Vital Bleaching: A Vanishing Revenue Center?

Copyright 2003 Journal of the California Dental Association

We have noticed with interest an evolution in general practice in the past decade as current generations of patients – benefiting from preventive instruction and techniques and improved dental hygiene – have been much less dependent upon restorative dentistry than their predecessors. In turn, this has caused many general practices that formerly had a traditional preventive and restorative approach to add practice management-developed concepts such as soft-tissue management and cosmetic dentistry. One or both of these philosophies will continue to be central to the success of the general practice well into the future.

However, one aspect of the cosmetic practice is likely to change. We refer specifically to tooth whitening, which has become very popular in recent years. When bleaching techniques first surfaced, many practitioners approached their possibilities very conservatively, being concerned about possible short- or long-term dangers to hard and soft tissues. In the early days, most of the bleaching systems developed were based upon dentist control, whether in the office or in kits designed for home use. Franchise practice centers devoted entirely to tooth whitening and over-the-counter systems available directly to the public soon entered the marketplace.

The importance to general practice cannot be diminished, as tooth whitening developed a new revenue center that had impact for two reasons. First, much like the initial dental “insurance” benefit plans in the 1960s, whitening brought new patients into the office who might not have had other incentives to come. In addition to cosmetic “wants,” they brought with them other oral health needs to be treated.

The second reason tooth whitening was important to general dentistry was that its revenue replaced the losses in restorative revenue that some practices had been experiencing due to the preventive gains in oral health care. However, there have been people both inside and outside of the profession who have been critical of this trend. Media critics and some within the profession have tended to look at tooth whitening as an activity that seems to lessen the image of a dentist as an oral health care professional.

The “looking good” phenomenon prevalent in society today has continued to help the concept of bleaching to flourish, as have the continued improvement in materials and techniques. Information market through the mail and the scientific shows bring continuing evidence that the technology is rapidly becoming more sophisticated. The formulas and equipment being introduced are making the bleaching process much quicker and the shade reductions more impressive; while, at the same time, the competition for adoption of the new systems seems to be dropping the unit or per-patient cost to the practitioner. It seems like a win-win for all, or does it?

We can’t forget the other major player in this scenario, the dental products divisions of the consumer giants that have been in the direct-to-patient marketplace for some time with whitening strips and paint-on bleaching materials. They have been bringing the whitening craze to the average citizen in a form that is easy to access, easy to use, and, in most cases, far less costly than the techniques the dentist is able to offer. The major differences with over-the-counter products seem to be the time and continuous commitment of the user to obtain reductions in shades. Another downside is the loss of the practitioner’s expertise and guidance on shade management.

According to one dentist expert in the field who has done valid clinical research, one of the materials and its technique marketed over the counter takes approximately two weeks to achieve the same shade lightening as might be accomplished by laser technology in the dental office in an hour or two. The individual without limitations on disposable income might continue to maintain the desired shade appearance through visits to the office. But what about those who either because of cost, convenience, or reluctance (out of fear) do not want to go to the dental office in the future? A recent television magazine feature specifically referenced that group of people in society who, while interested in whiter teeth, would not want to visit a dental office due to fear. The feature suggested that an office visit was no longer necessary because whitening can be achieved with over-the-counter products.

What if those previously treated in the office believe they can maintain their desired shade through periodic self-application of over-the-counter materials? It seems that in the future, the general practice revenue from this cosmetic procedure will diminish if a significant number of individuals who previously received one of the in-office bleaching techniques decide to maintain their appearance via over-the-counter kits and new patients wanting tooth whitening do not come forward to replace them.

As dentistry moves toward the future, it is likely that the bleaching craze and the revenue it generates will wane. However, there will be advances in the treatment of dental disease that will result in the emergence of a new role for the general practitioner, and the profession will renew its position as pre-eminent in matters of oral health.