Tooth whitening is big business. Generating over $1 billion in sales every year, professional whitening stands out as the most frequently-requested dental procedure. It’s also major source of revenue for dental practices across North America.
Together, a dentist and their hygiene team can create comprehensive whitening programs that integrate whitening into a long-term oral care plan. That way, whitening can serve to facilitate financial gain to hygiene and other ancillary offerings.
Professional Whitening 101: How the Tooth Whitening Process Works
There are several reasons why teeth lose their natural whiteness: diet, genes and oral hygiene all play a part.
Darkening can occur both in the tooth’s outer enamel layer and the secondary layer of dentin. Tooth enamel, made of phosphate and hydroxyapatite, can develop surface stains that attach to the biofilm. These so-called extrinsic stains typically stem from the patient’s diet and habits – frequent smokers and red wine drinkers are likely to have enamel stains.
Stains within the dentin, known as intrinsic stains, can result from medications, fluoride exposure, genetic conditions or systemic conditions. It is more difficult to remove stains from dentin than enamel.
Professional whitening gels use hydrogen peroxide (or a compound containing H2O2) to break the bonds of light-absorbing colour molecules on the teeth. These molecules, called chromophores, contribute to the darkened or stained appearance of teeth. Once the peroxide breaks the molecular ‘glue’ that holds the chromophores together, the teeth look whiter and brighter than before.
Tooth whitening is not a one-time solution – the procedure has a cumulative effect of breaking down stains over time. Additionally, since the average person’s teeth become two to three shades darker every ten years, requiring multiple whitening treatments to maintain the results.
Still, the popularity of professional tooth whitening (not to mention sales of whitening strips, tooth whitening strips and other home treatments) speaks for itself. Many patients are more than willing to invest the time and money necessary to improve the appearance of their smile. Dental practitioners can benefit by investing in a tooth whitening program.
Introducing a Whitening Program to Your Dental Practice
The benefits of a teeth whitening program go beyond offering your patients brighter smiles.
Consider the following in determining the best teeth whitening system for your patients.
1. Contact time. Modern whitening systems use a heat-activated mouthpiece to decrease treatment time, which reduces the risk of the bleaching agent causing sensitive teeth. Shorter contact time also means shorter appointments and increased efficiency.
2. Concentration. Higher concentrations of hydrogen peroxide (24 to 38%) produce more dramatic results, but also the risk of sensitivity. More concentrated whitening products may not be suitable for all patients.
3. Hydrogen peroxide versus carbamide peroxide. Carbamide peroxide provides a lower concentration of hydrogen peroxide and increases contact time, which can increase the risk of tooth and gum line sensitivity. A more concentrated formula with shorter contact time may be preferable for patients who require a shorter contact time.
4. Open versus closed environments. Closed-system environments (such as bleaching trays and whitening mouthpieces) result in superior whitening results by keeping the active ingredients in the whitening compound concentrated.
5. pH level. Consider the patient’s enamel health and sensitivity when choosing a whitening gel. When mouth pH drops below 5.7, enamel demineralization can occur.
Most of us chew gum, and we chew it for a variety of reasons. Whether it’s a piece before a first date, or after a particularly strong cup of coffee, many of us use the chewy stuff to keep our mouths smelling clean and fresh as we go about our day.
We see gum promoted in advertisements as something you can use not only to keep your breath smelling fresh; but to whiten and clean your teeth, improving your oral health.
Exaggerated marketing, or bona-fide fact? The answer lies in the ingredients of the gum you choose to chew.
The Potential Benefits
It comes as no surprise that if you’re chewing gum with a lot of sugar in it, it’s going to be bad for your teeth. Sugar promotes the growth of plaque bacteria, which in turn promotes the development of cavities, the decay of enamel, and other issues.
It’s because of this that many companies, such as Wrigley’s, have begun to use both aspartame and a substance known as Xylitol as a substitute for sugar in their products.
A naturally occurring compound that has been shown to prevent tooth decay, the National Centre for Biotechnology Information writes that Xylitol, “reduces the levels of mutans streptococci … in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death … Consumption of xylitol chewing gum for >3 weeks leads to both long-term and short-term reduction in salivary and plaque S. mutans levels.”
