What good is a cheap over-the-counter (OTC) whitener or the priciest professional whitening treatment if the patient doesn’t stay with the required regimen? The fact is, patient compliance is tantamount to whitening success. However patients choose to whiten their teeth, the value of whitening is tied directly to how easy it is for the patient to fully implement the modality.

The key to patient compliance is TIME. Note how time is at the core of each of these compliance issues and how At-Home 30% Carbamide Peroxide makes the best use of patients’ time:

Convenience – The shorter the treatment time, the greater the convenience. Using At-Home 30%, the treatments are only 20-30 minutes each. Therefore, whitening can fit into morning and night bathroom routines. Fitting into patients’ busy schedules with a routine makes it so much easier.

Treatment Days – Studies show most patients lose interest after 10 days. Unlike lower concentrations and OTC products that take 14 – 28 days per arch and beyond, At-Home 30% allows patients to finish both arches in just 7 to 10 days.

Reality Fudge Factor – Who is perfect? Most patients, in reality, miss a treatment here and miss a day there. The more days required to whiten the more missed treatments there will be. With the shorter number of days required with 30%, this fudge factor is kept to a minimum.

Treatment Recovery – Lower concentration modalities typically require longer wear times of 1 hour to overnight and keep teeth away from naturally hydrating saliva. Dehydration is one of the leading causes of tooth sensitivity – and pain inhibits patient compliance. The short treatments of 20-30 minutes, using water-based At-Home 30%, allow the teeth to rehydrate quickly.

Results – Visible results are motivating. Continuing treatment is so much easier when people are complimenting your patients and they are seeing for themselves the dramatic whitening. At-Home 30% simply produces the most visible, dramatic, and predictable at-home whitening results.

Respect – A modality that shows respect for the patients’ time is more likely to receive the respect of the patients. This respect in turn makes it easier for patients to invest their precious time. At-Home 30% offers this respect and makes the best use of patients’ time.

There is a common notion that higher concentration carbamide peroxide means greater sensitivity. While this is true for soft tissue, it is simply not the case when the objective is to whiten teeth, where higher concentrations can actually help avoid pulpal sensitivity through lower wear time.

There are two types of sensitivity: soft tissue irritation and acute pulpal sensitivity. When using carbamide peroxide to treat gums, a practice that is certain to continue to grow, low concentration (8-10% c.p.) is the choice when putting gel into contact with the soft tissue. When whitening, scalloping the tray makes the soft tissue issue moot. Acute pulpal sensitivity comes from two sources – access to the dentin and/or tooth dehydration.

Contrary to common thought, At-Home 30% fast bleach is the best way to avoid these problems; a small drop of 30% gel will create a smear layer from which maximum oxidation per volume occurs in 20-30 minutes. The tray is removed and the tooth rehydrates, reducing/eliminating hydrostatic pressure imbalance (pain source) in the dentinal tubules. The oxidizing agent enters the dentin via incisal wear, enamel fractures, faulty margins, and insufficient enamel coverage at the C-E junction; scalloping and dosage control keeps the gel off the soft tissue and the C-E junction. In short, less gel and less wear time in higher concentration is best for whitening your patients.

The response to the previous Whitener articles on periodontal disease and management has been enormous - understandable given that 80% of the population is at risk of periodontal disease which has links to heart disease, stroke, diabetes mellitus, premature births, respiratory ailments, respiratory ailments and hip replacement infections.

The remarkable therapeutic capacity of the topical application of low concentrations of carbamide peroxide is well documented, whose therapeutic significance has been diminished for a decade by its use for cosmetic whitening of teeth and the introduction of costly esoteric drug therapies. The benefits of patient empowered, tray delivered bio-oxidation is well documented for destroying anaerobic bacteria, discouraging plaque formation, reducing bleeding, and foaming away aerobic bacteria, retained food debris, and necrotic tissue.

The use of therapeutic extended bleaching trays is compelling, is covered by most insurances (cat. # 4381), and can be delivered via auxiliary personnel.

Watch for additional information in the Q4-2001 Whitener. Visit: www.life-like.com/perio to find last quarter’s information on Cleaning & Debriding, as well as other past issues of the Whitener. Or call 800-543-3545.

There are many advertisements claiming fast whitening. But ask yourself this question: how can lower at-home concentrations whiten faster than 30% carbamide peroxide?

• How can a “sustained release formula” help whiten teeth better? How can it help to slow down the chemical reaction that whitens teeth? Is the point to wear a tray for the longest time or is it just difficult to give up the overnight myth?

• Why do we think lower concentrations have less pulpal sensitivity, when extended wear time prevents the natural hydration of the teeth and lower concentrations require more wear time? Doesn’t it make sense to bleach for short sessions with high concentration and then let the teeth rehydrate after 30 minutes?

• Does it make sense to add chemicals to whitening gel to prevent sensitivity when there is the alternative of the shorter wear time patients want anyway?

• Why offer multiple, candy-flavored whitening gels when the patient should not be tasting it in the first place? Isn’t the taste of the gel a warning sign of overfilling the tray? What message are we sending by offering candy flavors?

• Which would you prefer as a patient – the shortest wear time and fastest results with 30% carbamide peroxide – or hours of extended wear time using a low concentration bleaching gel with additives such as potassium nitrate and fluoride?