Tooth whitening: a bright idea?
Nicolas Coomber, COLTENE national account and marketing manager, explores the options
A common desire for many patients is to achieve a whiter, brighter smile. In fact, a 2020 survey revealed that 22 per cent of Brits would like to have their teeth professionally whitened. An attractive smile can have a big impact on a person’s social life, making it a popular cosmetic treatment sought out by
a wide range of people. As such, it’s important that clinicians are able to offer patients the right solutions for them. Clinicians should be knowledgeable about any potential limitations or complications that patients should be aware of before proceeding with treatment, to help them make an informed decision about their care.
Causes of tooth staining
Discolouration can occur for many different reasons, with potential causes ranging from internal (intrinsic) to external (extrinsic) factors. The reasons for discolouration may have an impact on the patient’s desire to whiten their teeth, as well as the ability to reach the desired shade.
Intrinsic staining can be caused by factors like genetics, age (from worn enamel exposing yellow-coloured dentine), antibiotics, and non-vital discolouration. Additionally, some dental restorations, such as amalgam, can cause tooth staining. Extrinsic staining is usually caused by environmental factors like smoking, pigmented foods, and drinks including tea, coffee, and red wine.
The use and side effects of hydrogen peroxide
In the UK, the use of hydrogen peroxide (HP) for cosmetic purposes is very limited. It is illegal for tooth whitening products which contain more than 6% HP to be supplied or administered for cosmetic purposes. Further to this, tooth whitening products which contain 0.1%-6% HP should not be available directly to consumers, and should only be provided by a registered dental professional.
HP is associated with a number of side effects, particularly when used in high doses,or over a long period of time. Tooth sensitivity, for example, is experienced by 15-78% of patients who have had their teeth whitened using hydrogen peroxide. This common concern can cause patients unnecessary pain and, while it’s often temporary, might be an indicator of long-term issues. Other side effects of whitening using HP include gingival irritation, enamel softening, surface roughness, demineralisation, and cervical root resorption (when used for internal bleaching).
Efficacy of HP in low doses
Because the use of HP in the UK is limited to less than 6%, it is important to consider how effective it is to use such a low dose. A 2004 study found that a 5% hydrogen peroxide solution was just as effective as a 25% solution at whitening teeth. However, to achieve the same results, the 5% solution would need to be used 12 times compared to just once with the 25% solution. This means that, to achieve the desired shade using a concentration of less than 6%, more treatments will be required.
As such, patients may need to return to the practice on several occasions to complete their treatment, or be prescribed at-home tooth whitening to complete over a period of time.
What are the alternatives?
With the use of HP for tooth whitening restricted, it is sensible for clinicians to consider other options which produce a brighter smile for their patients without the negative side effects presented by hydrogen peroxide.
Phthalimido-peroxy-caproic acid (PAP) has emerged as a fantastic alternative for tooth brightening, and is likely to be the future of the cosmetic treatment modality. One study reported that PAP was nearly harmless to enamel, whereas HP would cause hypersensitivity and a burning sensation. Additionally, PAP had an equivalent effect to HP, but was fundamentally safer and more reliable.
The in-office brightening system, BRILLIANT Lumina from COLTENE is formulated with PAP. It offers patients tooth brightening without sensitivity, which is extremely gentle on the tooth structure,
and it is very easy to use. When prescribed by a dentist, the treatment can be provided by a dental therapist. More than 5,000 treatments have already been performed with BRILLIANT Lumina, with no tooth sensitivity observed during or after the procedure. This makes BRILLIANT Lumina the ideal choice for patients who are hoping to achieve a naturally brighter smile.
With so many patients looking to improve the appearance of their smile, offering a treatment which naturally brightens the teeth enables you to cater to their needs. Whilst many patients may assume that to reach their aspirations, aggressive tooth whitening or invasive restorative treatments may be required, leading to post-treatment sensitivity, it can be reassuring to offer a solution which makes comfort a priority.
With PAP, your patients can enjoy all of the benefits of a naturally brighter smile, without the sensitivity that is traditionally expected from tooth whitening using HP. This will be refreshing news for clinicians and patients alike, who wish to achieve stunning results, without the use of harsh and heavily restricted chemicals. Naturally, PAP is the future, and now is the time to embark on this journey with your patients.
For more on COLTENE, visit www.coltene.com, email info.uk@coltene.com or call
0800 254 5115.