current in terest in dentistry. JADA reserves the right to edit all communications and re quires th a t all letters be typed, double-spaced and signed. The views expressed are those of the letter w riter and do not neces sarily reflect th e opinion or official policy of the Association. Brevity is appreciated. ‘T O O T V IT A L ’
IIN G IS
A lette r from a dentist pub lished in the Nov. 4, 1991 issue of ADA News disturbed me. The fact th a t it was the only piece of inform ation on bleaching in the News (not to m ention th a t the succeeding News offered n oth ing on the subject) a t a tim e w hen we as a profession and public are a t a critical cross
roads regarding vital bleaching prom pted me to write. The dentist indicated he w anted to “give a cheer” for the action FDA has taken on vital bleaching. He then indicated
th a t he’d “give another two cheers” when FDA treated tobacco products likewise. I’d like to offer the following points: *■ Carbam ide peroxide, the agent used for take-home vital bleaching by the majority of dentists, is and has been approved for use in the mouth as an antiseptic for years, even for open oral lesions. We as dental clinicians have had our
patients use it w ith success for this purpose as well as for w hitening discolored teeth even in the absence of oral lesions. Never could we stretch the analogy of a sim ilar beneficial scenario for tobacco. M any dentists (CRA News letter, October 1991, a survey of 7,617 random ly sampled dentists) have been able to see th e beneficial effect of vital bleaching in patients. Also, 89 percent (from th e same survey) of dentists prefer the take-hom e m odality w ith 10 percent carba mide peroxide; 90 percent of dentists wish to continue using take-home bleaching, as they see it both safe and effective. In recent discussions w ith Dr. Gordon J. C hristensen, he stated th a t th eir basic science and clinical research supported the use of the at-home
Fixodent Clinicals prove it. Patients love it. Recent clinical studies reconfirm that Fixodent still provides a longer, stronger hold than Orafix Special® and Super Poli-Grip® cream. In fact it's the longest, strongest holding denture adhesive cream available. That's superior results your patients will appreciate. Fixodent is also heat-resistant so hot drinks are not a problem. No wonder Fixodent is the #1 selling denture adhesive. Fixodent® Fresh combines same superior hold with a mouth-freshening sensation that doesn't interfere with the taste of food. For superior hold and superior denture performance, don't recommend just any cream, recommend Fixodent and Fixodent Fresh. Call 1-800-523-5325 for free patient samples.
Fixodent The superior recommendation. © 1992 by Procter & Gamble
carbam ide peroxide bleaching procedures, and th a t he disapproved only when these products were purchased over the counter and used unsupervised by patients. Some have raised questions of potential m utagenic effects of peroxide. In the m ost prom inent study indicating possible m u ta genicity by W eitzm an (1988), 3 percent and 30 percent hydro gen peroxide was tested w ith a known carcinogen, DMBA. W hether DMBA was used w ith peroxide carcinomas occurred w hen exposed to the known carcinogen DMBA. None of the 30 percent peroxide solutions had th is effect when used alone.
The 3 percent hydrogen peroxide was not tested alone. The 3 percent hydrogen peroxide solution is and has been sold over-the-counter for years for patients to gargle, rinse, brush, irrigate, and with little to no concern for its long-term effects. From a practical standpoint, it should be a significantly lower level of concern m utagenically when compared to eugenol (a phenol), not to m ention the high level of formaldehyde, a well-known active carcinogen found in formocresol, addressed for its accepted uses in Accepted Dental T herapeutics and used by thousands of dentists daily. I do not condemn these chemicals but note them only for compar ison. Possibly there are much
greater potentially harm ful dental products we and/or FDA really ought to be addressing. ™ FDA and ADA say they have concerns about peroxide use on soft tissue for extended time intervals, and this even in light of w hat is m entioned above regarding peroxide toothpastes. Exposure tim e w ith dentist supervised take-hom e whitening can be as little as 10 to 48 hours depending on the system. Who, other th an dentists, are more appropriately trained to monitor tooth whitening, not only for soft tissue response, for which FDA and ADA have expressed concern, but also to counsel and guide patients for the attain m en t of an optimally pleasing level of whitening? And if long-term exposure is a concern, who b etter th an
It’s Clear Which Mouthrinse Is ADA-Accepted to Help Fight Plaque and Gingivitis...
