Cheap teeth whitening by ‘Fabulous Tan/Studio/Group/Smile’? Not too fabulous.

#section vetted by the caring Dr Tan Chuan Sien of Icon Dental Surgeons

Just Google for Teeth whitening and FabulousTan.sg pops up on the sponsored search. You look at your search box wondering if you could get that far a typo from ‘teeth whitening’ to ’sun tanning’ (which they pop up tops on the Google’s sponsored links as well). But on further clicking, you realise that they do indeed provide teeth whitening under the arm of ‘Fabulous Smile’.

So how does a company that started off with Tanning do with Whitening? The first darkens and the latter lightens. Maybe it keeps the Yin and Yang of the company in check. Most importantly, how do they fair at a treatment everyone goes to a dentist for? From what I found out, ‘Not too fabulous‘

#But firstly, let’s go through some of the steps in teeth whitening done by a dentist.

Pre-teeth whitening

1. Consultation
   Questions like “Do you have sensitive teeth?” must be asked and a precautionary warning that if you have very sensitive teeth but still want to go ahead with the whitening, you might experience strong teeth sensitivity. Often, a brief questionnaire is used to ask relevant questions.
2. Examination of teeth condition
   Some signs to look out for would be amount of plaque and tartar (stuff that don’t go away with brushing) on teeth surface, especially on the front where the whitening agent will be put.
3. Scaling & polishing (dental cool term for cleaning of teeth surface)
   By getting rid of the tartar, the whitening agent can be effectively applied on the teeth surface, giving an even opportunity for the entire surface to be exposed to the oxidising agent.
   However, as Dr Tan Chuan Sien has added, scaling is sometimes NOT done immediately prior to the whitening procedure as it may cause some gum bleeding, which interferes with the whitening procedure.
4. Expectations discussed
   The pateint’s expectations should be discussed: the shade difference after in-office whitening (eg using the BriteSmile system) is about 8-13 shades. Fillings, crowns and veneers on visible front teeth will NOT whiten together with natural teeth. Teeth affected by Tetracycline (a type of antibiotic) staining may require repeated whitening to achieve the same result as normal teeth.

Prep for teeth whitening

5. Applying protective gel-like layer on gums
   As the whitening agent is made up predominately by Hydrogen peroxide H₂O₂ (strong oxidising agent), the gums along the edge of your teeth must be completely sealed to prevent damage and to your gums. If this protective layer is not properly done, you will experience a stinging-biting sensation to your gums during the process.
6. Covering skin surface exposed to teeth whitening light
   Light used to ‘activate’ the whitening agent to rapidly release hydrogen peroxide might give off heat as cause some discomfort to lips, therefore cotton gauze or other protective material is used to cover your lushes lips.
7. Protective tinted glasses are worn to protect the patient’s eyes
   As the light used during teeth whitening can be quite bright, dentist would provide patients with protective tinted glasses to be worn during the light shining section. This way the patient can not only look quite cool, but also feel comfortable opening their eyes to look around.

Actual teeth whitening

8. Applying whitening agent (gel) on teeth + shining light
   This is where the whitening process takes place. Whitening gel(oxidising agent) is place on the exposed teeth and light is use to activate and speed up the oxidizing process. The light is left on shining on your teeth for around 10 - 15mins depending on the teeth whitening system used. After which you take a break and the gel is reapplied for another cycle. Most of the time, you’ll be sitting through 3 - 4 cycles and have the whole process done in 1 hour.

Post teeth whitening

9. Sensitivity & taking care of your smile
   As the micropores on your teeth are now exposed, your teeth are sensitive and cold drinks feel uncomfortably cold. You could be given sensitive toothpaste which helps to patch up these micropores to ease the sensitivity. Sensitivity, which could last for 1 or 2 days, can be relieved with over the counter painkillers eg Panadol.
   *VERY IMPORTANT* No dark coloured foods and drinks should be consumed for the next 24 hours. Frequent consumption of such foods or smoking after that period will accelerate re-staining of the teeth. On top of that, abstinence from anything staining (e.g. soya sauce, tea, coffee, red wine etc) for the next few weeks would help keep in the white-ness.
   Also available are home maintenance kits (eg. BriteSmile To Go) can be purchased to maintain the level of white-ness for the next 2-3 years. Sensitivity (which can last for 1 day)

