Their Patients" and published by the ADA Council on Scientific Affairs, there is no general update this year. That doesn't mean, however, that there isn't anything to talk about - far from it.
New for 2011: Dentists Take Non-Pro Whitening Services to Court
A case involving teeth whitening services performed by non-dentists - and whether or not they're safe for consumers -- has reached the Federal Trade Commission (FTC); with the FTC temporarily siding with the non-dentist operators.
Since teeth whitening is currently only regulated at the state level, a group from the North Carolina State Board of Dental Examiners decided to pursue their claim that non-dentists were performing dentistry without a license all the way to the Federal Trade Commission. The FTC took the preliminary position that since teeth whitening was available without dental supervision from over-the-counter products, and that the percentage of peroxide formula was controlled, that the choice of provider should be the consumers.
While some states have outlawed non-dentists from performing teeth whitening, like Alabama, other states such as California, Illinois and Ohio have placed regulations on non-dentists. Dentists and dental groups from additional states, including Texas, are now looking into the matter and taking action against non-dentist practitioners. But for now, non-dentists in North Carolina may continue to operate. The North Carolina group is still pursuing the issue; with twin cases on different tracks - one with the FTC and one against the FTC in U.S. District Court. We'll keep you posted on what happens.
The 2011 Report Round-Up
The introduction to the study tells of the field's progression from dental-prescribed-only treatments for damaged or diseased teeth in the 1800's to the commercial explosion of the 1980's, thanks to the development of multiple teeth whitening procedures and products. Today, the field may be categorized in four main areas: professionally applied (in the dental office); dentist-prescribed/dispensed (patient home-use); consumer-purchased/over-the-counter (OTC) (applied by patients); and other non-dental options (e.g., mall kiosks, spa settings, cruise ships). Teeth are whitened with a formula containing either hydrogen or carbamide peroxide in almost all American bleaching products.
While the peroxide concentrations used in commercial whitening (both OTC and in-office) are based on tests, not laws (teeth whitening is not regulated by the FDA), teeth whitening still appears to be a safe procedure. But there are a few notable exceptions; non-dental whitening venues such as mall kiosks, spas and cruise ships may be effective and safe for healthy dental patients, but are not equipped to diagnose or detect any of the dental abnormalities which may preclude whitening. Several states, in fact, have prohibited these businesses altogether. Also, teeth whitening may never be a solution for some people, due to a number of factors including: hypersensitivity, genetic factors leading to intrinsic staining and to the inherent color of their teeth.
Long-Term and Cumulative Effects
How often should you whiten? Can you combine in-office procedures with at-home procedures - without dental supervision? How strong does a bleaching formula have to be before repeated use is dangerous?
The ADA is keen to note that over 20 years of data indicate that occasional dentist-supervised whitening is a safe procedure. But many whitening procedures are performed with OTC products (and without dental supervision), so it's difficult to estimate the severity of any long-term issues because people simply don't report them.
Also, the results of the prolonged, frequent and combined use of both dentist-prescribed and OTC whitening have not been documented, so there are several remaining areas of concern, including: the cumulative effects of bleaching on the tooth (inside, outside and surrounding tissues), the repeated swallowing of bleaching formulas, and the potentially toxic effects of the free radicals produced by the peroxides used in bleaching products. The ADA encourages additional study and research, noting that most bleaching studies to date have been conducted by the people who actually make the bleaching products.
Surprise! The Dentists Recommend Seeing a Dentist
It should come as no surprise that the ADA Teeth Whitening Update recommends that people who want whiter teeth should see their dentist first. While it may sound self-serving, it's actually good science and responsible patient care. There's a lot that can happen - including the pain of severe sensitivity - if your teeth aren't in good shape before you whiten.
The ADA notes that a proper examination should include the following factors: a health and dental history, observation of hard and soft tissues, an allergy and sensitivity history, placement and condition of restorations, and, if necessary x-rays to determine the nature and depth of any irregularities. If visible staining is obvious, a full history and a thorough exam will help the dentist know whether or not the stains will respond to bleaching. Dentists are also encouraged to check out how your teeth and jaw work together - making sure that bleaching trays will be effective and safe if this treatment method is chosen.
Lots of patients also have very high expectations about the results of teeth whitening; and some of them may not be realistic. Dentists are encouraged to manage their patients expectations about the whitening experience - helping to minimize dissatisfaction that could lead to further unsupervised or unwise whitening attempts at home.
And, of course, the ADA advises dentists to be prepared for dental sensitivity in whitening procedures - even with unlikely candidates. Pre-treatment options may include use of non-steroidal anti-inflammatory drugs (NSAIDs), fluoride, amorphous calcium phosphate, or potassium nitrate.
Inside Secrets of Teeth Whitening Dentists
Dentists typically prescribe one of three methods: in-office bleaching, the at-home use of bleaching trays, or a combination of both. But the ADA has a lot to say about how to make sure each one of these methods is used safely and effectively.
About The Tray Bleaching Method
- Potassium Nitrate can help ease the sensitivity of tray bleaching. Soaking the trays in potassium nitrate for 10-30 minutes before usage can reduce sensitivity. And so can the use of a whitening toothpaste containing potassium nitrate.
- Higher peroxide concentrations don't give you noticeable results, since each person's teeth can only whiten so fast at a time.
- While brown discolorations respond well to bleaching, white discolorations don't - although they may look less noticeable against a lightened tooth.
- Occasionally, bleaching may need to be combined with abrasion techniques or bonded restorations to address white stains or markings.
- With tray bleaching, teeth normally lighten in 3 days to 6 weeks. However, nicotine-stained teeth may take 1-3 months, and tetracycline-stained teeth may require 2 to 6 months (or more) of nightly treatment.
About In-Office Bleaching
- To help minimize sensitivity with in-office bleaching, it's important for dentists to protect your gums and be on hand with non-steroidal anti-inflammatory medications prior to treatment.
- Scheduling bleaching treatments at least a week apart can also ease sensitivity.
- Dentists should be aware that using a "bleaching light" may cause additional sensitivity with some patients
- Apparently the light can raise the temperature of a tooth's pulp (the interior) and cause some pain.
- What's more, the ADA notes that bleaching lights have been studied and don't seem to make teeth any whiter than procedures without lights. There may be some immediate difference due to tooth dehydration (see our article), but that's it.
- Dentists should also know that the average number of in-office visits, including follow-up, for maximum whitening is three - with a range of 1 to 6 visits, depending on the process (in-office vs. tray).
Who Regulates Teeth Whitening & Does It Matter?
As mentioned earlier, teeth whitening procedures and products rely on commercial and clinical testing to establish safety and usage standards. And it's likely to stay that way, at least for the foreseeable future.
That's another reason that the ADA recommends people who are interested in whitening their teeth consult with their dentists before moving forward. Talking to your dentist - whether you're getting professional assistance or doing the whitening yourself - can help you select the right whitening product - can not only help you get the results you're looking for - but can help protect you from pain, sensitivity and disappointing results.
Reviewed by Dr. Alan Zweig
Dr. Alan Zweig runs a private dental practice in Beverly Hills, CA. With over 30 years of experience in cosmetic dentistry, Dr. Alan Zweig is a teeth whitening veteran. He’s been trusted by major celebrities, business leaders, and patients from over six different continents.
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