In-Office Product Comparison

This discussion is by no means an exhaustive comparison of in-office bleaching products or procedures available. I will, however, try to give you some comparitive information about some commonly used products so that you will be able to understand your dentist’s explanation of the system he has chosen to use.

I am going to talk about eight different in-office bleaching systems. I will compare each product with regard to the bleaching agent used, use of an accelerator light, average cost to the dentist for that light if so used, whether an at-home system is recommended as follow up, and the average time the treatments take.

NuPro (R) White Gold/Illumine (TM)

NuPro (R) White Gold/Illumine (TM) is produced by Dentsply International. There is no required light activation for this system and hence, no cost to the dentist for a light. The use of at-home bleaching system as a follow up is considered optional (to be determined by discussion with your dentist). The treatment takes a little over an hour total. The specific applications of bleaching agent is done in 3 fifteen minute applications. It uses a 35% hydrogen peroxide agent with a pH of about 6-8.

Niveous (TM) and Opalescence (R) Extra Boost (TM)

There are two products that consider an accelerator light optional. These are Niveous (TM) by Shofu and Opalescence (R) Extra Boost (TM) by Ultradent Inc. Both of these can be accelerated with a dental curing light if desired. Dental curing lights have other functions in the dental office and will already be owned by the dentist, so no extra cost is required by the dentist for a light. At-home bleaching follow up is considered optional for both products. Niveous (TM) requires two applications of a 25% hydrogen peroxide gel with a pH of about 7 for 15 minutes each. Total time in the chair of about 1 hour. Opalescence (R) requires three applications of 15 minutes and uses a 38% hydrogen peroxide gel with a pH of about 7.

BriteSmile (R) and Zoom (R)

BriteSmile (R) and Zoom (R) are both made by Discuss Dental Inc. BriteSmile (R) requires either a gas plasma or LED (light emiting diode) accelerator light. The lights are owned by BriteSmile Inc. (who’s bleaching systems were bought by Discuss Dental Inc.) and not by the dentist. Dentists are charged on a per patient basis. At-home bleaching follow up is considered optional. A 15% hygrogen peroxide gel with a pH of about 6.5 is applied in two 20 minute applications with a total chair time of about 1 hour.

Zoom (R) requires a mercury metal halide light with a cost of about $1,500. At-home bleaching is recommended as a follow up. It comes in a few strengths (16-25%) with a pH of about 7.5. It is applied in three 20 minute applications with a total chair time of about 90 minutes.

LumaCool (TM)

LumaCool (TM) is made by LumaLite Inc. It requires the use of a xenon halogen accelerator light, which runs from $2500-$4000. At-home bleaching is recommended as a follow up. It uses a 35% hygdrogen peroxide gel with a pH of about 6. Each bleachig session consists of three 8 minute applications with a total chair time of a little less than an hour.

Beyond (TM) Power

Beyond (TM) Power is produced by Beyond (TM) Dental and Health. It should not be confused with a similarly named over-the-counter product, Beyond (TM). Beyond (TM) Power requires a halogen accelerator light running an average of a few thousand dollars. At-home bleaching follow up is considered optional. It uses a 35% hydrogen peroxide gel with a pH of about 5.5 which is applied in three 10 minute applications with a total chair time of less than an hour.

LaserSmile (TM)

The final product I want to discuss here is LaserSmile (TM) by Biolase Technology Inc. This product requires the use of a diode laser, which costs the dentist approximately $20,000. However, the diode laser will be used for other dental procedures as well, so a dentist will not likely use this system unless he is already using a diode laser in his practice for other procedures. At-home follow up is considered optional. LaserSmile (TM) uses a 37% hydrogen peroxide gel with a pH of about 7. Each session consists of two applications of the bleaching agent: the first for 16 minutes and the second for 8 minutes. However, the laser light is applied only for a total of about 4 minutes during these applications. The session is about an hour.

In the above discussions, where at-home bleaching follow ups were mentioned, the final decision whether to use a follow up product is something to be worked out with the dentist based on his or her recommendation and based on the whitening goal desired as well as the original condition of the teeth being bleached.

Tooth Whitening

If your discoloration problem is primarily from extrinsic staining, you can often get very good results using toothpastes that advertise themselves as “whitening toothpastes”. This method is only for extrinsic staining and is not part of this discussion on actual bleaching procedures.

In-Office Bleaching

The first type of delivery system for tooth bleaching is the in-office procedure performed by a dental professional. These procedures use the highest concentration of bleaching agent and it is generally going to be a hydrogen peroxide agent, which tends to be stronger than carbamide peroxide. Carbamide peroxide breaks down into hydrogen peroxide when activated. When high concentrations of hydrogen peroxide (9-40%) are used, the gum tissues must be protected by isolation with a dental rubber dam and the agent applied carefully and monitored.