Sounds pretty good, doesn’t it? Less bacteria on your teeth means less enamel-eating acid created, which means a healthier mouth. Brands like Confadent advertise and discuss their use of Xylitol as a safe alternative to aspartame, and a plaque reducer.
According to Delta Dental of California, “With xylitol use over a period of time, the types of bacteria in the mouth change and fewer decay-causing bacteria survive on tooth surfaces.”
This sounds like a big-time benefit for your pearly whites, but how do the results compare to projection? Some research shows that the evidence regarding the long term benefits of Xylitol as a dental hygiene product is still unclear.
According to a review published by the American Dental Association in 2015, while there is some evidence that Xylitol may reduce tooth decay over a period of years, the evidence is low quality.
Research published by the Cochrane Library website suggests that there just isn’t enough high quality evidence to confirm that Xylitol prevents tooth decay.
Philip Riley, M.P.H., of the School of Dentistry at the University of Manchester in the UK, is quoted as writing, “More well-conducted, randomized placebo-controlled trials that are large enough (in terms of number of randomized participants) to show a difference, if one exists, are needed.”
The Cochrane Library review stresses in its conclusions, “We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste … The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population.”
So, What to Do?
In the end, the conclusions are yours to draw based on the evidence given, but it’s safe to say that chewing gum with Xylitol is better for your teeth than its sugary counterparts. While there needs to be some more research done to better reinforce this conclusion, Xylitol has indeed been shown to reduce cavity causing bacteria in the mouth.
Still, if you want to keep your teeth healthy, at the end of the day no gum is a substitute for regular brushing and flossing. For more information on Xylitol, its benefits and drawbacks, you can check out this article from Access Dental, or this one from Delta Dental.
Almost everyone concerned about the health of their teeth brushes regularly, but they may not know exactly why toothpaste performs the cleansing magic it does. They may not even know they also receive fluoride every day in their community’s drinking water.
There are various cleaning components in toothpaste and one of the primary ones is fluoride. The discovery of fluoride's cleaning abilities was a boon in preserving dental health. Toothpaste and tap water then became convenient fluoride delivery systems to aid in the fight against tooth decay.
A Natural Cavity Fighter
The discovery of fluoride’s ability to keep our teeth healthy dates back to the early 20th century. A pair of dentists in Colorado discovered that people in the area had teeth unusually resistant to decay. This was due to the high degree of natural fluoride deposits in the area, which had found their way into the local drinking water. Fluoride became a regular part of toothpaste beginning in 1914.
In the 1940s, a multi-year study began with the goal of determining whether adding fluoride to drinking water made a notable difference for dental health. The results showed a 60-65% decrease in tooth decay in children born after the experiment began. As a result, a number of states in America began water fluoridation programs to improve their citizens’ oral health.
How Flouride Works
The enamel of your teeth is the natural coating that helps to protect them. When children’s teeth are first forming, fluoride combines with the enamel to help stave off decay during a time of life when teeth are particularly vulnerable to cavities. Fluoride remains valuable throughout the life of your teeth by helping protect them against the ravages of sugar and plaque.
Rare Health Risks
As mentioned, almost everyone’s teeth come into regular contact with fluoride through exposure to drinking water and toothpaste. There are additional fluoride supplements in the form of drops or tablets, and it is also an ingredient in mouthwash. The degree of fluoride in the latter is quite high, so do not swallow it.
High doses of fluoride in water can be bad for you, but this would require ingesting a volume of water with fluoride going well beyond what the normal person drinks.
Excessive fluoride can cause conditions known as dental fluorosis and skeletal fluorosis. You can only come down with dental fluorosis as a child, as ingesting too much fluoride at a young age can lead to white spots appearing on your permanent teeth. Fortunately, degrees of this condition ranking above very mild are almost non-existent.
You can also acquire skeletal fluorosis by taking in too much fluoride. However, you would have to have a very high amount on a daily basis for a very long period. As with dental fluorosis, the odds of contracting this problem are extremely rare.
Government oversight helps to ensure the level of fluoride in drinking water does not exceed safe rates. In Ontario, municipalities follow the guidelines laid out in the Safe Drinking Water Act managed by the Ministry of the Environment.
You know the basics of oral health care: brush twice a day, floss your teeth, avoid sugary snacks, and visit your dentist at least twice a year. Here are 10 tips for oral health care you may not know (and a good refresher if you do!)
