Here is the pictures from a completed at home whitening case. Isn’t the result amazing???
Before:
After:
HA, Fooled you this is the same pictures of the baseline situations the only difference is the way the flash has lit up the scene. I’ve also not photo-shopped the light on these at all but I think from this you could see how easy it is for whitening manufacturers to fool patients. The best way to show/ prove whitening is to take pictures next to a shade tab. Here the closet shade to the case was A4 but the teeth were actually darker than this. I therefore took all the following photos with this tab against them. The sequence shows the patient at baseline, 2 week and 6 week check up.
If your interested the other work you can see that is my work is the 14 buccal composite and the 45 large composite build up. I root filled the tooth a few months ago and I’m set to crown it now the whitening has been completed.
I think this is a pretty good result and I really believe you need to be getting this kind of doccumentation for your whitening cases so you can monitor progress, relapse and protect yourselves.
You need a good written consent for gingival irritation, relapse and sensitivity. Then I like to start the patients on a low concentration agent for 2 weeks. I only give them 2 small tubes and tell them they have to make that last for 2 weeks night wear. This ensures they are not overfilling the trays. After checking there is no sensitivity and progress I then introduce a much stronger agent to wear for the next 2 weeks to speed the whitening up a little, I then typically lower the dose again for the last 2 weeks (night time) to maintain the shade reached. Reviews are at 2 and 6 weeks and again in the middle if the patient has any problems. I then recommend occasional night wear of the low concentration agent to prevent relapse. Just 2-3 nights every 3 months or so.
The regime works well for me and is a good mix of speed and keeping the concentration low over a longish duration which has been shown to reduce relapse rates.
The patient was really happy with this result and had no sensitivity. All the research I have read suggest tooth whitening in this way is safe and effective as long as it is done in a controlled way. If any patients are reading this blog then please remember that you need very close fitting trays that only a dentist can make and good quality whitening agents to get a good result. You also need to be aware that some staining will not be helped by whitening and should be checked by a dentist, you should also be reviewed regularly. If you want whitening done then I’d say go for it, but find someone good to do it, someone safe. I’ve seen some of the horror stories when it has been done in a unsafe way so please be careful.
Hope this blog brightens… or whitens your Monday morning blues!
Chris 
#1 by Farrahfawcett at March 8th, 2010
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Good pictures plus the good article certainly made this segment amazing. And it’s so informative blog. keep it up!!
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#2 by Dentist Philippines at March 20th, 2010
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What brand of bleaching material are you using?
#3 by Tom at May 8th, 2010
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have you found any studies documenting and comparing longevity of teeth whitening systems. Especially of interest is the Zoom light activated whitening system. I have not seen any significant advantage of using Zoom as opposed to an in office peroxide only whitening. I think the higher cost of the Zoom type system is a rip off and so do a number of my colleagues here in California, USA.
But I don’t really want to take such a hard line with out unbiased and independent research. There aren’t very many of those or I have just not been able to find them. What is your experience and have you any sources for scientific studies? Thanks !
#4 by ChrisO'C at May 8th, 2010
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Hi Tom, I just had a quick search on pubmed but I can’t find the article I read from a chap from the eastman institute (I heard him speak about whitening about a year ago, they should be very independent). I’ll try to find out who it was over the next few weeks and find links to articles on pubmed.
Basically the gist from his research was that whitening with a lower percentage hydrogen peroxide made the whitening last longer and reduced symptoms. Using a in office bleach made the whitening faster but more relapse/ sensitivity. The eventual shade you get to is the same with all systems but takes longer with lower percentages.
Personally I tend to use only 20% and 45% home hydrogen peroxide for most cases (by optident). The 45% is quite strong but is a better compromise of speed to sensitivity in my opinion than the in office systems.
Is that what the customer whats though? I think if someone wants white teeth as fast as possible then in office systems will continue to have a place in dentistry but this must be backed up with a low percentage home tray system to to prevent relapse.
Hope that makes sense and I’ll try to dig out that article. Can anyone else reading from Newcastle remember it?? It was in an odontological society talk about a year ago??
#5 by Toronto Dentist Blog at July 16th, 2010
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Nice results Chris!
Here’s a tip I got from an American dentist that you may want to try… Give only the top tray and have them back for evaluation and photo before giving them the bottom tray. Benefit is more excitement over results and great photo opportunity to capture difference.
Joe
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