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June 23, 2009 | dentalproductsreport.com
Web exclusive

3 instances to rethink whitening

It’s important to set realistic expectations for your patients.

By Amanda LaBonar, Web Editor

Sam Edwards/Getty Images

There’s no doubt many patients are looking to achieve gleaming white smiles. But is whitening right for every one?

Not all of your patients can achieve the white smile they want, making it important for you to set realistic expectations and explain the best course of treatment. From there the choice of treatment is up to the patient. Here, Dr. Kelly Suchman describes three instances when whitening procedures may need additional or alternative treatment.

1. Extreme sensitivity / root exposure
Set expectation: Whitening is always going to be sensitive.

“One of the questions I will ask patients is if they can bite into an ice cream cone. If the answer is no, then they have sensitive teeth,” Dr. Suchman said.

Patients with extreme sensitivity and/or root exposure will always experience sensitivity with a whitening procedure. However, there are ways to reduce the sensitivity while still allowing the patient to whiten.

“Teeth whitening is virtually always going to cause some sort of sensitivity. While it’s not going to do any pulpal damage, it’s a temporary transient thing most people will experience for maybe 24 to 48 hours. For those people, what I recommend other than not whitening is using a product like MI Paste (GC America). It’s great for patients to use a week or two prior to doing any whitening. Other things that have worked for people are fluoride varnishes or potassium nitrate,” she said.

Additional options include recommending a lower concentration of whitening gel or in-office treatment. “My personal opinion is I’d rather have my teeth sensitive for 24 hours with the use of the high strength in-office whitening gel rather than go through the suffering of a little bit of sensitivity for two weeks,” Dr. Suchman said.

2. White spots / dark brown spots / mottled enamel
Set expectation: These spots will not go away with whitening and may actually get worse with whitening.

Patients with white spots, dark brown spots or mottled enamel who are looking to whiten may never achieve desirable results. Treatments before the whitening are necessary and, in the end, restorative treatment may be required for the patient to achieve desired results.

“What we do prior to whitening is one of two things, either micro abrasion with a very fine diamond and/or a hydrochloric acid slurry like Ultradent’s Opalustre. We’ve also had some success using a protocol with MI Paste. It has to be the MI Paste without fluoride in it, to basically diminish the white spot lesions. So we try to minimize those with one of those two methods and then the patient can whiten,” Dr. Suchman said.

“I like to go through those steps of doing a conservative treatment with either the MI Paste or micro abrasion, doing the whitening and then if the patient is not satisfied, we can go to veneers,” she said.

These patients may never achieve the perfect, consistent tooth shade that some people are looking for without restorative treatment, but it will improve.

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