- The Washington Times - Tuesday, May 14, 2002

Teeth whitening these days has become more of a habit and less of a trend.
More people than ever before are taking advantage of readily accessible means to brighten their whites, paying as little as $5 for a special toothpaste and as much as $1,000 for dental office procedures that offer a customer supervised and experienced care with bleaching agents.
"We are booked through July for appointments," says Kierstin Motley, clinical supervisor in charge of such procedures at Hustead Dental Associates in Annapolis, where customers pay between $300 and $500, depending on the length of time they opt to spend in a dental chair. One satisfied Hustead patient, who spent $500 for a one-hour treatment, reports that his teeth got five shades lighter as a result.
Consumers freely admit they are doing it purely for cosmetic reasons and insurance plans typically won't cover it. Area dentists, whose normal charge averages $400 for in-house treatment, say there is little or no intrinsic medical benefit and virtually no danger to the teeth from most methods currently available. One of the newest and most expensive professional methods is done by laser, but most dentists associate themselves with one or another teeth whitening system promoted by various companies under such names as BriteSmile, Discus Zoom, Lifelike, and Rembrandt One-Hour Whitening. Hustead Dental uses the Discus Zoom method.
In-office procedures usually involve having a dentist make a mold of the teeth. A whitening agent is applied to the mold and the patient sits in the chair for 30 minutes or longer while the bleaching takes place. Having an individually made custom mold ensures that the whitening agent coats the enamel surfaces evenly. The treatment usually is more effective than a commercial product used at home because the bleaching agent is stronger.
A simple whitening product found in less expensive toothpastes works by abrasion: A chemical agent, which is either hydrogen peroxide or the less potent carbamide peroxide, does the work. (Hydrogen peroxide is three and one-half times stronger than carbamide peroxide.)
Either hydrogen peroxide or carbamide peroxide used in lesser or greater amounts is the key chemical agent in both over-the-counter and professional products, depending on the formula. The U.S. Food and Drug Administration regulates what is sold in every case.
Dr. Thomas Williams of 1800 K St. NW, says he is not convinced that a procedure using laser beams would not harm the structure of the teeth. "It's an option but it is very expensive," he says, noting that, in addition, the method may not reach all of the surface area of the teeth. A laser whitening method is faster than bleaching but it can cost an estimated $1,500.
A spokesman for Den-Mat, Inc., a manufacturer of both consumer and professional whitening products, reports that a Gallup poll last year found 73 percent of Americans agreeing they would like to have whiter teeth and that 79 percent were likely to purchase a whitening toothpaste. The market has more than complied with their wishes. Numerous products fill drug and convenience stores, the most likely place for purchasing commercial teeth whitening packs, pastes and gels.

