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It’s Never All Black and White

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Key Words: tooth whitening • dental products • technology transfer

Having recently returned from this year’s AADR meeting, I’m tempted to pose a variant to the old question: If a tree falls in the woods and there is no one there, does it still make a sound? I would ask, instead, "If a consumer uses a toothwhitening product in the woods and there is no one else there to observe, no mirror, and/or no computerized evaluating device, does the tooth actually get whiter?" Given the large number of presentations on tooth-whitening products at this meeting, it may well be the case that an extraterrestrial individual alighting at the meeting site could reasonably conclude that tooth stain is one of the most serious oral conditions afflicting humankind on Earth. Although it is tempting to be somewhat dismissive of studies dealing with products aimed at strictly cosmetic problems, we might reflect on what this says about current dental practice and the public’s perception of oral care priorities.

It could be instructive to consider the profusion of papers on tooth whitening in the context of the overall meeting content. The presentations at AADR and IADR meetings demonstrate the extraordinary breadth and depth of dental research. Papers encompass such areas as molecular biology, genomics, DNA microarrays, biomaterials, cariology, periodontal disease/systemic disease interactions, pharmacology, tooth whitening, and OTC mouthrinses, to name just a few. This is one of the few forums at which one can get a true appreciation of all that dental research represents. In particular, it provides an opportunity to present results of industry-supported studies on products and technologies that have actually been introduced into clinical practice and/or the consumer marketplace. Those involved primarily in basic investigations in academic settings may not always be aware of current trends seen in typical dental practices around the country. So while it is tempting to dismiss papers on toothwhitening products as somewhat frivolous, it may be sobering to realize that it is studies on products such as these that might have the most relevance to contemporary dental practice insofar as such products have great appeal to dentists and their patients. Basic investigations with potential applicability to future interventions and products are no doubt much less compelling to the typical dental practitioner.

There are several conclusions that can be drawn from this:

• We should not undervalue cosmetic procedures, products, and indications because they can produce significant improvements in the quality of life for many consumers and are in increasing demand by our patients.
  
• It is clearly necessary to better educate the public on the importance of oral diseases, their association with systemic diseases, and the need to seek appropriate treatment—that is, to successfully convey the message that oral health is integral to general health, one of the themes of the US Surgeon General’s report, Oral Health in America.
  
• It is also necessary that continuing education courses for practicing dentists present the most up-to-date information, especially that which has the potential of expanding the scope of dental practice.
  
• It is critical that we seek ways to facilitate the transfer of innovative, new technologies to interventions and products which will significantly and dramatically affect our ability to diagnose, prevent, and treat the gamut of oral diseases and conditions.
  

Perhaps it would also help for us to consider alternative terminologies for some of the cosmetic conditions we deal with to make them seem less frivolous. So, for example, instead of merely whitening teeth, we could be managing patients with odonto-chromophobia. Calculus reduction could, instead, be the prevention of odontoexolithiasis. There is precedent in the medical world for this sort of thing. Consider borborygnus ("rumbling tummy"), petechiae (small purplish-red spots), and, of course, flatulence.

While these suggestions of new terminologies could be considered tongue-in-cheek, we should nevertheless recognize the niche that each kind of study occupies within the universe of dental research. Corporate-sponsored studies of current products, including those with cosmetic indications, may lead to a meaningful enhancement of the quality of life for large numbers of patients. To be considered seriously, however, it is critical that these studies adhere to the highest standards of clinical research and that accurate conclusions be drawn from the data produced. In addition, the scientific community would be receptive to studies indicating the mechanisms of action by which the products work in the context of the causes of the cosmetic problems. Clearly, these products represent the present; it is the possibilities that current basic research presents for future technologies and the anticipation of the transfer of such technologies to clinical practice that will create and maintain the excitement of dentists and their patients in the years to come.

Received for publication March 24, 2003. Accepted for publication April 2, 2003.

Journal of Dental Research, Vol. 82, No. 8, 580 (2003)
DOI: 10.1177/154405910308200801


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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Barnett, M. L. Search for Related Content PubMed PubMed Citation Articles by Barnett, M. L. Social Bookmarking                         What's this?