How White is Right?
A practical answer to a very central question.

How does a patient know when their teeth are white enough? This is a valid question that covers the full spectrum of patient expectations. Some patients will ask the question after the first couple of treatments. Some patients will ask the question after going far past the usual whitening regimen in search of a mystical white.

The answer to the question, regardless of where a patient falls in this spectrum, is that there is no known safety limit. Therefore, patients can whiten as long as they’d like. Professional carbamide peroxide whitening has proven itself safe through its 10-year history. Patients can continue to whiten their teeth until they fail to see any significant change. Many patients have been known to regularly apply touch-up treatments. This only pro- motes better oral health and has no known downside.

What shade is the goal? Teeth only get so white depending mostly on the structure and internal color of the teeth. Following the uniqueness of each human body, there is no single prede- termined white that can be achieved by all people. However, Van Haywood, DMD, and other whitening experts teach that the esthetic ideal is to match the sclera (whites) of the eyes.

Regular whitening can also contribute to positive perceptions about one’s smile. Some women, for example, will routinely wear their bleaching trays while applying cosmetics to look their best. They look in the mirror and notice a difference each time. What is truly happening is that they are removing the plaque off the surface of their teeth causing them to shine more. Also, positive expectations always contribute to positive perceptions.

It can be helpful to manage the perceptions of the patient. It is always a good idea to use a shade guide and document in the chart of each patient the before and after shades. Taking a before and after picture is not only helpful to the patient, but can be used for a before-and-after whitening album for your waiting room to help market your whitening services.

It is a good approach to go ahead and give patients plenty of whitening material so they may decide for themselves how much is enough. Avoid the new mini-kits some whitening manufacturers offer and instead always maintain an adequate supply of bleach on hand to support your patients’ whitening needs and perceptions. Even if it requires a recall for additional material, it doesn’t pay to use the mini-kits. A mini-kit is just a pricing gimmick used by some manufacturers to make it seem like they are inexpensive. Compare prices by the cc and then dispense whatever works for your practice.

Another approach to touch-ups for patients who may chronically whiten is to use lower concentrations for cleaning and debriding. Regular use of 10% carbamide peroxide will promote periodontal health as well as help maintain the desired whitening level.

Every patient is going to have to answer this question for themselves, how white is right. The best way to help patients is to encourage them to ask questions so you can help them understand what to expect and how to achieve the right white for them.

Patient satisfaction is the key to the most powerful marketing tool available, word of mouth. It is those of us who are most "plugged in" to the needs of patients that can help our practices keep these issues at the forefront of our thoughts as we tailor our services. Here are some of the top patient whitening issues measured against the procedures currently available:

• Fast, Predictable Results - Patients want to see results, fast. The faster they reach their desired whiteness, the better. In-office whitening gives patients fast results, but the whitening is incomplete and does not provide a means to treat fadeback. Low concentrations of at-home bleach can take almost a month to achieve the desired results for both arches. Using 30% at-home is the best bet, as it produces the fastest and most predictable results available, 7 to 10 days versus 20 to 28 days for both arches.

• Simplicity - Patients want whitening to be simple. The number of days, the length of treatments, the ease of use of the delivery system all effect how simple whitening is for the patient. Low concentration at-home whiteners score low on this account as they require an inordinate number of days and treat- ments. In-office whitening requires the patient to be treated multiple times to achieve ideal whitening. At-home whitening with 30% is simple because the number of days and treatments are at an absolute minimum. Best yet, the treatments can be accomplished within the patients’ regular bathroom routines so they can fit into their busy lives and not require any special bleaching time. Further, Life-Like’s seal-syringe eliminates messy tips and is the most patient-friendly delivery system available.

• Safety with No Sensitivity - Patients want whitening to be safe and to cause as little discomfort as possible. Despite claims by some whitening gel manufacturers, some patients will have sensitivity regardless of the material used. In-office curing lamps combined with 35% H2O2 have been found to potentially cause pulpal damage. Low concentration at-home whitening is safe but overnight bleaching promotes unnecessary swallowing of gel. At-home 30% fast bleach is safe but must be kept off the soft tissue with proper scalloping and patient dosage instruction.

