Tooth whitening

Process to lighten the colour of teeth

For more information, please visit teeth whitening factory.

Figure 1. Before and after tooth whitening.

Tooth whitening or tooth bleaching is the process of lightening the color of human teeth.[1] Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel.[2] The chemical degradation of the chromogens within or on the tooth is termed as bleaching.[1]

Hydrogen peroxide (H
2O
2) is the active ingredient most commonly used in whitening products and is delivered as either hydrogen peroxide or carbamide peroxide.[1] Hydrogen peroxide is analogous to carbamide peroxide as it is released when the stable complex is in contact with water. When it diffuses into the tooth, hydrogen peroxide acts as an oxidising agent that breaks down to produce unstable free radicals. In the spaces between the inorganic salts in tooth enamel, these unstable free radicals attach to organic pigment molecules resulting in small, less heavily pigmented components.[3] Reflecting less light, these smaller molecules create a "whitening effect".[3] There are different products available on the market to remove stains.[1] For whitening treatment to be successful, dental professionals (dental hygienist or dentist) should correctly diagnose the type, intensity and location of the tooth discolouration.[3] Time exposure and the concentration of the bleaching compound, determines the tooth whitening endpoint.[1]

Natural shade

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The perception of tooth colour is multi-factorial. Reflection and absorption of light by the tooth can be influenced by a number of factors including specular transmission of light through the tooth; specular reflection at the surface; diffuse light reflection at the surface; absorption and scattering of light within the dental tissues; enamel mineral content; enamel thickness; dentine colour, the human observer, the fatigue of the eye, the type of incident light, and the presence of extrinsic and intrinsic stains.[4] Additionally, the perceived brightness of the tooth can change depending on the brightness and colour of the background.[4]

The combination of intrinsic colour and the presence of extrinsic stains on the tooth surface influence the colour and thus the overall appearance of teeth.[2] The scattering of light and absorption within enamel and dentine determine the intrinsic colour of teeth and because the enamel is relatively translucent, the dentinal properties can play a major role in determining the overall tooth colour.[4] On the other hand, extrinsic stain and colour is the result of coloured regions that have formed within the acquired pellicle on the enamel surface and can be influenced by lifestyle behaviours or habits.[2] For example, dietary intake of tannin-rich foods, poor tooth brushing technique, tobacco products, and exposure to iron salts and chlorhexidine can darken the colour of a tooth.[2]

With increasing age, teeth tend to be darker in shade.[5] This can be attributed to secondary dentin formation and thinning of enamel due to tooth wear which contributes to a significant decrease in lightness and increase in yellowness.[5] Tooth shade is not influenced by gender or race.[5]

Staining and discolouration

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Tooth discolouration and staining is primarily due to two sources of stain: intrinsic and extrinsic (see Figure 2).[1] In essence, tooth whitening primarily targets those intrinsic stains in which cannot be removed through mechanics such as a debridement (clean) or prophylaxis, in the dental office.[6] Below explains in-depth the differences between the two sources of which contribute to such discolouration of the tooth's surface.

Figure 2. Examples of tooth staining. Extrinsic staining examples: A. Smoking; B. Wine stain; and C. Food stain. Intrinsic staining examples: D. Age yellowing; E. Decay; F. Orthodontic white spot lesion; G. Mild fluorosis; H. Amalgam restoration; I. Tetracycline stain; J. Genetic (amelogenesis imperfecta); K. and non-vital colouring.

Extrinsic staining

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Extrinsic staining, is largely due to environmental factors including smoking, pigments in beverages and foods, antibiotics, and metals such as iron or copper. Coloured compounds from these sources are adsorbed into acquired dental pellicle or directly onto the surface of the tooth causing a stain to appear.[7]

• Dental plaque: Dental plaque is a clear biofilm of bacteria that naturally forms in the mouth, particularly along the gumline, and it occurs due to the normal development and defences of the immune system.[8] Although usually virtually invisible on the tooth surface, plaque may become stained by chromogenic bacteria such as Actinomyces species.[9] Prolonged dental plaque accumulation on the tooth surface can lead to enamel demineralisation and formation of white spot lesions which appear as an opaque milk-coloured lesion.[10] The acidic by-products of fermentable carbohydrates derived from high-sugar foods contribute to greater proportions of bacteria, such as Streptococcus mutans and Lactobacillus in dental plaque. Higher consumption of fermentable carbohydrates will promote demineralisation and increase the risk of developing white spot lesions.[8]
• Calculus: neglected plaque will eventually calcify, and lead to the formation of a hard deposit on the teeth, especially around the gumline. The organic matrix of dental plaque and calcified tissues undergo a series of chemical and morphological changes that lead to calcification of the dental plaque and therefore leading to the formation of calculus.[11] The color of calculus varies, and may be grey, yellow, black, or brown.[9] The colour of calculus depends on how long it has been present in the oral cavity for; it typically starts off yellow and over time the calculus will begin to stain a darker colour and become more tenacious and difficult to remove.
• Tobacco: tar in the smoke from tobacco products (and also smokeless tobacco products) tends to form a yellow-brown-black stain around the necks of the teeth above the gumline.[9] The nicotine and tar in tobacco, combined with oxygen, turns yellow and over time will absorb into the pores of enamel and stain the teeth yellow. The dark brown to black stains along the gum line of the teeth are the result of the porous nature of calculus immediately picking up the stains from nicotine and tar.
• Betel chewing.[12] Betel chewing produces blood-red saliva that stains the teeth red-brown to nearly black.[13] The extract gel of betel leaf contain tannin, a chromogenic agent that causes discolouration of the tooth enamel.[14]
• Tannin is also present in coffee, tea, and red wine and produces a chromogenic agent that can discolor teeth.[15] Large consumptions of tannin-containing beverages stain the dental enamel brown due to the chromogenic nature.[16]
• Certain foods, including curries and tomato-based sauces, can cause teeth staining.[17]
• Certain topical medications: Chlorhexidine (antiseptic mouthwash) binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth.[18] Chlorhexidine mouthwash has a natural liking for sulphate and acidic groups commonly found in areas where plaque accumulates such as along the gumline, on the dorsum of the tongue and cavities. Chlorhexidine is retained in these areas and stain yellow-brown. The stains are not permanent and can be removed with proper brushing.[19]
• Metallic compounds. Exposure to such metallic compounds may be in the form of medication or occupational exposure. Examples include iron (black stain), iodine (black), copper (green), nickel (green), and cadmium (yellow-brown).[20] Sources of exposure to metal include placing metal into the oral cavity, metal-containing dust inhalation, or oral administration of drugs. Metals can enter the bony structure of the tooth, causing permanent discolouration, or can bind to the pellicle causing surface stain.[19]

