WHY is it best to use the highest at-home concentration available for your patients? We asked one of the leading whitening experts for an explanation of his strong views about this, as well as a handful of other sizzling whitening issues.

Rodney Ogrin, DDS, has been a pioneer of whitening for more than 10 years. He began his career studying full mouth reconstruction under such notables as Niles Guichet, DDS, and Harvey Wipf, DDS. His focus on cosmetic dentistry began in 1985 and included research with two in-house ceramists working with hybrid porcelains for veneers, onlays, and inlays.

Dr. Ogrin began dedicating himself to whitening in 1990 when he founded Life-Like Cosmetics, a leading whitening materials manufacturer. A long-time proponent of higher concentrations, Dr. Ogrin’s company was the first to introduce 15%, 20%, and 30% carbamide peroxide strengths for at-home use.

Whitener: You’ve become well known for your strong opinions on tooth whitening. Can you explain how your thoughts on tooth whitening differ from others in the whitening community?

Dr. Ogrin: We’ve learned a great deal about whitening over its 10-year history. The good, the bad, and the ugly can be summarized as follows: Yes on high concentration for at-home use, yes on short treatment times, and yes on dual arch bleaching. No on overnight bleaching, no reservoirs, no KNO3, no curing lights, and no on fancy flavor choices. This approach is proving correct, based not only on the science, but on the most important factor of all, what is best for the patient, or what I call, "patient justice."

Whitener: What is an example of passé whitening vs. a more contemporary approach?

Dr. Ogrin: Why use 10% carbamide peroxide overnight with unnecessary reservoirs and require your patient to bleach for 20 to 28 days when you can do two, 20-30 minute treatments daily on both arches during bathroom routines for 7 to 10 days? Stop and think about it for a minute. Which would you choose as a patient: long wear time or short wear time, with the fastest, most predictable results? By using an at-home 30% carbamide peroxide, "fast bleach" product, you will best tend to your patients’ best interests.

Whitener: So what is the real efficiency advantage of the high-concentration, short-treatment- time whitener?

Dr. Ogrin: The science of whitening has pointed us in the right direction. Clinical Research Associates did a study in 1997 showing that approximately 50% of the active ingredient is degraded into water and CO2 in the first 30 minutes. All the major brands were tested. Further, a study by Zaragoza VTM. states that "the higher the concentration, the greater the effect of the oxidation process."1

At the end of 30 minutes, twice per day, the 30% fast bleach has entered the the tooth with 300% of the whitening power of the 10% product. Add to that a second application, actually doubling the whitening ower again. In other words, using the 30% at-home, with short treatment times, you will maximize the effectiveness of the patient’s treatment time and achieve the most bleaching. Who wants to wear a stent for longer than they have to when there’s a better alternative? Why not minimize the time it takes -- and maximize the effectiveness? Again, it’s a question of what’s best for the patient.

Whitener: What about the sensitivity using high-concentration, at-home?

Dr. Ogrin: The inventor of the 30%, Robert Drosman, DDS, conducted a 1,400-patient clinical evaluation and statistically verified less than a 5% acute pulpal sensitivity rate. That is only one out of 20 patients. Dr. Bill Strupp, a world-class clinician, now whitens ALL of his patients’ teeth with the new fast bleach and reports no significant difference in sensitivity beyond that of lower concentrations. Since the introduction of 30%, literally thousands of patients have used it to whiten their teeth without pulpal sensi- tivity. Soft tissue irritation is virtually a moot point when the tray is scalloped properly and when the patient follows a few simple dosage instructions.

Whitener: There has been so much dialogue about reservoirs vs. NO reservoirs. Why do you support NO reservoirs?

Dr. Ogrin: Reservoirs seemed like a good idea years ago when the idea first circulated. However, top independent authorities such as Clinical Research Associates, Van Haywood, DMD, and Reality (Michael Miller, DDS) have refuted the effectiveness of reservoirs. Most of the manufacturers are recommending discontinuing their use. The fact is, reservoirs have gone the way of the dinosaur . . .extinct! They are not in the best interests of the patient, as they put more gel in the trays, making it more available to be swallowed -- an especially scary thought when the gel contains KNO3. I teach no reservoirs, a .25 cc dosage, and short 20 to 30 minute treatments -- resulting in maximum oxidation per unit of gel. Van der Waal’s forces keep the tray in place, and the thin layer of gel is utilized maximally. The patient then expectorates and rinses with the very least possible amount of bleaching chemicals swallowed.

