Ask Dr. Christensen

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers.

by Gordon J. Christensen, DDS, MSD, PhD

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensen, please send an email to info@pccdental.com.

Question ...
I wonder if I should buy a light to assist in-office tooth bleaching. The much-advertised light-assisted bleaching is tempting, but I am pleased with the bleaching results I achieve with the at-home method.

Answer from Dr. Christensen ...
I first used light to "assist" in-office bleaching nearly 20 years ago. I assumed that the extra energy the light provided would help the hydrogen peroxide bleach the teeth faster and better. I had been bleaching teeth with heat for 20 years before the light concept was suggested. I did not do any research on the subject; instead, I relied on my intuition and the positive comments from colleagues and companies. I am embarrassed by this, but it goes to show you how our judgment can be wrong when adequate clinical research is not available.

Subsequent research on bleaching teeth from numerous sources questions the value of lights of any wavelength to assist in the tooth-bleaching phenomenon. It appears that if the singular main ingredient of all bleaching solutions or gels (hydrogen peroxide) is adequately applied to the teeth, similar bleaching occurs whether or not light or heat is applied during the bleach application.

It is possible that someone may develop a bleach formulation that will be stimulated or potentiated by light or heat, but, to date, tests have not proven that light or heat is necessary for bleaching teeth. Nevertheless, patients seem to like the light concept, and some dentists have incorporated the use of lights with in-office bleaching. If you like the concept of in-office bleaching, do it. I prefer at-home bleaching using trays and carbamide peroxide. With the at-home bleaching concept, the patient has control of the tooth sensitivity often produced, the frequency of bleaching, and the color change desired. In the meantime, while the patient bleaches at home, I can treat patients with other dental problems in the office. I fully admit that some dentists have opinions diametrically opposed to mine, so base your decision on your own experiences.

Question ...
What is a fair cost for whitening teeth using the nightguard bleaching technique? I hear fees that vary considerably, and I am confused about the level that I should charge for this service.

Answer from Dr. Christensen ...
As you know, there are many ways to bleach (whiten) teeth. All of them use hydrogen peroxide as the active ingredient. Patients can buy a package of bleach in their local grocery store and use it themselves. Using the "self-administered" bleach concept, a reasonable level of tooth whitening can be achieved. Why would a patient want to spend more money to have a dentist provide the bleach and supervise the at-home procedure?

I feel strongly that there are several important reasons why patients should have a dentist supervise the tooth-bleaching procedure (money paid to the dentist is not one of them):

Tooth sensitivity has been associated with tooth bleaching when using any of the bleaching procedures. Dentist-supervised bleaching allows the patient to be advised about changing the frequency and duration of the bleach application that can influence tooth sensitivity.

1 Teeth bleach, but restorations and crowns do not. Patients need to be advised of the lack of color match between tooth structure and restorations that will be present when bleaching is completed.

2 Occasionally, striations on teeth can cause a strange, lighter-colored, striped appearance in bleached teeth. Dentists can predict the effect of bleaching in these atypical situations and advise stopping the bleaching procedure if untoward occurrences are present.

3 Often, side effects such as sore throat, uncomfortable occlusion, and gingival desquamation accompany bleaching. Dentists can advise patients about these unfortunate clinical situations and how to prevent them.

What is this advice worth to a patient who wants to bleach his or her teeth? In my opinion, the advice is worth a significant amount. Consider doing your own auto mechanics, house painting, hair styling, or cooking for a large group of people. Of course, in each case the self-accomplished tasks can be very effective, but the odds of such success are lower than if a professional does the job. Typical fees for at-home bleaching in the United States are about $200 to $400 for both arches, with an average of about $300. Is the service worth the cost? In my opinion, yes!

A recently released Practical Clinical Courses video has been very well-accepted and will help you avoid many of the potential failures in dental practice. V4796 — "Dr. Christensen's Most Frequent Failures and How To Avoid Them" — can be ordered by calling (800) 223-6569, faxing to (801) 226-8637, or visiting our Web site at www.pccdental.com.

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates, which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.

Dr. Christensen's views do not necessarily reflect the opinions of the editorial staff at Dental Economics.

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