Tailored tooth whitening – always a good thing?
There is no doubt that tooth whitening has become increasingly popular over the last two decades. Yet opinion amongst dental professionals remains divided. Many dentists still lack the confidence to use their skills to provide their patients with this service. Others remain to be convinced that this treatment is in their patient's best interests.
The harm ?
Dentists can use precise concentrations of peroxides to denature the molecules that cause the staining appearance on teeth and hence lift the colour. The dentine is sometimes lightened as well.
You can either treat your patient in the surgery (in chair) with power whitening or you can supply them with a tray (take home) product to use themselves. Both are legal in the UK. But how much enamel does this remove and is it a price worth paying? In fact, it has been shown that drinking one can of Coca-Cola removes the same amount of enamel as a four week daily whitening course. It is certainly less invasive than fitting a set of veneers to improve the appearance of the teeth.
Every patient has individual needs
Whitening is certainly not a one-size-fits-all procedure. You will have some patients who will achieve exactly the required shade change with very little treatment. Then there will be others who reach only a small shade change after extensive treatment. Early prediction of the likely outcome of treatment will both inform the treatment regime and help to manage the patient's expectations. You will be able to treat the patient according to his or her particular needs.
The VITA shade guide can be useful in illustrating this point. It is good practice to make it clear to patients who have a VITA C4 shade that their single course of whitening may not be sufficient for their needs. We would explain that the darker shade is present deep into the dentine and that it may, in fact, be impossible to achieve the lightest shades. However, not so many dental professionals are aware of the dehydration factor as a further tool for predicting the outcome of a whitening regime. The enamel of teeth which are completely dry (dehydrated) have fewer water particles and reflect light in a different way; they appear more opaque and whiter. Wet teeth appear translucent. Your diagnosis should include accurately determining the initial dehydration shade; the whitening treatment will be aiming to achieve a shade that is lighter than this. A change of 10 VITA shades can normally be achieved with a full course of whitening. Patients that have a normal shade that is more than 10 VITA shades darker than their dehydration shade are not going to have a satisfactory and lasting whitening treatment outcome. The patient can be informed that their particular treatment is going to take longer to make sure that the fade back of the colour does not alter the final effect. The patient knows what to expect and is less likely to be disappointed with the end result and with the process.
For some of your patients, the colour of their teeth will be an important issue and a major part of their appearance. By treating each patient individually and adopting early assessment and diagnostic tools the process is handled in a professional, clinical way that takes into account your patients unique needs.