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October 2008
How to ensure that your whitening pitch hits the right tone when it comes to patient expectations. Today’s emphasis on whiter, brighter smiles has led to ever-increasing expectations from patients when it comes to whitening their teeth. Today, there are three basic whitening options: in-office, take-home trays and over the counter products, but regardless of the chosen method it is essential that patients understand the benefits and limitations of this treatment, and that we as clinicians manage the expectations of our patients to ensure their satisfaction with the treatment that is provided. There are a number of things to consider prior to whitening, including existing shade and restorations, potential for sensitivity, and follow-up home care habits. Considering a patient’s existing restorations and in anticipation of future needs, it is beneficial to obtain a baseline shade for all adult patients. Most patients will ask why you are doing this, which provides an ideal opportunity for you to discuss available whitening options. SHOW AND TELL When taking a shade, it is very helpful to make this a process of co-discovery with your patients; they will most likely identify the tooth that is darkest in color and typically, will think it is a few shades darker than you will. You can then bring out the shade guide and help the patient to where they fall and what can be expected in terms of possible shade changes, depending on the option they chose. Prepare a whitening shade guide arranged from lightest to darkest, and have this available for use at all times. Performing a shade analysis is something that can be easily implemented into the dental hygiene appointment and can lead to many other treatment discussions. Even if a patient does not choose to have their teeth whitened immediately, you will have a baseline shade for reference and can communicate any changes to patients as you see them at subsequent visits. Having a baseline or pre-whitening shade can also be extremely valuable when comparing pre- and post-whitening results. Engaging the patient in the selection of the shade at both points can contribute to a more predictable result and patient satisfaction. It is important to get across to patients that any existing restorations will not change or lighten. It may be a good idea to notify all patients of this fact, prior to scheduling treatment for porcelain or composite restorations. For example, “Suzie, we need to schedule time to replace these tooth-colored fillings here on your front teeth. But before we do, have you ever thought about having a whiter smile? This would be a great time for us to discuss the options available here in our office, as we would want to do this before we schedule those fillings.” SENSITIVE SUBJECT Understanding a patient’s risk for sensitivity is an important aspect of helping the patient value the whitening service provided. It is possible to achieve a result that is esthetically pleasing to the patient with regard to shade, however, if there is ongoing sensitivity post-whitening it will overshadow this result. Discussing sensitivity risks and implementing strategies pre- and post-whitening to help reduce such effects, should be considered. These might include treatment with fluoride and/or calcium phosphate; certain whitening products go so far as to include fluoride or calcium phosphate in their formula. PRACTICES DON’T ALWAYS MAKE PERFECT While we can offer and provide treatments for whiter teeth in our offices, the importance of home care cannot be underestimated. Our patients must be educated on the role that proper home care plays in maintaining an optimal whitening result. A complete review of brushing and interdental cleaning should be provided at the completion of whitening treatment. A discussion about dietary and social habits also should be part of the pre- and post-whitening analysis. Patients who might smoke, use smokeless tobacco or drink significant amounts of colored beverages (tea, coffee, wine) must understand that this can limit their long-term results of whitening treatments. Patients also must be educated about follow-up professional care, and a re-care interval should be established at which time the need for “touch-up” whitening can be discussed. Clearly, there are many things to consider to ensure both clinicians and patients achieve whitening results that are satisfying. Developing an informed consent form to use with patients is an easy way to document all the things you’ve discussed and can prove especially helpful when dealing patients who did not achieve their desired result, serving as reminder of the risks, benefits and limitations of the treatment. Whatever the choice for whitening, it is evident that a good majority of patients want a whiter smile and as clinicians we have a responsibility to assist them in making informed decisions about the treatment they desire.
Tammy L. Filipiak, RDH, BS, is a practicing dental hygienist with 17 years experience in clinical and educational settings. She currently is the Director of Dental Hygiene for Midwest Dental a group with 40 offices in Wisconsin, Illinois, and Minnesota. She is an active member of the American Dental Hygienists’ Association and is a Past-President of the Wisconsin Dental Hygienists’ Association. She owns Paragon Dental Resources, a dental consulting and education company. You can reach her at tfilipiak@midwest-dental.com.
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