Tooth Whitening Materials: Contemporary Products for Outstanding Results.

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show. I'm Dr. Phil Klein. With the popularity and demand for tooth whitening services and the abundance of materials to choose from, things can get confusing. Today, we'll be outlining the products that are available to best serve the needs of you and your patients. Our guest is Dr. Miles Cone, a key opinion leader, international speaker. author, and co-owner of Nuance Dental Specialists in Portland, Maine. In addition to achieving board certification and diplomat status within his prosthodontic specialty, Dr. Cone has earned his designation as a certified dental technician. Dr. Cone, it's a pleasure to have you on Dental Talk. Thank you, Phil. Pleasure to be here. So let's begin with a simple question, and most... that graduate dental school and assistants probably are trained in this to some extent, the difference between in-office bleaching and take-home bleaching? Yeah, it's a fantastic question. And this is something that I get asked when I give these lectures. This is something I always get asked by the patients because they know that we provide both of these services. And the thing is, is that a lot of people want to do just one or the other, but they really work the best when you do them in concert. In-office bleaching is going to be done typically, you know, at least with the SDI system that I use. It's a 38% hydrogen peroxide, and it is a very potent material. Only requires about 24 minutes. And so this way of bleaching is really impactful for people who have, you know, very little time. They're on the go. They've got a big event coming up. You know, usually it's like, oh, they got a wedding. you know a reunion they're going on vacation and you know they're just like slugging coffee back all day long red wine in the evenings and now and now they they need a really big impactful change you know we're talking like seven eight shades like over their lunch break right and so that's really great we use that as it's a big motivator you know for the people that need sort of that immediate gratification you know doing the um doing the polar rapid in the office is is really really nice but then we have a lot of folks um that also want to maintain um the brightness of their teeth and for them the take -home trays with a 10 carbamide peroxide and the product that we use for that is polonite and there's many different formulations of the carbamide peroxide or hydrogen peroxide that you can use at home. We've found that the 10% carbamide peroxide tends to have the best patient compliance because it's the least sensitive. And because of that, the patients are wearing this for eight to 10 hours through the night while they sleep and their teeth get... like really, really bright. And so we typically, like I said, we'll do the in-office to sort of kickstart them. We'll make them custom trays, oftentimes while they're sitting in the chair, getting their teeth bleached. And so they're usually leaving my office that same day with trays, maintaining, you know, that bright color. So we talk about over-the-counter products, obviously, with our patients from time to time, because they must ask, you know, what about this product I saw in Walmart that said it could bleach my teeth? You know, and we hear that all the time. So what do you say to patients when they talk about over-the-counter products? Maybe they even ask Dr. Cohn, can I use these over-the-counter products to maintain what you're achieving in this combination treatment of in-office and at-home? And are there any particular products that you would never use? Okay. Yeah, that's a really, really, really great question. So, you know, one of the things that I love about, you know, working with SDI is that they... distribute only to dentists. So you won't find their products like in the grocery store. They keep quality control and they try to make sure that it's professionally dispensed. So that way the patients that are getting this product know that it came from, you know, a clinician and it wasn't, you know, there's some level of like comfort and safety in having that dispensed to you by, you know, a licensed dentist. A lot of the stuff over the counter, there are products that will work. Here's one of the here's some of the rub of that, though. Many of these products are hydrogen peroxide. And so the hydrogen peroxide tends to burn a lot. And so I always tell patients, you know, going back to this idea of doing like in office versus the take home with the take home products that we use with the with the polonite. It's the 10 percent carbamide peroxide has additional benefits to it other than just the other than just the whitening. It has a really, really strong. oral hygiene component because it is a very mild slow release product that breaks down into urea and then three percent hydrogen peroxide and so with many of these strips and things that you'll buy you know at the grocery store you can find online these are stronger concentrations of hydrogen peroxide that is not providing