Where over-the-counter products mainly differ from one another is in packaging and the form in which the products are presented.
The Den-Mat company, manufacturers of Rembrandt Oral Care Products, advertises a combination whitening/bleaching toothpaste/gel in a single package they have patented under the name of "Rembrandt Dazzling White" that contains carbamide peroxide and claims to "whiten teeth 5 shades."
The back of a "Dazzling White" package notes that for "more whitening," a consumer can buy the more elaborate "Value Kit" which includes trays or molds to be filled with the bleaching gel and worn 20-30 minutes twice a day. The third "most whitening" method, the package says, is done by a dentist in an office using "Rembrandt Virtuoso Lightning Gel." The gel, sold only to dentists, will 'get your teeth 10 shades whiter in 30 minutes."
Only one company, Natural White, Inc., claims to offer what it calls a "non-peroxide" substitute, called sodium chlorite. Jeffrey Lokken, the company's director of research and development, says it has virtually the same effect. "It does particularly well in Europe because Europe hasn't recognized peroxide for tooth whitening," he says.
"Crest Whitestrips, which came out last summer, was the big new kid on the block," says Mr. Lokken,
Selling between $35 and $45 depending on the outlet, "Crest Whitestrips" from Procter & Gamble is also one of the most expensive over-the-counter products. The consumer is given 28 thin transparent strips pre-coated with hydrogen peroxide gel to apply on both upper and lower front teeth for 30 minutes twice a day for 28 days.
"Noticeably whiter teeth guaranteed in just 14 days," reads a line on the front of the box in Spanish and English. A 15-page instruction booklet provides the details, including the suggestion to use the strips "every six months or as needed to maintain whiteness."
Also stated is the crucial fact seldom noted on the outside of such products, that strips or, indeed, any whitening product will not remove stain or any discoloration on caps, crowns, veneers, fillings or dentures. Nor are they advised for someone with dental braces or people with gum disease or overly sensitive gums. Most staining comes from frequent use of tobacco, coffee, tea, colas and red wine. Crest notes that "aging" also is a factor.
The American Dental Association Web site (www.ada.org) tells which teeth whitening and bleaching products, both commercial and professional, have what they call their Seal of Acceptance. Company Web sites also help in understanding the nature of their products. Natural White, at www.naturalwhite.com, even includes a glossary of terms to help a consumer interpret the ingredient labels required by law on the outside of packages.
Natural White (which doesn't manufacture products for dentists) makes four different kits with four different names and sets of instructions with prices that range from $7 to $30. The recommended wear times range from five to 45 minutes. Just try figuring all that out if you are a consumer in a hurry pondering the most suitable choice.
In spite of its name, the company has nothing to do with the use of so-called natural or organic materials. All four of their kits employ a chemical solution either carbamide or hydrogen peroxide in amounts that vary from 3 percent to 10 percent. The tray sold in the Natural Light "Pro" and "Extreme" kits, Mr. Lokken says, is unusual only in being called "Warm 'n' Form," a patented name that simply means the forming tray must be soaked in warm water before being shaped to the teeth. A whitening gel is applied inside the mold, whether two-part "warm 'n' form" molds or two-in-one molds that cover the upper and lower teeth at the same time.
"You can use any of them while you take a shower," Mr. Lokken says blithely, adding that it would be wise for the person to keep his mouth closed.

Until such consumer products came along, the poor customer wanting brighter, whiter teeth had to put up with caps, laminates and bonding. Companies claim variations in their ingredients, but common to all products is the need for patience and persistence. Although it is more costly, many people find it easier and save time by making their way to a dentist's chair.
Dr. Williams signed with Rembrandt's system, he says, "because it is the latest one on the market, and because it was presented as producing zero sensitivity. We've had over 30 patients in the two months and only two had even a slight sensitivity. Basically what happened is, we gave them written instructions they didn't follow."
Dr. Donald Meyer in Foxhall Square Northwest went with the Lifelike method because it was suggested to him in a dental continuing education course.
Apart from the application of a stronger bleaching agent, the key difference in any office procedure is the use of light. Rembrandt calls theirs a "Sapphire Light," described by Dr. Williams as "a plasma arc curing light." The procedure requires a full hour and a half, he says, and employs the company's "Virtuoso Lightning Gel." He begins by taking a photograph of a patient's mouth (done afterward as well for comparison purposes), followed by an application of a desensitizing paste .
A liquid rubber guard or dam protects gums from the bleaching gel, which is activated by the light placed directly in front of the patient. Warm water is painted on the teeth periodically so they don't become dehydrated. The teeth are treated at the end with a high concentration of sodium fluoride to reduce sensitivity and seal the tooth structure.
"I went through the system first to be sure it worked correctly," Dr. Williams says. "I have seen as much as a change of 10 shades of lightening, which may last indefinitely if a patient uses a lightening toothpaste."
The favored method at Hustead Dental Associates is the "Zoom" treatment from Discus Dental, a one-hour process that Kierstin Motley calls "like power peels in dermatology. You basically are dehydrating the teeth. The gel opens up the teeth and takes out the porous stain. Teeth naturally rehydrate later."
Most patients experience some sensitivity throughout the procedure, she says, and are advised to avoid any staining drinks for three days. The more expensive treatment includes a mold and gel that a patient can take at home for follow-up care.

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