A new whitening approach
This full-day course included both lectures and practical sessions with a live demonstration of the techniques on a patient. Each course is limited to a small number of delegates so that everyone can be given individual attention.
Questions are encouraged and group discussion welcomed.
The morning opened with a discussion of the aetiology of tooth discolouration including a classification of extrinsic and intrinsic staining. Only by understanding the type of stain, its cause and its anatomical position can practitioners formulate a reliable treatment plan. The importance of giving patients realistic expectations of the probable outcomes of whitening was emphasised as was the need to provide a proper consent form explaining both anticipated benefits and possible limitations.
‘Under-promise and over-deliver’ was the key; explanation before treatment will be seen as information whereas explanation afterwards may be perceived as an excuse!
Moving on to shade taking, the importance of using natural daylight or lamps and devices producing light at 5500K was stressed. The place of spectrophotometers was considered and the importance of reliable photographic records emphasised. Most usefully, Dr Chan demonstrated a method of taking excellent clinical photographs with inexpensive ‘point and shoot’ pocket cameras. Not all clinicians own a dedicated SLR set with close-up lens and ring-flash but the method described results in perfectly adequate images for inclusion in the patient records.
Lectures were supported by a comprehensive slide show.
After a short break, the lecture moved on to a discussion of the current legal position concerning tooth whitening in the UK and then a comprehensive discussion about the products at our disposal including their chemistry, modes of action and physiological impact.
While I admit attending a lecture on ionic exchange, carbon bonds and the action of free radicals would normally leave me cold, Dr Chan’s engaging and enthusiastic style made this section fascinating and a pleasure to watch. Most importantly, it impressed upon colleagues how necessary it is to have a working knowledge of the behaviour of both chemicals and teeth if treatments are to be safe and reliable.
As we all know, there are several ways of whitening teeth but in all cases patient compliance is paramount. To ensure this, our treatments must be painless, easy to use, give rapid results and fit into our patients’ lifestyles.
The drawbacks dental professionals encounter when providing tooth whitening often include:
• Lack of compliance
• Patient dissatisfaction with the result
These drawbacks may be overcome by:
• Approaching the procedure in a logical way
• Having a full understanding of the mode of action of the chemicals used
• Keeping meticulous records
• Using proper counselling techniques before and after the treatment.
The next part of the presentation centred on addressing these issues and went into some detail describing various tooth whitening protocols, discussing their advantages and disadvantages and suggesting the most acceptable techniques for ensuring patient satisfaction. The issue of power whitening received much attention. As we are now constrained in what we can use for this procedure, the application of sound scientific principles is essential in maximising our results. In essence, tooth whitening is not complicated. It relies upon the principles of diffusion that, in turn, are based upon concentration, time and temperature.
There is, of course, a little more to it than that including the reactivity of the chemicals used, the physical and chemical properties of the gels and their delivery systems. Pertinently, we are now limited on concentration but patients still want quick results. This leaves us with possibilities of enhancing the reactivity of our chemicals and using them at higher temperatures but how to do this without causing sensitivity?
This is where the benefits of Dr Chan’s research really come into their own. Studying the density and porosity of enamel as well as the physiological response of the pulp tissue he was able not only to advise on reliable treatments but also accurately predict their outcomes. By first carrying out a careful examination, then noting shade changes during tooth isolation, he explained how to formulate individual treatment plans, including advice on the thickness of gel for each individual tooth, the intensity of heat and the time required.
The final part of the morning session was taken up with a step-by-step account of how to prepare a patient for power whitening and the use of sealed whitening trays using minimal amounts of gel.
In the afternoon, a patient arrived and kindly agreed to allow us to watch her ‘live’ treatment. A full examination had been performed and a careful medical and dental history taken. It is essential to do this in order to identify any potential problems or contra-indications prior to treatment. Pulp-testing and radiographs may be indicated as well as the visual examination.
The patient had had counselling and had signed an appropriate consent form. She was to undergo power whitening followed by home treatment with trays.
Delegates were invited to take starting shades using the daylight-mimicking aids provided and then take the shade again after isolation had been placed to draw the conclusions that can be inferred from dehydration shade changes. During the 45-minute treatment time further lectures were provided; again stressing the importance of taking every precaution to avoid tissue damage or sensitivity.
One of the major disadvantages of power whitening is patient dissatisfaction following ‘rebound’; the tendency of the whitening effect to quickly diminish as the teeth re-hydrate. The reasons for this and its avoidance was explained and delegates instructed in the techniques necessary to ensure reliable results.
At the conclusion of her treatment the patient was more than happy with the result and confirmed she had experienced absolutely no discomfort during the procedure.
The day ended with a general recapitulation of what had been taught and a further opportunity to ask questions and discuss the scientific principles of the technique promoted as well as the details of procedures themselves.
The course was demanding. There was a very great deal of information provided in a relatively short space of time; much of it based on new research. Fortunately, excellent course notes were provided for later review and Dr Chan offered his support to any delegate who needed to contact him about any aspect of the course. In addition to the notes delegates were provided with useful examples of examination forms, consent forms and patient information.
I have been involved in tooth whitening for many years and have studied the subject in some depth. Despite that this course provided me with a great deal of valuable additional information that will certainly change my approach on how I offer services. I was especially impressed with the thought and research which had gone into the presentations; virtually every slide contained an extensive list of published references supporting each point delivered. As well as its scientific content the course provided countless clinical tips suitable for immediate application in general practice.
Philip Lewis has a general dental practice on the Isle of Wight
Dr Wyman Chan has an interest in tooth whitening. So much of an interest in fact that his PhD thesis explored the action and chemistry of bleaching products specifically with a view to minimising the problems dentists face when providing this most popular cosmetic treatment. Over a period of 10 years, Dr Chan has trained more than 2,000 dental professionals in whitening techniques and has this year completely updated his course to address new developments in research and encompass the constraints of the regulations imposed in October 2012. Dr Chan holds his tooth whitening training sessions monthly at his practice. He can be contacted at [email protected] or visit drwymanchan.com