  Whitening your teeth is not safe and harmless So, you've decided to seek the glamour of a movie star… Years of drinking coffee, tea, or other dark colored beverages — or even smoking — have darkened your teeth, and spurred the urge to get them whitened. According to the American Academy of Cosmetic Dentistry, it's the single most requested cosmetic dental procedure by people of all ages… and the numbers are growing by a staggering 25.1% a year. The Academy also notes that the number of whitening and bleaching procedures has increased more than 300% during the 5 years from 2002 to 2007.1 So it's popular, for sure. But is it good for your health? We looked into it. . . Continued below. . .
Two processes for whitening your teeth A "whitening" process can work in one of two ways…
Whiteners can either be administered by dentists or purchased over the counter (OTC). Do-it-yourself OTC whiteners, as you might assume, are a lot less expensive, but require more effort. They consist of very thin, almost invisible, strips coated with a peroxide-based gel. You apply these strips for 30 minutes twice daily over the course of two weeks. Final results last about four months. These strips contain 10 percent carbamide peroxide. Professionally administered whiteners are the quickest route to whiter teeth, and are sometimes combined with heat, light or laser treatment. You can get dramatic results during a single one-hour appointment, though it's often repeated several times. This kind uses a hydrogen peroxide solution ranging from 15 to 35 percent. The practitioner protects your gum tissues with a rubber dam, or a protective gel. There are also whitening toothpastes available on the market. They contain polishing or chemical agents (instead of bleaches) to remove surface stains. The ADA 'Seal of Acceptance' — should you trust it? All whitening products carrying the American Dental Association (ADA) Seal of Acceptance contain 35 percent hydrogen peroxide. However, there is no requirement demanding this concentration. In water, carbamide peroxide breaks down into hydrogen peroxide and urea. Other ingredients may include glycerin, carbopol, sodium hydroxide, and flavoring agents. A couple things to note here… First, the ADA is reluctant to give its seal of approval to do-it-yourself OTC products. The association's viewpoint is that only dentists should administer tooth whiteners — "because professional consultation is important to the procedure's safety and effectiveness". Their "Seal of Acceptance" should perhaps make you as a consumer just a bit skeptical when coming from an organization that has been promoting poisons like mercury fillings and fluoride for more than half a century. We published our opinion on their shenanigans in a Special Report called The Secret Poison in Your Mouth. Big dangers, little dangers… According to the ADA, the most common side effects from either hydrogen or carbaminde peroxide are tooth sensitivity and gum irritation. Tooth sensitivity is likely to occur mostly during the early stages of bleaching… and tissue irritation is often from a poorly-fitting tray that holds the whitener. Both are said to be temporary and to cease after treatment. On rare occasions though, irreversible tooth damage has been reported. And the treatment is often ill advised for patients with many fillings, crowns, or very dark stains. In sum, this is the ADA position: There have been a few problems, mostly minor, and the procedure is generally safe. As you may have guessed, there are other opinions. Drugs.com advises that all medicines may cause side effects — and while whiteners typically cause no side effects, potential severe side effects are possible with carbamide peroxide solutions — rashes, hives, itching, breathing difficulties, chest tightness, and swelling of the mouth, face, lips, or tongue. But wait… it may be worse than that. Not to imply that breathing difficulties, chest tightness, or uncontrolled swelling or hives are minor… Britain warns of the dangers of whiteners It seems to have been kept hush-hush in the States, but four years ago, Britain warned all dentists and beauty salons in Gateshead of potential dangers from tooth whitening products… after discovering that many of these products contain dangerous chemicals such as hydrogen peroxide and carbamide peroxide far in excess of permitted levels. That level in the UK is only 0.1%. But some products were found to have levels as high as 10.0% -- a staggering 100 times the permitted level. Another product was found to be 60 times the permitted level.Officials are very concerned about finding products that breach safety guidelines by 60 to 100 times. It's a cosmetic, not a drug. . .so they say Meanwhile, in the United States, tooth whiteners are classified as a "cosmetic", not as a drug (even though they contain chemicals), and are therefore unregulated. So it's "buyer beware". Dentist Martin Fallowfield — spokesperson from the British Dental