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Dentistry’s primary concerns are establishing and maintaining optimal patient oral health. Our responsibilities include identification and control of disease, patient education, clinical and radiographic examination, health and family history evaluations, risk factors, bacterial identification and a constellation of treatment modalities. How does whitening fit into our professional responsibilities?
The ADA refers to in-office whitening as “professionally applied whitening” where the higher concentration of gels are used for shorter periods of time, and preferred by patients who want results immediately.
Efficacy of in-office whitening
Patients who prefer same-day, in-office whitening are being treated with light-activated whitening gels of varying concentrations. A body of research has demonstrated the efficacy of a supplementary light source; some studies demonstrated enhanced whitening with light sources, but indicated the importance of shade guides to measure changes in tooth color. Other studies have demonstrated improvement in whitening outcomes of 35–48 percent measured by spectrophotometer and visual methods, compared with non-light activated whitening gels.
The safety of light-activated whitening gels is of primary importance. Philips Zoom gel has a pH of 8.0, which does not demineralize teeth. It provides faster diffusion through enamel and dentin, hastening the whitening reaction. Deleterious effects on enamel and dentin reported in some studies may have been due to the acidic pH level of the in-office gels in the study. There have also been concerns regarding the safety of light-activated in-office whitening treatments on dental materials. Studies have shown the use of high concentrations of hydrogen peroxide do not affect the surface finish or hardness of restorations.[3,4]
Early whitening preparations created high incidences of sensitivity — in some cases severe enough to necessitate cessation of treatment. Considerable improvement has occurred since the earliest preparations were available. A 2012 study in Compendium of CE in Dentistry evaluated the effectiveness of 15 percent and 25 percent light-activated gels. The authors concluded that both concentrations produced significant tooth whitening immediately and seven days post-treatment, with no reports of gingival irritation or tooth sensitivity. Other studies have demonstrated a higher incidence of sensitivity with the use of light-activated whitening gels. Some in-office whitening systems have made modifications to take these findings into account. Philips Zoom WhiteSpeed (Fig. 1) is the only in-office whitening system with variable intensity settings for maximum sensitivity management.
Maximizing patient satisfaction
Setting patient expectations involves a conversation regarding outcomes, non-uniform results, sensitivity issues, the procedure itself, food and beverage restrictions, time and cost. It is vital the patient understands the results as well as potential concerns associated with the procedure. Failure to set patient expectations (including setting them too high) significantly increases the likelihood of a less than completely satisfied patient.
Whitening can be contraindicated; when discoloration is due to disease, conditions requiring endodontic therapy or dark coloration from restorations. Other disqualifiers include periodontitis, severe gag reflex and failing restorations. Documentation of the discussion is critical and should include the issues discussed and the patient’s answered questions. Pre-treatment photographs and existing tooth shades should be considered part of the documentation.
Indicating how whitening sensitivity will be addressed helps the patient feel more comfortable. Options for managing sensitivity include; fluoride products (Philips Fluoridex), non-steroidal anti-inflammatories (NSAIDS) and amorphous calcium phosphate (Philips Relief ACP). Reassure the patient that sensitivity is transient and manageable. Patients who have regular thermal sensitivity should be informed of the increased likelihood of sensitivity from whitening, prior to commencing.
Caution that whitening results will not last forever. Consumption of dark berries, tea, coffee and red wine will discolor teeth over time as will normal aging.
A discussion of whitening maintenance including additional Zoom in-office and/or Zoom at-home treatments (Fig. 2) provide an opportunity to examine the patient for restorative and cosmetic needs, verify periodontal health and continue to establish trust and mutual respect.
Strengthen practice revenue
The benefits of offering whitening to patients are immeasurable. There are no metrics for increased confidence, satisfaction and happiness associated with a whiter, brighter smile. The benefits to the practice are significant. The average national fee for chairside whitening is $525 (January 2011 survey). The typical dental practice sees approximately 400 patients per month. If only 1 percent of those patients have Zoom whitening, the revenue associated with four patients per month is $2,100 or $25,200 annually.
Three-percent patient participation yields $6,300 per month or $75,600 per year, while 6 percent participation yields $12,600 per month or $151,200 per year. Dental professionals can offer their patients safe, effective tooth-whitening options that provide consistent results while reducing the incidence of side effects. Philips Zoom WhiteSpeed provides these benefits.
Editorial Note: This article appeared in Dental Tribune Canada, Vol. 6, No. 6, November 2012 issue. A complete list of references is available from the publisher.