The Business of Smiles

Image-conscious people with disposable incomes are being targeted by a new wave in cosmetic dentistry that is spreading across California and the nation. Many general dental practices can help patients achieve whiter teeth, but patients who want more immediate results are beginning to take advantage of a new type of bleaching.

BriteSmile, Inc., headquartered in Walnut Creek, Calif., is expanding the use of a new whitening technology in tooth whitening centers and some dental practices. The company has 12 current or soon-to-open locations in Northern and Southern California and is in eight other states and Canada.

With the new technology, treatment can be completed in about an hour, offering patients an alternative to traditional practice-based whitening systems that take two weeks or more to complete. According to a dentist who uses the new system, it’s the latest in a series of whitening systems available to general dentists.

"We have been doing ‘instant’ bleaching with different methods for the past two years and for the past four years have included laser whitening. This is one more way to do it," says Robert Reyto, DDS, who works at a BriteSmile center in Beverly Hills, in addition to his own dental practice. "It’s just a new state-of-the-art technology."

The system uses a proprietary gel that is applied to the patient’s teeth. A special light that works on all teeth simultaneously activates the gel. The single-visit whitening system costs patients $500, more than the cost for traditional practice-based whitening systems.

The cost is offset by better control over the process, according to BriteSmile President Andrew Hofmeister.

"There is a wide body of literature that shows that dentists using a take-home tray system lose control of the patient’s compliance with the regimen, so the dentist can’t feel comfortable with the results a patient is likely to get," Hofmeister says. "With our new technology, dentists can show their patients where on the whiteness scale they’re likely to wind up. Dentists can control the procedure, and they can guarantee the level of satisfaction."

Lawrence Addleson, DDS, chairman of the board of governors of the American Academy of Cosmetic Dentistry, says that there is a great deal of advertising to dentists for new or supposedly better bleaching systems.

"There are some manufacturers that advertise new solutions that they claim get teeth brighter, usually incorporating a tray system," he says. "But I’ve never seen a system like BriteSmile where all the teeth are done at one time."

Addleson says that even though the concept sounds interesting, he is concerned about the image of dentistry that the company’s aggressive advertising program presents to the public.

"I’m certainly concerned it might have the same effect on dentistry as the overt advertising that plastic surgeons have done," he says. "We certainly don’t want to diminish our image in the public eye."

Kevin Anderson, DDS, president of the California Academy of General Dentistry, sees another downside.

"I know there are some limitations in what they’re doing," he says. "I’ve had three referrals myself from this procedure after problems have occurred and patients have had to follow up with someone else. Also, these procedures are not covered by insurance, and patients may also be paying more than they should. I think in general that patients are jumping on a bandwagon."

Anderson also says that in general dentistry the dentist is the gatekeeper of patients’ general oral health, like the coach of a team.

"That’s an important issue, whether it’s implants, whitening, oral surgery or referral to an orthodontist," he says. "This team, including the specialties, has the general practitioner as coach, who should direct all aspects of a patient’s oral care. In this regard, if patients ask about whitening, it’s important that we refer them to avenues within dentistry."

Roger Rempfer, DDS, chair of CDA’s Council on Dental Care says he believes there is a risk that this form of dental care will take some business from general dentists because patients may be more sensitive to cosmetic dentistry than the dentist is.

"The procedure has a lot of sizzle for the patient," he says. "It has an immediately perceived value and an immediate result."

Hofmeister says he disagrees with those who say that BriteSmile is taking away business from dentists.

"All dentists are open to use any technology they see fit," he says. "If our system has the broad access we hope it will, many dentists will be using this new technology in their offices, which ought to add to a practice’s revenue."

Addleson says he considers the interest among patients for whiter teeth to be an opportunity for progressive dental offices, if they are prepared to answer patients’ questions about whitening.

"Dentists can’t afford to be in the dark about this," he says. "They need to offer some form of whitening to their patients or their practice may change in a direction they don’t want. This is also one of those areas that gives dentists the opportunity to maintain a portion of a practice outside the managed care mode."

Blocking Perio Disease May Be Hormone Replacement Benefit

Postmenopausal women deciding whether to undergo hormone replacement therapy may be able to add another benefit to their list -- protecting their teeth.

A study published in the Journal of Periodontology suggests that estrogen supplementation in women within five years of menopause may slow the progression of periodontal disease.

Studies show that at least half of Americans older than 55 have periodontitis. Researchers have suspected that estrogen deficiency and osteopenia/osteoporosis speed the progression of oral bone loss following menopause. The new study concluded that estrogen supplementation may lower gingival inflammation and the frequency of attachment loss in women with signs of osteoporosis, thus helping to protect the teeth.

"For women at risk for osteoporosis, which likely makes them more vulnerable to rapid periodontal bone loss, this may be yet one more reason to be on estrogen," says the study’s lead researcher, Dr. Richard Reinhardt, professor at the University of Nebraska Medical Center College of Dentistry. "However, female smokers should note that the study found that smoking had a greater impact on speeding the progression of periodontal disease than estrogen deficiency."

Focus Falls on Children’s Health

Dentists planning to get involved in raising awareness about children’s dental health needs should begin now, since February is Children’s Dental Health Month.

The American Dental Association has kits to help dentists plan events in their communities. Ideas include sponsoring a coloring contest, creating an exhibit at the local library, giving school presentations, and working with community and civic groups. Among the support items are sample press releases and news articles, Dudley the Dinosaur artwork, and activity sheets.

Contact ADA’s Department of Public Information and Education for more information at (312) 440-2589.

Good Follow-Up Is Key In Blood Pressure Cases

Frequent dental visits following initial periodontal treatment may significantly reduce gingival overgrowth in patients taking nifedipine, a commonly prescribed medication for high blood pressure, according to a study in the Journal of Periodontology.

