June 2014, Volume 35, Issue 6
Published by AEGIS Communications
Clinical Effectiveness of Flash Teeth Whitening, a Novel Method for Teeth Bleaching
Flash teeth whitening is a two-step, once-daily method for whitening teeth that combines the use of a fine aerosol mist of a stabilized, concentrated hydrogen-peroxide solution and a saliva-activated, effervescent oral powder that is poured directly onto the tongue. An in-vivo study was conducted to evaluate the efficacy and safety of the flash teeth whitening method at three timed intervals in a 3-week period. Objective and subjective tooth-shade rating methods were used at baseline, after initial treatment, and after 1 and 3 weeks of once-daily use. A significant whitening effect was observed. Data also indicated a progressively improved whitening effect, suggesting that sequential use may optimize the whitening results, with maximum whitening occurring between 1 and 3 weeks of once-daily use. The study demonstrated that flash teeth whitening effectively whitens teeth. This novel method is suitable for safe use as an out-of-office treatment as a primary whitener, or as a maintenance method for keeping whitened teeth white, offering dentists a potential alternative tooth whitening recommendation that is easy to use, safe, and effective and improves the condition of soft tissue when used as directed.
Flash teeth whitening is a novel method for whitening teeth that is simple to use and fast acting, with a whitening reaction that occurs in seconds. The method was developed by Arnold1 following the in-vivo observation that, as a fine aerosol spray, concentrated aqueous hydrogen-peroxide solutions can be safely applied directly to soft- and hard-tissue surfaces simultaneously, without the need for a gingival barrier dam. This is in stark contrast to vital tooth bleaching, for which a dam must be constructed to protect the soft tissue from damage.2
Flash teeth whitening involves two steps. The first step is a unique, easy-to-use spray application of the “flash” bleaching chemical. The spray is administered directly to the maxillary teeth as a fine aerosol mist of a stabilized, concentrated hydrogen-peroxide solution (SprayWhite 90®, Wow® Oral Care, www.carsonlaboratories.com), without the need to protect the soft tissue (Figure 1).3 The fine aerosol is ejected from a handheld pump or pressurized spray dispenser. This takes 1 to 2 seconds for application, followed by less than 2 minutes of rinsing the resulting oxidizing salivary solution, then expectoration. The second step utilizes a saliva-activated, effervescent oral powder consisting of sodium bicarbonate, silicone dioxide, and xylitol (Wow® Powder Oral Rinse, Wow Oral Care) that is poured directly onto the tongue to create a mouthwash as a salivary mixture supersaturated with the powder’s ingredients. This step quenches the remaining peroxide, as well as adjusts and maintains the pH level of the oral cavity to the mildly alkaline range.4,5
Materials and Methods
For the study, 136 healthy adult participants were recruited for an in-vivo study to determine the efficacy and safety of a new technique to bleach vital teeth called the “flash teeth whitening method.”1 Participants were volunteers recruited through advertisements from the general population in the Los Angeles, California, area. Women composed 63% of the sample. The mean age was 31 years, with ranges of 23 to 72 years.
The study was designed to enable evaluation and minimize potential evaluator bias.6 This was accomplished by using two methods to rate the shade of the participants’ tooth No. 8 (ie, one objective and one subjective) and comparing data obtained objectively via the use of an electronic shade taker (Vita Easyshade®, Vident, www.vident.com) to the data obtained subjectively from the trained human eye of shade graders (ie, skilled ceramists with expertise in grading tooth coloration) who used a traditional shade guide (Vita Classical Shade Guide, Vident) to determine shade values (A1 to D4). Numeric values (1 to 16) were assigned to the corresponding value (A1 being the brightest [shade value = 1] to D4 being the darkest [shade value = 16]) of the linear array of shade values on the Vita Classical Shade Guide.
Ratings were conducted at baseline, immediately after the first controlled 90-second treatment application, 1 week later, and 3 weeks later. Participants were instructed to use the products according to the manufacturer’s instructions (ie, a two-step regimen), as follows:
Step No. 1: 1) Apply spray to front teeth; 2) Close mouth and rinse vigorously for 90 seconds; 3) Expulse.
Step No. 2: 1) Immediately after expectorating the salivary mixture resulting from Step No. 1, pour powder directly onto tongue; 2) Close mouth and rinse vigorously for 1 minute; 3) Swallow or expulse.
After the initial treatment, participants were sent home with instructions to use the treatment once daily for 3 weeks according to the manufacturer’s instructions. Participants returned to the same private office for 1-week and 3-week ratings.
While all or most participants provided data for the baseline and 90-second shade ratings, not all participants returned for the 1-week and 3-week ratings. Only those who were evaluated to have shade values of 6 (A3) or darker were included for studying whitening efficacy. A total of 21 participants presented at baseline with teeth that had measured values of 6 (A3) or darker on the Vita Easyshade, and 44 people presented with teeth that had measured values of 6 (A3) or darker based on the trained eye using the Vita Classical Shade Guide.
A significant whitening effect was measured for all periods, including the initial 90-second treatment (Table 1 and Figure 2). Multiple comparisons revealed that 1-week and 3-week shade ratings were significantly whiter than baseline and 90-second ratings (P < 0.001) for the electronic ratings (Figure 2). In all other cases, the 90-second, 1-week, and 3-week ratings were significantly whiter than baseline (P ≤ 0.001) (Figure 3).
