This online guide was created after numerous requests for my guidelines on external dental bleaching. 

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At the bottom right you will find my bleaching protocol in a one-page pdf format.

Note that the upper limit for how long you can bleach currently is around 12 months. 

(I have bleached some for 3-4 months before they got the desired effect. Dr. Pascal Magne states that he sometimes bleaches for up to 12 months, so there's no need to be nervous). 

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In-house whitening - Why not?

Back when we were still allowed to bleach with 35-40% H2O2, I used Zoom in-office whitening combined with tray whitening.

From a cost-benefit analysis, in-office whitening is in NO way recommended.

And certainly not today, where the H2O2 concentration in the EU is so low, that the only effect you will get from the light is from drying out the teeth. This effect will most often result in an uneven spottet white surface that will last less than a week. 

 

If you are tempted by bleaching lamps, laser light, in-office whitening or similar, please don't! It will most probably cost your practice too much money on wasted chair time. However every practice is unique. Feel free to reach out to me then we can discuss if you will be loosing or gaining money on doing it this today. 

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Benefits of external whitening

If you missed my blog post on external whitening, I recommend you follow the link here. I'm sure it will inspire you to get more patients started with teeth whitening.

Reservoir 

When i lecture on clear aligner treatments, I always tell the participants that bleaching is a great opportunity to give the patient a great, unexpected experience. As long as you don't tell the patient in advance, that whitening is included in your offering. You have a great branding opportunity by letting your patient whiten the teeth in the beginning of the aligner treatment. 

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I am always asked: "Can the aligner be used as a bleaching tray - there is no reservoir for the bleach gel".... It has been known for a long time, that the only reason you would want to build in a reservoir in the bleach trays is for the patient to use more bleach gel. This is a huge advantage for the companies selling the gel. In other words: "The reservoir has NO clinical effect". 

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Sensitivity

If you notice any infractions, abrasions or gingival retractions, you should apply Gluma desensitiser to the entire tooth surface 1 min. prior to the external bleaching. This will significantly reduce sensitivity throughout the entire bleaching process. 

I know of American colleagues who, by default, insert an Optragate and apply a desensitiser to all teeth prior to any tray whitening. 

You can also let patients whiten with daywhite 1 hour a day and let them sleep with Relief ACP (Philips) or UltraEZ (Ultradent - available as gel in syringes or in pre-filled disposable trays - buy the syringes) at night. 

 

For more information about Philips products, I recommend contacting your local representative. 

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Why Daywhite or Nitewhite?

Over a test period of about 2 years, we tried almost all available products in our practice. 

Overall, bleaching gel is bleaching gel.... And then again. 

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We chose the Philips products because they are nicely packaged, contain everything we need, there is enough gel (buy the kit with 6 syringes) and most importantly: They don't need to be refrigerated. The refrigeration thing might seem a bit of an exaggeration. But trust me. We have experienced being sent products from dental depots where there was a huge difference in the effect... On the same patient. Upon closer inspection, we realised that they were different batch numbers and production dates. This led us to conclude that either the patient didn't know how to keep the products refrigerated (VERY likely) or perhaps there were also issues with storage at the depots and during transport. At Philips (formerly Zoom from Discus Dental) we never experienced these issues. 

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Since we prioritised safety of effect above all else, we chose to go with Philips. 

For a period of time, we packed our own kits with our own dental care products in packages with the clinic's branding. This became expensive and cumbersome, so we went back to the standard Philips package. We then put it in a nice bag (with the dental practice's branding) along with the products we recommended during- and after whitening. 

 

I'll probably write in a bit more detail about our process from start to finish in an upcoming blog post. 

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If you're interested in this, sign up for the blog. You can do this by clicking "login" in the top right corner. You will receive an email with a link to the latest post once or twice a month. 

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More benefits

As I write in the blog post, whitening is a great way to get patients to pay more attention to their own teeth. 
External whitening has been proven to reduce the incidence of tooth decay (why this happens is still an academic debate as far as I know). 

Patients who whiten their teeth demand more comprehensive treatment and are more keen to get the best, rather than the cheapest, treatment. Often, we just need to listen carefully to what patients are saying and respond appropriately. 

 

If you want more patients to say "yes" to your treatment suggestions, sign up for one of our patient communication courses. 

Click the link here, or take a look around the website to see what courses we're offering in the coming months.

 

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