A case of whitening ‘failure’

It was supposed to be a routine whitening follow-up visit. The record indicated that the patient began with a shade of C3. Home whitening was performed for approximately one week, using 10% Carbamide Peroxide. Her shade at the follow-up visit was B1, but the treatment was still deemed a failure.

How is that possible? Easily. Clinically, her treatment was a success by anyone’s standards — anyone that is except for the patient. When Mrs Johnson arrived for the follow-up visit, she made it painfully clear that she was disappointed.

Given her demeanor, and the starting shade (C3), I anticipated that I would see little or no result from the whitening. Upon examination, however, my staff and I agreed that she had achieved an enormous result, almost equal to a B1.

The failure was not in the bleach, but in our team’s inability to adequately set proper expectations prior to the treatment. Mrs Johnson simply wasn’t happy with her new shade and was certain she should have achieved a much brighter result.

‘Under promise and over deliver’ is the phrase that should have been followed in practice. Instead, Mrs Johnson clearly had unrealistic expectations of the potential for home whitening.

Alternatively, Mrs Johnson’s pre-treatment conversation should have gone something like this: ‘Mrs Johnson, today we’ll be taking impressions to make the custom trays for your home whitening. Just to recap what we said at your planning visit, I’d like to review what we said you may expect for results. The shade you see here is C3. Please take a look in the mirror, and verify that you agree that C3 matches your starting point. Now, take a look at this tab here. This is C2. I can guarantee you that your result will be at least as bright as C2.’

If we had set out the expectations like this at the outset, we’d never have reached the mutually disappointing post-treatment visit of Mrs Johnson. She was unhappy because she believed her teeth should have been even whiter, and me because we’d done a terrific job and the patient had failed to recognise it.

It’s far better to lose an occasional treatment that hasn’t been started yet, rather than to over promise to make the sale.

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