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gingival margin. Lightly flame-polish The whitening tray should be seated
the tray edges. Check for fit of tray on from side to side and excess gel wiped
stone model. If the tray does not fit away. Instruct the patient on the use of
properly, use a flame torch to reapply the take-home shade guide. The patient
and recontour the application tray will use the guide to document and
where necessary. Wash and disinfect the date shade changes.
whitening tray. Dry thoroughly and
place in a storage case for delivery. Patients need to be aware of the
saturation point. The saturation point is
the point at which only hydrophilic
colorless structures or stainless
Figure 5 molecules exist. Optimal bleaching
achieves whitening, over-bleaching
Visible Light Cure (VLC) unit degrades tooth enamel without further
(DENTSPLY Caulk, York, PA) for two whitening.6
minutes (figure 5). Wipe the cured gel
surfaces with alcohol-moistened gauze Post-daily treatment instructions
or cotton strip to remove excess include removing the tray, rinsing, and
material or oxygen-inhibited residue. brushing and flossing to remove any
Some manufacturers do not Figure 7 residual whitening agent remaining on
recommend the use of reservoirs. tooth surfaces. A separate toothbrush
should be used to clean the tray, and
Tray Delivery and
then the tray should be stored in a case
Whitening Instructions
with mouthwash or water. Instruct the
At the tray delivery appointment, the
patient to call with any questions or
baseline shade will be documented.
concerns, and re-schedule for a
Also pretreatment photographs with
follow-up.
and without the shade guide can be
taken. The tray is tried in for proper fit
and comfort. The whitening procedure
Figure 6
is reviewed with the patient. The Whitening Success and
American Dental Association (ADA) Compliance
recommends the use of a value oriented The number one reason for whitening
Place the tray material (pebble finish
shade system that is sequenced by success is compliance. Comprehensive
toward the model) on a heat/vacuum
brightness. Factors influencing the and understandable patient education
tray-forming machine. Soften the
shade determination are ambient light will ensure patient acceptance and is
whitening sheet until it sags 1 to 2
and the clinician’s vision. The ambient critical to whitening success. Despite
inches. Engage the vacuum. Slowly
light should be consistent, neutral, claims that some whitening products
lower the heated whitening tray onto
reproducible and unbiased. Gender, do not cause sensitivity, double blind
the stone model. Allow ample time
age, genetics and distance can all affect clinical studies have shown that
under the vacuum for optimal retention
the clinician’s vision. In general, the sensitivity occurs in 55 to 75% of
and definition. After the tray has
youngest female member of the dental treatment.7 Treatment of tooth
cooled, remove it from the stone model.
team should be involved in the shade sensitivity can be active or passive.
Using scissors, trim the tray
determination. Passive treatment for sensitivity
approximately 2 to 3 mm beyond the
teeth (figure 6). Trim and refine the involves reducing treatment time or
remaining portion with precision Patient education should include frequency of treatment, and
scissors, scalloping around the loading and seating the tray. Review interruption or cessation of the
interdental areas. Or trim the tray with the patient the teeth to be whitening treatment. Shorter wear time,
directly on the model using a soft tray whitened. Demonstrate placing a small such as 30 minutes once-a-day, as is
trimmer such as Tray Magic™ (Premier bead of the whitening agent along the recommended for Perfecta® Bravo™
Dental Products Company, Plymouth front base of the tray and emphasize (Premier Dental Products Co.) can help
Meeting, PA) (figure 7). Trim the tray the importance of utilizing the proper improve patient compliance.
approximately .5 to 1 mm short of the dose of the whitening agent.
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Sensitivity can be treated actively through pretreatment with neutral sodium
TABLE 2, MARKETING IDEAS
fluoride, application of an in-office fluoride treatment followed by a home-
applied fluoride, or use of other therapeutic agents. Haywood, et al recommend Develop Gift Certificates for Life
Occasions
tray delivery of a 5% potassium nitrate – 1000 ppm fluoride gel.8
A comfortable, properly fitting tray, a palatable whitening agent with proper Compile a Photo Album of “Successes”
viscosity, and an appropriate delivery system are also critical to whitening Use Statement Stuffers
success. Whiten Staff Members Teeth
One Arch at a Time
Post-Visit and Marketing Ideas
Intraoral Camera
Document the final shade, and take photographs with and without a shade
guide. Obtain a testimony from the patient for marketing purposes. Review Value Arranged Shade Operatory Display
maintenance issues with the patient. Take-home treatment results typically last Posters/Brochures
two to three years, while in-office treatments last four to five years.9 Telephone “On Hold” Message
The goal of incorporating whitening into your practice should involve educating Target Mailing
the patient about whitening. Marketing ideas for incorporating whitening into Website
the practice are listed in table 2.
BIBLIOGRAPHY
1. Dunn, JR. Whitening Symposium. Tufts University: Oct 2000. 8. Haywood, VB, Leonard, RH, Nelson, CF, and Brunson, WD. Effectiveness,
2. Dunn, JR. Dentist-prescribed home bleaching: current status. Compendium side effects, and long-term status of nightguard vital bleaching. J Am Dent
19(8): 760-764, 1998. Asso. 1994 Sep; 125(9): 1219-1226.
