Moving neck-in-neck with the medical community, cosmetic enhancement has become all the rage in dentistry these days. A spin-off of the cosmetic explosion is whitening. Whitening remains one of the single most economical ways to enhance your smile. As Americans, we can’t get enough of it, spending $1.4 billion annually on tooth whitening products. Statistics show tooth whitening procedures have increased an incredible 300 percent in recent years!

While advertising and marketing is generating buzz about the latest products, there is a lot of confusion — and even debate — about the best way to whiten. Consumers want to know: What system produces the best results? How much does it cost to get optimum results? How much time will it take? And, how hassle-free is the process? The answers to these questions tend to be conflicting and ambiguous.

Over-the-counter systems claim to use the same ingredients and produce the same results as professional systems; yet the professional market claims to produce the only worthy results. The Food and Drug Administration (FDA) does not regulate teeth whiteners, and the American Dental Association (ADA) is siding with the professionals. So, where does this leave the consumer when they hear about somebody who just bought those strips and enjoyed great results?

The consumer is left somewhere between somewhat puzzled and downright confused. Most people hesitate or hold off completely on pursuing their whitest smile due to the uncertainty and fear of wasting time and money. To shed some light, we went on a quest to answer all the probing questions surrounding whitening — and hopefully disperse the myths and mystery behind this craze.

Most whiteners use a peroxide-based chemistry. Peroxide compounds have the ability to whiten teeth through an oxidation process. It has been demonstrated that peroxide has the ability to penetrate the inner aspect of the enamel within a matter of only a few minutes after application. There are complex organic molecules within the tooth that reflect a specific wavelength of light and are responsible for the color. It is believed that by releasing free radicals, peroxide has the ability to oxidize the color-producing organic compounds found within the enamel’s matrix. When these organic compounds are oxidized, the residual molecules reflect less light, or can also be described as colorless, thereby creating a reduction or elimination of the discoloration — whiter teeth!

Current compounds are hydrogen peroxide and carbamide peroxide. In-store or over-the-counter whitening systems use hydrogen peroxide. In-office whitening can utilize both carbamide peroxide and hydrogen peroxide. Carbamide peroxide contains approximately 35 percent hydrogen peroxide. This is sometimes preferred because it is a more stable compound than hydrogen peroxide, which allows for a more predictable shelf life. Also, carbamide peroxide penetrates the tooth at a slower rate and can aid in more patient comfort and compliance, as well as better-controlled results.

Peroxide-based whiteners used today can be classified into three categories:

Professionally applied/In-office use only (i.e. power whitening)
Hydrogen Peroxide – 30% to 40%
Carbamide Peroxide – 35%

Professionally dispensed products
Hydrogen Peroxide – 10%
Carbamide Peroxide – 16%

In-store or over-the-counter
Hydrogen Peroxide – up to 10%

The large majority of studies and literature confirms the safety of peroxide-based systems. In fact, peroxide compounds have been safely used in various dental procedures for many years. There is a significant amount of clinical data, particularly in strong support of a neutral pH, 10 percent carbamide peroxide system. However, there are few studies and some speculation as to the carcinogenic effects associated with the free-radical release of hydrogen peroxide. None are conclusive. Additionally, some authors have reported alterations of the enamel surface, which include demineralization or etching (increases porosity), shallow depressions and slight erosion. These findings were with the use of high concentrations. Alterations were expected to be reversed through salivary and fluoride remineralization.

Specific product documentation on safety, effectiveness and comparative research is somewhat limited and findings primarily consist of testing sponsored by the respective manufacturer of the product.

Teeth whiteners are not classified as drugs, therefore the FDA does not regulate them. The ADA has given its seal of acceptance to some bleaching products available through the dentist. It is important to understand, however, that ADA acceptance is not an obligation. The absence of an ADA seal does not imply the product is unsafe or ineffective. The ADA promotes whitening only after consultation with a dentist.

