As the name implies, peroxide prophy paste is a prophy paste which contains hydrogen peroxide for the purpose of lightening teeth. It is manufactured by Challenge Products Incorporated (800-322-9800) and distributed by a number of companies. It is an alkaline (pH 11), hydrophilic, viscous paste that is presently available in a 3.5% hydrogen peroxide concentration. A 7% hydrogen peroxide paste (comparable to 20% carbamine peroxide), should be available for sale by the end of 2000. It is mint flavored, creamy white in colour and has a smooth texture.
When these products are used according to manufacturer’s directions, one can achieve a small but visible brightening of the teeth, the results vary from patient to patient as we have come to expect with other bleaching products. This product can be used by dentists, hygienists as well as preventive dental assistants. It will brighten teeth after a routine hygiene appointment, or can be used to jump-start bleaching procedures or as a maintenance procedure after a patient has completed bleaching.
It is available in 2-oz. jars and is packaged with 30 ring holders and a plastic spatula. The polishing paste does not contain either pumice or silicate because they contain metal filings from the milling procedures and are therefore not compatible with hydrogen peroxide. Instead it contains another fine polishing agent that is stable with the peroxide. At present it does not contain fluoride. This product and most prophy pastes contain glycerin. Glycerin when bought by the manufacturer can be derived from a number of different types of oils. Peanut oil can be one of the oils employed, so one should not use a prophy paste on a patient with a nut allergy, without consulting the manufacturer.
ARMAMENTARIUM
A very flexible, soft prophy cup is desirable. The softer cup allows for better conformation to the tooth surface in an attempt to create some suction and generate heat. I strongly suggest eye protection for both the patient and operators. Suction is advised to minimize the amount of product swallowed. In addition, because of the splash factor in the prophy procedure I suggest draping the patient to protect against bleaching their clothes. Lately I’ve been using disposable bed underpads which are readily available from most pharmacies. When the patient tucks their arms under these, they are well protected.
PROCEDURE
The technique of using a peroxide prophy paste is different than prophying with a pumice or silicate paste. I generally isolate the lips and cheeks with retractors or cotton rolls to minimize contact with the peroxide. The manufacturer’s directions do not indicate this is necessary and I have not had any complaints when I did not retract.
The teeth should be prophied wet as water activates the peroxide. This material is somewhat hydrophilic, so you may want to occasionally add a drop of water if the material becomes too tacky. The prophy cup which is very soft and flexible is used with a slight amount of pressure in an attempt to get a “suction” effect and also a “burnishing” effect to produce heat which also activates the peroxide. These effects would be very difficult to achieve with a rigid prophy cup. It is recommended to prophy each tooth continually for about 30 seconds using this firm pressure. I usually prophy the upper arch first and leave the paste on the uppers while I do the lower arch. I also lower the chair light close to the teeth to allow for additional heat. The 3.5% peroxide mixture is more viscous than the 7% mixture and is more difficult to rinse off. It is recommended that the patient be given a toothbrush to remove the final residue if necessary. I am also suggesting a neutral sodium fluoride rinse to complete the procedure.
DISCUSSION
I have only been using this product in my office for six months and it has been well received by both patients and hygienists. It is a great practice builder, and when patients have tried it they tend to request it at subsequent appointments. I have had patients who had no interest in bleaching their teeth change their minds after a peroxide prophy.
There are some downsides to the procedure. I did not find that this material removes stains as efficiently as our regular prophy paste, so we do stain removal with a different product. The procedure is also more time consuming than a conventional prophy. I find I need about 10 minutes in addition to our regular hygiene appointment. This extra time must be scheduled or you’ll run into booking problems. That brings us to the cost issue. Although the material, is priced reasonably, charging a nominal fee might be considered to cover extra expenses.
Dr. Janice Goodman practices general dentistry in Toronto. She is a member of Oral Health’s editorial board, general dentistry.
The author would like to acknowledge the helpful advice of Dr. Jordan Soll. The author does not have a financial affiliation with the product being reviewed.
Oral Health welcomes this original article.
