The search for more effective options in the treatment of tooth staining is nothing new. Historically speaking, there has been an ongoing interest in seeking solutions for whitening teeth. In ancient times the Romans used Portuguese urine in an attempt to whiten their teeth! During the 14th century, having your teeth bleached was the most requested treatment after that of tooth extraction, and was performed through the combining of metal files and nitric acid. In the late 19th century a mixture of hydrogen peroxide, ether and electricity was used. Soon after, electricity was replaced by heat. Hydrochloric acid was introduced as a method of teeth whitening in 1916, and in 1966 it was used in combination with hydrogen peroxide. By 1970 it was established that hydrogen peroxide was the most effective stain removal agent.
As most dentists know, aesthetic dentistry has become an enormous industry. The seemingly insatiable appetite of patients for better-looking whiter teeth has changed modern dentistry. And this need has been answered by dental companies in no uncertain terms. One only needs to look at the number of products available that claim to safely whiten teeth with long-lasting results and no hassles, ranging from home-bleaching kits through to in-office photochemical laser bleaching systems like Smartbleach. This then makes questions like which system is the most effective, and importantly which system can deliver predictable results, much more difficult to answer. Additionally, many bleaching systems make claims of dramatic shade improvements, backed up by glossy brochures featuring outrageously white teeth. All of which make the decision to choose a bleaching system seem harder still.
The Smartbleach concept is quite different from most other teeth whitening systems. Bleaching is the reduction of large light absorbing molecules in dental structures, into smaller molecules which are no longer in a light-absorbent state. This causes a greater level of reflection, and therefore whiter teeth. Smartbleach incorporates this concept, with research published in the Journal of Endodontics in 1988 by Loong Chün Lin, David L. Pitts and Lloyd W. Burgess. They were able to demonstrate that teeth stains caused by tetracyclines can be removed within 24 hours, solely under the influence of light. In other words, it was demonstrated that photobleaching is possible. What is important to note, however, is that only two ranges of wavelengths are able to create a photobleaching effect: UV light (290 nm and 365 nm) and green light (510 to 534 nm). Accordingly, Smartbleach incorporates a laser light (in the green range), together with hydrogen peroxide and a chemical agent (powder), to induce a photochemical reaction. These three components ensure a safe and controlled bleaching treatment with predictable results in just one hour.
The photochemical reaction in the Smartbleach procedure is the main reason it can improve all kinds of stains, including tetracycline, without any risk of heat build up in the teeth. Remember, only specific wavelengths can produce a true photochemical reaction. To create a bleaching effect with light sources of other wavelengths, heat is necessary to further breakdown the hydrogen peroxide. This was the basis of the Britesmile CO2 laser bleaching system. This extra heat can lead to pulp trauma and result in tooth damage. As a consequence, if a bleaching system does not have a true photochemical reaction and the light souce emits little or no heat, then the light source has almost no effect on the bleaching result. Importantly, this point was confirmed in research conducted by the Clinical Research Associates, which showed that over the range of bleaching systems they had assessed, it made no difference once the gels were applied to the teeth, whether the light sources were shined on the teeth or not. (CRA Newsletter August 2000: Why resin curing lights do not increase tooth whitening).
The Smartbleach system uses a small and portable dental laser that can be used for a wide range of other applications including, endodontics, periodontics, haemostatic soft-tissue surgery, gingival troughing and retraction, caries prevention, desensitizing, fistula pathology, enhanced fluoride treatments and more. In all of these cases treatments with the Smartbleach laser are less invasive and can deliver superior results than those achieved with traditional methods.
Some other bleaching systems also claim to use laser technology or at least imply that they use a laser. In fact many use heat lamps or halogen lights, which are limited in their versatility, and as the CRA data showed, their effectivenes; this is an issue that every dentist should consider, particularly because there are distinct clinical and marketing benefits to using laser technology. As Dr Jacques Meschemberg from Adelaide has discovered, the marketing potential of a state-of-the-art laser system can change the way patients perceive a dental practice. Dr Meschemberg has been using the Smartbleach system and has treated over 400 patients. He states: “The Smartbleach laser has proved to be an excellent profit centre in its own right and also a great practice builder”. Dr Meschemberg’s experience shows that not only will existing patients try Smartbleach, but many new patients visit his practice because he offers Smartbleach. This has generated further business through these new patients returning for other dental work.
In conclusion, to avoid misleading patients and to ensure that they are choosing the most approprite system for their practice, dentists should understand all of the facts about teeth bleaching before making a decision about which system to introduce into their practice. As part of High Tech Laser Australia’s commitment to ongoing research and education, Smartbleach is part of short-term and long-term university studies that will help dentists to make informed desicions about in-office bleaching methods.
About the Author
Matthew Moncrieff is Managing Dirctor of High Tech Laser Australia.
High Tech Laser Australia conducts one-day training courses on lasers in dentistry and laser teeth whitening. For more information call (07) 3367 2444 or visit www.hightechlaser.com.au