These data show that statistically significant whitening effects were achieved within the first 90-second treatment. Both evaluation methods showed statistically significant whitening after 1 week (ie, value difference from week one compared to baseline) and also after 3 weeks (ie, difference between baseline and 3-week values).
For the subjective measurement of the Vita Classical Shade Guide, an average whitening effect was determined to be on the order of 1 to 2 for 90 seconds; 3 to 5 for 1 week; and 4 to 6 for 3 weeks of once-daily use. Similarly, data from the Vita Easyshade yielded an average whitening effect on the order of 3 to 4 for 1 week and 4 to 6 for 3 weeks.7,8 The data also indicated a progressively improved whitening effect, suggesting that sequential use may be important for optimizing the whitening results, with maximum whitening occurring within the 1-week and 3-week periods with once-daily use (Figure 4 and Figure 5).
Safety to the soft and hard tissues was determined via observation of the participants’ tissue and overall oral health by the dental professionals upon examination during each whitening evaluation/grading, and via grading of intraoral photographs by four independent, skilled investigators, which revealed no noticeable changes to the gingival tissue. Additionally, there were reports from participants of no discomfort during or post-treatment; many reported none of the sensitivity experienced with other vital bleaching techniques.
Post-treatment interviews with 33 participants were conducted 6 months after their study completion date, during which no one reported sensitivity issues or complaints of harm as a result of the treatment. Several participants issued unsolicited comments about the improved health of the soft tissue and appreciable whitening of the hard tissue, and two indicated that their primary dental practitioners commented on the stark improvements of their gingival tissue. Three participants overused the product and complained of irritation to the inner lip area. However, the inflammation disappeared after stopping treatment for 4 days, and these participants did not report any discomfort, damage, or sensitivity after using the treatment according to the manufacturer’s instructions (ie, once daily, not multiple times daily). Also, it was noted that with “good maintainers” (ie, those who brushed their teeth more than twice daily), especially those with low saliva levels, it was better to instruct them to use the whitener before toothbrushing or flossing (ie, an oral environment with heavy bio-load produces much better activity and less sensitivity for “good maintainers”).
Because it is often advised that patients avoid exposing gingival tissues to whitening solutions, in-office treatments mandate the use of rubber dam, and take-home whitening kits rely on properly fitting custom bleaching trays.2,3 However, as demonstrated in the present study, the aerosol whitening mist did not cause sensitivity or irritation, likely because the exposure time was minimal, limited to once daily, and the hydrogen peroxide was immediately quenched by the powder oral rinse.4,5
Regardless of the shortened contact time between the teeth and whitening solution, the flash teeth whitening method was shown to be effective in whitening teeth via two teeth rating methods. Whereas any one method for assessing tooth color may be prone to bias or error, similar findings were observed among subjective and objective rating techniques.7,8
Interestingly, the two-step flash teeth whitening produced additional beneficial effects beyond effectively whitening teeth without sensitivity to hard or soft oral tissues. Based on evaluator observations, as well as post-treatment interviews with participants, the two-step process improved the appearance of gingival tissues. This perhaps can be attributed to the antibacterial activity of the sodium bicarbonate contained in the oral powder rinse.9
Flash teeth whitening is safe and effective for “take-home” teeth whitening, demonstrating efficacy comparable with other take-home and in-office bleaching methods. However, its significant advantages for the user include short application time, convenience, lack of the sensitivity typical with glycerin/urea hydrogen-peroxide gels, and overall desired oral results, including mouth feel, taste, esthetics, and freshness of breath. The user may apply the flash teeth whitening method as a primary “take-home” or maintenance whitener.
1. US Patent and WPTO Patent Application Numbers: US2009/039031, 5817294, 5804165, and 5965110.
2. Powell LV, Bales DJ. Tooth bleaching: its effect on oral tissues. J Am Dent Assoc. 1991;122(11):50-54.
3. Scherer W, Palat M, Hittelman E, et al. At-home bleaching system: effect on gingival tissue. J Esthet Dent. 1992;4(3):86-89.
4. Turssi CP, Vianna LM, Hara AT, et al. Counteractive effect of antacid suspensions on intrinsic dental erosion. Eur J Oral Sci. 2012;120(4):349-352.
5. Messias DC, Turssi CP, Hara AT, Serra MC. Sodium bicarbonate solution as an anti-erosive against simulated endogenous erosion. Eur J Oral Sci. 2010;118(4):385-388.
6. Browning WD, Chan DC, Blalock JS, Brackett MG. A comparison of human raters and an intra-oral spectrophotometer. Oper Dent. 2009;34(3):337-343.
7. Browning WD. Use of shade guides for color measurement in tooth-bleaching studies. J Esthet Restor Dent. 2003;15(suppl 1):S13-S20.
8. Dozić A, Kleverlaan CJ, El-Zohairy A, et al. Performance of five commercially available tooth color-measuring devices. J Prosthodont. 2007;16(2):93-100.
9. Drake D. Antibacterial activity of baking soda. Compend Contin Educ Dent Suppl. 1997;18(21):S17-S21.
ABOUT THE AUTHORS
Amanda Arndt, DDS
Private Practice, Tustin, California
Edward A. McLaren, DDS, MDC
Professor and Director, UCLA Center for Esthetic Dentistry, Los Angeles, California
Gwen Ulman, PhD
Chief Executive Officer, Vital Statistics, Los Angeles, California