Removal of extrinsic staining

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Extrinsic staining may be removed through various treatment methods:

• Prophylaxis: dental prophylaxis includes the removal of extrinsic staining using a slow-speed rotary handpiece and a rubber cup with abrasive paste, mostly containing fluoride.[21] The abrasive nature of the prophy paste, as it is known, acts to remove extrinsic staining using the action of the slow-speed handpiece and the paste against the tooth. Adversely, the action of the rubber cup together with the abrasive nature of the paste, removes around one micron of enamel from the tooth surface every time a prophylaxis is performed. This method of stain removal may only take place in the dental office.
• Micro-abrasion: allows a dental professional to make use of an instrument which emits a powder, water and compressed air to remove biofilm, and extrinsic staining. This stain removal method can only be undertaken in a dental office, not at home.
• Toothpaste: there are many available on the market that implement both peroxide as well as abrasive particles, such as silica gel, to help remove extrinsic stains, while the peroxide acts on intrinsic staining. This method of stain removal may take place at home as well as in a dental office.

Intrinsic staining

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Intrinsic staining primarily occurs during the tooth development either before birth or at early childhood. Intrinsic stains are those that cannot be removed through mechanical measures such as debridement or a prophylactic stain removal. As the age of the person increases, the teeth can also appear yellower over time.[15] Below are examples of intrinsic sources of stains:

Methods

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Prior to proceeding to tooth whitening alternatives, it is advised that the patient comes into the dental office to have a comprehensive oral examination that consists of a full medical, dental, and social history. This will allow the clinician to see if there is any treatment that needs to be done such as restorations to remove cavities, and to assess whether or not the patient will be a good candidate to have the whitening done. The clinician would then debride (clean) the tooth surface with an ultrasonic scaler, hand instruments, and potentially a prophy paste to remove extrinsic stains as mentioned above. This will allow a clean surface for maximum benefits of whichever tooth whitening method the patient chooses.[6] Below will discuss the various types of tooth whitening methods including both internal application of bleaching and external application through the use of bleaching agents.

Figure 3. Shade guides

VITA classical A1-D4 shade guide arranged according to value

VITA classical A1-D4 shade guide arranged according to chroma ; A: red-brown, B: red-yellow, C: grey, D: red-grey

Before the treatment, the clinician should examine the patient: taking a health and dental history (including allergies and sensitivities), observe hard and soft tissues, placement and conditions of restorations, and sometimes x-rays to determine the nature and depth of possible irregularities. If this is not completed prior to the whitening agents being applied to the tooth surface, excessive sensitivity and other complications may occur.

In office tooth whitening with laser light activation

The whitening shade guides are used to measure tooth colour. These shades determine the effectiveness of the whitening procedure, which may vary from two to seven shades.[34] These shades may be reached after a single in office appointment, or may take longer, depending on the individual. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Consuming tooth staining foods or drinks that have a strong colour may compromise effectiveness of the treatment. These include food and drinks containing tannins such as; coffee, tea, red wines, and curry.

In-office bleaching procedures generally use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10% and 44% carbamide peroxide, which is roughly equivalent to a 3% to 16% hydrogen peroxide concentration. The legal percentage of hydrogen peroxide allowed to be given is 0.1&#;6%.[where?] Bleaching agents are only allowed to be given by dental practitioners, dental therapists, and dental hygienists.

Bleaching is least effective when the original tooth color is grayish and may require custom bleaching trays. Bleaching is most effective with yellow discolored teeth. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective (tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer), there are other methods of masking the stain. Bonding, which also masks tooth stains, is when a thin coating of composite material is applied to the front of a person's teeth and then cured with a blue light. A veneer can also mask tooth discoloration.

In-chair whitening is faster and more effective in comparison to the take-home bleaching options.[medical citation needed] Some clinicians also make custom bleaching trays, which can take up to a week to create. After the whitening treatment is completed, the patient is able to use these trays for maintenance of their bleaching with at-home kits or for use with desensitising products.

Light-accelerated bleaching

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Power or light-accelerated bleaching uses light energy which is intended to accelerate the process of bleaching in a dental office. Different types of energy can be used in this procedure, with the most common being halogen, LED, or plasma arc. Use of light during bleaching increases the risk of tooth sensitivity and may not be any more effective than bleaching without light when high concentrations of hydrogen peroxide are used.[35] A study showed that the use of a light activator does not improve bleaching, has no measurable effect, and rather is likely to increase the temperature of the associated tissues, resulting in damage.[36][37]

The ideal source of energy should be high energy to excite the peroxide molecules without overheating the pulp of the tooth.[38] Lights are typically within the blue light spectrum as this has been found to contain the most effective wavelengths for initiating the hydrogen peroxide reaction. A power bleaching treatment typically involves isolation of soft tissue with a resin-based, light-curable barrier, application of a professional dental-grade hydrogen peroxide whitening gel (25&#;38% hydrogen peroxide), and exposure to the light source for 6&#;15 minutes. Recent technical advances have minimized heat and UV emissions, allowing for a shorter patient preparation procedure.

