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Operative Dentistry - Best Practices

Tooth Whitening

(last modified 31JUL2014)

Background

  • Over the past two decades, tooth whitening has become one of the most popular esthetic treatment and is defined as a treatment involving an oxidative chemical, that alters the light absorbing and/or light reflecting nature of a material, thereby increasing its value.1
  • In general, most dentist-prescribed at-home and in-office whitening techniques have been shown to be effective.  However, results may vary depending on type of stain, age of patient, concentrations of the active agent, and treatment time and frequency.1

Indications and Precautions

  • Pt dissatisfaction with tooth color; pre-restorative whitening: single tooth discoloration
  • Avoid whitening if pregnant and avoid smoking, coffee, tea, staining foods/beverages.
  • Restorations don’t whiten: Inform patient of replacement needs and additional costs
  • Wait 2 weeks after whitening before restoring-color stability and bond strength recovery

Tooth Sensitivity

  • Sensitivity commonly presents itself as generalized sensitivity to cold stimuli, but often also occurs as a spontaneous sharp shooting pain or “zinger” limited to one or few teeth.2
  • Recommend to reduce tx time or to increase tx interval for patients with mild sensitivity.
  • Prescribe UltraEZ/Relief ACP/Prevident 5000 Sensitive for moderate to severe sensitivity.

Type of Whitening Treatment

  • The type of whitening performed depends mainly on patient’s preference and severity/type of tooth discoloration.
  • At-home whitening is recommended for patients with good compliance, whereas in-office whitening is suggested for patients desiring faster results without the need to wear trays.
  • The efficacy of light activation for in-office whitening is still controversial and we leave the decision for use to the practicing clinician.

Appointment Sequence for At-Home Whitening (D9975)

  • Initial examination visit: Diagnosis, consultation, shade taking, photos, impressions
  • Delivery visit: Try-in trays, give 3 boxes Opalescence PF 10%; tray container; instruction sheet-explain options of night-time (6-8 hrs) and day-time wear (2 hrs) of tray.   
  • Monitor every 2 wks, depending on severity and patient compliance, whitening may take 2-6 weeks.  Tetracycline stains may need an extended period for up to 6 months.

Appointment Sequence for In-Office Whitening (D9972)

  • Initial examination visit: Diagnosis, consultation, shade taking, photos, impressions
  • In-office whitening visit: Perform procedure according to manufacturer’s directions. Opalescence Boost 40% HP without LA/Philips Zoom White Speed 25% HP with LA.
  • In-office session may have to be repeated two more times or followed up with at-home whitening.

Appointment Sequence for Internal Whitening (D9974)

  • Initial examination visit: Diagnosis, consultation, shade taking, photos
  • Internal whitening visit: Evaluate existing root canal filling; isolate tooth; place a barrier; mix sodium perborate with water; place mix into chamber; temporize; check occlusion.
  • Whitening material may need to be replenished 3-5 more times at a 1-wk interval.

References

  1. American Dental Association Council on Scientific Affairs. Tooth Whitening/Bleaching: Treatment Considerations for Dentists and Their Patients. Chicago: ADA, 2009.
  2. Haywood VB. Treating tooth sensitivity during whitening. Compend Contin Educ Dent. 2005;26(supp 3):11-20.