to you the oral hygiene benefit that the 10 carbamide peroxide does and also because it's a strip and it's not customized the results are never going to be as good as they would have been if you were using customized trays from your clinician. And, you know, one of the things that people will often ask me about is like, hey, hey, Miles, Dr. Cone, what do you think about, you know, charcoal, you know, charcoal-based toothpaste? You know, what do you, can we use that, you know, to whiten my teeth? One of my buddies used that. I saw this guy. And again, you know, the literature shows that charcoal-based toothpaste, not only do they not... the teeth but when you look under you know the the enamel at the scanning electron microscopes there's like striations and streaks and it can do a lot of damage to the teeth and again that's been shown in various different journals and things like that so I really would advise folks not to use charcoal based toothpaste and if you it's interesting here's an experiment here's homework for anybody listening next time you're at the grocery store grab any box of charcoal charcoal toothpaste And take a look at the inactive ingredients. You know what's listed in the inactive ingredients? Charcoal. It is just a marketing thing. It has no benefit whatsoever. That's interesting. That is very interesting. So the take-home message here is stick to what the dentist provides. Chairside and whatever that dentist recommends to the patient to do at home. Stay away from over-the-counter. Not great quality control, most likely. And there's also the chance of having hydrogen peroxide. go where you don't want it to go right i mean it could leach absolutely yeah i mean it can go to the gingival tissue and and so forth um and that's something yeah that like i've heard my patients say all the time hey i use these strips but man it hurt you know so now they're a little hesitant to use trays at home and so what we found again in our office with the with the products that we use is they have very little sensitivity if any at all. And it's been definitely not to the gingiva, the delicate gingiva. They don't burn the gingiva anymore. Now, we talked on a previous podcast about Invisalign and the buttons. And your answer was not to worry because the bleaching material seeps underneath those composite buttons and does what it has to do. And it's pretty undetectable once those buttons are removed that they were even wearing buttons in the first place on the teeth. And that's an association with Invisalign when it comes to traditional orthodontic brackets. What's the story with that? Yeah, you know, that's a that's a really good question, too. And we don't see this as much anymore, you know, again, with the with the popularity of Invisalign. But I'd say, you know, three or four times a year, we'll get a patient in that has traditional orthodontic brackets. And the struggle has always been, you know, making an impression over those over those brackets. It's really difficult to do. And even if you have an impression now, you got to do a. Even if you were to like scan the arch, you know, now you've got to have this like suck down tray that's over the top and it kind of gets hung up and it can tear and rip. So that's really difficult. So SDI has this really, really wonderful product. And, you know, especially around the holidays, it is difficult for me to keep this on the shelf. So they call it the Polo Light. And it's essentially a little mouthpiece. It looks like if you ever played, you know, soccer, football, basketball, and you had one of those little boil. mouth guards that you'd like you bite into yeah you know what i'm saying it's kind of like that but it's got like a reservoir for the maxilla a little reservoir for the mandible and it just goes in your mouth and it's sort of a pre-formed like silicone tray and so this fits easily over the brackets um so there's you don't have to worry about you know making something in the laboratory making an impression um because these folks again they want to whiten their teeth too and again everybody who's ever had have worn braces or has children that have had braces, you know, and then they get them off. Everybody knows that the tissue is always a little bit raw and inflamed. You know, there's a little white spot lesions sometimes on the teeth. So if you're using the Pololite, you know, you can put whatever concentration is in there. And so again, I mentioned, you know, earlier that I really, really, I cannot say enough good things about the 10% carbamide peroxide. And I have, I don't know if I'm allowed to plug this, but we have an ebook out. that we discuss all of the benefits for all of the different specialties for using that 10% carbamide peroxide. And this was one of them for orthodontics is that, you know, when you do have those patients with the traditional brackets, you put that 10% carbamide peroxide in the pololite. And now the hygiene benefits that are going to come to these patients who have the brackets on are going to be incredible. And again, mentioning, you know, from previous podcasts about not