Whitener: Speaking of KNO3, why are you NOT in support of its use in bleaching gels? Doesn’t it help with sensitivity?

Dr. Ogrin: I believe, as do Michael Miller, DDS, of Reality magazine, Van Haywood, DMD, and Rella Christensen, PhD, of Clinical Research Associates, that zero sensitivity is a misnomer. Again, I refer to authorities such as CRA and the FDA. Until we see a study or statement from an authority discounting the CRA assertion that "when nitrates make contact with amino acids, they convert to nitrosamines, and nitrosamines are one of the most carcinogenic compounds known," I will not support the addition of KNO3 in bleaching gels. Even animal studies show that resulting nitrites combine with hemoglobin to form methemoglobin, thus decreasing the ability of the blood to carry oxygen. The FDA Federal Register makes it clear that digestive nitrosation is an issue. Further, KNO3 toothpaste includes a warning that if you swallow more than a toothbrush full, you should go immediately to a poison control center. These warnings should suffice as you decide whether you should expose your patient to the chronic swallowing of KNO3. Why place the 19 patients out of 20 who have NO acute pulpal sensitivity at potential risk when that ONE patient can be treated preventively with a KNO3 toothpaste that is expectorated . . . and not swallowed?

Whitener: You mentioned no flavor choices. How can that be important?

Dr. Ogrin: Again, it’s a question of what’s best for the patient. Sure, tasty flavors sound fun, but this is a dental procedure! Flavor is a warning -- and not a candy! When the patient tastes these gels, the taste is a warning the tray is overfilled. Pleasant tasting gel does not justify all-night/multiple-hour swallowing of gel.

Whitener: Dual arch, Single arch: What’s the difference?

Dr. Ogrin: It makes a big difference to patients who want whiter teeth now and wish to be done with their treatments. Dual arch whitening is now possible because of fast bleach. Try wearing two stents for an hour or more; it is simply uncomfortable. Additionally, multiple-hour wear time can also cause potential TMJ problems. The other factor is that fast bleach overcomes the need for opposite-arch comparisons. With a fast-acting bleach, patients and their loved ones can easily see the expedient and dramatic difference. They don’t need the contrasting arches for motivation.

Whitener: Given your advocacy for patient issues, what are your thoughts on patient compliance?

Dr. Ogrin: The single most important facet of tooth whitening is patient compliance. Studies tell us that patient compliance after the "new procedure instruction" wanes dramatically after 7-10 days. Since most tooth whitening procedures take 10-14 days per arch, you can see that whitening two arches separately (in 20-28 days) promotes a dramatic decrease in compliance, with the consequence of questionable whitening results. Fast bleach (7-10 days) falls within excellent patient compliance range. Given the informed choice, patients will choose the option to whiten in a matter of minutes verses multiple hours or all night. Furthermore, fast bleaching is a paradigm shift for your new patients. Now your patients can whiten their teeth while in the bathroom. A patient can load her/his tray with gel, bathe, dry, shave, apply cosmetics,then take the trays out, spit, and rinse.

And, voilá! I call that "timeless patient compliance" because it doesn’t demand a dedicated time for bleaching, but fits quickly and seamlessly into most patients’ busy lives.

Whitener: What about the issue of A.D.A. acceptance? You support the use of 30% at home, while the A.D.A. has approved only 10%.

Dr. Ogrin: The A.D.A. will not accept anything except 10% c.p. gels for testing. But the gels sold in the market include 11%, 13%, 15%, 16%, 20%, 22%, and now 30%. All bleaches work! The A.D.A. refuses to test higher concentrations. Available sales data tell us very few dentists use 10% gels for their patients. So, the vast majority of whitening patients are whitened with higher concentrations. Obviously, dentists inherently know that higher concentrations bleach faster and are more predictable. I am not aware of a single lawsuit after years of whitening teeth with higher concentration bleaching gels. Dental science reflects no downsides to enamel, dentin, or the pulp.

Whitener: What is your position on curing lamps?

Dr. Ogrin: They appear to me to be ineffectual and potentially dangerous. Try putting your finger next to the light for three to five seconds and then try to tell yourself there is no risk of pulpal damage. There are studies, such as a recent CRA report, questioning the efficacy beyond the effect of the bleaching gel alone 2. There have been studies available for years re- garding pulpal damage from heat and 35% H2O2. Why put your patients at risk when you can get faster, safer, and better results with 30% at-home?