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Newsletter – 3rd Quarter 2002

This Issue:

  • The Compliance Issue – This issue focuses on whitening patient compliance
  • Hub of Compliance – Fast, High Concentration At-Home Whitening Wins the Compliance Race
  • The Mysteries of Compliance & Low Sensitivity – Patients will not stick with it if it is painful
  • Doctor Testimonial – Craig Downen, DDS on compliance using 30%
  • The 10 Day Compliance Window – Complete whitening before “life happens”
  • Do It in the Shower – Making whitening routine
  • RDH Corner – Compliance Tips
  • The Competitive Advantage of Compliance – Position yourself above OTC, kiosk, infomercial, and internet offers
  • At-Home vs. In-Office Compliance – Strategies for complete whitening
  • Oral Hygiene Compliance – help your patients achieve the next level of oral hygiene

This issue is dedicated to the subject of Patient Compliance. There is no better marketing tool for your practice at any price than word-of-mouth of patient success stories. What is equally hard to debate is what one word best represents the key issues behind patient whitening success. That word is COMPLIANCE. Patient compliance is the silver bullet of successful professional whitening for both patient and practice.Whether you use whitening as a major income stream or a loss leader, whitening has the potential to bring a great deal of value to your practice that will only be achieved via excellent patient compliance. The best way to maximize that potential is to offer whitening in the form most likely to achieve success for the patient, and therefore, your practice.Whitening modalities are not equal when it comes to compliance. There are so many tooth whitening options from which to choose – everything from old-school overnight 10% to flashy lasers. All of them work given the perfect patient who will see it through no matter what. However, in the real world, most of those options will result in partial whitening and incomplete treatments. One of those options is markedly different.Compliance Wheel
Fast, High Concentration At-Home Whitening Wins the Compliance Race
The fastest wins the race. Achieving patient compliance and successful whiting cases has never been more achievable. FAST is what it takes to support whitening within the context of the real lives of your patients. Life-Like’s At-Home 30% Carbamide Peroxide provides the hub for these spokes of fast whitening:Fast Treatments – Short treatments of just 20-30 minutes make each treatment easy. Fitting 20-30 minutes into the busy lives of patients is much more realistic than hour, two hour, or all-night treatments that require much more dedication. Fast treatments also help avoid the mental and logistical barriers that arise from long treatments. Short-term commitments are just easier to make.

Making It Routine – Because treatments are so short, it is easy to make them part of other routines. Now whitening can be done while showering, commuting, or watching a regular program – see related story Do It in the Shower.

Low Sensitivity – The short wear time of At-Home 30% means super low sensitivity because it avoids pulpal sensitivity caused by dehydration. Having lower sensitivity by using a higher concentration of carbamide peroxide may sound funny but it is the short wear time of fast whitening that is the key to preventing pulpal sensitivity – see related story Mysteries of Compliance & Sensitivity.

Reinforcement – Fast whitening means easily perceivable results and the instant gratification that keeps the patient engaged and enthused about whitening treatments. It is difficult for friends and family not to notice and make comments when the results are so fast, predictable, and perceivable. When it takes weeks for anyone to notice a change, it is easy to get discouraged or to just loose interest.

Low Treatment Days – Fast whitening with At-Home 30% Carbamide Peroxide only takes 7 to 10 days. Other whiteners may make this claim, but common sense will tell you there isn’t anything available that will whiten faster at-home than 30%. Seven to ten days stays within the common compliance window before most patients drop out – see the related article Compliance Window.

Dual Arch Whitening – Because treatments are so short, both arches can be whitened at the same time without TMJ concerns. And, because the results are so visible, there is less need to provide the contrast between arches. That means complete whitening cases can be done in half the time – just 7 to 10 days total!
You are a busy professional; your time is precious, so with which product would you be most likely to complete a full and successful whitening regimen?
If you aren’t answering 30%, you probably haven’t tried it yet. Call 800-543-3545, ask for a sample of Life-Like At-Home 30%, and you soon will be winning the compliance race.

Patients are not going to stick with it if it is painful. There’s no mystery to that. But, what isn’t as obvious is, how high concentration at-home whitening using 30% carbamide peroxide is the best way to reduce sensitivity and get patients to complete their whitening treatments.

Higher concentration for lower sensitivity – how can that be you may ask. If you’ve not proven it to yourself, at first blush it is difficult to believe. But here it is – when it comes to pulpal sensitivity, wear time (or treatment time) is a much bigger factor than the concentration of active ingredient.

The old school of wearing 10% all night is the antithesis of the 30% approach. The old way was to wear 10% all night, do very little whitening, and stress the teeth via a lot of unnecessary dehydration. Back in 1997 CRA did a study that showed the majority of the active ingredient is blown-off after the first hour. Therefore, most of the whitening has been done. Wearing the trays after that point maintains a barrier for saliva, prevents the natural hydration of the teeth, and offers little whitening.

The 30% approach is very different – the trays are worn for short treatments of just 20 – 30 minutes each, maximum bleaching is achieved while the trays are in the mouth using high concentration 30% carbamide peroxide, and the teeth are then allowed to quickly rehydrate to avoid pulpal sensitivity.

