Ask Dr. Christensen

What is the proper protocol for patients who desire whiter teeth but who also need veneers on the anterior teeth? Do you whiten all of the teeth prior to fabrication of the veneers?

by Gordon J. Christensen, DDS, MSD, PhD

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensen, please send an email to info@pccdental.com.

Question ...

What is the proper protocol for patients who desire whiter teeth but who also need veneers on the anterior teeth? Do you whiten all of the teeth prior to fabrication of the veneers? If so, will there be any future return of color in the natural teeth and an overall change of color in the veneered teeth? Further, can the veneered teeth be rewhitened later?

Answer from Dr. Christensen ...

I will describe a situation that occurs frequently, sharing my opinions on the questions you pose. Suppose you are treating a person who needs veneers due to unacceptable tooth contour and faulty previous restorations, and the person prefers to lighten the overall tooth color in the entire mouth. The veneers alone can provide improved tooth contour and tooth-color lightening for those teeth that are veneered. However, sometimes the color of the surrounding teeth without veneers requires whitening also. When this is the case, I suggest a thorough scaling and polishing first. Wait a few days to allow the patient to get over the trauma and tooth sensitivity caused by these procedures, and then whiten all of the teeth before accomplishing the veneers. Both the teeth that require veneers and those that do not will be lightened. Wait a few weeks after bleaching before starting the veneers. This will allow the bleached tooth color to mature and the chemicals used in the whitening procedure to escape.

As is well-known, almost all bleached teeth demonstrate a slight, unpredictable return to a darker color after bleaching. Fortunately, most of the color return occurs in a few weeks, followed by very slow return of color over the coming months and years. There are many variations in the amount of color return that can be expected in bleached teeth. The long-term aesthetic result obtained with whitening followed by veneers varies. Over time, the natural teeth without veneers become noticeably darker than the veneered teeth. At that time, further tooth whitening bleaches the natural, nonveneered teeth again, and also bleaches the veneered teeth from the lingual aspect. Obviously, bleaching solutions can penetrate the tooth structure from the lingual portion of the veneered teeth. The result is a return to the original post-bleach, post-veneer aesthetic result ... and a happy patient.

How often is rewhitening required? My experience has shown a wide range in time for re-bleaching. I have some patients, bleached and veneered more than 15 years ago, who still look acceptable; I have others, bleached and veneered in the last few years, who already require re-whitening. Make sure you advise patients of the unpredictability of the time interval before rewhitening is necessary.

Recently, Practical Clinical Courses released a new VHS/DVD video that relates directly to your question — C902B, "Veneers for Lower Anterior Teeth." Contact PCC for further information at www.pccdental.com or (800) 223-6569.

Question ...

As a brand new merchandise representative for the dental industry, what is the best way to deliver a higher level of value to a dental office, and to rise above price considerations?

Answer from Dr. Christensen ...

You ask some very important questions. Dentists and staff can buy dental supplies and equipment from many locations without even contacting a representative. Why would they want to purchase their supplies through a dealer? I will answer your question using my personal experiences, as well as my long-time contacts with the dental industry and the dental profession.

The cost to practice dentistry is high compared to many professions. As a result, dentists attempt to buy their supplies and equipment at the lowest possible cost. Discounts, price reductions for volume purchases, premiums, and other benefits are useful attractors, but honesty, trust, and friendship are far more valuable. Product samples are motivators and can initiate interest in new products. Some dentists are far more cost-conscious than others, but generally the cost of products is not the primary consideration.

Many products are well-known to practitioners; they do not need any education or additional information about them. But some products — especially new ones — are unknown to dentists. One of the easiest ways to create "value" as a representative is to develop the trust of your clients by providing reliable product information. Dentists are very busy, and if they can get reliable information from a representative, they will be very happy to have a visit with that person. Find out which dentists, evaluation groups, schools, etc., in your area are trusted by the dental practitioners in your area. Our own group, Clinical Research Associates (CRA), has been well-accepted by most practitioners because of its noncommercially oriented product evaluations. Products published in the CRA Newsletter are known to be independently evaluated, useful products that have not had evaluations paid for by the manufacturers.

Arrange visits with your clients at convenient times for them. Dropping in without warning is upsetting for most busy practices. Personally, I like short (a few minutes), prearranged, end-of-the-day meetings with my industry friends. Don't be afraid to be candid about products, even those made by your own company. If some problems are occurring with a product, be truthful about them. Dentists appreciate candor and will welcome you to return. Willingness to come to study clubs or staff meetings to tell about products of interest can be helpful to both dentists and salespeople. Financial participation in community charity projects through donations of products, time, or educational materials is important to establish trust and goodwill. Be easily available for answers to questions or to assist when equipment is nonfunctional.

Merchandise representatives of dental companies range from trusted friends whose visits are anticipated by busy practitioners, to irritating interruptions that provide only sales-oriented, biased hype. Time, tact, patience, humility, education, and planning are required to establish positive relationships with your dentist-clients. Make the effort to accomplish your goals, and that effort will benefit both the dental industry and the practitioners you serve.

At least two of our video presentations are available on this subject — "Dr. Christensen's Most Frequent Failures and How To Avoid Them" (DVD/VHS 4796) and "Advice for the Ideal Practice" (DVD/VHS 4798). Contact us at www.pccdental.com or (800) 223-6569.

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates, which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.

Dr. Christensen's views do not necessarily reflect the opinions of the editorial staff at Dental Economics.

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