There has been a lot in the news about teeth whitening recently: a quick google search brings up stories about whitening being carried out in beauty parlours and recently the father and son duo who were convicted and jailed for their teeth whitening business.
It is clear cut in law now that teeth whitening is the practice of dentistry and as such it can only be carried out by the appropriate professions, these being dentists, dental therapists and dental hygienists, the latter two practicing under a prescription from a dentist.
What struck me recently, however, is that apart from the brief training we got in dental school (which was all theoretical), I haven't placed as much emphasis on developing my teeth whitening skills, as I have approached other areas of dentistry. So I felt it was time to focus on teeth whitening and the BDA's Whiter than White seminar allowed me to do just that.
Focusing on whitening
There were a number of talks through the day with clinical lectures, such as those by Dipesh Parmar and Simon Chard, and tips on marketing whitening effectively by Sandeep Kumar and Chris Barrow. Having a number of clinicians on the panel showed where the consensus is, and what areas might be contentious.
As always, attending a course, you inevitably bump into colleagues from university or friends you have made on other courses and get a chance to catch up and network. And an enjoyable day of CPD is a valuable day of CPD, as you're likely to take on and engage more rather than when you are sitting at home in front of a computer.
We all know the basis of home whitening and it was confirmed at the seminar by almost everyone that home whitening with 10% carbamide peroxide was the gold standard of treatment.
But what about those cases where we have a single discoloured teeth, or intense brown and white marks on teeth? Or tetracycline staining? Do we just take impressions, fit, and demonstrate how to use the tray, and then send the patient on their way hoping for the best?
No, we can do better and this is what I learned on this course.
Here are my top five tips from the course:
- Consent is key for any cosmetic anterior work prior to whitening: they may choose to not have it, but if you don't ask the question and the patient wants to whiten their teeth after they may come back to you when they're told their new veneers done a year ago would need to be replaced to match the colour. Let them make the choice at the start of treatment. It all forms part of the informed consent of your overall treatment plan.
- Progressive treatment is the cornerstone of minimally invasive dentistry: For almost any discolouration consider peroxide-based whitening as an initial non-invasive starting option in a progressive treatment plan. It may not resolve the problem to your satisfaction, but the patient may decide it's a good enough result for them. Or you may move onto using products and techniques like inside/outside bleaching, ICON, micro-abrasion, macro-abrasion and composite or porcelain restorations.
- Not all whitening is impressions and trays and two weeks long: Evaluate each case and manage the expectations of the patient. Are they older, and a bruxist with tetracycline discolouration near the gingival margin? Warn the patient they may take a long time to whiten and quote appropriately. Will they get sensitivity? Have you told them this? All this will stem from your diagnosis, what is causing the problem, and explaining how will this affect the treatment.
- Take photos: lots of photos. These document your cases for medico-legal reasons, which in today's litigious environment, is key. Not only that, but with the correct consent you can use your previous cases to show what kinds of results patients can expect by showing them cases similar to their own teeth.
- Build a rapport with your patients: if you diagnose their problem properly, show them what they can expect, treat them effectively, and meet the expectations you've agreed on, they will be your biggest advertisement (and be happy to be so!). They will tell their friends about you, but only if you ask them too. Don't be afraid to ask for a testimonial, it will boost your confidence and the confidence that future patients will have in you.
The law states whitening is the practice of dentistry. Let us treat it as such and not just as an add-on, and ensure that we develop our skills to offer your patients the best result.
Harman Chahal, Chair, Young Dentist Committee
BDA Advice: Teeth whitening
The BDA offers a range of advice and resources on teeth whitening for members. The next Whiter than White seminar dates will be announced shortly, email firstname.lastname@example.org you are interested in attending.