dentists to tell p atients th a t no more benefit can be gained and discontinue supply of peroxide to patients and hence discon tinue exposure to soft tissues? Yes, self-adm inistered vital bleaching can be problematic, particularly if acid pre-rinses or overly acidic peroxide p rep ara tions are used. As dentists and as an Association, let’s see to it th a t dentist supervised w hiten ing rem ains. The problem is not dentist supervised take-hom e bleaching, but unsupervised take-home bleaching. ■■ One can argue th a t FDA has not banned dentist supervised take-home bleaching b u t simply reclassified them as “new drugs.” For all practical purposes, however, this puts it beyond the realm of dental m anufacturers who have
supported the dentist supervised concept to m eet expeditiously new FDA requirem ents (possibly two to six years). Ironically, this greatly increases the likelihood of the only peroxide w hiteners being supplied only by large toothpaste companies, who have the economic resources for extensive “new drug” studies. T heir in ten t is to m arket direct to consumer, m eaning little to no dentist supervision. This can very well remove the procedure from the dental office. A nother question or recom m endation th a t we should perhaps communicate to FDA is, “Why consider 10 percent carbamide peroxide take-home bleaching as ‘new drug1rath e r th a n th a t ‘old dental m aterial’?” Such procedures have actually
been used and tau g h t by Drs. William Klusmeier and Dr. Jerry W agner, both of Fort Smith, A rkansas, since the 1960s. Both have tau g h t and passed it to others. ■■ An ironic note of in terest is th a t it appears FDA m ay allow the labeling and sale of 30 percent to 35 percent peroxide for “in-office” bleaching even though it appears to be prevent ing the labeling and sale of a peroxide one ten th as strong (10 percent carbam ide peroxide equates to about 3.4 percent H20 2). It also appears th a t our ADA Council on D ental T hera peutics is considering granting acceptance for a 30 percent to 35 percent hydrogen peroxide in office bleaching m aterial. I’m sure all of us who have used this strong peroxide
LISTERINE* ANTISEPTIC Listerine Is Accepted by the ADA Council on Dental Therapeutics to Help Prevent Supragingival Plaque and Gingivitis* 1 “Listerine has been shown to help prevent and reduce supragingival plaque accumulation and gingivitis when used in a conscientiously applied program of oral hygiene and regular professional care. Its effect on periodontitis has not been determined.” _________ Council on Dental Therapeutics American Dental Association
A D A
CONSUMERHEALTH PRODUCTS GROUP
A C C E P T E 1)
Morris Plains, NJ 07950 © 1990 Warner-Lambert Company
A m erican
Dental
Association Reference: 1. Council on Dental Therapeutics Accepts Listerine. JADA 117:515-516,1988. *When used as a supplement to daily oral hygiene and regular professional care .
. First-line antimicrobial defense for your patients.
understand the logistical problems of isolating it to the teeth even w ith rubber dam or by “sealing” it in a non-vital tooth with tem porary cement. Most of us can relate to the in sta n t w hite burned areas th a t appear all too frequently when this strong peroxide leaks around the rubber dam or past th e tem porary filling, or even onto patien ts’ uncovered lips, face, our hands, or th a t of our staff handling containers, for th a t m atter. And yes, possibly there are few long-term side effects, albeit we can be puzzled about the greater concern for a 3.4 percent equivalent peroxide (10 percent carbamide peroxide) which is approxim ately onete n th as strong. ™ Albeit m ost probably in excess of one million patients have received the benefits of dentist supervised take-home vital bleaching, few if any significant side effects have been JÊT reported. M any studies show insignificant effects on " enam el, some show minor effects. We all know w hat effect our high-speed handpieces have on enamel, soft tissue and yes at tim es pulp. We also know th a t if alternative more costly crown and/or veneer treatm ents are required, millions of patients could never realize a more pleasing, confidence-building smile, simply because of economics. One can speculate on the remote possibility of long-term tissue side effects. We also know the ever present potential systemic side effects (and yes, through infrequent, a t tim es catastrophic) associated with the necessary adm inistration of local anesthetics or additional 14
JADA, Vol. 123, March 1992
drugs when more invasive veneer or crown preparations are performed, though these procedures and drugs m ay be of m uch less concern to FDA. From the CRA survey, one can realize th a t the vast m ajority of dentists feel the take-home bleaching w ith 10 percent carbamide peroxide to be safe, effective and of benefit to their patients and their practice. It is a critical tim e for the silent m ajority of dentists to be heard, both individually and as a group. A joint voice of dentists, relevant dental m anufacturers and ADA (ideally from ADA representatives who have used and know take-home bleaching) is needed. If this is not communicated w ith FDA and soon, it will simply be history. Is ADA, the association of American dentists, representing for American dentists th eir
position? R oger H icks, P r e sid e n t Salt Lake D istrict D en tal S ociety Salt L ake City E d itor’s Note: The action taken on commercial tooth w hiteners by the U.S. Food and Drug Adm inistration was reported in detail in the Oct. 7 ADA News, page one. Also, Dr. Gordon Christensen, who authors a monthly column in JADA, expressed his views on whiteners in the December 1991 issue of The Journal. U N IT E D W E S T A N D . . .
