Ali Salehi explains how maximising the aesthetic result of tooth whitening can be achieved by answering three questions.
When it comes to dental aesthetics, tooth colour is an important consideration. It is well understood that tooth colouration can be caused by intrinsic and/or extrinsic staining. The success of tooth whitening, whether in-office or at-home, is directly related to two important parameters:
- Proper case selection
- Precision in executing the whitening protocol.
Maximising the aesthetic result of tooth whitening can be achieved by answering three questions:
- Who is a good candidate for tooth whitening?
- In-office or at-home, what is the better option?
- What protocol will maximise the result?
Who is a good candidate for tooth whitening?
Combining tooth whitening procedures with other types of treatment can address many cases of intrinsic staining. Patients who would benefit most from this conservative aesthetic treatment (Figure 1) typically have extrinsic staining issues affecting the enamel.
We should consider tooth colourations related to food (e.g., red fruits, tomato sauce, colourful spices like curry or paprika), drink (e.g., tea, coffee, wine), tobacco or marijuana use, excessive use of certain mouth rinses (such as chlorhexidine), and the activity of certain chromogenic bacteria.
In these cases, the staining affects the entire tooth. Over time, deposits cause a superficial discolouration that can impact deeper aspects of the tooth structure. In these cases, neither simple oral hygiene techniques nor in-office polishing measures are sufficient to remove the staining.
In these examples, the chromophores that are responsible for the colour change can easily be oxidated by hydrogen peroxide within the tooth. This oxidation associated with an opacification of enamel, that also comes with tooth whitening, will significantly enhance the aesthetic outcome.
Natural loss of brightness due to normal tooth ageing also gives interesting results but one has to remember that the brightness of a tooth surface is directly related to enamel, such that the thicker the enamel, the brighter the tooth (Figure 2).
This explains why teeth look whiter at a younger age. It also explains why tooth whitening procedures could be less successful with older patients and/or young patients with a thinner enamel.
In-office or at-home?
Tooth whitening involves applying a chemical agent (hydrogen or carbamide peroxide) directly to the tooth surface to enhance its brightness. It can be administered as an in-office treatment or conducted at home by the patient. Each technique has its pros and cons.
Due to the high concentration of the product, in-office treatments yield more immediate results. However, these results tend to be less stable over time, with a faster relapse, an unpleasant experience for the patient, and the requirement to dedicate the dental chair and staff for the procedure, which could otherwise be used for different treatments.
At-home tooth whitening uses a lower concentration of hydrogen peroxide, resulting in a longer treatment duration to achieve a desirable outcome, with the added need for patient compliance during the process. However, this method provides a more stable, long-lasting result and is generally a more pleasant experience for the patient. The dental chair is only used for brief follow-ups to ensure everything progresses smoothly.
What protocol will maximise my result?
The tooth whitening results are directly related to the concentration of hydrogen peroxide and the application time. For instance, using lower-concentration hydrogen peroxide products at home over two to three weeks can produce similar colour changes to high-concentration products used in a single in-office session.
Due to the advantages of at-home whitening (longer stability of results and improved patient experience). However, to optimise the outcome, following the procedure is essential.
Steps before starting tooth whitening:
- Conduct a full dental check-up to ensure no contraindications such as cavities, gingival inflammation, or ill-fitting restorations.
- Carry out professional prophylaxis and polishing to remove any residual dental plaque and superficial discolourations.
- Take impressions for working casts to create customised nightguard trays.
At-home whitening procedure
- Place a small drop of gel into each tray compartment for the teeth undergoing treatment.
- Seat the tray with the gel around the teeth.
- Wipe away any excess gel in the mouth using a tissue or a dry, soft brush.
- After the treatment, remove the tray.
- Rinse both the tray and the mouth.
- Brush teeth.
For effective results, it’s important to advise the patient to avoid eating, drinking, or smoking during treatment. Smoking should also be avoided immediately after treatment (wait at least two hours). Additionally, foods and drinks with strong colours should be avoided for at least 48 hours after the treatment period or consumed in moderation. Another critical point is to use gel at room temperature.
The manufacturer’s guidelines for seating time (which correlates with concentration) should be followed precisely. Treatment is typically prescribed for two to three weeks to ensure an optimal result. The treatment may extend to six months in more severe cases, such as grade one or two tetracycline discolouration.
Documentation and monitoring
A major element of whitening treatments is documentation. Taking before-and-after photographs and checking in with the patient regularly during treatment is essential. This helps to improve the patient experience and objectively monitor and assess the results.
Following all these steps distinguishes a professional at-home whitening treatment from an over-the-counter (OTC) option, providing a secure and effective environment for patients to address their discolouration issues.
The manufacturer’s treatment guidelines regarding the seating time (correlated to concentration) should be precisely followed. This treatment should be prescribed for at least two weeks and up to three weeks to ensure an ideal result (Figure 5). Literature indicates that this treatment could go as far as six months in more extreme cases, like grade one or two tetracycline discolouration.
A major element of whitening treatments is documentation. It is mandatory to take before-and-after pictures and regularly check in with the patient during treatment to improve the patient experience and monitor and assess the result objectively.
Respecting all these points makes the difference between a home professional whitening treatment and a home OTC whitening treatment. This will create a secure and efficient environment for patients to properly address some of their unaesthetic discolouration issues.
Discover more about Pola Professional Whitening and how our solutions can help you elevate your whitening uptake.
Ali Salehi graduated with a Bachelor of Dental Surgery from the Faculty of Dental Medicine, University of Strasbourg, in 2008, after completing a master’s in biological and medical sciences in 2007. He worked as clinical faculty in the Department of Prosthodontics at Strasbourg until 2015. Since 2023, he has been pursuing an advanced DDS degree at NYU College of Dentistry.