For any whitening treatments, it is recommended that a comprehensive examination of the patient is done including the use of radiographs to aid in the diagnosis of the current condition of the mouth, including any allergies that may be present. The patient will need to have a healthy mouth and free of periodontal disease or cavities and to have had a debridement/clean done to remove any tartar or plaque build up.[39]

It is recommended to avoid smoking, drinking red wine, eating or drinking any deeply coloured foods after this as the teeth may stain considerably straight after treatment.

Nanoparticle catalysts for reduced hydrogen peroxide concentration

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A recent addition to the field is new light-accelerated bleaching agents containing lower concentrations of hydrogen peroxide with a titanium oxide nanoparticle-based catalyst. Reduced concentrations of hydrogen peroxide cause lower incidences[spelling?] of tooth hypersensitivity.[40] The nanoparticles act as photocatalysts, and their size prevents them from diffusing deeply into the tooth. When exposed to light, the catalysts produce a rapid, localized breakdown of hydrogen peroxide into highly reactive radicals. Due to the extremely short lifetimes of the free radicals, they are able to produce bleaching effects similar to much higher concentration bleaching agents within the outer layers of the teeth where the nanoparticle catalysts are located. This provides effective tooth whitening while reducing the required concentration of hydrogen peroxide and other reactive byproducts at the tooth pulp.

Internal bleaching

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Internal bleaching is a process which occurs after a tooth has been endodontically treated. This means that the tooth will have had the nerve of the tooth extirpated or removed through a root canal treatment at the dentist or by a specialist endodontist. Internal bleaching is often sought after in teeth which have been endodontically treated as tooth discolouration becomes a problem due to the lack of nerve supply to that tooth. It is common to have this internal bleaching done on an anterior tooth (a front tooth that you can see when smiling and talking). A way around this is by sealing off the bleaching agent inside the tooth itself and replacing it every few weeks until the desired shade has been achieved. The amount of time between appointments varies from patient to patient and with operator preference until the desired shade has been achieved.[41] Even though this is a great option, the disadvantage of this treatment is a risk of internal root resorption of the tooth that is being internally bleached. This may not occur in every patient or every tooth, and its occurrence is difficult to determine prior to completing the treatment.[41]

At home

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At home tooth whitening products are available from dentists or 'over the counter' (OTC).[42] At home whitening methods include over-the-counter strips and gels, whitening rinses, whitening toothpastes, and tray-based tooth whiteners.[42] OTC products can be used for milder cases of tooth staining.[42] Home-based bleaching (following manufacturer's instructions) results in less tooth sensitivity than in-office bleaching.[43]

Strips and gels

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The plastic whitening strips contain a thin layer of peroxide gel and are shaped to fit the buccal/labial surfaces of teeth.[1] Many different types of whitening strips are available on the market, after being introduced in the late s.[1] Specific whitening strip products have their own set of instructions however the strips are typically applied twice daily for 30 minutes for 14 days.[1] In several days, tooth colour can lighten by 1 or 2 shades.[1] The tooth whitening endpoint does depend on the frequency of use and ingredients of the product.[1]

Whitening gels are applied onto the tooth surface with a small brush.[1] The gels contain peroxide and are recommended to be applied twice a day for 14 days.[1] The tooth whitening endpoint like that of the whitening strips.[1]

Rinses

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Whitening rinses work by reaction of the oxygen sources such as hydrogen peroxide within the rinse and the chromogens on or within the tooth.[1] It is recommended to use twice a day, rinsing for one minute.[1] To see an improvement in shade colour, it can take up to three months.[1]

Toothpastes

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Whitening toothpastes differ from regular toothpastes in that they contain higher amounts of abrasives and detergents to be more effective at removing tougher stains.[1] Some whitening toothpastes contain low concentrations of carbamide peroxide or hydrogen peroxide which help lighten tooth colour however they do not contain bleach (sodium hypochlorite).[1] With continuity of use over time, tooth colour can lighten by one or two shades.[1]

Tray-based tooth whitening is achieved by wearing a fitted tray containing carbamide peroxide bleaching gel overnight or for two to four hours a day.[1] If manufacturer's instructions are followed, tooth whitening can occur within three days and lighten teeth by one or two shades.[1] This type of tooth whitening is available over-the-counter and professionally from an oral health professional.[1]

Baking soda

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Baking soda is a safe, low abrasive, and effective stain removal and tooth whitening toothpaste.[44] Tooth whitening toothpaste that have excessive abrasivity are harmful to dental tissue, therefore baking soda is a desirable alternative.[44] To date, clinical studies on baking soda report that there have been no reported adverse effects.[44] It also contains acid-buffering components that makes baking soda biologically antibacterial at high concentrations and capable of preventing growth of Streptococcus mutans.[44] Baking soda might be useful for cavities-prone patients, as well as those who wish to have whiter teeth.[44]

Pens

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Whitening pens are a convenient way to touch up any dental surface. The plastic, convenient, tube contains a bleaching gel that can be easily applied in hard-to-reach spots. In order to work, the gel needs to stay on the tooth surface for around 20&#;30 minutes.[45]

Indications

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Tooth whitening may be undertaken for a variety of reasons, but whitening may also be recommended to some individuals by dental professionals.[46]

• Intrinsic tooth staining
• Aesthetics
• Dental fluorosis
• Endodontic treatment (internal bleaching)
• Tetracycline staining

Contraindications

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Some groups are advised to carry out tooth whitening with caution as they may be at higher risk of adverse effects.

