3 minute read
Is teeth whitening bad for our patients?
Like it or lump it, teeth whitening is in fashion and in demand. We look at the pros, cons and legalities
Story by Kailey Paterson
THE OVERWHELMING force of social media influencers hustling endless products, and the blurry lines of responsibility in regards to whitening treatments in Australia, has seen the teeth whitening industry grow to epic proportions.
Once a procedure that seemed beyond the financial reach of the average patient, it would be hard to find a patient who hasn’t whitened, thought about whitening or tried multiple whitening products.
The internet and Google are providing so much information and availability, that consumers rarely ask our advice anymore without a myriad of material and products gathered from various sources. Patients rarely ask for the research and it has become easy for people to be swept up in social media frenzies over products like charcoal toothpaste, amongst other dentifrices.
I constantly find myself reminding patients that cream-coloured teeth are totally normal and that we are all being subjected to B1 tooth shades or porcelain-white teeth making anything darker seem like social leprosy!
However, patients do have a right to the choice of treatment. so we cannot be the fun police; and as the research suggests, teeth whitening is relatively harmless when delivered appropriately.
The active ingredients in all professional whitening products is hydrogen peroxide. Whether it comes as a percentage of hydrogen peroxide (HP) or a carbamide peroxide (CP) solution, it will essentially break down at a chemical level to hydrogen peroxide.
The trick to comparing strength is that CP requires a three-times larger percentage to be of comparable strength to HP. The majority of take-home kits are lower dosage – usually 3-9.5% HP or 10-22% CP – and require an alternative length of exposure time, relative to the strength. It is therefore important to be familiar with the recommended instructions of the brand you choose to prescribe to your patients, as well as the restrictions on the strength of self administered HP/CP.
The research does not find any notable differences in the results produced between the two types of peroxide, and usually the choice is based on practitioner preference or the patient’s ability to wear CP solutions overnight. Technically, neither have a reduced sensitivity over the other, however it has been suggested that CP has more ability to reduce the exposure time which could help patients manage sensitivity that may occur during and after whitening treatment.
In recent times, there has been a significant outcry from dental practitioners in regards to non-dental professionals administering whitening treatments or whitening products.
Information available on the Dental Board of Australia website reports, that although whitening gels fall within the poison standard on the Therapeutic Goods Administration list, it doesn’t outlaw the use of products of less than 6% HP and 18% CP for home use, and ultimately by non-dental professionals.
We, as dental professionals, are also held to this standard and it is therefore unlawful to provide patients with home whitening kits that exceed this strength to use as self-administered by the patient. The regulation of this becomes slightly stickier as the Poison Standard recommends states to provide regulation to control the supply and advertisement of whitening products. However, it does prove to be difficult to control providers that fall outside regulatory bodies. According to the ADA, they have recently approached the Australian Competition & Consumer Commission (ACCC), to attempt more enforcement of this upon individuals not adhering to these laws.
The exact wording is as follows: “The standard specifically states that teeth whitening products containing more than 18 percent carbamide peroxide or more than six percent hydrogen peroxide may only be sold, supplied and used by registered dental practitioner as part of their dental practice.” (Dental Board of Australia, 2019.)
As trained dental professionals, we still retain the only legal ability to use and supply higher strengths to be used under our supervision for in-chair whitening procedures. Usually 35% HP is used for in-chair whitening with the use of Diode Laser or LED light. The necessity of the light with the higher percentage of HP is debated amongst many, with studies finding opposing results as to whether the light impacts the whitening result.
The idea behind the light is that it speeds up decomposition of the peroxide by increasing formation of hydroxyl radicals, but some studies suggest this occurs due to thermal increase which in-turn could cause the patient to experience more sensitivity and the potential for pulp irritation. It is proposed that Diode Laser treatment has less associated sensitivity than LED, but this may be dependent on less light exposure to the teeth and gingiva required in the Diode Laser application.
Either way, the sensitivity caused by whitening is temporary. However, it may impact the patient’s perception of treatment. With the conflicting research available on the efficacy of light in high strength, in-chair whitening, it is difficult to establish whether the use outweighs the risk of discomfort to the patient, and the cost of the device to the practice. Evidence-based practice should always be used when making clinical decisions and up-to-date information sought by clinicians to provide patients with the best level of care.
The information within this article does not serve as substitute for research of peer reviewed journal articles.