1) Brush Smarter
Which is better: a humble manual toothbrush or a fancy electric one? They can be equally effective, but what really matters is your brushing technique.
Don’t just brush up and down or back and forth. Hold the brush at a 45-degree angle and use a gentle, circular motion to clean each surface of the teeth, including the chewing side and the side facing your tongue, for at least two minutes. Brushing harder or faster doesn’t do you any good. In fact, it can actually lead to tooth and gum damage!
2) Don't Forget to Floss
People often think flossing is secondary to brushing, but they are both essential to good oral health. If you aren’t flossing, you’re leaving a third of the surface of the teeth unclean.
The ideal flossing technique is a forward or backward motion, with the floss forming a curved ‘C’ shape around the tooth. Use a fresh part of the floss for each tooth so you aren’t re-inserting the bacteria you just removed.
3) Pay Attention to Sensitive Teeth
Sensitivity to heat and cold is a common dental complaint, and it’s often a sign of an underlying issue like tooth decay, gum disease, or tooth grinding. It’s important to find and treat the source of tooth sensitivity, even if the pain is mild. See your dentist at the first signs of sensitive teeth.
4) Eat Well and Brush Often
You’ve heard it since you were a kid: sugar causes cavities. True, a diet high in sugar can lead to cavities, but the real cause is plaque, produced by bacteria in your mouth that eats the carbohydrates left on teeth after a meal.
While sugar is the biggest cavity culprit, even healthy food leads to some plaque formation. This is why you should brush after every meal, not just after dessert, and avoid eating or drinking anything, aside from water, after you have brushed your teeth at night.
5) Watch Your Fillings
Do you have fillings? If so, you can usually expect them to last for eight to 10 years. However, some fillings break down earlier than that. When a filling starts to chip and break apart, food and bacteria can get caught underneath, causing decay deep in the tooth. Be sure to make a dental appointment if your tooth filling is not holding up.
6) Wear a Mouth Guard
Mouth guards are standard equipment for contact sports like hockey and football. However, less confrontational sports—such as baseball, skiing, and skateboarding—can also pose a risk of injury to your teeth. Even minor dental injuries can lead to long-term consequences, so a mouth guard is a good investment for anyone who participates in a sport on a regular basis.
7) Read the Ingredients on Toothpaste
What’s in your toothpaste? Different kinds of toothpaste—those for desensitizing, tartar control, whitening, et cetera—consist of different active ingredients. Understanding how these ingredients work will help you choose the right toothpaste for you. You should always choose a toothpaste containing fluoride, even if your tap water is already fluoridated.
8) Beat Bad Breath
There are many possible causes of bad breath, but poor oral hygiene is a common source. When you don’t brush and floss regularly, odor-causing bacteria can accumulate between teeth and in the back of your throat. However, bad breath can also be a sign of a medical problem, so have a dentist rule out any oral hygiene issues first.
9) Use Mouthwash as Directed
Mouthwash cannot replace proper brushing and flossing, but it can help boost your oral hygiene and control issues like bad breath, plaque, and oral sores. Be sure to read the instructions on the bottle before using it. Depending on the ingredients, the manufacturer may recommend using it either before or after brushing or flossing for the best results.
10) Make Regular Dental Appointments
Do not wait until you have a problem to see your dentist! Even if your teeth and gums seem fine, the dentist might notice things you can’t feel or see. Scheduling regular dental exams will help you detect and treat cavities, tooth decay, gingivitis, and other oral health issues before they become painful and/or expensive to fix.
It's human nature to concentrate on the main details of a situation. For example, if you were going in for an open-heart procedure, you would likely concern yourself with the surgeon’s track record. This particular specialist is the main part of the operation, but they receive assistance from other highly qualified professionals.
If you a love a movie, you make a point of remembering the director’s name, but not necessarily the editor or key grip, both of whom are likely also exceptional at their jobs. Let’s face it, there are very few specialists who work entirely alone, but it is often customary for the world to have only one person take a bow.
Veteran dental hygienist Candice Feagle attended a function awhile back and when mentioning what she did for a living, the person she spoke to replied, “Oh, you’re just a hygienist.” Most of us take pride in what we do and it was understandable that Candice had a negative reaction, though she kept it to herself. It wasn’t the first time this had happened to her or other people in this profession.
