Dentaltown June 2018 - 86

Whitening gels: Hydrogen peroxide
versus carbamide peroxide
Understanding how whitening gel works to break up tooth stains is an important part
of selecting the best whitening system, and can be a valuable tool when educating your
patients. As stated earlier, double-carbon bonds are responsible for the yellow color in tooth
stains. The whitening molecules absorb into the semipermeable membrane of the tooth
and break double carbon bonds into single-carbon bonds.
Many professional whitening gel formulas are formulated with hydrogen peroxide or
carbamide peroxide. How can we determine the most effective formula for patients? Which
formula produces the fewest byproducts and least tooth sensitivity?
Hydrogen peroxide breaks down into water and oxygen ions, or whitening molecules.6
The whitening oxygen ions effectively target double-carbon bonds, and when heat is added
the reaction rate doubles to accelerate the whitening applications.
When selecting a hydrogen peroxide formula, look for a stable hydrogen peroxide
system with a hermetically sealed delivery system. In modern whitening systems, a pH
raiser is typically added to hydrogen peroxide formulas to increase shelf life and efficacy.
Carbamide peroxide breaks down into hydrogen peroxide, urea and ammonia.5 Because
of its formula structure, carbamide peroxide has one-third the whitening power of hydrogen
peroxide. The lower efficacy of carbamide peroxide lengthens treatment time, which can
cause tooth and gum sensitivity.

How to communicate with patients about whitening
The word selling is taboo in the dental world, and most dentists and hygienists are
uncomfortable bringing up the topic of whitening. Educating is a word we feel confident
using. Comparable to X-rays and perio chart assessments, shade assessment is a tool that
allows us to monitor the health and vitality of patients' teeth over a period of time. Further,
it motivates patients to share their thoughts about whitening comfortably, and educates
them about how their lifestyle may be affecting their tooth shade.
Having open conversations with patients about expectations and reality is crucial. When
treatment planning, asking patients to identify their ideal tooth shade is just as important as
assessing their starting shade. We know not all patients' teeth whiten the same, so it's best to
speak candidly about patient expectations to help create a personalized bleaching treatment.
Depending on the starting shade, a treatment plan may be developed that involves both
in-office and professional take-home applications. Teeth that are yellow in shade typically
have better results than teeth that have a grayish hue. Take before-and-after photos to show
progress and results, and if regressions occur; this will prompt patients to stay motivated
to maintain ideal tooth shade. By explaining the science and methods behind whitening
to your patient, your discussion is no longer perceived as selling but as educating.
A key component to integrating a successful whitening business into your practice is a
team effort. Discussing whitening promotions during morning huddles or monthly meetings
is a great way to promote consistency and cohesiveness among your team.

Fig. 1

Before and after photos
Figs. 1 and 2: A 24-year-old smoker presented with C2 shade, whitened to a B1 with
in-office Glo Science Professional whitening 30 percent H202 gels. He reported no sensitivity.
Figs. 3 and 4: A 32-year-old presented with A3 shade whitened to an 1M1 with the

Fig. 2

JUNE 2018 // dentaltown.com

FIGS. 1-6: REPRINTED WITH PERMISSION OF DR. JONATHAN B. LEVINE

whitening maintenance is essential to stabilize and prolong tooth shade. Compared with
other beauty regimens that require multiple visits for touch-ups, professional whitening
maintenance can be discussed at recall visits, as well as hygiene appointments with the
dentist.

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Table of Contents for the Digital Edition of Dentaltown June 2018