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. Therefore, it’s important that clinicians can 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 that contain more than six per cent HP to be supplied or administered for cosmetic purposes. Furthermore, tooth whitening products that contain 0.1 per cent to six per cent 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-to-78 per cent 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
Due to the use of HP in the UK being limited to less than six per cent, it is important to consider how effective it is to use such a low dose. A 2004 study found that a five per cent hydrogen peroxide solution was just as effective as a 25 per cent solution at whitening teeth. However, to achieve the same results, the five per cent solution would need to be used 12 times compared to just once with the 25 per cent solution. This means that, to achieve the desired shade using a concentration of less than six per cent, 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, clinicians should consider other options that produce a brighter smile for their patients without the negative side effects presented by HP.
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 could 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. Over 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 hoping to achieve a naturally brighter smile.
With so many patients looking to improve the appearance of their smile, offering a treatment that 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 that prioritises comfort.
With PAP, your patients can enjoy all of the benefits of a naturally brighter smile, without the sensitivity 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.
References available on request.