Managing Unrealistic Teeth Whitening Expectations

Patient disappointment with whitening treatment manifests in many ways. Maybe the patient is subtle, using body language or subconscious signals, like the set of the patient’s mouth when they first see the results or an almost undetectable squint of their eyes.

You can also detect disappointment in phrases like, “Oh, I thought it would look different than this,” or “Is it going to get brighter after I leave?”

Disappointment could also appear in a rant on social media or in a less-than-flattering online review.

Regardless of how you hear about it, disappointment with whitening treatments is never the outcome you want. We explore ways to avoid patient disappointment with whitening treatments in your dental practice.

Expectations and Personality Contribute to Perceived Outcomes

So, what causes disappointment? Disappointment results from many things that happen during treatment.

A 2020 literature review of medical and dental patient-reported outcome measures in the International Journal of Dentistry concluded as much. However, the researchers also say if clinicians and their teams can better understand how to manage patients' expectations by giving them information in a clear and timely way, it could help reduce patients’ chances of feeling unhappy about their medical or dental treatment.¹

Traditional marketing theories agree that expectations are to blame here. The theory behind consumer satisfaction is called the User's Satisfaction Theory. This theory says that even if someone has a good experience with a product or service, they might still feel unhappy if it fails to meet their expectations. This is called Negative Disconfirmation. By contrast, if the experience is better than expected, it leads to Positive Disconfirmation, a flip-flopped scenario where people feel satisfied.¹

In other words, people form expectations about how well a product or service will or won’t work, influencing how satisfied they feel. The Disconfirmation Model also explains that satisfaction doesn't depend on whether expectations start negative or if the product's performance ends up negative. What matters is the difference between what people expect and what they experience.¹

Assimilation Theory might apply, too. This theory describes how people try to avoid unhappiness by changing how they see the product. Some might adjust their expectations to match the product or service's performance. Other people might downplay their performance dissatisfaction by convincing themselves it's not a big deal.¹

In addition to expectations, the personality type might affect how a patient perceives the outcome of their whitening treatment. A 2015 study in the Brazilian Dental Journal suggests that most people seeking whitening treatment had common personality traits; moreover, they had moderate expectations and were mostly satisfied. The one exception was the extroverts, who were motivated by social inputs. Their personality type affected their satisfaction more than the other participants. Still, the effect of their personality was that they would be more satisfied with the whitening outcome than other personality groups.²

The researchers also concluded that people shared common goals in seeking whitening treatment among personality types. People who seek whitening do so to feel happier and less inhibited, improve self-esteem, and increase their successful participation in social environments. Moreover, knowing these goals should direct clinicians in individual treatment planning.²

So, How Do You Communicate Proper Expectations?

Sarah Jebreil, DDS, AAACD, says effective communication is crucial for a positive patient experience. She adds that psychology also plays a key role in facilitating this process, as different personalities respond to communication styles in various ways. Dr Jebreil emphasizes tailoring communication strategies to suit each patient's personality type.

Dr Jebreil says most of her patients are happy with their whitening treatments. In her experience, only about 10% are disappointed. She says their disappointment is likely related to the brightness outcome rather than the whiteness achieved.

“Maybe their color does get whiter on the shade guide,” Dr Jebreil says, “but it’s not as bright as they want. That has to do with the enamel they have.”

Dr Jebreil explains that helping patients understand their enamel type's role in the outcome is essential in managing unrealistic expectations before whitening treatments. Patients with inherent prismatic enamel, or translucency that extends from the middle to the incisal edge have limitations regarding brightness compared to a person with translucency only in the lower third.

Before whitening, she explains how these biological limitations affect the outcome to avoid patient disappointment, particularly with those patients whose biology will affect how bright the smile looks. However, she simplifies the message, removing the clinical terms and making it accessible for patients.

For example, she explains that brightness from whitening is affected by the tooth's translucency and draws patients' attention to how the light shows through their teeth at the present shade. She says photos help, too, by giving patients a before-and-after view to compare after whitening.

“We always do a pre-op shade photo and then post-op,” Dr Jebreil says.

Regarding conversations about procedures with patients, it is essential to recognize that what may seem routine to you is usually new and unfamiliar to patients. Intentional overcommunication is key. Reviewing the treatment and including its details can strengthen trust and improve the patient experience. Additionally, clinicians should:³

• Reconnect with your empathy and compassion by remembering that you went into the field to help people.
• Build trust and rapport with patients by communicating outside the typical interactions in the practice with tools like social media.
• Discuss with patients what you consider realistic outcomes.³

Dentists and their teams can set proper expectations for dental whitening treatments by first understanding what the patient hopes to achieve and guiding them based on expert knowledge. Asking why patients want to whiten their teeth provides insight into their motivation, and having them show their desired shade on a guide helps determine realistic options. It's also essential to discuss the time it might take to achieve results, as some patients may have specific deadlines or cases that require longer treatment.⁴

Additionally, it is crucial to inform patients about the limitations of whitening on existing dental work and plan for future restorative cases. Discussing potential side effects like gum irritation and tooth sensitivity beforehand can prevent negative surprises.⁴

Lastly, patients should be informed about the temporary nature of whitening and the maintenance required. Explaining how diet and beverage choices can affect results helps manage expectations and ensures patients understand how to maintain their whitened smile.⁴

Dr Jebreil also emphasizes to patients that long-lasting whitening effects do not have a quick fix. She wants patients to understand that from the beginning. Moreover, she explains that patient compliance is a factor in the whitening treatment outcome. Dr Jebreil uses the Kör Whitening system, which takes place over 2 to 4 weeks and requires patient behavioral management (e.g., refraining from drinking beverages that stain, like coffee, for 2 weeks and consistent treatments every night). She finds that patients willing to commit the time and energy involved with this system consistently get the best results.

In cases where this pre-emptive expectation management falls short, or the patient thinks the compliance requirements are too much work, Dr Jebreil sees an opportunity to suggest veneers. With veneers, patients can still have the desired value, even if it isn’t possible with their natural dentition or they are unwilling to stick to the whitening program.

“Either you put the time in and get what you want, or you spend the money and do the permanent fix, like veneers. Nobody will get amazing whitening results without following the protocol and putting the time in,” Dr Jebreil says. “The good whitening systems are where you're spending the time and doing it consistently for 2 to 4 weeks to get those nice results.”

References

1. Kelvin I. Afrashtehfar, Mansour K. A. Assery, S. Ross Bryant. Patient Satisfaction in Medicine and Dentistry. International Journal of Dentistry. 2020. doi:10.1155
2. Martin J, Rivas V, Vildósola P, et al. Personality Style in Patients Looking for Tooth Bleaching and Its Correlation with Treatment Satisfaction. Braz Dent J. 2016;27(1):60-65. doi:10.1590/0103-6440201600127
3. Christian, K. (2024) Managing Patient Expectations: Communication For Medical Professionals, Forbes. Forbes Magazine. Published January 25, 2024. Accessed April 5, 2024. https://www.forbes.com/sites/kwamechristian/2024/01/25/managing-patient-expectations-communication-for-medical-professionals/?sh=7d1a98d3778a
4. Sinclair, L. Managing Whitening Expectations. Colgate. Published July 2022. Accessed April 9, 2024. https://www.colgateprofessional.com/hygienist-resources/patient-care/managing-whitening-expectations