• Value - Everyone wants the most bang for their buck. In-office procedures fall short here as chair time is expensive and there is only so much bleaching that can be achieved in one session. Low concentration at-home whitening would be a better value if it weren’t for problems with patient compliance. If patients don’t see fast results, compliance so often wanes. Again, 30% at-home shines as patient compliance is greatly enhanced by fast and predictable results. Additionally, when you consider the cost of whitening potency -- per cc -- the 30% product gives you the very best value to pass on to your patients. Regardless of what you charge -- patients who stick with it and who see good results will be walking billboards for the value they received from your office.

Safety First
Is High Concentration Safe?

The popularity of 30% carbamide peroxide for at-home use has skyrocketed within the last year. Still, some dentists prefer to stick with 10% to play it safe. This raises the question, is 30% suitable for at-home use? Does such a high concentration potentially compromise the safety of your patients? Here are some key points to consider:

• Whitening Gold Standard - Carbamide Peroxide has been used successfully in dentistry for over 10 years with no history of any kind of problem to enamel, dentin, or pulp.

• Safety Testing - The highest at-home concentration on the market, 30% carbamide peroxide, was tested by an independent laboratory using the ADA protocol for safety. The purpose of the tests was to determine irritation to mucous membranes, i.e. carcino- genicity. The study concluded 30% was not a mucous membrane irritant.

• Patient Study - Before being put on the market, the at-home 30% underwent a 1,400 patient study by the inventor, Robert Drosman, DDS. The study not only found the product to be safe and effective but to have minimal acute pulpal sensitivity of less than 5%.

• Commercial Track Record - Carbamide concentrations of 20% and 22% have been on the market for years. The 30% has now been on the market for over a year. These products have been proving themselves safe in the real world with patients and practices everywhere.

• Faster Hydration - Higher concentrations have safety advantages. The short wear time allows the teeth to rehydrate more quickly. Dehydration is a leading cause of sensitivity. Lower concentrations using overnight modality prevent hydration unnecessarily for hours. Additionally, the 30% product is 20% water which also contributes to hydration.

• Minimal Tissue Irritation - Higher concentrations can irritate soft tissue. However, the effects are minimal and can easily be avoided. Proper scalloping of trays and instruction to the patient to avoid overfilling the trays keeps the gel off the soft tissue. If a patient overfills the tray, soft tissue blanching heals quickly and is reversed within hours.

• Minimized Swallowing - Higher concentration whitening uses no reservoirs and the least amount of wear time. Therefore, the potential to swallow gel is reduced significantly. This is a safety advantage over low concentration gels worn overnight with reservoirs full of gel, most of which will be swallowed.

• Eliminates TMJ Threat - The short wear time of high concentrations, dual arch whitening eliminates the potential for TMJ problems.

Company is coming! Parties are everywhere! ‘Tis the season when almost EVERYone will want to look his or her best.

The holidays are a great time to whiten more patients and to attract new patients with whitening.

How do you remind your community that you are the one to come to for professional, safe, fast, and effective tooth whitening?

First, prop your reception room early with evidence that you are a whitening dentist. Remember that not all dentists do whitening, so this special season could be your opportunity to attract new patients -- who just might stay with you when the season is over.

Second, try a Holiday Special! Your objective is to get the word out, and your solution is to start a buzz among your current patients. Just telling patients to pass the word about your holiday special to their network of family and friends can produce surprising results. A special is a good call-to-action to use in everything from a holiday newspaper ad to a statement stuffer.

Examples of good whitening specials include:

• A Two-for-one -- Bring a friend and bleach the friend for free.

• A % Off -- Provide a coupon for 10% to 75% off your usual whitening price.

• A Package -- Bundle whitening with a cleaning and/or a checkup -- great for attracting new patients.

Start making plans now and help more patients have a whiter holiday!