"This is good news for the 20 to 40 percent of patients taking nifedipine who experience discomfort from recurring gingival overgrowth and rely on nifedipine to control their high blood pressure," says Robert Genco, DDS, PhD, editor in chief of the Journal.

The study found that gingival overgrowth recurrence was eliminated in more than half of patients with a combination of initial periodontal therapy, including surgical and nonsurgical treatments, followed by dental visits every three months. This regimen appeared to affect recurrence more than previously known risk factors, such as gender, drug type, and duration of drug therapy.

Cooperation Is a Key

Dental health practitioners and child care providers need to work together to establish dental health programs for children in day care and training programs for child care staff, according to a West Virginia study published in the summer 1999 issue of the Journal of Dental Hygiene.

The study by Shelia S. Price, DDS, EdD, and Dina Agnone Vaughan, BSDH, MS, surveyed 119 child-care facilities in West Virginia. The study found that 63 percent of the responding child care facilities included toothbrushing in the children’s daily schedule; 72 percent reported inviting dental health professionals to discuss dental health with the enrollees. However, it was less common (29 percent) for the dental health professionals to address the child care staffers regarding children’s dental health.

Price and Agnone Vaughan found that a large number of facilities promote supervised toothbrushing after every meal or snack, even though state licensing requirements only call for daily toothbrushing.

"This additional preventive measure is an indication of their motivation to ensure children’s dental well-being," they write.

The authors suggest that while the majority of child care centers in the study are in compliance with state requirements, there is an under-utilization of dental consultation and in-staff training on oral health. They contend that local dental hygienists would be good resources for periodic dental workshops with child care staff.

Direct Reimbursement Makes Solid Gains

The number of people who joined direct reimbursement dental plans surged 163 percent from 1997 to 1998, and the number of new DR plans implemented nationwide climbed nearly 100 percent, according to statistics from the ADA Purchaser Information Service.

With a total of 287 DR dental plans implemented in 1998, 101 in California, the fee-for-service option promoted by the ADA Purchaser Information Service as well as the California Dental Association, is carving out a growing segment of the dental benefits market. The growth in DR plans hardly compares to the 7,500-plus dental plans implemented by an insurance giant like the Guardian Life Insurance Co. of America, but it compares favorably to the growth experienced by Aetna Life Insurance Co. (557 new dental plans in 1998). It exceeds the growth experienced by Metropolitan Life Insurance Co. (145 new dental plans in 1998).

As for HMOs and PPOs, two recent articles in a Cincinnati newspaper and Employee Benefit News report that enrollment in dental health maintenance organizations was up 5 percent to 8 percent in 1998, and enrollment in dental preferred provider organizations was up more than 30 percent.

The articles, which cite statistics from the National Association of Dental Plans, also note that participation in traditional indemnity plans dropped 15 percent to 20 percent.

Hot Tips for Reducing Office Energy Bills

The Environmental Protection Agency offers the following list of tips to help small business keep their energy bills down in winter:

* Adjust the thermostats for colder weather. Set them at the lowest comfortable temperature. Cost: Nothing. Savings potential: Can be $1,000 for a small building.

* Open drapes or blinds in cooler months to let the sunshine warm the office and give the thermostat a break. Just do the opposite in the warmer months. Cost: Nothing. Savings potential: About $5 per window.

* Check for drafts coming from doors and windows, then caulk and weatherstrip as necessary. Cost: $5 or less. Savings potential: About $2 per fixed draft.

* Clean all air filters monthly. Cost: Nothing. Savings potential: Up to $60 a year.

* Turn off computers and other office equipment overnight and on weekends. Cost: Nothing. Savings potential: Up to $44 per year, per computer.

* Install occupancy sensors where lights can be left off most of the time. Cost: Less than $100. Savings potential: Up to $40 per year.

* Turn off water heater overnight and on weekends. Cost: Nothing, or $30 if you buy an automatic timer. Savings potential: Up to $54 per year.

* Lower the temperature on the water heather. Cost: Nothing. Savings potential: About $24 per year, if the setting is reduced by 10 degrees.

* Install LED exit signs. They last 20 times longer than conventional exit signs. Cost: About $70 to retrofit. Savings potential: Up to $24 per year.

* Set back thermostats at night and on weekends. Cost: Nothing. Savings potential: About $1,800 per year for a 33,000 square foot building with a thermostat originally set at 75 degrees Fahrenheit, 24 hours per day during the heating months.

Web Watch: Auxiliary Dental Groups

Pages of interest to dentistry.

http://acdaoralhealth.org/
The Alliance of the California Dental Association

http://home.fuse.net/kspradlin/adaainfo.htm
American Dental Assistants Association

http://www.cdha.org/
California Dental Hygienists’ Association

http://www.cdla.org/index.html
California Dental Laboratory Association

http://www.dloac.org/
Dental Laboratory Owners Association of California

A listing here does not constitute endorsement by the California Dental Association. As is the case with all web sites, content is subject to frequent change.

Upcoming Meetings

Jan. 19-22 American Academy of Dental Group Practice, San Antonio, Texas, (602) 381-1185

Jan. 27-29 Miami Winter Meeting & Dental Expo, (800) 344-5660

March 1-4 Academy of Laser Dentistry Conference and Exposition, Panama City Beach, Fla., (954) 346-3776

April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408

April 13-16 CDA Scientific Session, Anaheim, Calif., (916) 443-3382, Ext. 4470

May 15-20, World Biomaterials Congress and Exposition, Kamuela, Hawaii, (612) 543-0908

Sept. 15-17 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org

Oct. 28-Nov. 1 ADA Annual Session, Chicago, (312) 440-2500

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.