Now that we understand how a teeth whitening is done by a dentist, I wonder how points 1, 2 & 3 could be done by a smile therapist. What experience does a smile therapist or what level of formal education of teeth did they go through to do even an thorough examination of their customer’s teeth condition? FabulousSmile uses SmileQuest teeth whitening system and smile therapist undergoes certain form of training. (Quote from SmileQuest brochure)

“How easy is it to become a SmileQuest smile therapist?
Lazer Teeth Whitening is a cosmetic procedure, therefore you will find it is no more difficult a technique to learn than any other beauty treatment you already practise in your salon.Your training will include in-depth anatomy of the mouth and tooth as well as the four easy steps to the teeth whitening procedure.You will also undertake supervised practical sessions until you are confident in carrying out the treatment. On completion of the two day training course you will qualify as a SmileQuest ‘Smile Therapist’…”

After their training, are they supposed to accept anyone and everyone that would like teeth whitening?
No! Not everyone. Quoted from www.smilequest-london.com.

Are there any people for whom tooth whitening is not a good idea?
Individuals with a history of extreme sensitivity to hot and cold food or drink, fracture lines in their teeth, large dental pulps, and severe loss of enamel may not be suitable candidates for tooth whitening as the procedure may precipitate sensitivity.

Decay, periapical lesions, and gum disease should be treated before any tooth whitening procedure is carried out. Tooth whitening should not be carried out on individuals with a peroxide allergy.

It’s quite surprisingly that their smile therapist would be able to detect “fracture lines in their teeth, large dental pulps, and severe loss of enamel” after the 2 day training course.

Also, interesting to note, SmileQuest uses strong concentrations of 15-35% hydrogen peroxide (according to their website smilequest-london.com) which is what standard dental clinics use in comparison to lower concentrations that can be bought off the shelf at Watsons or Guardian.

Curious about the experience of customers that have gone through FabulousSmile, I went on to interview Brenna, a customer that was attracted by their teeth whitening package:

1. What made you and your bf choose a tanning studio like FabulousTan to do teeth whitening?
   Well, I was actually contemplating on whether to go for the Dental Studio at Paragon which charged $700+ for 1 person, then i went on to search and found FabulousStudio which charges $699 for 2 persons. Was really tempted by the low price, but the process really shocked me quite badly. But then again, I haven’t done teeth whitening at a professional dental clinic before, hence i really don’t know how it should be like.
2. What happened when you arrived? (did you require to fill up a form, did they ask any questions like are your teeth very sensitive etc)
   When we arrived, we were given a form to fill up, sounds like an indemnity form rather. And some other points on how to take care of our teeth after the treatment. Could’nt really remember what else was asked.
3. During the teeth whitening process, how did you feel and what did the staff do?
   The process was horrific. It started quite okay. I had 4 applications done on me, which lasted for an hour. After 20-30minutes, the pain was severe, it was biting into my gums. So i told the lady and she kinda just wipe off some of the gel thingy and continued with the process.
4. Would you recommend teeth whitening to others done by FabulousStudio?
   I definitely wouldn’t recommend anyone else back to FabulousStudio. I didn’t know that the procedure was not done by a professional dentist and i’m pretty sure there isn’t any effect at all.
5. After your teeth whitening, how long was the “pain/ sensitivity”?
   After the treatment i had very sore gums for the next 2 weeks! It was really that bad that i called up Fabulous and told them about it but was told that it was normal. And so i have no other choice but to endure with the pain, and i also bought gum protection gels from the pharmacy cos it’s really that bad.
6. How much did you pay in total?
   As discussed, i paid a total of $699 for 2 persons.

More about Brenna’s experience can be found on her blog dat0u.blogspot.com

I further research to find other bloggers giving somewhat of a similar experience going to FabulousSmile for their teeth whitening.

From http://lavenderlullaby.wordpress.com/2009/03/18/not-so-fabulous-afterall/

Quote: “…so moral of the story: to everyone out there who dreams of a hollywood smile like me, please please please do your research well and NEVER trust a local tanning studio to do your teeth whitening (seriously i must be out of my mind..). ALWAYS ONLY TRUST CERTIFIED DENTISTS”

and from http://littletwinstarblue.blogspot.com/2008/03/been-for-teeth-whitening.html

Quote: “…The pain increase with each application!!! ARRR.. I ad to go through 3 applications.. Imagine the discomfort i was going through.. Till the last application i almost wan give up as the pain was a little too much for me to handle.. But the S***(smile therapist) just keep saying it’s NORMAL!!!”

