Tooth whitening 101 – part four
Dentistry Study Club hosted various webinars with Andy Wallace, Megan Fairhall and Affan Saghir on tooth whitening recently. Here is the fourth in a five-part series covering everything you need to know about offering tooth whitening in your dental practice.
Lockdown has been an opportunity for the dental profession to catch up on their education.
Philips Oral Healthcare sponsored a number of webinars on tooth whitening. The Philips team were delighted to see how so many dentists, hygienists and therapists were enthusiastic to learn more about the subject.
Aerosol-free tooth whitening is an attractive practice builder, which can involve the whole dental team. Here are the questions and answers provided by Dr Affan Saghir, Dr Andrew Wallace and dental hygienist Megan Fairhall during their webinars.
Can whitening be overdone – will it change the structure of dentine – if so how?
Andrew Wallace: There is some evidence of minor changes to the enamel and dentine in the so-called bleachorexics.
Can repeated use of teeth whitening cause enamel translucency? And can whitening damage the enamel?
Andrew Wallace: Only in severe cases where the patient is overdoing it extremely can we see minor changes to the enamel and dentine.
It is therefore safe to whiten for tetracycline patients for months at at time.
Can patients ever have bad reactions to the gel?
Andrew Wallace: I am sure it is possible, but I have not come across any reports of this.
Patients often ask if whitening weakens the teeth. How do we respond to this?
Andrew Wallace: My typical response is a single can or bottle of a fizzy drink does more harm than weeks of whitening.
It is entirely safe to have dentist-prescribed whitening.
What about patients with Bruxism?
Megan Fairhall: For patients who grind their teeth a lot, I recommend day time whitening. They can carry on wearing their night-guard.
Otherwise trays would need replacing more often if they wear them out.
What impact does whitening have for patients with fluorosis?
Andrew Wallace: As shown in the case presented, it will improve dark patches.
White patches will initially get more noticeable as the enamel becomes more opaque. But after treatment, the white patches fade back to the initial opacity. The differential with the whiter tooth is also less.
Should we be concerned about dental erosion?
Megan Fairhall: Studies have shown little to no effect of whitening on tooth enamel. This is reassuringly what you can tell patients.
Everything has been long-term tested and there are lots of studies behind that.
The one whitening session is often compared to a fizzy carbonated drink or acidic fruit, which many have in their diet. Saliva also tends to remineralise afterwards anyway.
On average, how long does it take for patients to get a good result?
Andrew Wallace: It depends. But two to three weeks, six tubes of Daywhite or night white gel is sufficient for most.
How long will the effects of tooth whitening last for?
Andrew Wallace: I discussed the 3×3 protocol I use for maintenance but some patients do not require as much.
How would you deal with a patient who says: ‘I don’t want my teeth to look unnaturally white’? How do you assess what is unnatural in their point of view?
Andrew Wallace: With take-home whitening they can be the judge. Some people say the whites of the eyes should be the shade. Brighter than this looks unnatural.
Any tips for taking an accurate shade?
Andrew Wallace: Good lighting, a good camera, also standardising the photo with a vita classic shade guide.
How do you control the outcome of whitening to the expected outcome and to the shade expected by the patient?
Andrew Wallace: It is vital that you understand the patient expectations pre-operatively. Then make sure they are within the realms of possibility.
Chairside whitening will normally get six shades of improvement on a vita shade guide set in value order. Take home can be as much as eight shades. But if the teeth are whiter to begin with then the visible change is less.