Teeth Whitening: Smile please
Once the preserve of the rich and famous, whiter-than-white teeth are the new, ‘must-have’, accessory. It’s the number one request when people are asked what they’d like to change about their smile, says Dr Andrea Shepperson, chairman and director of the NZ Academy of Cosmetic Dentistry; blame it on television make-over shows or those celebrities with their dazzling dental work.
Tooth whitening has been called ‘a highly positive behaviour-changing procedure’, but the desire for an ever-whiter, brighter smile is a contentious issue. On the one hand are the dentists who claim they alone have the qualifications and the expertise to do the job and that, as part of a regulated industry, the client is protected by their safety codes of practice. On the other are the beauty therapists who regard tooth brightening as a cosmetic procedure which, given the right products and training, they’re more than capable of handling. Some therapists says it’s a little like the situation with dermatologists when they first began IPL treatments.
There are many causes for tooth discolouration. Medication, dental trauma, inherited conditions or simply staining from coffee, tea, red wine or cigarettes, can all be factors. The cause of discolouration and the choice of treatment, is best determined by a trained dentist, says Dr David Drum executive director of the NZ Dental Association.
Whitening teeth is essentially a process of oxidisation, using peroxide (bleach), in varying strengths and formulations, to lift extrinsic (surface) and intrinsic (embedded) stains... The likelihood of causing damage increases as the strength of the bleach increases, says Dr Drum. “I’ve seen advertisements claiming bleach strengths many times that normally used by dentists.” Bleaches are caustic; they can cause burns to the soft tissue of the mouth, gums and palate. “Tooth sensitivity is a common side effect of external tooth bleaching.
“Research also shows bleaches entering a tooth via broken or leaking fillings, dental decay or exposed tooth root surfaces, can cause inflammation of the live tissue within the tooth and even tooth death. Why risk this?”
Beauty therapists may be interested to learn the NZDA has even stronger concerns regarding the bleaching booths appearing in some malls. “I’ve seen some that do not even have running water so there isn’t even basic hand washing occurring between clients. If these are to continue the Association would like to see immediate and vigorous enforcement of standards to assist in preventing cross-infection between clients,” says Dr Drum.
Beauty New Zealand spoke with two of a growing number of suppliers of teeth brightening products, Steve Arthur at House of Camille, Lumabrite suppliers, and Don Shannon from Smile Headquarters Pty. Both stress it’s important to understand that the client ‘does the work’ with their systems. The therapist does not enter the client’s mouth. “The client completes a consent form and oral check list and based on the outcomes of this they’re given the mouth tray complete with gel to insert and on completion they remove it,” says Shannon. “Therapists can’t believe how simple, safe and effective it is.”
Both companies also make it clear that therapists must undergo thorough training before they’re able to treat clients. Arthur says when they place a system with a clinic, therapists are given full training. “Part of this involves therapists undertaking a treatment themselves because they need to experience it.” They also practice a treatment. “They are given full manuals, full training on the consultation process, contra-indications, application of the treatment and use of the machine.” It’s like any advanced treatment, he says. “They need to understand how to select their clients. It’s not for everyone. A lot of clients do have teeth problems and they should be referred straight to their dentist.”
Of course there are risks, he says. “It’s the same when you use any chemical. If you’re doing an eyelash tint you have the potential to blind somebody. The pre and post care advice is critical.”
It’s important not to set unrealistic expectations. Few of us actually start out with ‘white’ teeth; colour ranges from yellowish brown (generally more responsive to brightening) to greenish-grey, and intensifies over time. “When we do a consultation we talk a minimum of four shades brighter,” says Steve Arthur. The colours are confirmed, using the shade card, before and after treatment, he says. Taking before and after photos will also help the client realise just what a transformation has taken place.
Dr Shepperson says their concern, shared by the NZ Dental Association and other international dental bodies, is that beauty therapists are inadequately trained to recognise dental anomalies in tooth position and the risk to soft tissues. “A patient who has had some gum disease will often have had gum recession exposing small ‘black triangles’ between teeth. Failure to adequately seal these zones, often from both sides of the teeth, will result in chemical burns to the soft tissue during a whitening treatment.”
(In a much publicised case, brought by the Dental Practice Board of Victoria in Australia last year, a beauty therapist was found guilty of practicing dentistry while not registered as a dental care provider and fined AU$2000 for causing harm as a consequence of a whitening procedure. The client suffered severe mottling and marbling of the teeth, gum ulcerations and chemical burns.)