However, after mulling it over the next day, she decided to write about the incident for Dentistry IQ.
Not "Just" Collecting a Paycheck
The vast majority of dental hygienists worked hard to earn their certification, and continue to enhance their knowledge by taking advantage of related learning opportunities.
"Oh, you're just a hygienist"
Like any profession, some hygienists are content with their current routine, but there is room to grow in this role. Candace felt at several points that she was indeed “just” a hygienist, which prompted her to expand her career possibilities. Most recently, Candace chose to pursue a bachelor’s degree in allied dental health, allowing her to experience the nonclinical side of the profession, an aspect many patients do not realize exists.
Not "Just" Cleaning Teeth
The average client probably doesn’t realize how much their hygienist does for them. Is it the dentist who reviews their medical history with them and goes out of their way to help ease their anxiety? Does the dentist perform oral cancer screenings, sterilize the equipment, conduct fluoride treatments, take blood pressure, or do periodontal charting?
They can, but in the vast majority of cases, the hygienist performs these as well as other key aspects of a dental appointment.
As Candace also points out in the article, motivated hygienists can go on to become public health professionals, researchers, administrators, entrepreneurs…you name it!
Not every job will make you a millionaire or put your name up in lights. Sometimes the greatest satisfaction comes from knowing you are making an important contribution to a person’s health and well-being.
“Having been in the dental profession for the last 26 years, I can honestly say I love my profession...I know the varied abilities and diverse opportunities being a hygienist represents.”
The pride Candice expresses in that statement makes it clear she knows the value of what she does. And that’s just fine with her.
An inviting smile can open doors and our oral health is also important to our overall well-being. Most of us brush and floss regularly to ensure our teeth remain clean and free of cavities, though some people go the extra step of having their teeth whitened.
Such measures can be quite expensive and inconvenient, so wouldn’t it be wonderful to have another more cost-effective way of ensuring your dental health you could do at home? Not to mention one that may also result in fresher breath?
Oil pulling might be the way to accomplish this. While there is no definitive scientific evidence to say this method works, many people swear by it. Although oil pulling is a hot topic on the internet, it is actually a case of renewed interest in a cleaning method dating back several centuries.
How Does it Work?
Oil pulling is the practice of swishing raw coconut oil in your mouth for 15 to 20 minutes each day. If you are interested in trying this, don’t worry—you won’t have to be splitting or milking coconuts. You can find bottled coconut oil in your grocery store. You can also use sesame or sunflower oil, though most people find the taste of coconut oil preferable.
Coconut oil is solid in form, but quickly liquefies as it mixes with your saliva. Take a generous tablespoon of the oil, place it in your mouth, and swish. You don’t need to swish as vigorously as you would with mouthwash as your jaw would become quite tired.
Do the oil pull first thing in the morning before you eat to get rid of the bacteria build-up in your mouth that occurred overnight. Once the time has elapsed, spit out the oil, and gargle for one minute with a mixture of lukewarm salt water. Then brush your teeth using a brush separate from one used normally. After brushing, rinse the brush thoroughly in warm water.
It is important to avoid swallowing. While the coconut oil will not harm you, swallowing means you will ingest all of the oral bacteria you want to purge from your body.
Detoxing Your Mouth
Those who swear by oil pulling say it is a great way to detox your mouth. Tooth decay results from a build-up of harmful bacteria in the mouth. These germs can lead to plaque, gingivitis, cavities, and even gum disease. Brushing your teeth regularly helps to eliminate such germs, but could oil pulling provide extra help for you in this area? Possibly, but there is no concrete proof.
Tooth Whitening and No More Bad Breath?
We all want whiter teeth. Could oil pulling provide a cheaper and easier way to attain this without having to go to the dentist or deal with those annoying whitening strips? Oil pulling enthusiasts enthusiastically claim yes, your teeth will look cleaner.
They also claim oil pulling will make your breath fresher, though this is not something that would last throughout the day.
Should you try oil pulling? Doing so will not cure cavities or correct any major dental issues, and it is no replacement for daily brushing and flossing. There is no scientific basis for the claims made on behalf of oil pulling and some dental professionals feel you can get comparable results using mouthwash and possibly even just water.
However, oil pulling certainly cannot harm you in any way and will not worsen your oral health.