Every year, Americans spend an estimated 1.4 billion dollars on over-the-counter teeth whitening products, and consistently report tooth color as the number one cosmetic concern about their teeth. Many dentists blame the prevalence of veneers in Hollywood for the unnaturally white shade patients desire, but regardless of the reason, patients are using teeth whiteners, and a lot of them. The colloquialism "bleachorexia" has even sprung up to describe patients who are chronically unsatisfied with the color of their teeth.
The practice of whitening one's teeth has been around for a lot longer than Hollywood, however. Ancient Egyptians used a paste of ground pumice stone mixed with wine vinegar, while the Romans used ammonia derived from urine as a bleaching agent. Perhaps most brutal of all was 17th century England, where barbers actually filed off stains and treated teeth with various acids to whiten them further.
The modern whitening method of insertable trays loaded with bleaching solution emerged in the 1980s, following an accidental discovery decades earlier that the antiseptic peroxide solutions used during periodontal treatment whitened teeth as a side effect. While this method may be much gentler than historical ones, it is not without its own risks, especially when overused by patients seeking that Hollywood look.
Over the counter-teeth-whitening products most often contain a peroxide releasing compound, such as hydrogen or carbamide peroxide. These peroxide compounds break down many pigmented materials that cause staining of the tooth surface, but also can soften the enamel under some circumstances, especially given that many patients use their whitening trays or strips beyond the recommended time interval, seeking more dramatic results. Aside from using the product for the recommended time only, patients should also avoid any products utilizing an acid pretreatment. While the addition of acid may improve the whitening results, the acid sensitizes the enamel surface to the peroxide treatment, further degrading the enamel, just like in the days of the Tudors.
Many products boast protective additives aimed at mitigating the enamel damage or strengthening the teeth, such as fluoride, calcium, and microgranular hydroxyapatite. A recent study in the Scandinavian Journal of Odontology found that not only is higher peroxide content associated with greater enamel erosion, but addition of microgranular hydroxyapatite did not have any protective value. Fluoride and calcium continue to be the most effective topical prophylactics administered to teeth.
Peroxide-based whitening also carries risks of damage or irritation to the gums, and risks sensitizing the teeth to changes in temperature or contact. Dentist-applied whitening procedures usually employ dams or gum guards to localize the active compounds to where they are needed. Research shows that dentist-applied whitening is usually less damaging to the enamel and gums than over-the-counter whiteners, and more effective in brightening the patient's teeth.
Educate your patients about safe usage of cosmetic dental products, as many do not realize that over-the-counter products have the potential to damage their teeth. Many patients assume dentist-administered whitening treatments are prohibitively expensive, so if you do offer whitening, advise them that they may safely get better results in your office, not at home.
Sources:
Barlow, R. (2012, April 25). The Truth about Teeth Whiteners | BU Today | Boston University. Retrieved January 4, 2016, from http://www.bu.edu/today/2012/the-truth-about-teeth-whiteners/
Bleaching and Enamel Damage. (2015, December 26). Retrieved January 4, 2016, from http://www.drbicuspid.com/index.aspx?sec=sup&sub=cos&pag=dis&ItemID=301769
Santos, L., Torres, C., Caneppele, T., Magalhães, A., & Borges, A. (2015). Effect of home-bleaching gels modified by calcium and/or fluoride and the application of nano-hydroxyapatite paste on in vitro enamel erosion susceptibility. Acta Odontologica Scandinavica, 121-126.
The risks of tooth whitening. (2010, August 1). Retrieved January 4, 2016, from https://www.deltadentalins.com/oral_health/bleaching_risks.html Vernon-Sparks, L. (2010, November 15). A history of tooth-whitening. Retrieved January 4, 2016, from http://www.seattletimes.com/seattle-news/health/a-history-of-tooth-whitening/
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