Why would one of the nation’s leading clinical dentists whiten ALL of his patients with the highest concentration at-home whitening product on the market? We asked him in a candid interview and found out some critical practicalities of whitening science, patient compliance, and whitening materials.

Bill Strupp, Jr., DDS is a world-class, hands-on clinical dentist. Over the last 31 years, he has consistently produced between 80 and 120 units of Crown & Bridge per month. He lectures all over the United States to thousands of dentists annually and is published in many prominent dental publications. His newsletter, Crown&Bridge UPDATE, is published 10 times per year, and goes to more than 12,000 dentists.

Whitener: What role does whitening play in your practice?

Dr. Strupp: Whitening plays a significant role in my practice, as we bleach 100% of all our patients. We switched to using Life-Like Cosmetic Solutions 30% carbamide peroxide (c.p.) on all of our patients about 6-7 months ago. That is all we are using now. That’s 25-30 new patients a month -- all whitening with the 30% at-home. Fast whitening is of great value to my patients and my practice.

Whitener: Why 30%; how did you come to use only the 30%?

Dr. Strupp: Dr. Ogrin sent a protocol that immediately piqued my dentist-scientist imagination. He maintained that higher concentration bleaching gels did not increase the incidence of acute pulpal sensitivity as supported by a 10-year, 1,400 patient study done by Robert Drosman, DDS. The protocol was as follows:

1. Offer my patients a choice of tooth whitening gels:
   1. 15% c.p. or double strength 30% c.p. gel.
   2. Statistically monitor the incidence of acute pulpal sensitivity between these two gels.
2. Use NO RESERVOIRS.
3. Scallop at the junction of the hard and soft tissues (the gingival margin).
4. Instruct the patients to wear the 15% gel for one hour.
5. Instruct the 30% carbamide peroxide patients to bleach for two 20-30 minute sessions.

To my surprise and delight, the patients who whitened their teeth with the 30% c.p. gel were very compliant due to the immediate gratification they experienced from seeing their teeth whiten so rapidly. More importantly, the patients who chose the 30% carbamide peroxide gel did not report any incidence of acute pulpal sensitivity over my patients for whom I prescribed the 15% c.p.

This 30% concentration gel affirmed to our office that indeed, my patients deserved to have the choice of high concentration/fast acting gels verses low concentration/slow acting gels.

Whitener: What causes sensitivity?

Dr. Strupp: Some people wear any percentage 20-60 minutes, find it is too sensitive and they take it out. These are people who have open dentinal tubules, fillings that are leaking, root surfaces that are exposed, decay, or other serious problems present. You have to have a root surface exposed, or a filling exposed, or an incisal edge with the dentin showing through in order for there to be sensitivity. Just plain old virgin teeth with enamel on them typically do not get sensitive.

Whitener: Is there science supporting the use of high concentration for at-home?

Dr. Strupp: Contemporary research verifies that higher concentrations of c.p. have no negative impact on the enamel, dentin or pulp. All bleaching works. Bleaching is time and concentration dependent! As soon as carbamide peroxide touches something, it starts breaking down. As the heat from the mouth gets in there, it begins to degenerate and turn into oxygen and water. That process happens relatively rapidly. If you’re dealing with a higher concentration, you are going to get more active ingredient into the tooth. We get a better result because we are using 30% c.p. that works faster and consequently patients are more compliant, without any downsides.

Whitener: Can’t the 30% irritate soft tissue?

Dr. Strupp: We have had a few patients burn or blanch themselves from overfilling the trays. Some of the patients, when the tray was not trimmed exactly right, got a little tissue irritation, but they get tissue irritation with 10%. It is just a matter of making sure that you do not have the tray trimmed too long and/or have a situation where you wind up with too much material in the tray. That’s why I use a syringe; so patients can dose themselves instead of “eye- balling” it. If you have too much material in the tray, it will definitely get on the tissue and irritate the tissue, but that is 100% reversible. It is kind of like a pizza burn and in fact, it is not even as bad … it’s about 20% as bad as a pizza burn.

Whitener: How does in-office bleaching stack up against your 30% at-home?

Dr. Strupp: In the April, 2000 issue of Dentistry Today, there is an article by Van Haywood that basically says the lights do not enhance the whitening process. Think of it this way: you sit your patient down in a chair with an expensive machine that combines heat with the 35% to 50% H202. Studies warn against this potentially damaging combination. I see no reason to put a patient into that kind of situation. The heat can definitely create problems. It makes no sense to me to subject a patient to that kind of risk when we can achieve such startlingly fast and predictable results with 30% at-home whitener. The fact of the matter is, in-office doesn’t make any sense whatsoever, considering chair time economics and the marginal whitening achieved.

Whitener: Would you use 30% on yourself?

Dr. Strupp: That’s the only way I’ll do it, because I can’t stand walking around with that stent in my mouth. I also realize my patients are no different and deserve the best possible option.