Managing challenging whitening cases

Alif Moosajee explains how to overcome some technically demanding tooth whitening challenges.

When it comes to tooth whitening in my practice, we treat a variety of different age groups – and each one is treated differently. 

As my focus is now limited to implant treatment, my patients are generally older than the ones seen by my associates who focus on composite bonding and Invisalign treatments. It is therefore important to differentiate how one manages patients’ expectations to save yourself many headaches. 

Time and care should be taken when going through the whitening details with patients. A tailored approach should be made when consenting patients, being mindful of different age groups and specific presentations that we see.

Understanding colour

Understanding colour in dentistry can greatly help to understand when whitening cases will be straightforward and when they will be more challenging. This greatly aids predictability.

It is first important to recap some of the basics about colour in dentistry. 

Colour is made up of: 

  • Hue
  • Chroma 
  • Value.

The hue relates to the colour itself – is it red or blue or green? 

The chroma is the intensity of the colour (for example, if you had a glass of water and poured one drop of blackcurrant juice into it, it has a low chroma, but as you add more juice, the concentration of that purple increases, and therefore the chroma increases).  

The last aspect is value or brightness. If you were to desaturate a picture and show it as completely black and white, then the value would be assessed by going from white all the way to black, and all the shades of grey in between.

Let’s look more closely at colour in dentistry.

Tooth colour comes predominantly from dentine. When people present for tooth whitening and the teeth are darker then they can normally be grouped into those who have yellow shades and those who have grey shades. We often use the term chromaticity to describe this. 

In the same way that the prevailing colour comes from the dentine, the brightness of the tooth comes from the enamel. ‘Value’ is the term that is used to describe this. 

If we know that the chromaticity (the hue and chroma) comes from the dentine in the tooth and the value comes from the enamel and understand how these two factors together influence the colour, shade and character of the tooth, we can communicate those aspects to our patients much more accurately, They can then understand easily what we are trying to achieve and why some cases may be more difficult than others.

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