Smart whitening

Sept. 1, 2005
How to ensure a more comfortable and satisfying whitening experience for your patients.

How to ensure a more comfortable and satisfying whitening experience for your patients.

The figures speak for themselves - professional tooth-whitening has increased by more than 300 percent since 1996! Tooth-whitening is the most requested cosmetic dental procedure by patients between the ages of 20 and 50, according to the American Academy of Cosmetic Dentistry.

With so many people seeking whiter, brighter teeth, dentists are challenged to position their practices in a way that ensures both patient satisfaction and profitability. Being smart about tooth-whitening can help increase your number of bleaching procedures through patients who, satisfied with their treatment, will be more likely to refer others to your practice.

This article details a series of steps - including an in-depth discussion of your patient’s expectations and an understanding of the potential side effects associated with tooth-whitening - to help you ensure a more comfortable and satisfying whitening experience. Patients excited about their new smiles are great ambassadors for your practice, bringing in new patients seeking similar services, which boosts practice profitability.

The rise of tooth-whitening

White, model-perfect smiles can be seen in all forms of visual media - from television shows and advertising spots to magazine and newspaper feature articles and ads, to Web pages on the Internet. Today’s consumers are inundated with advertisements promising that they, too, can have perfectly white teeth. In fact, sales of the top 30 over-the-counter tooth-whitening products have nearly tripled since 2001.

Unfortunately, many patients are not aware of the possible side effects related to tooth-whitening or bleaching, including temporary gum irritation and the most common side effect, tooth sensitivity. Data suggests that up to 75 percent of patients who professionally whiten their teeth experience sensitivity.

Are these patients going to be satisfied? Many patients who commit to professional whitening treatment are so focused on the end result that they are willing to endure painful tooth sensitivity. However, because of the sensitivity, they may be forced to delay or stop treatment for a time, prolonging the amount of time it will take for the patient to discern noticeable results. Dental professionals also may use a lower concentration of bleaching agent in an effort to reduce sensitivity, again prolonging the treatment process. In fact, some 41 percent of dentists recommend patients actually discontinue treatment to alleviate sensitivity, possibly leading to whitening results that may not meet patient expectations.

Sensitivity can occur from both in-office whitening and professionally supervised, at-home tray-whitening. There are definite advantages and disadvantages to both methods. In-office, chairside whitening procedures deliver results more quickly than alternative methods; however, this typically is a more expensive option. Generally, treatment can be completed in one to three appointments. On the other hand, tray-whitening commonly takes seven to 14 days, and patients must wear the bleaching tray for 30 to 60 minutes daily. Ideal patients for the tray method are those who are willing to comply with the treatment protocol and who have the manual dexterity to fill the tray with the whitening agent prior to using it. Since chairtime tends to be minimal for this procedure, it is a more profitable procedure for most dental practices.

Quicker results = satisfied patients

Regardless of which treatment is chosen, most patients seeking professional tooth-whitening want fast results and can be discouraged by an interruption in their treatment plan. Dental professionals can help prevent disruption by discussing the potential for tooth sensitivity with patients before treatment begins. A newly published study demonstrates that brushing with an antihypersensitivity toothpaste for two weeks prior to and during whitening can significantly reduce painful tooth sensitivity, potentially preventing any delays or discontinuation of treatment. The toothpaste used in the test was Sensodyne® Fresh Mint Toothpaste (GlaxoSmithKline Consumer Healthcare), an antihypersensitivity toothpaste containing five percent potassium nitrate. The group using the antihypersensitivity toothpaste experienced significantly more sensitivity-free days compared to a control group using regular toothpaste. In addition, the proportion of patients who developed tooth sensitivity during the first three days of bleaching while using Sensodyne was significantly less than those using the control toothpaste.

The first three days of treatment are typically when sensitivity is most severe. Study results also showed that patients who brushed with the antihypersensitivity toothpaste were more satisfied with their whitening treatment overall and were more likely to repeat treatment in the future. The study was based on patient satisfaction surveys and diary entries. To help promote patient compliance with this protocol, sensitivity should be addressed up front, during a pretreatment exam.

Pretreatment exam is key

The pretreatment exam is easily the most valuable time the dentist has with patients considering professional whitening. During the consultation appointment and exam, dentists have an opportunity to review patients’ wants and needs and discuss their expectations.

In many cases, patients want a shade of white which is either unattainable because of previous discoloration or existing restorations, or a shade which is uncomplimentary to their coloring. A patient’s ideal tooth shade should approximately match the whites of the eyes. Bleaching tends to work very well on teeth which have a yellow hue, while brownish-colored teeth may not respond as well. Teeth with a gray tone are least likely to respond to whitening treatment. In addition, whitening or bleaching treatment may not have a significant effect on patients who have teeth that are already very white.

Taking the time to counsel patients about suitable shades, as well as discussing what they can realistically expect from their treatment, can help prevent disappointment and reinforce the fact that you truly have the patient’s best interest in mind. In some cases, it is better to actually show patients a selection of suitable shades. Another option is to whiten one arch at a time, so patients can easily see the shade difference.

During the initial exam, patients should be questioned regarding any issues preventing them from achieving their desired results. Patient education software, such as CAESY (Patterson Dental Supply, Inc.) can be extremely helpful in explaining the treatment procedure to patients and ensuring they understand what is involved.

Treatment delivery, both during chairside whitening and when issuing the tray and whitening agent to the patient, presents another valuable opportunity to discuss potential side effects and patient expectations. Patients should be reminded to continue brushing with an anti-hypersensitivity toothpaste two times per day throughout the course of their treatment. The study mentioned earlier in this article concluded that the antihypersensitivity toothpaste did not interfere with the results of the whitening treatment. Patients in the study also reported they were not inconvenienced by switching toothpastes.

It also is important to ensure auxiliary office staff members - including dental hygienists, assistants, and office managers - are well-versed in the various whitening procedures and are prepared to address patient questions which may arise regarding the treatment protocol or side effects. In my experience, many patients feel more comfortable turning to these staff members with questions. That’s why it is so important that all members of your staff are aware of potential side effects and the impact they may have on treatment. They should be prepared to refer questions about sensitivity back to the dental hygienist or dentist.

Once treatment has been completed, a post-treatment or follow-up appointment presents an opportunity to ask if the patient was pleased with treatment, as well as inquire about any side effects. Patients will appreciate the effort made to address their satisfaction and any issues or concerns they may have had during treatment. You also can recommend that patients who experienced sensitivity during treatment continue to use an antihypersensitivity toothpaste. Antihypersensitivity toothpastes containing fluoride are safe to use as a patient’s everyday toothpaste and may prevent a recurrence of pain.

Become the patient�s choice

Consumers today have many choices when it comes to whitening their teeth, and they are doing so in record numbers. Unfortunately, many patients will not be able to achieve the dramatic results they desire due to sensitivity. By discussing what each patient hopes to achieve - and reviewing realistic expectations for whitening before treatment begins - dentists can help prevent potential disappointment.

Patients who complete their treatment comfortably and on time will be more satisfied with their treatment, and will be more likely to refer friends and family for professional whitening procedures, providing you with new opportunities to increase practice profitability.

(References available upon request.)

Dr. Ron Perry has a private general dental practice, Meridian Dental Associates, in South Weymouth, Mass. He also is director of the Gavel Center for Restorative Research and associate clinical professor at Tufts University School of Dental Medicine. Dr. Perry has published numerous articles and abstracts and lectures both nationally and internationally. He can be contacted by e-mail at [email protected], or visit his Web site at