Am I the only dentist in the ADA who was offended by Dr. M eskin’s editorial “W here the
Women Are.” (December)? W hat is to be gained by the current escalating trend of scrutinizing “women dentists”? Like most dentists, I see m yself as a dentist, not a brown-haired dentist, not an under 5/2 feet tall dentist, not an ADA component past president dentist and certainly not a woman dentist, although I am all those things. All this public scrutiny of “women dentists” is only going to drive away dentists th a t happen to be female. Surely it doesn’t take a sociologist to figure out th a t a dentist m ight feel uncomfortable at first to attend m eetings or committees where every other person is of the opposite gender. I am ra th e r surprised th a t so m any are active in organized dentistry, given th a t formidable barrier. Nor does it take a psychologist to see why dentists who are m others of young children are not rushing out to take over the leadership reins of organized dentistry. Their hands are quite busy practicing dentistry while rocking the cradle. Dr. M eskin’s paragraph comparing male and female political activity is indeed alarm ing, not because it shows .06 percent difference between m ales and females, but because it shows th a t 98 percent of dentists are not politically active! As dentists and ADA m em bers, let us stop contem plating our collective navel and stop singling out p art of us to be designated as “other.” We are all us, regardless of gender. Let us all pull together. There are more th an enough other groups whose activities are worthy objects of organized dentistry’s creative thinking:
IIN G IS
A lette r from a dentist pub lished in the Nov. 4, 1991 issue of ADA News disturbed me. The fact th a t it was the only piece of inform ation on bleaching in the News (not to m ention th a t the succeeding News offered n oth ing on the subject) a t a tim e w hen we as a profession and public are a t a critical cross
roads regarding vital bleaching prom pted me to write. The dentist indicated he w anted to “give a cheer” for the action FDA has taken on vital bleaching. He then indicated
th a t he’d “give another two cheers” when FDA treated tobacco products likewise. I’d like to offer the following points: *■ Carbam ide peroxide, the agent used for take-home vital bleaching by the majority of dentists, is and has been approved for use in the mouth as an antiseptic for years, even for open oral lesions. We as dental clinicians have had our
patients use it w ith success for this purpose as well as for w hitening discolored teeth even in the absence of oral lesions. Never could we stretch the analogy of a sim ilar beneficial scenario for tobacco. M any dentists (CRA News letter, October 1991, a survey of 7,617 random ly sampled dentists) have been able to see th e beneficial effect of vital bleaching in patients. Also, 89 percent (from th e same survey) of dentists prefer the take-hom e m odality w ith 10 percent carba mide peroxide; 90 percent of dentists wish to continue using take-home bleaching, as they see it both safe and effective. In recent discussions w ith Dr. Gordon J. C hristensen, he stated th a t th eir basic science and clinical research supported the use of the at-home
Fixodent Clinicals prove it. Patients love it. Recent clinical studies reconfirm that Fixodent still provides a longer, stronger hold than Orafix Special® and Super Poli-Grip® cream. In fact it's the longest, strongest holding denture adhesive cream available. That's superior results your patients will appreciate. Fixodent is also heat-resistant so hot drinks are not a problem. No wonder Fixodent is the #1 selling denture adhesive. Fixodent® Fresh combines same superior hold with a mouth-freshening sensation that doesn't interfere with the taste of food. For superior hold and superior denture performance, don't recommend just any cream, recommend Fixodent and Fixodent Fresh. Call 1-800-523-5325 for free patient samples.