When you’ve proven to yourself that 30% is the best way to prevent sensitivity, you will have the confidence that you are offering the fastest most predictable results, the lowest sensitivity, and the easiest way for your patients to successfully finish the whitening treatments. End the mystery for yourself and try 30% on the most sensitive person in your office. Call now for a FREE sa mple at 800-543-3545.

Craig Downen, DDS
Montecito Dental Group, Montecito, CA
Dr. Downen wasn’t always a 30% believer, “I was sure it would be a sensitivity problem,” explains Dr. Downen. “But then I heard how the clinician William Strupp, Jr., DDS started whitening all his patients with 30% and how Michael Miller, DDS of Reality said 30% ‘is the way that home bleaching is going to go.” Dr. Downen then tried it on some of his more sensitive patients and saw for himself At-Home 30% was the best way to avoid dehyrdration and, therefore, pulpal sensitivity.

“Since going to At-Home 30%,” says Dr. Downen, “occurrences of sensitivity have plummeted and, best yet, patient compliance has skyrocketed. My patients love the short wear time and that they can be done in just 7 to 10 days. I know my patients don’t have to pay for the failures that come with other whiteners. They get every penny’s worth of whitening, and then go out and tell their friends. I’m hot on the idea that I’m giving my patients their best chance to successfully whiten their teeth.”

Be Finished Before “Life Happens”
If your average whitening cases TRULY take longer than 7 to 10 days, that modality is pushing your patients out the compliance window.

There is a fairly definitive window of treatment days in which you can expect the average whitening case to maintain compliance.

The well known whitening guru Dr. Van Haywood published an article of his finding back in 1999.1 One of the key conclusions of his study was the dramatic drop in patient compliance after 7 to 10 days. The inertia of the initial visit and start of the treatments just can’t be maintained by many patients over 7 to 10 days.

The fact is, it is asking a great deal of a patient to stay with a whitening regimen over 7 to 10 days because patients live real lives in the real world. We all know life happens – life’s little interruptions that can take the focus away from something like a dental treatment. The more the days the greater the chances of an interruption to the whitening routine. Oops, a day got skipped here because things got so busy. Okay, that’s one more day for possible interruptions. It can easily balloon from there.

The answer to this problem is simple – Life-Like At-Home 30% Carbamide Peroxide. With 30%, your patients will be done within the 7 to 10 day compliance window reducing the chances of interruption. Ask your patients who have failed to complete their treatments and see how many days it took them. Then offer them 30% and watch them stay inside the compliance window, their teeth get white, and your success stories multiply.

1. Haywood V.B., “Current status and recommendations fo rdentist-prescribed at-home tooth whitening” Contemporary Esthetics & Restorative Practice supplment, 3S1:2-9, 1999

Making Whitening Routine
What a wonderful place to do it; the warm water running over you, refreshing you, brightening your day. What better way to start the day than a clean, rejuvenating shower while whitening?

It is much easier to make a small adjustment to an existing routine than it is to add a new one and expect it to stick. A shower is something you do on a regular basis and takes about the same amount of time as fast whitening with Life-Like At-Home 30% Carbamide Peroxide.

Think about it. How many people stick with that new routine at the gym or using a new exercise bike in the den? Most won’t. But how hard is it to just make a minor adjustment to an existing routine such as adding a set of situps to a half hour workout?

The shower is a great routine for whitening. The bathroom is the common place to keep the whitening materials (seal-syringe, stent case all in the handy tote bag). One can insert the trays, enter the shower, shave or apply makeup, and the 20 minute treatment time will be done. It can be that simple and that routine.

Good patient instruction can make all the difference in the success of a case. Here are some tips on how to help your patients achieve their whitest smiles.

Safety – Let the patient know the procedure is safe and review all safety issues. Explain to the patient this is similar to the hydrogen peroxide with which they wash out their mouth. Let them know that carbamide peroxide has been used to professionally whiten teeth for over a decade and has been proven safe and effective. Talk to the patient about soft tissue exposure and the importance of following instructions to prevent overfilling the tray.

Establish Expectations – Let the patients know what to expect during the process of whitening. Talk to the patients about blotching/hypocalcification and how it will whiten out as they continue the regimen.

Routine – Talk to the patients about making whitening routine by fitting regular daily treatment times into other daily activities such as showering, during a commute, or while watching a favorite daily program.

Demonstrate – Show the patients specifically how to open and close the seal-syringe. It’s important to stress to the patients how important it is to use only 1/4 cc of material. During the demonstration, make the drop into each indentation very small and show the patient how little it takes to whiten without overfilling the tray.

Document – Take and file a before picture. Record the initial vita-shade number on your patients’ charts. No matter how fast the whitening is, some patients will have trouble perceiving the difference.

Recall – Bring the patient back in a week. By that time, the patient should be seeing results (almost complete) and any issues can be addressed during this visit.