• Patients with unrealistic expectations
• Allergy to peroxide
• Pre-existing sensitive teeth
• Cracks or exposed dentine
• Enamel development defects
• Acid erosion
• Receding gums (gingival recession) and yellow roots
• Sensitive gums
• Defective dental restorations
• Tooth decay. White-spot decalcification may be highlighted and become more noticeable directly following a whitening process, but with further applications the other parts of the teeth usually become more white and the spots less noticeable.
• Active periapical pathology
• Untreated periodontal disease
• Pregnant or lactating women
• Children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Tooth whitening under this condition could irritate the pulp or cause it to become sensitive. Younger people are also more susceptible to abusing bleaching.[47]
• Persons with visible white fillings or crowns. Tooth whitening does not change the color of fillings and other restorative materials. It does not affect porcelain, other ceramics, or dental gold. However, it can slightly affect restorations made with composite materials, cements and dental amalgams. Tooth whitening will not restore color of fillings, porcelain, and other ceramics when they become stained by foods, drinks, and smoking, as these products are only effective on natural tooth structure. As such, a shade mismatch may be created as the natural tooth surfaces increase in whiteness and the restorations stay the same shade. Whitening agents do not work where bonding has been used and neither is it effective on tooth-colored filling materials. Other options to deal with such cases are the porcelain veneers or dental bonding.[48]
• Individuals with poor oral hygiene

Risks

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Some of the common side effects involved in teeth whitening are increased sensitivity of the teeth, gum irritation, and extrinsic teeth discolouration.[42]

Hypersensitivity

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The use of bleach with extremely low pH levels in the tooth whitening procedure may lead to hypersensitive teeth, as it causes the dentinal tubules to open.[49] Exposure to cold, hot, or sweet stimuli may further exacerbate the intensity of the hypersensitive response. Amongst those who receive in-office whitening treatment, between 67 and 78% of the individuals experience sensitivity after the procedure where hydrogen peroxide and heat is utilized.[50][51] Although it varies from person to person, sensitivity after whitening treatment can last up to 4&#;39 days.[52][53]

Potassium nitrate and sodium fluoride in toothpastes are used to ease discomfort following bleaching, however, there is no evidence to suggest that this is a permanent method to eradicate the issue of hypersensitivity.[54]

Irritation of mucous membranes

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Hydrogen peroxide is an irritant and cytotoxic. Hydrogen peroxide with concentrations of 10% or higher can cause tissue damage, be corrosive to mucous membranes and cause burning sensation to the skin.[55] Chemical burns can commonly occur whilst bleaching, irritation and discolouration of the mucous membranes may occur if a high concentration of oxidising agent comes in to contact with unprotected tissue. Poorly fitting bleaching trays are amongst the most common reasons for chemical burns. The temporary burning induced by whitening treatments can be reduced by using custom-made plastic trays or nightguards provided by the dental professional. This prevents the leakage of solution onto the surrounding mucosa.[56]

Uneven results

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Uneven results are quite common after bleaching. Consuming less foods and drinks that cause surface staining of teeth can contribute to attaining a good result from tooth whitening.

Return to original pre-treatment shade

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Nearly half the initial change in colour provided by an intensive in-office treatment (i.e., one hour treatment in a dentist's chair) may be lost in seven days.[57] Rebound is experienced when a large proportion of the tooth whitening has come from tooth dehydration (also a significant factor in causing sensitivity).[58] As the tooth rehydrates, tooth colour "rebounds", back toward where it started.[59]

Over-bleaching, more often known as the "bleached effect", occurs among treatments that promise a large change over a short period of time e.g., hours. Over-bleaching can emit a translucent and brittle appearance.[60]

Damage to enamel

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Teeth enamel can have an adverse negative effect by whitening treatment.[61] Evidence from studies show that carbamide peroxide present in whitening gels can damage the enamel surface. Although this effect is not as damaging as phosphoric acid etch,[62] the increased irregularity of the teeth surface makes the teeth more susceptible to extrinsic staining, thus having an increased detrimental effect on the aesthetics. The increased porosity and changes in surface roughness may have an impact on the formation of supra- and subgingival plaque, thus increasing the adhesion of bacterial species such as Streptococcus mutans and Streptococcus sobrinus, significant contributors to dental cavities.[56] Dental restorations are susceptible to unacceptable colour change even when using the home-based systems.[1]

Weakened dentine

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Intracoronal bleaching is a tooth whitening method that uses 30% more hydrogen peroxide. Such tooth whitening methods can weaken the mechanical properties of dentine and could potentially lead to severe tooth sensitivity.[63]

Effects on existing restorations

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Dental restorations are susceptible to unacceptable colour change even when using the home-based systems.[1]

Ceramic crowns &#; aggressive bleaching can chemically react with ceramic crowns and reduce their stability.[1]

Dental amalgam &#; exposure to carbamide peroxide solutions increase mercury release for one to two days.[63][64] The release of amalgam components is said to be due to active oxidation. This increase in amalgam mercury release is proportional to the concentration of carbamide peroxide.[65]

Resin composite &#; bond strength between enamel and resin based fillings become weakened.[66] Many studies have found that 10-16% carbamide peroxide tooth bleaching gels (containing approximately 3.6&#;5.76% hydrogen peroxide) leads to an increase in the surface roughness and porosity of composite resins.[65] However, the saliva may exert a protective effect. In addition, changes in the reflectance of the composite have been analysed following whitening with high concentration (30-35%) hydrogen peroxide.[65] This suggests that tooth whitening negatively impacts composite resin restorations.[65]

Glass ionomer and other cements &#; studies suggest that solubility of these materials may increase.[67]

Bleachorexia

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Bleachorexia is the term that is used to describe an individual that develops an unhealthy obsession with teeth whitening.[47] This condition is similar to body dysmorphic disorder. The characteristics of bleachorexia are the continuous use of whitening products even though the teeth cannot possibly become whiter, despite the provision of repeated treatment.[60] A person with bleachorexia will continually seek out for different whitening products, hence, it is recommended that a target shade is agreed upon before starting the treatment procedure to help with this problem.[60]

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Home teeth whitening risks

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The use of personalised home whitening trays is a patient administered therapy that is prescribed and dispensed by a dentist.[68] Patients need to actively participate in their treatment and follow the guidelines given by the dentist accurately.[69] Erratic or inaccurate use of the bleaching trays could cause harm to the patient such as blistering or sensitivity of the teeth and the surrounding soft tissue.[70] Inconsistent use of the bleaching trays can lead to the slowing and irregularity of the whitening process.[71] Some patients with a substantial gag reflex may not be able to tolerate the trays and would need to consider other methods of teeth whitening.[69]

Other risks

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Evidence suggests that hydrogen peroxide might act as a tumour promoter.[72] Although cervical root resorption is more evidently observed in thermocatalytic bleaching methods, intracoronal internal bleaching may also lead to tooth root resorption.[72] Moreover, severe damage to intracoronal dentine and tooth crown fracture can occur due to this bleaching method.[72]

However, the International Agency of Research on Cancer (IARC) has concluded that there is insufficient evidence to prove that hydrogen peroxide is a carcinogen to humans.[73] Recently, the genotoxic potential of hydrogen peroxide was evaluated. The results indicated that the oral health products that contain or release hydrogen peroxide up to 3.6% will not increase the cancerous risk of an individual,[74] hence, it is safe to use in moderation.