Fixodent The superior recommendation. © 1992 by Procter & Gamble
carbam ide peroxide bleaching procedures, and th a t he disapproved only when these products were purchased over the counter and used unsupervised by patients. Some have raised questions of potential m utagenic effects of peroxide. In the m ost prom inent study indicating possible m u ta genicity by W eitzm an (1988), 3 percent and 30 percent hydro gen peroxide was tested w ith a known carcinogen, DMBA. W hether DMBA was used w ith peroxide carcinomas occurred w hen exposed to the known carcinogen DMBA. None of the 30 percent peroxide solutions had th is effect when used alone.
The 3 percent hydrogen peroxide was not tested alone. The 3 percent hydrogen peroxide solution is and has been sold over-the-counter for years for patients to gargle, rinse, brush, irrigate, and with little to no concern for its long-term effects. From a practical standpoint, it should be a significantly lower level of concern m utagenically when compared to eugenol (a phenol), not to m ention the high level of formaldehyde, a well-known active carcinogen found in formocresol, addressed for its accepted uses in Accepted Dental T herapeutics and used by thousands of dentists daily. I do not condemn these chemicals but note them only for compar ison. Possibly there are much
greater potentially harm ful dental products we and/or FDA really ought to be addressing. ™ FDA and ADA say they have concerns about peroxide use on soft tissue for extended time intervals, and this even in light of w hat is m entioned above regarding peroxide toothpastes. Exposure tim e w ith dentist supervised take-hom e whitening can be as little as 10 to 48 hours depending on the system. Who, other th an dentists, are more appropriately trained to monitor tooth whitening, not only for soft tissue response, for which FDA and ADA have expressed concern, but also to counsel and guide patients for the attain m en t of an optimally pleasing level of whitening? And if long-term exposure is a concern, who b etter th an
It’s Clear Which Mouthrinse Is ADA-Accepted to Help Fight Plaque and Gingivitis...
dentists to tell p atients th a t no more benefit can be gained and discontinue supply of peroxide to patients and hence discon tinue exposure to soft tissues? Yes, self-adm inistered vital bleaching can be problematic, particularly if acid pre-rinses or overly acidic peroxide p rep ara tions are used. As dentists and as an Association, let’s see to it th a t dentist supervised w hiten ing rem ains. The problem is not dentist supervised take-hom e bleaching, but unsupervised take-home bleaching. ■■ One can argue th a t FDA has not banned dentist supervised take-home bleaching b u t simply reclassified them as “new drugs.” For all practical purposes, however, this puts it beyond the realm of dental m anufacturers who have
supported the dentist supervised concept to m eet expeditiously new FDA requirem ents (possibly two to six years). Ironically, this greatly increases the likelihood of the only peroxide w hiteners being supplied only by large toothpaste companies, who have the economic resources for extensive “new drug” studies. T heir in ten t is to m arket direct to consumer, m eaning little to no dentist supervision. This can very well remove the procedure from the dental office. A nother question or recom m endation th a t we should perhaps communicate to FDA is, “Why consider 10 percent carbamide peroxide take-home bleaching as ‘new drug1rath e r th a n th a t ‘old dental m aterial’?” Such procedures have actually
been used and tau g h t by Drs. William Klusmeier and Dr. Jerry W agner, both of Fort Smith, A rkansas, since the 1960s. Both have tau g h t and passed it to others. ■■ An ironic note of in terest is th a t it appears FDA m ay allow the labeling and sale of 30 percent to 35 percent peroxide for “in-office” bleaching even though it appears to be prevent ing the labeling and sale of a peroxide one ten th as strong (10 percent carbam ide peroxide equates to about 3.4 percent H20 2). It also appears th a t our ADA Council on D ental T hera peutics is considering granting acceptance for a 30 percent to 35 percent hydrogen peroxide in office bleaching m aterial. I’m sure all of us who have used this strong peroxide
LISTERINE* ANTISEPTIC Listerine Is Accepted by the ADA Council on Dental Therapeutics to Help Prevent Supragingival Plaque and Gingivitis* 1 “Listerine has been shown to help prevent and reduce supragingival plaque accumulation and gingivitis when used in a conscientiously applied program of oral hygiene and regular professional care. Its effect on periodontitis has not been determined.” _________ Council on Dental Therapeutics American Dental Association
A D A
CONSUMERHEALTH PRODUCTS GROUP
A C C E P T E 1)
Morris Plains, NJ 07950 © 1990 Warner-Lambert Company
A m erican
Dental
Association Reference: 1. Council on Dental Therapeutics Accepts Listerine. JADA 117:515-516,1988. *When used as a supplement to daily oral hygiene and regular professional care .
