New York -- The aging of the nation's moneyed baby boomer willing to spend millions on that million-dollar smile has led to an explosion on drugstore shelves of products most people used to see only every six months at the dentist's office.
With the array of oral equipment now available, just about all you need to turn your bathroom into a dental office is a swivel chair and Muzak.
Going to the dentist's office has always set people's teeth on edge, and adding to dental-chair jitters is the growing apprehension of contracting HIV from an infected dentist or unsterilized equipment.
"Fear does play a part in it," says Eli Cohen, head of purchasing for Duane Reade pharmacies. "People want to keep [visits] down to once or twice a year."
But dentists say fear should not deter people from checkups. "I have sensed nervousness, and patients sometimes remark, 'I'm glad to see you're wearing gloves,' " says Dr. S. Sigmund Stahl, professor of periodontics at New York University.
A quick scan of the tooth-care department of your local drugstore will reveal, in addition to the usual range of mouthwashes, toothpastes and flosses:
* Orapik, much like the sickle-shaped curet your hygienist uses to scrape plaque (about $6).
* The Butler Mouth Mirror, shaped like the probing mirror your dentist uses (under $2).
* Doctor's Tooth Polisher, a battery-operated instrument similar to polishers used by dentists (about $8).
* Stim-U-Dent plaque removers.
* Suisse-Pik gum stimulaters.
* Butler's Proxabrush, pipe cleaner-shaped brushes designed to get between the teeth (under $2).
* Special rinses designed to reduce plaque buildup.
For those who don't bristle at paying upward of $35, there are Water Pik, which cleans teeth and gums with a jet of water, and Interplak, a toothbrush with rotating bristles to get under the gum line.
Also turning pharmacy aisles into the Great Whitening Way is a variety of bleaching processes, introduced about a year and a half ago on cable television "infomercials" for about $50.
The active ingredient in whiteners is peroxide, and the most effective brands have about 6 percent, says Joe DeKama, president of J. D. Cosmetics, Fort Lee, N.J., which sells White Step. "People worry about the safety, but dentists use as much as 25 percent."
"Whether they are effective is something that must be looked at," says Dr. Stewart Hirsch, associate dean of the New York University College of Dentistry, adding they don't work on embedded stains such as those caused by the antibiotic tetracycline.
While some over-the-counter dental instruments may be beneficial -- or at least benign -- others could be dangerous.
"I'm no fan of the metal curets [sharp, sickle-shaped picks]," says Dr. Stahl. "Orapik or any sharp instrument can slip. Even instrumentslike Proxabrush can cause injury. I've seen patients jab themselves and get nasty bleeding."
And even the most careful, diligent patients can't detect what's lurking below the surface. "The patient can't get under the gum, and that's where most of [the damaging bacteria] forms," Dr. Stahl says.
While over-the-counter rinses can help keep down plaque (which can lead to gum disease), Dr. Stahl says the best periodontal mouthwash is chlorohexidine, marketed as Peridex
and available in the United States only by prescription. (It is available without prescription in Europe and Canada.)
Toothbrush options like Waterpik and Interplak are especially effective for those lacking the dexterity to brush properly, Dr. Stahl says, but he cautions against going without periodic checkups. "If patients turn to over-the-counter maintenance, it can create a false sense of security."