These procedures are much faster than other methods, but also correspondingly more costly. The cost can range from $500 – $700. Many of these systems are used with an activating light of some kind. There is controversy in the profession about the effectiveness of this light activation and some studies seem to show no significant difference between light activation and no light.

Professionally Dispensed At-Home Bleaching Kits

The second type of delivery systems for bleaching the teeth is custom tray fitting with professionally dispensed bleaching products. An impression is taken of the teeth in the dental office, a custom tray is produced from this impression and the patient takes the tray and bleaching material home to wear the bleach filled trays from 1/2 hour to 1 hour per day, depending on the product used.

These products rely on the less strong, but safer agents using carbamide peroxide. As mentioned, the carbamide peroxide breaks down into hydrogen peroxide having about 1/3 the strength of hydrogen peroxide. A 15% carbamide peroxide solution is equivalent to about a 5% hydrogen peroxide solution. It usually will take a couple of weeks of consistent use to get the desired whiteness of the teeth with these sytems. The cost is usually only about $150 – $300.

Over-The-Counter Bleaching Kits

The third category of bleaching sytems are the over-the-counter store bought whitening kits. These systems have the lowest concentrations of bleaching agent which is usually applied with a general sized tray, some kind of strip, or painted onto the teeth with applicators. This results in considerably less acurate dispensing of material to the teeth. This can result in burning and discomfort to the gums, and uneven whitening results overall. There is also a tendency for these systems to only be able to whiten some of the front teeth as opposed to the full arch whitening possible with custom fit trays. These sytems typically cost from $20 – $100.

Realistic Expectations

It should be noted that whichever type of bleaching system one chooses, no amount of bleaching can achieve a whiter shade than a person’s own natural optimum whiteness. If bleaching is carried out beyond professional instructions, the enamel can lose its luster and be left with a chalky appearance which weakens the surface. If proper directions are followed this danger is very minimal, so follow the directions.

Various shade guides are dispensed with these kits for analysing your beginning tooth color and your progress towards a lighter shade. There are many factors affecting the outcome of bleaching procedures and it is important to have a realistic expectation when trying to achieve a lighter (whiter) tooth color. Usually, from two to five or six steps on a shade guide is realistic. Your dentist can give you a good idea what you can expect given the condition of your teeth.

What I often do with my patients is to show them a shade guide representation of their current tooth color next to the shade they might realistically hope to achieve. Then I will suggest that instead of using the paper shade guide that comes with most kits, I ask them to bleach first the upper teeth and use their own lower teeth to measure their progress. Then when they have reached their desired goal, they can bleach the lowers to match the uppers.

Demand For Whiter Teeth

More and more, people are demanding whiter teeth. They are no longer willing to accept the slow discoloration of their teeth over time. As a result, a major industry has grown up around “tooth whitening”. I want to bring some clarity into the cloud of information (and misinformation) concerning “tooth whitening” and the procedures and products used to achieve whiter smiles. This is going to be a series of posts addressing this subject.

Today we will start with some definitions and explanations. In subsequent posts I will discuss the pros and cons of the different methods and materials employed and then, finally, discuss some of the major brands of tooth whitening systems out there currently. Let’s get started.

The Factors Affecting Tooth Color

Tooth color is an enormously complex subject composed of many factors including hue, saturation, transluscency, stains and age to name a few. However, for our purposes here, the thicker the enamel, the whiter the appearance of the teeth. Some people start out with thick opaque enamel and, hence, whiter looking teeth. In general, the original color of teeth ranges from the yellow-brown caste to the grey-green caste. As teeth age, the enamel tends to wear and become thinner and more transluscent. This allows the yellow-brown color of the underlying dentin to show through more. Also, aging is accompanied by slight cracking and imperfections in the surface of the enamel allowing deeper penetration of stains.

Types of Stains

Stains are classified as either intrinsic (internal) or extrinsic (external or surface). Intrinsic staining can be a result of age, trauma (either accute or chronic), exposure minerals (as in Tetracycline) during formation or fluoride in too large doses. Often there is a combination of all these factors, different for each individual.

Extrinsic stains affect the surface of the tooth enamel coming from foods, dark colored beverages (wine and juices), tobacco and other sources that penetrate surface imperfections over time with the wear and trauma of chewing and/or tooth grinding.

Whitening vs Bleaching

Although the term “tooth whitening” is commonly used for all types of whitening systems, there are actually two distinct types of procedures involved. The FDA classifies the use of a peroxide containing agent to produce a whiter intrinsic shade as “bleaching”. “Whitening” on the other hand is the process of removing as much of the extrinsic or surface stain on teeth through the use of toothpastes, toothbrush floss and other cleaning agents such as the pumice used by the hygienist.

In the next installment, we will talk about the three types of whitening systems commonly available: In-office systems, At-home systems and Over-the-counter systems.