The two most common side effects are soft tissue irritation and hypersensitivity to the teeth. Irritation typically occurs when either an ill-fitted tray or the whitening agent is in direct contact with the tissue for a prolonged period of time. Sensitivity usually occurs when there is a high concentration of hydrogen peroxide used and/or when the pH of the whitening agent is more acidic. These side effects are considered mild and temporary. With discontinued use these issues are usually resolved within a few hours to a couple of days. With professional supervision side effects can be monitored and sometimes avoided completely. 

These can be classified into two categories:

In-Office

Power whitening
Power whitening can be performed with or without light technology. Light technology is referred to as photopolymerization and was first approved by the FDA for teeth whitening in 1996. There are two light techniques that can be used: blue-light or argon laser light. Both techniques require about one hour in the dental chair. Application of a high concentration hydrogen peroxide is applied to the tooth surface four times at 15-minute intervals. Both light systems claim to work by accelerating the chemical reaction. This provides faster, more effective results. There are some concerns associated with the light generating heat and the possible adverse effect it may have on the teeth. Additionally, recent debate has spurred further examination in the dental community about how necessary the light actually is in the process.

Power whitening without light technology simply uses an in-office application of a high concentration of hydrogen peroxide to jump-start the process.

Both techniques (with or without light technology) will usually include an at-home whitening process involving custom trays made by a dental professional. A whitening agent is placed in the trays and they are worn usually once a day for up to three hours. The length of time worn and duration is determined on factors considered by you and your dentist. Custom trays are made to continue the whitening process at home and ensure you achieve optimum whitening results.

The primary benefit of power whitening is that the process takes only one in-office visit and results can be dramatic and almost immediate. The disadvantages include cost. Power whitening is significantly more costly than other methods. You are paying for the technology, professional application and guidance along with the convenience of fast results. Also, due to the high concentration of peroxide used, hypersensitivity is a likely side effect. For those who typically experience tooth sensitivity, power whitening may not be the best method.  

Custom trays
Custom-fitted trays are made by first taking impressions (molds) of both upper and lower teeth. Flexible clear plastic trays are fabricated to fit precisely to your teeth. The benefit of custom trays is supported by literature that states whitening effectiveness is directly related to the percentage of peroxide and length of time it is in direct contact with the tooth surface.

With a custom tray the whitening agent is able to remain in direct contact with each tooth, allowing for more accurate and uniform whitening with less chance of seepage and gum irritation. Trays also allow for convenience of re-treating and touch-up as needed. Custom trays are typically more affordable than power whitening. However, a disadvantage in using trays is the self-placement factor, which can sometimes be a little messy and difficult to work with. 

In-Store/Over-The-Counter

Strips
Whitening strips are probably the most common in-store systems used. To create a more affordable approach to whitening and simple delivery system, these strips were first introduced in 2000. There are currently three major manufacturers offering strip systems varying in concentration of hydrogen peroxide from 3 to 10 percent. The cost for whitening strip systems range from $25 to $45 and can easily be found in most grocery and drug stores. A whitening strip is a paper-thin piece of clear plastic coated with a thin layer of hydrogen peroxide on one side. The strip is peeled away from the backing, lined up with the midline of your smile and positioned over the surface of the teeth with the gel directly in contact with each tooth. These are flexible and adapt fairly easy to the tooth surface. Systems vary on length of time and duration of treatment. It is advised to follow the manufacturer’s directions. 

Disadvantages of the strip system include the fact that the strips slide around easily and have the potential to produce uneven whitening. They may also cause increased gum irritation. Strips can also be messy during application and removal. One of the newest systems has a dissolving effect that can unfortunately leave a sticky residue and unpleasant taste.

