Aesthetic Dentistry Expert – the bright side of whitening

For National Teeth Whitening Day, Manrina Rhode shares her passion for the treatment and the pitfalls to avoid when discussing whitening with patients.

Today, we are talking about teeth whitening. I think it’s fair to say I love teeth whitening. I’ve probably whitened 99% of my patients’ teeth, if not 99.9%.

I literally can’t think of anyone whose teeth I haven’t whitened in the last 20 years. My patients, my family, my friends – everyone who knows me has whitened teeth. And that is because I genuinely believe that everyone looks better with a whitened smile.

I think some people feel nervous about teeth whitening. They think that they’re going to end up with these very bright ceramics that maybe they’ve seen on TV. Then I need to explain to my patients that teeth don’t whiten to a paper white. They whiten to the whites of your eyes.

I don’t know if you knew that – my patients often don’t. I take a full face picture of them and put it up on the screen with them smiling. Then, I get them to look at the colour of their teeth compared to the colour of their eyes. And that’s where your your teeth will whiten to.

That level looks very natural and clean, and it looks right on all of us. Typically teeth will whiten to, I’d say, a BL3 on the Ivoclar shade guide. That’s the most common shade they will whiten to. But some people will only go to a BL4 and some people go to a BL2.

But BL3 is a really common shade. So it’s also my favourite shade for doing porcelain veneers. Because I think that way, you can get a really natural result so a patient just looks like they’ve got a perfect smile rather than like they’ve had all this work done.

Watch out for white spots

I think one thing to note about whitening is fluorosis, or white spots. A lot of our patients have fluorosis and I think we need to look out for it. In my new patient exam, that’s a question that we always ask.

We make a note about whether there’s any signs of fluorosis because fluorosis spots become even whiter when you whiten.

It doesn’t mean that if someone has fluorosis we shouldn’t whiten, it just means that you need to tell the patient about it. Otherwise, they’re going to start whitening, and then they’re going to message you and say: ‘Oh, my teeth were quite even before. And now I’ve got these big white spots and you’re not whitening my teeth equally.’

You need to tell them that the fluorosis spots will whiten, and because they’re already white, they’ll become quite bright. And then the rest of the tooth will whiten to get closer to the fluorosis spot.

But whitening doesn’t make your tooth surface even in colour, it just makes everything whiter. So wherever there were discrepancies before, so where the tooth is warmer at the neck of the tooth or lighter at the tip where it’s thinner, that will still be there. That degradation of colour will still be there, but it will all be lighter.

And why is that degradation coming back? It is because the tooth is thicker at the gum margin so it holds more colour and it’s thinner at the edge and so it holds less and tends to look lighter.

So I think that’s quite a lot of teeth whitening chat. I hope that’s useful. See you next month for our next episode.

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