Association — warns that some home tooth whitener kits contain the same acid used to disinfect swimming pools, chlorine dioxide.And, it's not always listed on the label. He says the chemicals destroy your tooth's protective enamel… they obtain their whitening effect by etching your tooth's surface. This causes sensitive teeth, and in extreme cases can lead to tooth loss. It can also lead to chemical burns on your gums (furthering your risk of tooth loss). Ironically, it also can cause further discoloration due to the destruction of your protective enamel, making those teeth more easily stained by food or drink. Furthermore, if the mouth guard containing the bleach fits poorly, your gums will be exposed for an extended time… causing soft tissue burns, irreversible gum recession, tooth decay and sensitivity. If you swallow the chemical while the trays are in your mouth — which is very easy to do — you can also burn your throat, stomach and gut. Whitening toothpastes may seem like harmless alternatives to the procedures I've just described. But they often use abrasive ingredients such as sand to polish stains off. They're less risky in one way — no chemical burns or gum recession — but they can damage teeth. New warnings about long-term damage to teeth Unfortunately, no one quite knows the long-term effects of the popular bleaching products, regardless of where they're administered. Andrew Eder, professor of restorative dentistry and dental education at UCL Eastman Dental Institute (UK), says, "Teeth are porous, so whatever you put on the enamel, and especially on the deeper dentine, may have an effect deep inside the tooth over many years."2 He suggests using products short term only, never on an ongoing basis — and only if you feel you must. On top of all the other problems, whiteners may cause cancer In 2004, WebMD ran an article suggesting the possibility of tooth whitening products leading to oral cancer. They pointed to Georgetown University Hospital researchers who say the active ingredient in popular whiteners may be the reason two young people in their 20s with no other markers for cancer developed advanced tongue cancer. This is very speculative, and one case doesn't make a conclusion.But whiteners are one of several possible explanations for an increase in oral cancers among young people. Under normal circumstances, almost all victims of oral cancers are older folks with bad habits that clearly contributed to their disease. Ninety percent of oral cancers strike people over age 45 who are long term smokers or drinkers. But still, some doctors question whether the blame should be pointed at tooth whiteners or to some other exposure. Bruce Davidson, MD, FACS, chairman of otolaryngology-head and neck surgery at the Georgetown hospital, suggests it may be linked to the carbamide peroxide — one-third of which is composed of hydrogen peroxide. Further, carbamide peroxide changes into hydrogen peroxide when used as a whitener. Peroxide was shown to promote cancer growth inside the cheeks of rodents and to cause GI cancers when ingested. I found no reports of human testing on this. So, the theory goes that when hydrogen peroxide gel leaks from the trays into your mouth, it releases free radicals. At least one doctor says, "Think twice" Dr. Davidson told WebMD, "If I was in the market for teeth whitening, I'd think twice about it."3 Davidson reported at the 6th International Conference on Head and Neck Cancer the cases of two patients who developed advanced tongue cancer decades earlier than would be normal… after repeatedly using tooth whitening products. Both patients drank only occasionally. One was a light smoker; the other didn't smoke at all. They were part of a group of 19 oral cancer patients (of all ages) studied by Davidson's team of head and neck cancer surgeons. Two of the six patients who developed oral cancer prior to age 40 used tooth whiteners. And both had more advanced cancer than the others, despite not smoking or drinking more heavily. A middle aged man with tongue cancer also used tooth whitening polish. But the others did not use any bleaching products. The medical community's opinion...? Terry Day, MD and director of head and neck oncologic surgery at Hollings Cancer Center at the Medical University of South Carolina and spokesperson for the American Academy of Otolaryngology-Head and Neck Surgery, says we should pay attention to this study… because of the huge spike in consumers seeking a movie star smile, and the rise in oral cancers in young people, especially cancer of the tongue. However, the small size of the study doesn't provide enough support for a final conclusion that tooth whiteners are carcinogenic. Davidson's study is believed to be the first to consider a link between cancer and tooth whiteners. Meanwhile, the ADA says there's no evidence that tooth whiteners increase cancer risk or cause other problems (though they admit that some people do abuse them). Of