Maintenance

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Despite achieving the results of treatment, stains can return within an initial couple of months of treatment. Various methods may be employed to prolong the treatment results, such as:[citation needed]

• Brush or flush out mouth with water after eating and drinking
• Floss to remove plaque and biofilms between the teeth
• Take special care during the first 2 days &#; the first 24&#;48 hours after the whitening procedure is seen as the most crucial period in which you must protect for your teeth the most. Hence, it is vital that non-staining drinks or foods are eaten during this time as enamel is prone to adhere to stains.
• Drink fluids that may cause staining through a straw
• Depending on the method used to whiten the teeth, re-treatment every six months or after a year may be required. If an individual is a smoker or they consume beverages with the capacity to stain, regular re-treatments would be required.

History

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Teeth whitening remedies have been present since ancient times. Despite seeming absurd, some methods were somewhat effective in their results.

Ancient Roman dentists believed in using urine with goat milk to make their teeth look whiter.[75][76][77] Pearly white teeth symbolized beauty and marked wealth. In the Auyrveda medicine system, oil pulling was used as an oral therapy. For this process today, swish coconut or olive oil in your mouth for up to 20 minutes each day. In the late 17th century, many people reached out to barbers, who used a file to file down the teeth before applying an acid that would, in fact, whiten the teeth. Although the procedure was successful, the teeth would become completely eroded and more prone to becoming decayed.[78] Guy de Chauliac suggested the following to whiten the teeth: "Clean the teeth gently with a mixture of honey and burnt salt to which some vinegar has been added."[79] In , oxalic acid was proposed for whitening, followed by calcium hypochlorite.[79]

In the late s, mouthwash containing pyrozone (ether peroxide) was found to reduce cavities while providing a whiter appearance to the teeth.[80] By s and s, ether and hydrogen peroxide gels were used to whiten vital teeth, whereas non-vital teeth were whitened using pyrozone and sodium perborate.[80]

In the late s, Dr William Klusmeier, an Orthodontist from Fort Smith, Arkansas, introduced the custom tray bleaching. However, it was not until that Haywood and Heymann published an article in support of this method. Carbamide peroxide with a shelf life of one to two years, as opposed to hydrogen peroxide with a shelf life one to two months, was seen as a more stable agent for whitening teeth.[80]

Society and culture

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Teeth whitening has become the most promoted and mentioned methodology in cosmetic dentistry. In excess of 100 million Americans brighten their teeth using different methods; spending $15 billion in .[81] The US Food and Drug Administration only endorses gels that are under 6% hydrogen peroxide or 16% or less of carbamide peroxide. The Scientific Committee on Consumer Safety of the EU consider gels containing higher fixations can be dangerous.[citation needed]

As per European Council guidelines, only a certified dental professional can lawfully give tooth whitening products utilizing 0.1&#;6% hydrogen peroxide, provided the patient is 18 years of age or older.[82] In , the UK General Dental Council became concerned of the "risk to patient safety from poor quality tooth whitening being carried out by untrained or poorly trained staff."[83] A public attitudes survey, conducted by the GDC, showed that 83% of people support "policies of regulating tooth whitening to protect patient safety and prosecuting illegal practice."[83] A group of dental professionals and associations called The Tooth Whitening Information Group (TWIG) was founded to advance protected and beneficial tooth whitening information and assistance to the general population. Reports can be made to the TWIG through their website with respect to any individual giving unlawful tooth whitening services, or if an individual has personally undergone treatment done by a non-dental professional.

In Brazil, all whitening items are classed as cosmetics (Degree II).[47] There are worries that this will bring about increasing abuse of whitening products and thus there have been calls for reanalysis.[47]

According to research, tooth whitening can produce positive changes in young participants&#; Oral Health Related Quality of Life (OHRQoL) in aesthetic areas such as smiling, laughing, and showing teeth without embarrassment. However, its main side-effect, tooth sensitivity, negatively affects quality of life.[84]

See also

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References

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Teeth whitening is an increasingly popular beauty treatment today. Influenced by pop culture and celebrities, many people, young and old, seek to improve the appearance of their teeth with tooth whitening products.

As it is a very lucrative market, many new companies are popping up to try and harness the market&#;s possibilities.

Launching such a business can seem expensive and daunting, particularly if you are looking to manufacture your own products. As such, if you are starting it out, it is best to work with experienced teeth whitening product manufacturers that can produce private label products for your new brand. This way, you can safeguard the quality of your products.

Is Teeth Whitening Business Profitable?

The cost of teeth whitening may vary based on a variety of variables, including the kind of whitening procedure performed, the level of staining, and the business&#;s location.

Professional teeth whitening procedures might cost anywhere from $500 to $1,500 or more. It is crucial to remember that the cost of teeth whitening may vary substantially, so before making a choice, it is always advisable to investigate the alternatives and costs available in your region.

Therefore, a teeth whitening business can be profitable if it is well-managed and marketed effectively to the right target audience. Many people are willing to pay for professional teeth whitening services because they want to improve the appearance of their smile. With the right approach, a teeth whitening business can be a successful and profitable venture.