3. Freedman, G. In-office bleaching systems. Dental Products Report: April 9. Freedman, G. Yankee Dental Congress 1999.
2002. Sandra Marcil, RDH, MS, is the Southeast Clinical Educator for DENTSPLY
International, Professional Division, York, PA. Ms. Marcil presents continuing
4. Leonard, RH Jr, Haywood, VB, and Bentley, CD. Quintessence Int. 1994 Aug;
education courses and academic lectures nationally on topics related to
25(8): 547-550.
ultrasonic therapy, air polishing, tooth whitening and sealants. Ms. Marcil
5. Goldstein, RE, Garber, DA. Complete Dental Bleaching 1995: 96. recently received her Masters of Science degree through a distance learning
6. Albers, H. ADEPT Report 1991; 2(1): 1-24. program at the Florida Gulf Coast University. She may be reached at:
smarcil@dentsply.com or 727-298-8311.
7. Haywood, VB, Caughman, WF, Frazier, KB, and Meyers, ML. Tray delivery
of potassium nitrate-fluoride to reduce bleaching sensitivity. Compendium
21(28): S10-S17, 2000.
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©2002 Premier Dental Products Co.
Take-home gel for $21.42 per patient – ask your Sullivan-Schein Sales Consultant!
Visit DenTrek.com – view brief tutorial.
1. Clinical Evaluation of the Bleaching Efficacy of Two Different Concentrations, Sheila H. Koh, D.D.S., F.A.G.D.UTHSC-Dental Branch; Esthetic Professionals-Dental Materials and Technology Update, July 2002.
5
Continuing Education Test Questions
Answer Sheet on Back Cover
1. Each of the following whitening options is professionally 9. Which of the following is required for proper fabrication of
monitored except: whitening trays?
a. in office a. pour model in stone
b. over the counter b. trim the tray .5 – 1 mm from the gingival margin
c. dentist prescribed c. pour model in plaster
d. walking bleaching d. both a & b
2. In office whitening systems are generally 30- 35% hydrogen 10. The ADA recommended value oriented shade system is
peroxide. Dentist prescribed take-home systems can range sequenced by:
from 4.9 to 22% carbamide peroxide. a. brightness
a. Both statements are true. b. color
b. Both statements are false. c. eruption patterns
c. The first statement is true; the second is false. d. age
d. The first statement is false; the second is true.
11. Which of the following factors will influence the shade
3. An acid pH extends the shelf life of the whitening agent. An determination?
alkaline pH begins the whitening process within five minutes a. ambient light
and allows the process to continue for several hours. b. clinician’s vision
a. Both statements are true. c. patient’s age
b. Both statements are false. d. both a & b
c. The first statement is true; the second is false.
d. The first statement is false; the second is true. 12. When selecting patients for whitening options which of the
following should be considered?
4. Patients with yellow, orange or light musky brown teeth will a. behavioral habits
usually have the best whitening results. b. patient expectations
a. True c. extent of stain
b. False d. all of the above
5. Evaluation of the cause and extent of the stain is not 13. Sensitivity occurs in 55 – 75% of whitening cases.
important for successful whitening. a. True
a. True b. False
b. False
14. Sensitivity can be actively treated through pretreatment
6. Which of the following criteria are helpful in evaluating a with neutral sodium fluoride.
take-home whitening system? a. True
a. high viscosity b. False
b. continuous release
c. neutral or palatable taste 15. Take-home treatment results typically last two to three
d. all are helpful years. In-office treatment results last four to five years.
a. Both statements are true.
7. Wait one to two weeks post whitening treatment before b. Both statements are false.
replacing any esthetic restorations. c. The first statement is true; the second is false.
a. True d. The first statement is false; the second is true.
b. False
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Two years after her whitening,
Beth’s friends and family still look at her differently TM
Buy 10 boxes of Nupro White NUPRO White Gold. Fresh new look. Same proven long-lasting results.
• In a clinical study, more than 80% of patients treated with NUPRO White Gold
Gold Patient or Intro Kits and Median shade change maintained
at 6 months and 2 years1
(10% carbamide peroxide) maintained their
whitening results* for at least 2 years (P<.0001)1
8
• Each complete treatment comes in a convenient,
new, 2-part packaging system
absolutely FREE! 6
4
– Lab materials for you
INTRO KITS: ...................................$47.99 12 @ $44.99 – A take-home kit for the patient
(555-6243-VB) 10% Carbamide Peroxide
2 – Available in 10% carbamide peroxide and
0 15% carbamide peroxide with fluoride
(555-8379-VB) 15% Carbamide Peroxide End of
Active Bleaching
6 months 2 years
†
Vita shade units on 16-tab value-oriented shade guide.
(Vita Lumin, Vita Zahnfabrik, Bad Säckingen, Germany) • New preattached syringe tip for easy dispensing
PATIENT KITS:...................................37.99 12 @ 35.99 • Convenient, 2-pack travel case that goes anywhere your patients do
(555-3479-VB) 10% Carbamide Peroxide
(555-4511-VB) 15% Carbamide Peroxide *According to American Dental Association guidelines, a bleaching material is judged to be efficacious
if its use results in at least 2 shade changes according to a value-oriented Vita shade guide.1
Reference: 1. Swift EJ, May KN, Wilder AD, Heymann HO, Bayne SC. Two-year clinical evaluation
TRAVEL KITS: ....................................10.99 12 @ 9.99 of tooth whitening using an at-home bleaching system. J Esthet Dent. 1999;11(1):36-42.
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Vital Tooth Whitening – The Gold Experience
Sandra
Sandra Marcil,
Marcil, RDH,
RDH, MS
MS
Sullivan-Schein Dental
Attn: CEHP
26600 Haggerty Rd.
Farmington Hills, MI 48331
3 CE
Course Evaluation
CREDITS Please evaluate this course by responding to the
following statements, using a scale of
Course Fee $55.00 Excellent=4 to Poor=0.
1. The content was valuable:
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