Brush-on
Brush-on systems are currently found in a stylish pen. There are only a couple manufacturers offering a brush-on system. One end of the pen is a twist dial which, when turned, delivers the whitening agent to the opposite end where it is applied. A cap covers either a sponge-type or a narrow brush-type applicator that applies the whitening agent directly to the tooth. Cost is as low as $13 for a single pen. The primary benefits are the obvious: ease and convenience of touch-up whitening or single tooth whitening and complete control for placement on each tooth surface. The disadvantage of this system is the short period of time the whitening agent is in contact with the tooth. And it is difficult to isolate the teeth from the lips and tissues so they tend to wipe the agent from the tooth, making whitening much less effective.  

Trays
There are two types of over-the-counter tray systems. A recent manufacturer advertises its system as a tray. However, these are actually better described as pre-formed strips. These trays look and feel like strips that fit over the front of the teeth and wrap around onto the inside surface. These trays are pre-filled with a thin ribbon of a hydrogen peroxide-based gel. The cost is comparable to whitening strips. These are more secure than strips and provide more control with placement.

The other tray-type whitening is referred to as a boil and bite system. There are a few manufacturers, commonly found online, that offer this system in an attempt to create an at-home custom or semi-custom tray. These are pre-formed (arch-shaped) plastic trays designed to be softened in hot water and placed over the teeth. With biting and pressure they mold around the teeth. These are designed to be used exactly the same way as custom trays with placement of a whitening agent in the tray and fitted directly over the teeth. However, it is nearly impossible to get the precise fit like a professional custom tray does. These trays are difficult to shape and trim accurately, which creates greater risk for seepage of the whitening agent. This has the potential for causing increased gum tissue irritation and sensitivity. 

A primary reason results vary significantly is because many factors influence the whitening process. Some of these factors are controllable; some are not. And they may vary from system to system and person to person. Therefore, it is difficult to make claims that will satisfy the conditions of all those wanting a whiter smile. Primary factors include:

• Color to start with – it is documented that those with more of a yellowish hue have greater response to whitening than those who have more gray or brown. Intrinsic gray discoloration is commonly seen in exposure to different types of medications. The most widely known is the antibiotic, tetracycline. Brown is often seen with excessive intake of fluoride, referred to as fluorosis. Fluorosis may also create a mottling or blotchy look to the enamel and make it equally difficult to achieve optimum results.
   
• Unique and inherent whitening potential – it is believed that we each have a level at which our teeth cannot whiten any more.
   
• Clean teeth – it is advised to have your teeth professionally cleaned to remove all deposits, as well as surface stain that may interfere with the whitening agent being in direct contact with the tooth.
   
• Percentage of whitening agent – meaning the higher the concentration, the faster the results. However, the higher concentration can also result in a greater risk of sensitivity. Therefore, the percentage of whitening agent should be determined based on: how sensitive your teeth are to begin with; if you have any root surfaces exposed; the delivery system you choose and over what period you want results.  In-store or over-the-counter systems have a much lower whitening agent percentage, so it takes a little longer and may require more frequent touch-up. In-office systems provide a higher percentage, the alternative of using carbamide peroxide (penetrates slower) and a more controlled application.
   
• Duration of time – the whitening agent is in direct contact with the tooth surface. This is delivery-system sensitive as well. And it is related to the ratio agent. Each system requires a different timeline and should be followed accordingly. The key is to maintain direct contact with the entire tooth to provide even and precise whitening results.
   
• Compliance – is easy when you choose a system based on your needs and concerns; when you use the system as directed and when you minimize risks. It is recommended to use an agent within neutral pH range. This is safer for the enamel and reduces sensitivity. Additionally, pay attention to all the factors that influence whitening and consult a dental professional with any concerns.
   
• Oral habits – can play a major role in the whitening process. Before any application, it is a good idea to thoroughly brush and floss plaque, stain and food debris from the surfaces of the teeth. Maintaining good oral hygiene will keep your smile looking brighter longer.
   
• Avoid – foods and drinks dark in color or that are acidic (tea, coffee, sodas, wine, grape juice, chocolate, orange juice), smoking and chewing tobacco. Beware of oral home care products that contain alcohol and dyes/colors or may be high in abrasion or acidity.