What&#;s the Profit of Teeth Whitening Business

The profit of a teeth whitening business can vary depending on factors such as the location of the business, the cost of materials and equipment, and the pricing structure.

A teeth whitening business can be run out of a physical location or mobile, and can also be offered as a service at a dental office. Some businesses choose to offer take-home kits or online sales. It is difficult to provide an estimate without more information about the specific business.

Based on our knowledge and research, a teeth whitening business can potentially generate a profit margin of around 20-40%.

This can mean for example if a teeth whitening service is priced at $100 per session, the profit margin would be between $20 to $40 per session.

However, it&#;s important to note that this is just an estimate and the actual profit margin can vary depending on the cost of materials, overhead expenses, and pricing strategy of the business. It would be best to research the market and competition in your specific location as well as consulting with a professional financial advisor to determine the best pricing structure and estimate the potential profit of your teeth whitening business.

Do I Need to Be Qualified to Whiten Teeth?

To provide teeth whitening treatments, you do not need to be a certified dental expert in most circumstances.

However, there may be local restrictions and standards that you must follow in order to lawfully provide teeth whitening services.

To ensure that you are operating properly, it is always advisable to examine the rules and regulations in your region before establishing a teeth whitening service.

Additionally, receiving training or certification in teeth whitening treatments may be useful in order to give the best possible service to your customers.

Mobile Teeth Whitening is the New Business Trend

The latest in the teeth whitening business is mobile teeth whitening. There are many different reasons why this is becoming such a lucrative and popular way for people to whiten their teeth.

It is a great way for a new business to start out or for an existing dental clinic to branch out into. Let us delve into some of the reasons why you might want to catch this opportunity in this new business trend.

1. Embrace Client Lifestyles and Busyness

Firstly, people are increasingly busy these days. They do not always have the time available to visit a salon when they could try to whiten their teeth at home. Many are working from home and cannot pop to their usual salon or clinic on their lunch break.

Additionally, many people today prefer things if they are quick and easy and can be done in their own time close to or at home.

The Covid-19 pandemic has impacted and increased this further. With salons and clinics needing to be closed for such long periods, getting an appointment after reopening has been increasingly difficult. Many have had to wait additional weeks just to be seen by their regular teeth whitening expert. As such, creating a business that allows you to visit others&#; homes to carry out treatments is a great idea in these unprecedented times.

Being a mobile teeth whitening business will mean that your clients can access their treatments at their convenience and in the comfort of their own homes, whether the usual spas, salons, and dental clinics are open or not.

Quick Tips: Cosmetic dentistry is going into everyone&#;s home. Think about how to what products can fit the new lifestyle.

2. Think Budget and Finances

Secondly, setting up a salon, spa, or clinic is a great challenge for those who want to go into this business. Many people have a great business idea for a tooth whitening clinic but do not have the funds to invest in a retail space.

Such businesses also need large amounts of stock available and large, laser teeth whitening machines too. For many, it is simply not an option.

Setting up a mobile teeth whitening business cuts out a lot of this expense. The business would not need a large stock and would not need to account for rental space and the bills that come with that. The set-up costs would simply include products, marketing and advertising, insurances, and equipment. It would be a great reduction in the bills!

Quick Tips: A minimum viable product(MVP) is better to start your new business.

3. E-Commerce Benefits and Upselling Opportunities

Thirdly, a mobile teeth whitening business can take advantage of e-commerce opportunities.

Selling your own teeth whitening kit can be achieved alongside appointments in people&#;s homes or you can stock your products in established salons and sell them that way. Additionally, trade shows, medical shows, mall kiosks, and health fairs can all be good opportunities to showcase your products in person if you rent space for these events. Usually, there are small fees for such events, but these are much less than if you had premises the whole time.

Likewise, in terms of e-commerce, you can easily set up your own webpages, social media accounts, and Amazon&#;s FBA model is also a good choice for e-commerce and upselling opportunities. People love to browse and buy things online and grabbing this opportunity could be financially rewarding for your business.

Fast Link &#; Private Label Mobile Teeth Whitening Kits

4. Add-on to Existing Services 

Lastly, if you have your own clinic or salon, offering teeth whitening services is often sold as a great &#;add-on&#; treatment. If someone is coming for lash extensions or a facial, for example, you could offer teeth whitening as an additional treatment to your existing services.

As such, you can take care of your client&#;s teeth and keep that very same customer loyalty that you have built up in other areas of your business.

Quick Tips: Extend your services with a quality but not that expensive product, to bring more customer experience.

Catch The Teeth Whitening Business Opportunity!

As you have read above, teeth whitening is really coming into its own now. It is no longer considered a treatment that only dentists and dental clinics can carry out. Cosmetic dentistry as an industry is exploding! According to a report by Market Insider, revenue from teeth whitening products will likely reach $6.6 billion by !

Many beauty salons and individuals are going it alone to catch the amazing opportunity that mobile teeth whitening treatments can offer. And with good reason! This is a unique time in that there has been a huge increase in social and digital consumerism. This is likely to become one of the main drivers in this market.

However, the other risk is that some companies may not have legitimate and safe products for sale, neither have the right teeth whitening supplier guides advise them. This is why we have already recommended to you to work with an experienced cosmetic dental product manufacturer so that you can take this opportunity and have the backup and support of a well-established, trustworthy manufacturer.

Going it alone takes some bravery, but with the right team behind you, you can reach your product selling goals. If you would like to know more about how Cinoll can help you create fantastic, private-label products, get in touch with us today.

With us on your side, you will be well on your way to not only reaching your client base but also in reaching your goals as a business.

Items to Start Teeth Whitening Business

To start your own business, you will need some items to get everything prepared. Here&#;s a list of the necessary items to present your service to the customers.