After reading many other complaints about FabulousSmile’s teeth whitening, I began to question if they were even allowed to provide such a service in Singapore. I went on to seek advice from the ever smiling and friendly Singapore Dental Association (SDA) Ethics Committee regarding teeth whitening done by a non-dentist.

Below is their reply:

Dear Editor MySingaporeDentist,

Your questions have been forwarded to me at SDA Ethics Committee. Because your questions concern treatment by non-dentist, we have also consulted MOH to get some feedback so that we can give you a more complete answer.

Q: Can teeth whitening be done by a non-dentist?

1) It is the opinion of SDA Ethics Committee that for Teeth Whitening to be done effectively and safely, it has to be performed by a dentist.

2) Issue of Effectiveness

• Almost all effective teeth whitening procedures requires some form of peroxide, usually hydrogen peroxide or carbamide peroxide.
• According to HSA (Health Science Authority), non-dentist can only use hydrogen peroxide to a limit of 0.1%.
• It is our opinion that at such extremely low concentrations, done in 1 hour, the teeth whitening is not effective.
• Bottom line, if non-dentist use a concentration higher than 0.1% it is against the law. If they use concentrations of less than 0.1% for only 1 hour, it is not effective and could be construed as false advertising.

3)Issue of Safety

• Teeth whitening is definitely not indicated if there is gum disease (periodontitis) or if there are teeth decay. Therefore it is vital that a proper Examination & Diagnosis by a dentist is done before teeth whitening.
• Peroxide can cause also chemical burns to the gums if they are not properly protected.
• Teeth Whitening can also cause teeth to become very sensitive especially if the enamel is thin or if there are cervical cavities.
• If there are existing deep decay, or leaking fillings, peroxide can be damaging to the pulp(nerve) of the tooth.

4)Infection Control

• Another important safety issue is infection control. This is to make sure that infectious diseases like HIV, Hep B, Tuberculosis, SARS etc are not spread from 1 patient to another.
• All Dental clinics are licensed by MOH and they will conduct inspections to check on the infection control procedures to make sure that equipment used to treat patients are disposable or properly sterilized.
• Teeth whitening performed at premises of non-dentist are not checked for proper infection control procedures to prevent cross contamination.

Q: If a patient suffers from chemical burns or extreme sensitivity (due to incorrect examination) as a result of teeth whitening done by a non-dentist, can the patient come to the SDA for help?

If a patient is hurt by teeth whitening procedures by non-dentists, they can definitely approach the Singapore Dental Association.

• We will discuss with them to find out more about their complaint, analyse the situation and advise them how to proceed.
• We can help arrange for them to assess the damage to their gums, teeth etc and also try to help the patient solve the problem.
• We can refer the patient to the relevant authorities who will investigate if the non-dentist is using a concentration or procedures that are not approved by HSA.
• If the non-dentist is found to be breaking the law by using an unapproved product or has been negligent in their treatment, the patient can consider a legal claim against the non-dentist.

I hope we have managed to answer your questions, if you have any further queries please do not hesitate to contact me as the Singapore Dental Association is very concerned about issues regarding patient safety.

Thank you for your kind attention

Best Regards

Dr Raymond Ang
Chairman
Singapore Dental Association
Ethics Committee

Before you start shouting ONESIDED, BIAS, UNFAIR! to what is reported so far, I did email Bernard (General Enquiries), Zephron (Marketing Affairs) and Richard (Business Opportunities) from FabulousTan to comment on their teeth whitening procedures but unfortunately I did not get a response. But I am open to their comments after posting this story.

Having said all this, in the UK, teeth whitening is considered a ‘cosmetic procedure’ and can be done by a non-dentist.
“Tooth whitening products were confirmed as being cosmetics on 28 June 2001 by the House of Lords ruling in the case of Optident Limited V The Secretary of State for Trade and Industry. This means that they fall under the EU Cosmetics Directive (implemented in the UK by the UK Cosmetic Products (Safety) Regulations 1996). “

For all the Singaporeans that are looking for cheap teeth whitening, you might want to reconsider and have it done by a dentist. Or if you’re more attracted by FabulousTan’s price tag, do share with all of us about your experience.

*Photos (male & female model) taken from Fabulous Smile’s brochure