course, dentists have much to gain if whiteners can be proclaimed as "safe", given the huge boon in their whitening cosmetic dentistry business. Whiteners applied by dentists cost upwards of $200. A customized tray is used, theoretically reducing the risk of hydrogen peroxide leakage. But Davidson reports studies that show that less than 50% of the whitener is still in the tray one hour after application, representing significant leakage. It's a clear hint that customers are ingesting the stuff. My recommendation…? Until we get more data indicating whether or not whiteners are definitively linked to oral cancer, I'm inclined to stick to my toothbrush and organic toothpaste. Just for the record, my dentist advised me against whiteners long ago because of the damage they do to the enamel, and I've followed his advice. I just live with my yellowed, old-dude teeth. Your addiction to glamour could have unwanted consequences — and it may be years before we can say for sure. Meanwhile, industrial society keeps producing other wonders. Our last issue wrote about one of them — a prostate cancer treatment for which you need the most expensive medical machine ever made, one that requires a building as large as a football field. If you missed this doozy, we're repeating it again just below. You Can Now Treat Prostate Cancer with the Most Expensive Medical Device in the History of the World If you've heard that proton therapy is the magic bullet for prostate cancer, be warned: There's a lot of money tied up in this therapy, but not a lot of research. That's a scary combination for any health treatment. Let's look at the facts. . . Continued below. . .
This treatment definitely has some advantages Proton therapy isn't even a new breakthrough, although the public didn't get interested till recently. The therapy was initially prompted by Dr. James Slater of Massachusetts General, who first started harvesting protons from a Harvard cyclotron in the early 1960s. Dr. Slater had been disheartened by the side effects of radiation treatment (using X-rays) and has since devoted most of his professional life to bringing proton-based treatments to medical facilities.Proton therapy itself is fairly simple. It uses a beam of protons to inject a tumor with radiation. Protons are one of the three main particles that make up atoms (the other two are electrons and neutrons). Protons have a positive charge while electrons have a negative charge. Like X-rays, protons wreck the genetic makeup of a tumor. More importantly, proton therapy is much more precise than other radiation therapies, but without the side effects. For example, when a patient undergoes X-ray treatment, tissues surrounding the tumor site are easily destroyed. The side-effects and resulting sickness can be overwhelming. But in proton therapy, the stream of charged particles can be tailored to the contours of the tumor, without affecting any tissues except the tumor. Unfortunately (and like too many things in the medical industry), proton therapy suffers from a money bias. Construction costs for a proton-beam generator can top $200 million, making it the most expensive medical device ever invented. One of the reasons the treatment is so expensive is that protons aren't exactly easy to harvest. For proton therapy, protons must be stripped from hydrogen atoms and then moved into a stream that is nearly as fast as the speed of light. The device that makes this possible weighs around 220 tons and must be housed in a structure at least the size of a football field. So, beyond the cost of the machine itself come considerable construction expenses for any hospital toying with the idea of offering this treatment. But here's the worst problem of all. . . Proton therapy involves spending a stupefying amount of money on something that doesn't necessarily work better than other prostate cancer treatments. Anthony Zietman, MD, of Massachusetts General Hospital in Boston and past president of the American Society for Radiation Oncology, has gone on record saying proton therapy is a very good treatment for prostates, but "It just doesn't appear to be superior treatment." In the world of peer-reviewed journals, they won't be able to say whether proton therapy deserves all the rave reviews it's gotten until somebody puts together a decade-long, randomized trial to see which treatments have the best outcome overall.In the meantime, the Internet has become a serious hindrance to spreading accurate information about this treatment. Loads of blogs and websites run by men who had success with their own proton treatment laud the benefits of proton therapy. I don't deny that they have good intentions. Many of these enthusiastic Internet writers feel proton therapy was the best and only cure for their prostate cancers. Plus, men love the fact that's it's non-invasive. Who wouldn't? After all, few things shake a man's pride like the idea of losing bladder function or becoming impotent. A