Wednesday, August 17, 2011

Professional Whitening vs Crest Whitestrips

"What kind of bleaching/whitening is best for my teeth?" 
In the past, I was never quite sure how to answer this question. I feel like my primary goal as a dentist is to diagnose and treat disease, not to make recommendations on the pros and cons of bleaching options. In fact, I wasn't sure if I thought our professional system was worth the fee we needed to charge to cover our costs. This was especially true as the studies done on bleaching systems were inconclusive. However, the majority of new patients to our practice ask about whitening and so it was clearly an important topic that deserved an explanation. 
So, what are the differences? 
Professional bleaching systems have a higher concentration of bleach giving patients faster results. In addition, professional systems utilize a custom fitted appliance to deliver the bleach. Compare this to one of the most popular over-the-counter products, Crest White Strips. The strips are often difficult to keep in place and patients tell me they are uncomfortable to keep in place for very long. However, the initial cost is significantly different. Crest White Strips can be purchased for $60 compared to the average cost of professional bleaching in the Portland area of $420. However, there is often a difference between initial cost and value. 
Most of my patients who ask about bleaching options have already tried an over the counter product with disappointing results. Common complaints we hear is that over the counter products do not whiten as expected and often cause discomfort and sensitivity to teeth and gums or the strips only cover the front six teeth.... 
I strongly recommend a professional bleaching system with custom trays for several reasons:
  1. The professional whitening gels have very good desensitizing agents which is a common complaint for patients who bleach their teeth
  2. The custom trays can also be used to deliver additional desensitizing medications further reducing sensitivity and can be used to deliver medications used to treat decay or gum disease or be converted into a nightguard to protect teeth from wear
  3. Custom trays limit the chances of a bleach burn to the gums that is common with over-the-counter products
  4. Probably the most important reason is that a thorough dental exam accompanies a professional whitening system, which often identifies previously unknown causes of tooth lose, gum disease, decay or discomfort and ensures optimal oral health. Small cavities, worn out teeth and early onset gum disease often do not have any noticeable symptoms and patients who have not had an exam is some time are often surprised to hear their oral health is not as good as it could be.
  5. New studies suggest that some bleaching products can acutally damage tooth structure. This makes it even more important that any bleching be done under the care of a dentist especially if unknown cavities or enamel defects are present.
In the end, over the counter products are inexpensive but relatively ineffective. A professional whitening system, on the other hand, represents a good value and is the safest most effective way to a white smile.
Kyle Valentine DMD

Tuesday, April 26, 2011

Mothers' use of xylitol gum helps prevent kids' cavities

Mothers who use gum containing xylitol will reduce the risk of their children developing cavities over the long term, according to a recent study reported on 

I recently shared this story with my sister who has two beautiful, young girls and she wasn't very impressed. She questioned how she could prevent cavities in her children by chewing gum herself. She also wondered how much gum she would have to chew and pointed out that xylitol gum does not keep its flavor long, so how could it make much difference?

I realized that simply sharing recent news like this with my patients via Facebook or on my official practice website is not particularly helpful without further explanation. So, I created a blog and a new website where I can be a little less formal and explain the practical side to recent news like this headline regarding xylitol.

So to my very intelligent and practical sister, here are the answers to your questions and my first blog post:

How can a mother's use of chewing gum prevent cavities in children?

The answer is actually quite simple. Studies show that we inherit the bacteria in our mouths from our primary caregivers. This recent study only examined mothers, but the same principle applies if the father, grandfather or nanny is the primary caregiver. When children are born they only have a few varieties of bacteria, but as they are kissed and coddled and fed and cuddled, they begin to pick up bacteria from mom and dad. The person who does the most kissing and feeding tends to be the person most responsible for the children's bacteria. The problem is that some bacteria are much more likely to create cavities than others.
Chewing xylitol gum or using xylitol as a natural sweetener inhibits the growth of these cavity causing bacteria.  It follows that moms and dads chewing this gum have less of the cavity-creating bacteria to give their children, and this results in fewer cavities.

How much gum do I have to chew?  Do I have to chew that gum that loses its flavor so quickly?

The answer to this question is not so straightforward. A little background on how these studies are conducted is helpful. When researchers create a study for a drug or product, they normally design the study using a very large dose of the product. They reason that if the product is ineffective in a small dose, then an additional study must be completed to see if a bigger dose will be effective. So instead they start with a large dose, and if the product proves ineffective they can move on and they no longer need to consider the product being studied.

This makes it difficult for doctors and dentists to make recommendations based purely on studies like this one. The bottom line is that to get the same results as those in this study, a mom or dad must chew gum with a big dose of xylitol such as Epic gum, which is expensive and as my sister pointed out, isn't much fun to chew for long.  However, Trident gum comes in many flavors and therefore it is the gum of choice for me even though it contains a lower dose of xylitol.  If used in conjunction with xylitol as a sweetener, then it is reasonable to assume a mom or dad could reduce the risk of cavities in their children.

However, here is the crucial point: chewing xylitol gum is not necessary for all parents.

Here is the easy way to figure out if a xylitol gum regiment might be right for you.  If you are the primary caregiver and you have untreated cavities or have a history of having cavities every time you go to the dentist, then guess what?  You have the cavity causing bacteria and you may be a good candidate for xylitol.  However, if you can't remember the last time you had a cavity filled AND you go to the dentist regularly, then xylitol will be of little help to you and your children.

Every patient in our office receives a cavity risk evaluation free as part of our new patient exam. This is helpful for both parents and children.  Our office can also screen for levels of mutans streptococci, which is the major cavity causing bacteria. If you would like more information, please call our office at 503-254-5593.  I would love to hear your feedback regarding whether this was helpful or not.  I'd also love to hear your other dental related questions. You can provide feedback by visiting us on Facebook at and leaving a comment on our wall.

Please check back as I plan to include additional topics such as:
1) How much and in what form should I give fluoride to my children?
2) When should my son or daughter first visit the dentist?

Thanks for reading.  

Kyle Valentine, DMD
10000 S.E. Main Street, Suite 20
Portland OR, 97216