worrying about the resin buttons. those brackets are held on with resin too so same thing when those brackets come off the teeth are going to be bright they're going to be white the tissue is going to be really healthy and so that's what we that's what we have in our office and uh yeah like i said it's difficult to keep it on the shelves i think we i think we charge maybe like 150 bucks or something for it so it's a really great option for folks who either don't like having impressions made because they have a gag reflex or like i said they've got they have brackets on there which would make custom trays um you know really really challenging Right. And that leads into my next question. What options are available for your patients who don't want to wear trays in their mouth? Yeah. And, you know, we get those two. And this is another one of these products that we have. And we keep it right, you know, right at our front desk. So it's in eyesight of everybody as they're checking out. So SDI has a bleaching pen as well. And it's called the Pola Luminate. Now, this pen is a 6% hydrogen peroxide. So it's definitely a little bit stronger than the 10% carbamide peroxide. It's about that 10% carbamide peroxide. has a three percent hydrogen peroxide component built in that breaks down once it's in the oral cavity so this is a six percent hydrogen peroxide so it's twice as strong um really potent but you can apply this to select teeth and you can do it on the go you just you know hold your lip up a little bit let the tooth dry apply it and it's almost like almost like a mascara you know it's really small imagine like you know a little tube of chapstick times like two like that tall and it fits in your pocket i've got one in like every jacket pocket i can't tell you how many times i've been like on an airplane digging into an old fleece or something i'm like oh son of a gun there's a there's a pole illuminant and i'll you know disappear into the restroom real quick and paint some on you know if i'm going off to give a lecture or something and it's really really nice and again we see a ton of patients that are doing you know a single veneer two veneers or a couple crowns in the front and then you know if we've made them bleaching trays ahead of time We've now changed the topography of the mouth. So those, their trays no longer fit and they don't really need them. You know, they just really need one or two teeth, you know, on the sides. Like maybe if we've done like a seven through 10, maybe they just want to bleach their canines. Well, it doesn't make sense to, you know, make them new trays again. We just give them one of these pens. They're really inexpensive. Again, I don't know even what we sell them for in our office, maybe like 25 bucks or something like that. And so. Patients will buy three or four of these at a time. Again, these are very difficult for me to keep in office. People are constantly buying them. They can just paint this right on at their leisure, on the go, and they just whiten as they're walking around with no sticky gels or messes or anything like that if they're opposed to wearing custom trays. Have you seen, as we wrap up this podcast, have you seen a change in the whitening rage that occurred in the makeover days of I don't know, when was that? 15 years ago when things were like crazy with the makeover? Or has whitening stabilized as a procedure in your office that has staying power and it's consistent and it's a nice revenue model for you? Your patients continue to ask for it. Absolutely. And you know what? I'll tell you this. This is just me sharing a little bit of the behind the scenes. During the pandemic, Right. Bleaching was one of the things that really got us through that time because we were trying to reduce aerosols in the office. Right. So what kinds of procedures can you do that doesn't generate an aerosol like bleaching doesn't generate an aerosol? You know, people were trying to be a little bit more thrifty with their spending. You know, so people who are opting not to get the veneers, not to do like the crown and bridge, you know, they'd say, well, hey, what can I do that will make me feel good about me? Like. right now is is relatively quick again has that like immediate they don't you know patients who don't want don't want the delayed gratification they want to look good now the bleaching really got us through those times and i know i remember hearing a lot of patients or a lot of my colleagues who were saying like oh man we're just not doing the implants we're not doing the big full mouth cases and they were genuinely concerned or like wondering like how i was staying afloat during like these hard times i said man bleaching advertised bleaching like everybody wanted to do that And so that's it's I think it does have the staying power. Absolutely. Yeah. And that feeds into our next podcast of this series, which is marketing made simple, adding value to your clinical practice with tooth whitening. So stay tuned for that. Dr. Cone, thanks so much for your insight. And we'll see you on the next podcast. Thank you, Phil. Cheers.