. First-line antimicrobial defense for your patients.
understand the logistical problems of isolating it to the teeth even w ith rubber dam or by “sealing” it in a non-vital tooth with tem porary cement. Most of us can relate to the in sta n t w hite burned areas th a t appear all too frequently when this strong peroxide leaks around the rubber dam or past th e tem porary filling, or even onto patien ts’ uncovered lips, face, our hands, or th a t of our staff handling containers, for th a t m atter. And yes, possibly there are few long-term side effects, albeit we can be puzzled about the greater concern for a 3.4 percent equivalent peroxide (10 percent carbamide peroxide) which is approxim ately onete n th as strong. ™ Albeit m ost probably in excess of one million patients have received the benefits of dentist supervised take-home vital bleaching, few if any significant side effects have been JÊT reported. M any studies show insignificant effects on " enam el, some show minor effects. We all know w hat effect our high-speed handpieces have on enamel, soft tissue and yes at tim es pulp. We also know th a t if alternative more costly crown and/or veneer treatm ents are required, millions of patients could never realize a more pleasing, confidence-building smile, simply because of economics. One can speculate on the remote possibility of long-term tissue side effects. We also know the ever present potential systemic side effects (and yes, through infrequent, a t tim es catastrophic) associated with the necessary adm inistration of local anesthetics or additional 14
JADA, Vol. 123, March 1992
drugs when more invasive veneer or crown preparations are performed, though these procedures and drugs m ay be of m uch less concern to FDA. From the CRA survey, one can realize th a t the vast m ajority of dentists feel the take-home bleaching w ith 10 percent carbamide peroxide to be safe, effective and of benefit to their patients and their practice. It is a critical tim e for the silent m ajority of dentists to be heard, both individually and as a group. A joint voice of dentists, relevant dental m anufacturers and ADA (ideally from ADA representatives who have used and know take-home bleaching) is needed. If this is not communicated w ith FDA and soon, it will simply be history. Is ADA, the association of American dentists, representing for American dentists th eir
position? R oger H icks, P r e sid e n t Salt Lake D istrict D en tal S ociety Salt L ake City E d itor’s Note: The action taken on commercial tooth w hiteners by the U.S. Food and Drug Adm inistration was reported in detail in the Oct. 7 ADA News, page one. Also, Dr. Gordon Christensen, who authors a monthly column in JADA, expressed his views on whiteners in the December 1991 issue of The Journal. U N IT E D W E S T A N D . . .
Am I the only dentist in the ADA who was offended by Dr. M eskin’s editorial “W here the
Women Are.” (December)? W hat is to be gained by the current escalating trend of scrutinizing “women dentists”? Like most dentists, I see m yself as a dentist, not a brown-haired dentist, not an under 5/2 feet tall dentist, not an ADA component past president dentist and certainly not a woman dentist, although I am all those things. All this public scrutiny of “women dentists” is only going to drive away dentists th a t happen to be female. Surely it doesn’t take a sociologist to figure out th a t a dentist m ight feel uncomfortable at first to attend m eetings or committees where every other person is of the opposite gender. I am ra th e r surprised th a t so m any are active in organized dentistry, given th a t formidable barrier. Nor does it take a psychologist to see why dentists who are m others of young children are not rushing out to take over the leadership reins of organized dentistry. Their hands are quite busy practicing dentistry while rocking the cradle. Dr. M eskin’s paragraph comparing male and female political activity is indeed alarm ing, not because it shows .06 percent difference between m ales and females, but because it shows th a t 98 percent of dentists are not politically active! As dentists and ADA m em bers, let us stop contem plating our collective navel and stop singling out p art of us to be designated as “other.” We are all us, regardless of gender. Let us all pull together. There are more th an enough other groups whose activities are worthy objects of organized dentistry’s creative thinking:
