Tooth Whitening Myths: Making Sense of the Data.

You're listening to The Dr. Phil Klein Dental Podcast Welcome to the show. I'm Dr. Phil Klein. Albeit widely utilized by clinicians across the globe, the world of tooth whitening bleaching contains many outdated dogmas and long-held beliefs that require closer examination. Today we'll be discussing some of those tooth whitening myths and how to make sense of all the data. 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. Pleasure to be here, Phil. Thanks so much again for having me. Yeah. So we did a podcast many, many years ago. It was early in my career of doing podcasts. I think it went back to something like 2018. I don't know if you remember that. It was a long time ago. I do. We've done a bunch. Yeah. You were one of my first interviewees and it was very good and I enjoyed it. And it sent me the message saying, hey, this ain't so bad. I could do some of this. And of course. Yeah. Well, here we are back again. five years later we're still doing it yep still doing it so we're talking about bleaching today and this is a four-part series so we're excited to have you on so let me begin with this question after bleaching either in office or at home what are the dietary recommendations do patients need to eat any particular diet or avoid any certain foods that's a really good question i think this is probably one of the biggest questions i get right because what's more central to a person's lifestyle than the food that they're eating right and we always get these folks in here that have these ideas in their head one of their friends told them that you know after bleaching um you have to have a white diet meaning you know you got to eat cauliflower and tofu and water you can't have all of the good stuff like red wine coffee chocolate the green smoothies right and so that was the long-held belief and I'll be honest with you early in my career I used to tell my patients that because I thought it too and then I did a lot of research really looked into it did sort of a deep dive into this and I thought can that really be because I had bleached my own teeth you know and I'm a I'm a chocoholic you know and I like I like to eat you know things that are dark colors I like you know eating red fruits and stuff and I never noticed any change in my teeth so when I went back to the the literature and started really, really looking at that, I found that actually there was no science or evidence to support that. And the papers that had been written actually tested that out. And they found that you can eat and drink whatever you want as soon as you're done bleaching without any side effects or the teeth becoming darker or being more sensitive to stains immediately after bleaching. So no, you can eat whatever you want, have at it. Yeah, that's good. So that's excellent information. And that busts a myth right there. Many patients use Invisalign. That's pretty common now these days. And, you know, with everybody wanting their teeth looking whiter, they also want them looking straighter. So Invisalign kind of goes along with bleaching to some extent. If they whiten their teeth, will the resin leave an area of unbleached tooth structure once the composite buttons are removed? Yeah, again, this is like another one of these. really widespread and common myths and I don't blame people right because it's hard to like nobody wants to find this out like the hard way that you know if you've got Invisalign and my daughter has Invisalign and to be honest with you this is just about the only way I can get her to really keep her trays in is to have her bleach you know so the long-held belief was that okay if you've got composite on your teeth right the little buttons that the invisalign is holding on to that's how it's you know moving the teeth that well what happens when when the invisalign when the trays are done when the teeth are finished moving and now the little resin buttons need to come off oh my gosh what happens if there's little like cheetah spots like underneath the teeth right what if you've been wearing what if you've been using bleach in your invisalign this whole time and the entire tooth is white but there's like a little bullseye right in the center of you know like a3 shade enamel so it turns out again this all goes back to the peer-reviewed literature and everything regarding myths you know regarding all of these topics that i'm going to be discussing with bleaching there is some very sound scientific basis to it and so when you remove those buttons i guarantee you will find that the tooth is the exact same color as the rest of the tooth because the way that that bleach works after as it permeates through the enamel and through the dentin it's going to go underneath that composite and it is going to bleach the tooth from the inside out so anybody who is listening to this you do not need to be afraid and you can say with the utmost confidence to your patients that they will not have hyperchromatic little uh areas underneath underneath the resin buttons after they bleach so they can go ahead and do that you don't need to be afraid to to bleach if they've got excellent composite Well, that's good. That's encouraging. And yeah, also the brain tends to, when it looks at something, it kind of does some blending of its own. Oh, absolutely. I'm not sure that you would even pick that up if the bleaching material didn't fully get underneath those buttons. It's good to hear that it does, and it's good to hear that there's no worries there. So what does the literature say about the use of in-office lights to amplify the effect of the whitening gel? Yeah, again, another really great question. And when we first started in our practice, and I think if you look at my webpage, I think we still have on our bleaching page. It's hard for me to update this, but I think we talk about, you know, using a light, you know, using the light during our bleaching procedures. And now we have long since figured out that the lights. it's really just theater i mean there's really it's really just kind of for the patient experience i will still have patients come in that want the light you know so when we're when we're doing um like the polar rapid bleaching for them in office and this is like a 37 i mean this is really potent gel that bleaches in like 24 minutes you know they're just sitting there they really do not need to have that light on there, you know, because they, but some of my patients, they think that that light is going to activate it. They've read it online. They saw a thing and a thing, and that has been carried out through like online marketing, YouTube videos, you name it, people see the light. And now there's, you know, companies out there that are selling, you know, the little mouthpieces with the lights. And so now they think, oh, well, this is really cool. And they see it on, you know, social media and Instagram and Facebook, and they think that they need the light. But they actually really don't. So there's no harm in using the light. But again, all of the peer-reviewed literature tends to show that there is no actual benefit to using that light whatsoever. So for me, it just kind of gets in the way and it's one extra thing that I have to do. So my regulars that come in, they know that they're not getting the light. Right. And I think part of the marketing plan to get the patient to actually do in-office whitening was to implement the light system. over the chair, right? I mean, that's something that tells the patient, I can't do this at home. I've got to come in and get this work done. And that's exactly it. It's a thought. Right. No, and you're exactly right. And that's just it, is that they think, okay, well, this is like a professional experience. Like I said, it's part of that experience. But I will say this. I will use the light on rare occasions because what the light can do, especially with one of the products that I use all the time, I'd mentioned is the Polaroid. and it's, it's only, it's only 24 minutes long. And so it's anybody who's ever like, you know, been surfing on their phone knows that that time evaporates so quick and you get, you get lost. And I sit there chair side with all my patients. I don't just like walk out of the room and leave them. So I sit there. So every now and then I will put a light on as I'm sitting, as I'm sitting there doing my notes, the light is just a visual cue for me to let me know that the bleaching is done. So I can set that light to go off, you know, at like. eight minute intervals so that it goes off and i'm like all right now they're like a third of the way done and patients also like to hear that too you know again for the in office it tends to provide a little bit more sensitivity so i'll tell them the patients can view it as like a countdown timer like okay cool i'm a third of the way through all right it goes off for another eight minutes all right i'm two thirds of the way through you know and then they kind of know it gives them like they can see the finish line you know what i mean so i will use the light in that way but i don't use it to amplify the effects of the bleaching gel And here's another question that you might have come across in the past by your patients. Some people may be concerned that the final whitening result is going to be too white or look fake. And I can understand that. So is that something you've seen or have experienced where the patient sees their final whitening process being too white and it doesn't look natural? No. And this is another question I get all the time. So when I'm sitting there and it doesn't matter what... of information we tell the patient ahead of time this i think this question when i always ask them hey do you have any last minute questions before we start they say yeah yeah um i don't want my teeth to look fake and i get it nobody wants to i you know i think there was a show um there was an episode of friends like a while back where ross bleached his teeth and it was like this big practical joke i mean his teeth were like literally like glowing in the dark and i think everybody has that you know because that's such a part of popular culture too so now people are so worried that that's going to happen. And I, like, Phil, I will tell you, not once, never. And it's rare. And you know, you know, in dentistry, it's rare that you could ever say, never has it happened. Never has someone in my office bleached their teeth, looked in the mirror and said, my teeth are too white. I want my money back. This is not what I signed up for. So that doesn't happen. And what they, what people see on television and, you know, in movies and advertisements, these are oftentimes images that have been Photoshopped. these are you know celebrities that have a full mouth of crowns or veneers and the porcelain is just like so opaque and bright and that's artificial like that that's not real life when we when we bleach the teeth in office or they're you know we're making trays and they're doing it at home your teeth can only ever get as white as they as they ever really were um and so it always looks natural i feel like on people and i've never like i said i've never had somebody say gosh i I want a refund. This was not what I expected. It looked too bright. So yeah, that doesn't, that doesn't happen. Before we wrap up this podcast and we have several others that we're going to be covering in this series of whitening. If you can guide us on any particular systems that you like in your office. Yeah. So, and you know, when we first started out, I mean, we tried every system that was out there, you know, and we had like some, like. okay success with some we had some complete failures i won't mention those but the one that we found that was the absolute most reliable for the patients that had the least amount of sensitivity and then the best results and that's essentially what people want is they want to look good they don't want their teeth to be sensitive so we use sdi in our office that's um that's the big one that we've used from the beginning and sdi of course stands for southern dental industries they're out of australia they're a fantastic company um and you know they're like a smaller company they're not like some of these big kind of like faceless companies, you know, and they put a lot of like pride and research and passion into their products. And so the systems that we use for the in-office, I mentioned before, we use the Polarapid and that's like a, you know, 37 and a half, 38% hydrogen peroxide. And then we use the Polonite system for the folks that want to use the trays or they have, you know, children or they are themselves in Invisalign. And so they use a 10% carbomide peroxide. which is the pull a night when they go home. SDI has been in the whitening business for a long time. Oh, forever. Right. So if you're going to be looking to adopt a new system in your office, it's always good to work with a manufacturer that has years and years of experience and R &D behind them. That's been very helpful, Dr. Cone. I'm looking forward to the next one. I'm going to be talking about tooth whitening materials, contemporary products for outstanding results. So that's going to be in the next one. We hope you guys tune in. I'm talking to the audience now. And until next time, Dr. Cone, have a great evening. Thank you so much. Cheers, Bill. Bye-bye.