• It is recommended not to begin the whitening process prior to age 13. This may vary depending on the patient. Due to the enlarged pulp chamber in children and young adults, the nerves of the teeth can be very sensitive and it may not be advisable. If there is any question about whether it is advisable at a particular age consult your dental professional.
   
• Pregnant and lactating women are advised to avoid any whitening procedure.
   
• Anyone with gum disease, broken and damaged teeth or restorations, exposed roots, incomplete dental work and/or hypersensitivity in general are advised to seek dental care and treatment of these conditions before beginning any whitening procedure. Not addressing these conditions first may put you at risk for additional damage and serious side effects.
   
• Whitening is not effective or advisable for those undergoing orthodontic treatment. Whitening can be considered once treatment is completed.
   
• Those who have dental work that completely covers the front surfaces of the teeth. Whitening agents do not alter bonded fillings, crowns, veneers, bridgework and implants. Whitening will only have an effect on natural tooth surface.

There are many claims made by whitening toothpaste manufacturers, including that they contain the same ingredients used in professional whitening. Actually, these toothpastes are only able to remove some surface staining caused by foods and beverages through the action of harsh abrasive agents — not whitening agents. Whitening toothpastes that contain hydrogen peroxide usually have less than 1 percent. Additionally, these toothpastes are limited in the duration of time they are in direct contact with the surface of the teeth. Therefore, these toothpastes cannot alter the intrinsic color of the teeth. The danger is these toothpastes can actually be harmful to the enamel and exposed root surfaces by causing unnecessary wear and increasing risk of sensitivity.

Whitening Gel
Oxyfresh offers its own whitening agent designed to be used with a custom tray system. Formulated by a dentist and plastic surgeon, this whitening gel is used and recommended by leading dental professionals worldwide.

Completely safe and gentle – water-based, hydrated gel with a neutral pH ensures hydration to the enamel and minimizes tooth sensitivity.

Effective – 19% Carbamide peroxide ensures quicker whitening with fewer sessions and less chance of sensitivity.

Convenient and easy to use – uniquely packaged in a single, 1-oz accordion dispenser that allows for uniform flow with ease. No messy syringe tubes to juggle or misplace; can be used for the initial whitening or touch-up process.

Economical – Cost comparable with in-store systems but with professional quality.

Tastes great – Mint flavor.

100% Satisfaction Guarantee – or your money back!

Home care products
Oxyfresh offers an entire line of professional-grade home care products that complement any whitening system. Oxyfresh dental care products are carefully designed to be gentle, yet effective, great tasting and safe for the entire family. These products can be tailored as a complete home care system to fit individual needs.

Toothpastes – low abrasion, no artificial flavors or dyes. Fluoride and fluoride-free options; freshens breath and maintains whiteness.

Tongue Cleaners – most favorable and popular design on the market. Ensures optimum oral hygiene, fresher breath and a cleaner mouth.

Mouthrinses – formulated within a neutral pH range with unique blends of essential oils, no artificial flavors, colors and are alcohol-free. Fluoride options available. Freshens breath completely, without burn or aftertaste.

Dental Gels – aloe-based gel used to soothe gum tissue from any irritation or oral wound. Fluoride option available to assist with sensitivity concerns and remineralization.

Oral Irrigator – with a patented hydromagnetic technology, the OxyCare™ 3000 provides optimum cleaning ability at home and is ideal for those who have challenges with flossing.

Commitment to excellence
Oxyfresh has recently committed to researching the latest available techniques and innovative delivery systems to develop a new cutting-edge whitening system that continues to be safe, effective and competitive.

As the demand persists, we will continue to see advancements in teeth whitening procedures, both in-office and in-store. Primary factors that will dictate and direct the focus are what everyone wants — ease of delivery, effectiveness and affordability!