Interest in teeth whitening in New Zealand is high. Don Shannon reports the SmileHQ stand, with eight teeth whitening lights and three operators in action, “was inundated from start to finish”, when they launched in New Zealand at Girls Day Out last year. But Steve Arthur says take-up by clinics has been slower. He suggests there’s a level of fear of the unknown. “It was the same with IPL and electrolysis.”
Jude Luke at The Elements Medi-Spa & Beauty offers Lumabrite teeth whitening as part of a makeover. “It’s a simple process and one that can be performed in the comfort of the salon. But it’s a competitive area and one where prices vary considerably,” she says. “There are a lot of people offering the service and finding the best one is hard for clients.” Luke believes it’s a service that will become an expected part of beauty therapy, “although my dentist may beg to differ. It’s certainly not a fad – I’d put it on a par with acrylic nails 20 years ago, and look at that today.”
Tooth whitening is also on the client menu at Waiwera Infinity Spa, but it’s not the spa therapists who are doing the treatment. “We’re beauty therapists, not dentists,” says manager Amanda Brewer. She’s happy to stay with being “a skin specialist, not a tooth specialist. I won’t even touch IPL without a registered nurse on site, never mind doing anything like tooth whitening!”
Waiwera Infinity Spa Dental Centre offers complete dental treatment, including tooth brightening, and spa clients have the option of take home or in-chair whitening procedures, says practice manager Debbie Bayes. “Whitening trays (for take home treatment) are made to accurately fit each individual tooth and clients can choose to have a facial or a massage while this is done. Phone supervision is made during the take-home procedure to ensure that the best results are obtained.”
Clients also need to understand tooth whitening is not a one-off. Regardless of the process used – or where the procedure is done – colour returns to the teeth, sometimes in a relatively short time. Bayes says they have touch-up kits available for further whitening “a year or so later”, but many clients will require treatment before 12 months is up.
Sexing up those smiles is a growth industry, and while clients may think their teeth can never be too white, many professionals are urging caution. Clients who have had restoration work done will find this no longer matches their newly bleached natural teeth and they’re faced with the prospect of costly replacements. And, in spite of the widespread use of tooth brighteners, there’s little research on the long-term effects. 
As with any other treatment, clinic owners should do their homework thoroughly before committing to a system. Shannon’s check list includes the country of manufacture; does it have FDA approval and is it ISO accredited? Are the LED lights FDA approved? “Steer clear of UV-producing lights,” he says. Check the gel and the percentage of peroxide and the teeth shade guide provided. “Some operators promote eight shades off in 20 minutes as the guides they use have up to 30 shades – the industry standard, used by dentists, has only 16.”
Training and on-going support, and warranties on equipment, also need to be investigated, he says.  So what about the cost? Buying on price alone could expose clients to serious hazards, says Dr Shepperson. And while tooth whitening may not be a huge investment for a clinic owner, knowing there will be a return on that investment is important.
Can tooth whitening provide a significant income stream for clinics? Do the math and don’t forget the potential in repeat business as clients return for top-up treatments. “And remember, this can happen at the same time a client is having a manicure or pedicure,” says Don Shannon.
Therapists may also need to consider setting up counselling for clients who discover whiter, brighter teeth really are behaviour changing and need advice on managing those changes.

 

 

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