Positioning Yourself Above OTC, Kiosk, Infomercials, and Internet Whitening Offers
You see them almost every time you surf the channels on the TV – infomercial selling whitening materials at that unbelievable low price (and if you order now). Whitening strips adorn the shelves of your local drug store for under $50. Has one of those mall whitening kiosks that have been sweeping the country opened in your area yet? Think how many junk emails you’ve deleted for whitening material “just like that offered by your dentist.” How about all the internet sites offering cheap whitening? So, how are you to compete with all this?

In a word, you can offer a strategy for success whitening based on patient COMPLIANCE. Compliance is the key. What value does a whitening kit have at any price if the patient does not complete the regimen? It’s not inexpensive if it doesn’t work and it cannot work if the patient doesn’t complete the treatments.

Road to Professional Whitening – Think of all the other whitening choices as the long path to you. Most consumers will fail after 10 days using the other options and be ready to see a professional to achieve success. Here is a common scenario – a patient is sitting in your chair and says, “oh yes, I tried the strips. But after a week or so I got busy, life happened – I hope to try again.” Okay, your response, “You can try the same approach and hope that life won’t interrupt again. OR, I can set you up with a true professional treatment that is easy to do and you will be done in 7 to 10 days. You can continue to pay for failure multiple times or pay for success with me just once.”

Success Competes Best – By offering your patient At-Home 30% Carbamide Peroxide, you offer them the best chance of whitening success. The short treatment time means it is easy to fit the treatments into the busy schedules of real people. The super low sensitivity means painless whitening. Fast, predictable results means your patients will see the difference, receive the complements from family and friends, and simply be done in 7 to 10 days. Others may claim these results but the simple truth is, you know nothing can whiten at-home faster than 30% carbamide peroxide. Once you’ve tried it and seen for yourself that nothing is faster or has lower sensitivity, you will be confident you can compete against any other option – professional or consumer. There’s nothing that sells better than the confidence of knowing you’re offering a much greater value.


How hard is it to be compliant when it is just one visit? With in-office whitening, the patient just shows up once and it’s done. That is the promise. But is that real?

With hopes of overcoming the patient compliance problems of low concentration at-home whitening, in-office whitening has grown in popularity. Exploding on the dental scene with flashy new lights and sizzling marketing campaigns, patients answer the call of single-visit miracle whitening. With the passing of time, the cracks between patient expectations, practice realities, and the actual whitening results reveal major flaws in this strategy.

Incomplete Whitening – Most laser and light modalities are finding they must send their patients home with at-home kits to achieve complete whitening. It is no surprise. Lasers, lights, and lamps only speed up the process of the chemical whitening (usually 35% H2O2). There is only so much whitening that can be done in a single visit. Few cases achieve sufficient whitening in just one appointment.

Safety & Pulpal Sensitivity – There are studies that red flag the use of 35% H2O2 and heat.1 As the popular clinician William Strupp, DDS puts it, “The risk of pulpal damage just isn’t worth it.” Ask anyone who has been around a practice with one of these “whitening center” lamps and about the frequency of pulpal sensitivity. Again, it just isn’t worth it.

In-office whitening has its place. It can be the best way to give a patient a jump-start into an at-home whitening regimen. It is a great touch up or quick fix before a special event. But, to achieve complete whitening and true success case after case, you’ll find At-Home 30% Carbamide Peroxide is by far the superior option.

1. Bosma M, Bowman J, Dorfman W, and Soll K, Clinical evaluation of a tray fabrication design and effects on vital tooth bleaching. Hill Top Research, Inc., Miamiville, OH; 1:3

A Higher Level of Regular Periodontal Hygiene
Considering the fact that 80% of all American adults have some form of gum disease, there is clearly a need for a higher level of regular periodontal hygiene. For some patients, it is enough to get them to brush and floss. For many others, there are new tools you can offer them to take their regular oral hygiene to the next level.

Less than 20% of adults admit to flossing daily, and only 2% admit to it between every meal. It doesn’t make sense that millions of people allow their oral health to lapse each day when there is such a simple, practical, and effective way for busy people to remove food from between their teeth after every meal. The Life-Like Tripick Toothpicks feature:

* Unique triangular shape is designed to remove innerproximal food and plaque
* Glides smoothly between teeth without splintering
* Plastic construction with reusable strength is supple yet strong

Tongue Scraper
Approximately 60% of all bad breath comes from bacteria in the mouth. The Life-Like Tongue Cleaner:

* Acts like a squeegee to remove the coating of plaque and bacteria on the tongue
* Is more effective at reducing halitosis than even brushing
* Reduces plaque formation on the teeth
* Unlike a toothbrush, it avoids causing the gagging reflex

PerioFormula, an 8% carbamide peroxide product, is applied using a stent that is trimmed to extend onto the gingiva by 2-3 mm. Patients wear the tray and gel for just 5 to 10 minutes a day. Carbamide peroxide has been shown to:

* Reverse gingivitis and incipient periodontitis
* Retard moderate to severe periodontitis
* Remove unhealthy tissue, clean and soothe minor wounds and inflammations
* Significantly reduce halitosis
* Promote periodontal health without antibiotics
* Keep teeth white

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