|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.”