Item NameFunctionHow to UseDental BibsTo prevent materials, debris, fluids from contacting the patientAttach the bib around the patient&#;s neck with a bib holder or clipTeeth Whitening Face GauzeTo absorb saliva and other fluids and protect the face from the whitening gelPlace the gauze over the face and under the lips, leaving only the teeth exposedDental RetractorTo retract the lips, cheeks, and tongue and provide better visibility and access to the teethInsert the retractor into the mouth and adjust it to fit comfortablyGogglesTo protect the eyes from light, chemicals, or debrisWear the goggles over the eyes and adjust the strap to fit snuglyGingival BarriersTo protect the gums from irritation or damage by the whitening gelApply a thin layer of the barrier material along the gum line with a syringe or brushBarrier Curing LightsTo activate or accelerate the gingival barrier and enhance its adhesionHold the light close to the gums and shine it for the recommended timeWhitening LED LampTo provide additional light source for better visibility during the procedurePosition the lamp over the patient&#;s mouth and turn it onTeeth Whitening GelsTo lighten the color of the teeth by breaking down stainsApply a small amount of gel to each tooth surface with a syringe or trayTeeth Shade GuideTo compare the color of the teeth before and after whiteningHold the guide next to the teeth and match them with the closest shadeDental Cotton RollsTo absorb saliva and other fluids and isolate teeth during whiteningPlace cotton rolls between the cheek and gum or under the tongue

To start quick, you can just have a chair-side whitening kit with everything you need like this:

Teeth Whitening Business Models

Teeth whitening is a popular cosmetic dental procedure that can help improve the appearance of discolored or stained teeth. There are several different business models for starting a teeth whitening business, each with their own advantages and disadvantages. Here are a few of the most common models:

1. In-office whitening: This model involves performing the whitening procedure in a dental office or clinic, typically using a high-powered whitening gel or laser. Advantages of this model include the ability to deliver fast and effective results, and the ability to provide professional supervision and care. However, the cost of setting up an in-office whitening business can be high, and there may be some challenges in attracting and retaining customers.

2. Take-home whitening: This model involves providing patients with a take-home whitening kit, which they can use to whiten their teeth on their own schedule. Advantages of this model include the ability to reach a wider customer base, and the lower cost of setting up a take-home whitening business compared to an in-office whitening business. However, the results from take-home whitening may not be as dramatic as those from in-office whitening, and there is a risk that patients may not use the kit correctly or may experience side effects from overuse.

3. Beauty spa: Beauty spas usually provide a variety of services aimed at improving a person&#;s looks and well-being. Teeth whitening is a complementary service that works well within this paradigm because it improves the general look of a person&#;s smile while also increasing confidence and self-esteem.

4. Mobile whitening: This model involves providing teeth whitening services at a location of the customers choice, such as their home or office. Advantages of this model include the convenience for the customer, and the ability to reach a wider customer base. However, the cost of setting up a mobile whitening business can be high and the results may not be as effective as in office teeth whitening.

5. Online sales: This model involves selling teeth whitening products online, such as whitening gels and strips. Advantages of this model include the ability to reach a global customer base, and the low overhead costs associated with running an online business. However, the results may not be as effective as other methods, and it can be difficult to establish a reputable brand in a crowded market.

6. Hybrid Model: This model is a combination of above-mentioned models, this can be a combination of in-office whitening and take-home kits, mobile and online sales, etc. This model can be more effective as it can provide a range of options for the customers to choose from and can be more profitable as well.

Steps to Start Teeth Whitening Business

To start a teeth whitening business, you will need to follow these steps:

1. Research and understand the teeth whitening industry: It is important to research the teeth whitening industry to understand the competition, the demand for teeth whitening services, and the regulations governing the industry in your area.

2. Develop a business plan: A business plan is a document that outlines your business idea, including your target market, your unique selling proposition, your financial projections, and your marketing and sales strategy. A well-written business plan can help you secure funding and attract investors.

3. Obtain necessary licenses and permits: Depending on where you are located, you may need to obtain licenses and permits to operate a teeth whitening business. This could include a business license, a dental hygiene license, and a permit to use specific teeth whitening products.

4. Choose a location: The location of your teeth whitening business will impact its success, so it is important to choose a location that is easily accessible and visible to potential customers. Consider factors such as foot traffic, parking availability, and proximity to other businesses that may attract your target market.

5. Purchase equipment and supplies: To provide teeth whitening services, you will need to invest in equipment and supplies such as a teeth whitening lamp, whitening gel, and protective eyewear. You may also need to invest in other equipment such as chairs and a reception area.

6. Market your business: Once you have everything in place, you will need to market your business to attract customers. This could include advertising in local publications, creating a website, and utilizing social media to promote your services.

7. Provide high-quality services: The key to success in the teeth whitening industry is providing high-quality services that meet the needs and preferences of your customers. This may require ongoing training and development for you and your team, as well as investing in the latest technology and products.

30 Name Ideas for Teeth Whitening Business

Do you want to establish a teeth whitening company and need a name that represents your identity and services? Choosing the correct name for your company can have a substantial impact on its performance. 

To distinguish your company from rivals, it should be catchy, unforgettable, and one-of-a-kind. We&#;ve collected a list of 30 teeth whitening company name suggestions to help you stick out in a crowded market. Examine these teeth whitening business name ideas to find the one that best reflects your company and connects with your target audience.

1. PureSmile Teeth Whitening
2. BrightenUp Teeth
3. SmileWorks Whitening
4. CrystalSmile Whitening
5. WhitePearl Teeth Whitening
6. SparkleWhite Co.
7. Luminate Teeth
8. ClearSmile Whitening
9. BrilliantSmile Whitening
10. IvorySmile Co.
11. PearlShine Teeth Whitening
12. RadiantSmile Co.
13. SnowWhite Teeth
14. PlatinumSmile Whitening
15. DiamondBright Whitening
16. PearlyWhite Smile
17. PureRadiance Teeth
18. GleamingWhite Co.
19. Opalescent Teeth
20. The Whitening Place
21. Brightly Whitening Co.
22. Tooth Sparkle Co.
23. CleanWhite Teeth Whitening
24. BrightenYourSmile Co.
25. Shimmering Smiles
26. BeamingBright Teeth
27. Crystalline Teeth Whitening
28. BrightUp Teeth Whitening
29. Polished Pearl Whitening
30. Luminous Teeth Whitening.