man's well-being after conventional radiation or surgery can be very poor indeed. But the buzz reminds me of prime-time commercials from the pharmaceutical industry (although more honest, I hope). When you see a commercial for the latest and greatest pill, featuring happy people evangelizing a drug, it's hard not to wonder if it might work for you. Just remember, the bloggers are comparing proton therapy to conventional radiation and surgery. To be fair, it IS an improvement — a very expensive one. But why go there at all? The problem in this case is that too many websites are written by guys who aren't aware of the costs-versus-benefits of this treatment, much less the benefits of alternative cancer treatments. They're excited by the high-level technology — the ultimate power tool for guys — and they give false hope to millions of men searching the Internet for legitimate answers. The bias for proton therapy technology continues to grow with time, making it hard to put together any kind of a reliable study on outcomes. Researchers are finding that men who went in thinking proton treatment was superior, who then have unexpected and unnecessary side effects, still advocate proton therapy as the best choice they could have made. Marketers call it "post-purchase dissonance." When people have made an important choice, they have to convince themselves they did the right thing. If the purchase is a let-down, some people go into denial and still insist they made a good choice. And remember, as with most medical therapies these days, the advice you get from doctors is subject to a ton of bias. Dr. Zietman, while being interviewed for an article in Men's Health last year, said, "In the absence of knowledge, anything goes. Surgeons recommend their favorite surgery. Radiation oncologists recommend their favorite form of radiation." It follows that oncologists smitten with cool technology — and with making money — recommend proton therapy. Money-driven healthcare, the vampire that's sucking the life out of our country What's obvious here is that the least expensive option for treating early-stage prostate cancer rarely gets lip service from the experts. Officially, it's called "active surveillance." You may know it as "watchful waiting." Watchful waiting boils down to closely monitoring a patient and watching for any signs of growth in his cancer. If there's no growth, there's no treatment. If there is growth, the patient gets treated. Most prostate tumors are slow-growing. There's no pressing need to take action. And there are dozens of safe nutrients, foods and herbal remedies a man can use to control or eliminate prostate tumors without resorting to radiation, chemotherapy and surgery at all. I gave readers my take on all this in my Special Report, Don't Touch My Prostate.Proton treatment sounds to me like technology-driven medicine gone crazy. Frightened people with cancer are willing to buy into any kind of nonsense recommended by the men in white coats, and of course we all get handed the bill. Medical care is the single biggest expense driving the country into bankruptcy and potential social and political collapse. Meanwhile, to the doctors and industrialists meting out the treatments, there are massive profits to be had treating prostate cancer with protons. Proton therapy isn't worthless. Far from it. It actually shows more reliable promise for treating brain, eye, and spinal cord tumors, as well as certain kinds of tumors in children. But treating something like childhood cancers requires multiple, lengthy sessions and insurance companies are loath to cover it. Prostate patients, on the other hand, are in and out in 20 minutes and need fewer total treatments. Medicare and most insurance companies cover the cost without hassle. And there are a lot of prostate cancer cases to funnel through the system. It's healthcare dictated by money, which is the worst kind. I should point out that even with the heavy emphasis on proton therapy as a miracle cure, it's hard to come by. Only 1% of radiation oncologists in the U.S. have experience in proton therapy. And right now, there are only nine proton centers in operation (though eight more are in development, which shows how the medical industry is responding to demand). Sometimes the best healthcare means bucking the trends Conclusive studies are a long way off. But for now, the best information we can find is that proton treatment is not much better than standard radiation treatment — just more expensive and more techno-fancy. I admit, it's hard to beat claims like those made by Loma Linda Medical Center on their website's "Proton Therapy for Prostate Cancer" page: "More accurate, non-invasive, painless, provided in an outpatient setting, little impact on energy level, and requires no recovery."But don't be so sure it's a good choice. There are many, many easy alternative treatments I'd try first.  |
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