Lighten, camera, action!

by Karen Kaiser

The NBC sitcom "Friends" revolved around an ensemble of six closely knit friends. The show placed the actors in familiar life circumstances with, at times, unbelievable outcomes. Many fans remember an episode that poked fun at cosmetic smile whitening. The character Ross decided to bleach his own grin and somehow over-whitened his teeth until they literally glowed. For weeks following that episode, recare patients asked me about the possibilities of whitening and over whitening their smiles. Even today, prompted by a re-run of the show, patients inquire about the whiter-than-white topic.

Whitening products have been available for some time. These products have evolved from a bottle of runny bleaching liquid (overflowing in a custom tray) to ultra thick gels with numerous modes of application.

One current product with much appeal to consumers is Crest Whitestrips®. The whitening strip is similar in size to a clear bandage for the upper anterior, and the lower clear strip is smaller and shaped on a slight curve to contour over the lower teeth. Both upper and lower strips are textured and strongly resemble a thin diaper fastener or very tiny bubble wrap smeared with thickened whitening gel. The original Whitestrips made its debut (non-retail) in 1999. In 2000, the strips went through a formula change and were introduced into stores in 2001. That same year also yielded the introduction of the Professional Strength Whitestrips in a kit, with 6.5 percent hydrogen peroxide potency.

In July 2003, the Supreme Whitestrips kit (highest concentration of hydrogen peroxide at 14 percent) made its way into the dental office as the strip of choice for in-office dispensing. This kit has a 21-day supply — 42 upper and 42 lower strips for placement twice daily. In December 2003, the Premium strip went retail. At this time, only the Professional and Supreme strips are restricted to dispensing in dental offices.

Programming line-up

With several varieties of strips available, confusion regarding the names of the strips is a slight shortcoming. Strips labeled Professional formula (which one would think was the only office-strength choice) is dispensed in the office but does not have the strongest concentration.

Supreme is the strip of maximum strength for in-office dispensing if you desire the highest concentration of gel available for whitening at 14 percent hydrogen peroxide. Advertisements for the Supreme strips boast up to 80 percent better whitening than the original Whitestrips, and 43 percent better than the Professional type. The Professional strength states that it is 42 percent stronger than its original retail strip. Supreme (office strength) and

Premium strips (available retail with fewer strips per box) are so close in name patients often feel they are the same product. In many of these instances, one comes to expect the common response from patients: "I saw those strips in the store."

Assure your patients that they would need to purchase eight retail boxes to deliver the same whitening experience as offered by one three-week box of Supreme Whitestrips. Supreme is dispensed in a convenient, boxed kit that includes a tube of Dual Whitening Crest toothpaste and the battery operated Spinbrush. Regardless of which strip is chosen, the protocol is similar. Instruct the patient to wear two strips daily for 30 minutes at each session.

Procter & Gamble has vigorously marketed to your patients on the ease of smile lightening using Crest Whitestrips. In my practice, patients frequently inquire, "What are those Whitestrips I saw on TV, and do they really work?" I have begun to see recare patients whose teeth are whiter than at their last visit, and most of them are using Whitestrips.

Up until that point, our office used strictly custom tray whitening and we had first-rate results. Preferably, guided whitening treatments for patients allow the hygienist to monitor tissues and assist with product recommendations if tooth sensitivity is a byproduct of treatment. Unless a product is dispensed from the office, we have no way of knowing what strength of product or over-the-counter method the patient has chosen.

Before incorporating Whitestrips into our prime time line-up, we selected appropriate candidates for the in-office whitening treatment. By and large, the only barrier encountered toward treatment acceptance was the fee. Our team wondered if we could bridge the case acceptance gap by adding, at a lower fee, Supreme professional strips to our programming. We opted to learn about Whitestrips from our sales consultant. As a result, we investigated the product and each team member was given a sample kit to use and evaluate.

Our office was delighted to see case acceptance soar with the addition of the Whitestrips, and is now dispensing an average of 15 kits a month. My patients' smiles were transformed by offering an alternative to tray methods, and they were pleased to refer others to our dental office for strength strips. Crest also offers dental professionals a rewards program where points are redeemed in a gift catalog when kits are purchased. Your office needs to dispense two kits per week, and for every case of Whitestrips (four per case) bonus points are given. Point totals can be monitored by accessing the Crest Web site.

Package instructions suggest the strips may have whitening impact for a six-month (12 months possible) duration, so maintaining the desired shade may require touching up. Generally, patients who use tobacco products, drink staining beverages such a dark wine, soda, tea, or coffee will be the first patients to request a re-run of whitening strips. Keep in mind your patients' expectations for treatment outcomes. The strips are not a good choice for patients who want full mouth coverage, as the strips are limited to reaching only to the premolar region.

Whitestrips are a good recommendation for those patients who have already completed full-mouth tray whitening and want an easy method for smile touch-up. Strips are also good for patients who experience (or fear they will experience) increased tooth sensitivity or have a gag tendency on full-mouth tray systems. If patients experience sensitivity during strip use, have them continue to use two strips each day but for a shorter duration at each application. Or you can change channels and use a lesser peroxide concentration of strip.

An additional incentive for your patients to purchase an in office Whitestrips kit is the $10 rebate from Crest. By getting online and visiting the Crest Web site, sample strips for patient dispensing can be requested. When time permits, place strips on patients while they wait for an examination from the doctor. This in-office placement increases the number of kits bought during the prophy recare because of the product preview, and it allows one to demonstrate positioning on the teeth. After the 30-minute session, instruct the patient to brush because there will be residual gel on the teeth. If you send the patient from the office with the strip in place, send a tissue or gauze along so they can wipe the gel remnants.

When patients request an easy method to lighten their smile, consider slotting Crest Whitestrips into your whitening programming. By adding Whitestrips, your office will entertain critical acclaim for overall approval and remain at the top of the whitening ratings. Give patients an astounding season finale — whiter teeth using smile enhancing Crest Whitestrips.

Karen Kaiser, RDH, graduated from St. Louis' Forest Park dental hygiene program in 1994 and currently practices at the Center for Contemporary Dentistry in Columbia, Ill. She has written several articles for RDH and other publications, sits on dental hygiene panels, and presents seminars. She can be contacted at hygiene [email protected].