&#; More teeth whitening business name ideas here!

30 Slogans for Teeth Whitening Business

Having a bright and attractive grin is more essential than ever in today&#;s culture. Many people are looking for efficient methods to whiten their teeth and attain a brighter, whiter grin. As a teeth bleaching company, it&#;s critical to have a powerful brand image that distinguishes itself from the competition. That&#;s where these slogans come in; they&#;re meant to capture prospective consumers&#; attention and make a lasting impression.

Whether you want to draw new customers or keep current ones, these slogans will help you market your company and highlight the benefits of teeth whitening services. So, without further ado, let&#;s get started and find the ideal catchphrase for your teeth whitening company!

1. Smile brighter with our teeth whitening services.
2. Say goodbye to yellow teeth.
3. Get a whiter, brighter smile in just one visit.
4. Reveal your brightest smile yet.
5. The power of a bright smile.
6. Your best smile is waiting for you.
7. Transform your smile with our teeth whitening services.
8. Brighten up your day with a brighter smile.
9. The key to a confident smile.
10. Let your smile shine.
11. Let us help you achieve a perfect smile.
12. Because a brighter smile is always in style.
13. Love your smile again.
14. A whiter smile is just a visit away.
15. Brighten your day, one smile at a time.
16. Enhance your smile with our teeth whitening services.
17. Confidence starts with a brighter smile.
18. Your smile is our top priority.
19. Unleash your true smile with our teeth whitening services.
20. A brighter smile, a brighter you.
21. It&#;s time to love your smile again.
22. Say hello to a whiter, brighter smile.
23. Make your smile your best accessory.
24. Life is too short for yellow teeth.
25. Give your smile the attention it deserves.
26. Because a beautiful smile is priceless.
27. Experience the joy of a brighter smile.
28. Let us bring out the best in your smile.
29. The perfect smile is just a treatment away.
30. Smile with confidence thanks to our teeth whitening services.

Start Quick : How to Combine AI in Your Teeth Whitening Business

Integrating AI into your new teeth whitening business can streamline operations, enhance customer experience, and ensure you stay at the cutting edge of dental cosmetic services. You can use AI app such as ChatGPT, Stable Diffusion, etc. Below are ways AI can be utilized in your teeth whitening salon or spa:

1. Use AI to Generate Branding

AI-Driven Logo Design:

Use AI-powered graphic design tools to create a unique logo for your brand. These tools can generate a variety of designs based on your preferences in style, color, and iconography.

Brand Name and Tagline Creation:

AI can help brainstorm brand names and taglines by using natural language processing to understand the context of your business and generate creative and relevant options.

Content Creation:

AI content generators can help you craft marketing materials, website content, and social media posts that are optimized for search engines and tailored to your target audience.

Market Analysis:

Leverage AI to analyze market trends and consumer preferences. AI can process vast amounts of data to inform your branding strategy, helping you position your business effectively in the market.

2. Learn Latest Whitening Knowledge with AI

Stay informed about the latest advancements in teeth whitening by using AI to sift through research papers, articles, and studies. AI can summarize this information, highlighting key points and new techniques.

3. Appointment Scheduling

Implement an AI scheduling system that allows clients to book, reschedule, or cancel appointments through a user-friendly interface. AI can manage the calendar, send reminders, and optimize the scheduling to reduce downtime.

Plus: How Do I Get Teeth Whitening Clients

There are several ways to attract clients to a teeth whitening business, including the following:

1. Offer promotions and discounts: Consider offering promotions and discounts to attract new clients to your business. For example, you could offer a discounted rate for first-time clients or a discount for multiple whitening treatments.

2. Advertise your services: Use targeted advertising to reach potential clients who are interested in teeth whitening. This could include advertising in local newspapers or on social media platforms.

3. Build a website: Create a professional website that showcases your services and provides information about the benefits of teeth whitening. This can help attract new clients and also make it easier for existing clients to book appointments or learn more about your business.

4. Network and collaborate with other businesses: Reach out to other businesses in your area that serve a similar target audience and explore opportunities for collaboration or referral programs. For example, you could partner with a local salon or spa to offer teeth whitening services to their clients.

5. Provide excellent customer service: Make sure that you provide excellent customer service to all of your clients, as this can help attract new clients through word-of-mouth recommendations. This could include offering a comfortable and relaxing environment, providing detailed information about the whitening process, and following up with clients after their treatment to ensure their satisfaction.

Teeth Whitening Business FAQs

What teeth whitening products are good starts?

Three good choices: teeth whitening kits, teeth whitening strips or teeth whitening toothpaste.

Why? Teeth whitening kits are quick and easy to use teeth whitening products that can whiten teeth in as fast as 10 minutes. These whitening results offer you instant marketing materials.

Teeth whitening strips are easy to use and small in sizes. They&#;re cheaper in shipping and lower priced than teeth whitening kits, so that you can have quick money-back.

Teeth whitening toothpastes are really good choices when you have clients or repeat customers that need long-term whitening. As perfect daily-used whitening products, it supports your teeth whitening business in a much longer way.

Does Cinoll help with business customization?

Of course. We believe you have a logo for your business and with that we can provide you a demo with your logo on it so you can have a compete picture of your products.

Do I need to consider the formulation?

Well, formulation is the foundation of your good sales. If you have no idea what teeth whitening ingredients work best, Cinoll can definitely help. Since we&#;re factory of many top teeth whitening business, we understand popular ingredients and how long will they work. So don&#;t hesitate and ask us for free advice.

Do I have to order large volume to start?

Oh that&#;s absolutely not. For teeth whitening business starters, we understand the order quantity you need. Therefore, we have many ready-to-custom products which can be private labeled in low MOQ. Ask Cinoll team for product information.

The company is the world’s best peroxide free whitening strips supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.