The Future of Teeth Whitening

I think at some point in the future we will look back on our practices and remember the unusual stories generated by dentistry during COVID-19. Sort of like Tales From the Crypt, only more appropriately named Tales From the Pandemic, perhaps.

I had a very nice lady come into the practice. She has been a patient for many years, and we have developed a great rapport. She has always been very fastidious about her appearance with the latest fashion, hairstyle, and an amazing, well-kept smile.

On this day she had called because she fractured tooth #10 and wanted options for restoring it. Because we had just fully reopened after the pandemic shutdown, we were very busy with trying to catch up. When this patient made the appointment, she knew we had a brief slot to do triage and then we would have her back as soon as possible.

When I stepped in, my team had already taken a periapical x-ray, and intraoral images and had given her an idea of what to expect. What I saw was a gorgeous #10 with about one-third of the clinical crown fractured from the incisal edge down. Full coverage was the only practical solution, but I had 15 minutes.

I tried to figure out whether I could somehow use composite until we could have her back to do the crown. I told her a crown was her best option. Then I segued into what I would need to do immediately to get her back to “presentable.” I began to explain that I would try to rebuild the missing part with “white filling material” but she would really need to favor it until the crown appointment. She laughed and said, “Dr Flucke, that’s sweet of you to be that concerned, but you don’t have to do anything today. I’m living my life in a mask.”

I was seeing things from the doctor’s perspective and had forgotten that those of us in dentistry were the only ones, other than relatives, who were seeing individuals without masks.

And Now for the Big Reveal!

During the past 12 to 18 months, masks have spared practices a lot of stress. However, masks are starting to come off in some areas, and eventually we will probably be back to a minimal mask environment. That means patients are going to start looking for ways to flash a bright smile.

One of the things we have found to be a good low-pressure marketing tool is the wallpaper on the patient monitor. For the past 6 months or so, we have been using that space to promote our whitening program. We have several different images that rotate on the screen: one with a model in a mask, one with a model wearing a mask with a cutout so you can see the smile, and some with our usual whitening images. We have gotten positive feedback on this and have had quite a few patients decide to whiten based on it.

Trays

The most common whitening process still involves the custom tray. Nowadays we are scanning patients with our iTero Element^® 5D Plus intraoral scanner and then printing the models with our SprintRay Pro Dental 3D Printer.

One thing I love about technology is that it basically markets itself. People are fascinated watching their teeth appear on the screen as we scan their mouth. We usually take the time to move the images around on the screen, rotate them, and zoom in just so they can see and appreciate how amazing the scanner truly is. When we give them their models and explain to them that we have taken their digital scan and printed it using the office 3D printer, they have a greater understanding of how we are using technology to make things better.

Strips

When Procter & Gamble (P&G) brought its Crest Whitestrips to the market, the dental industry was less than pleased. There was a great deal of concern that patients would forgo professional teeth whitening in favor of the lower-cost P&G option. What eventually happened was that patients tried Whitestrips, and those who did not get the desired results turned to their dental office for brighter smiles.

Along those lines, in addition to custom trays, we also offer our patients a couple of strip options. Our recommendation for a strip system depends on what we glean from the patient as we discuss the options.

Many complain that white strips were flimsy and difficult to keep in place. For those individuals, we recommend Sheer White! from CAO Group. The system uses 20% carbamide peroxide. What sets Sheer White! apart from other strip products is its adhesive. Other brands can slip, but once Sheer White! strips are applied to the teeth, they stay in place until the application time is met. After about 2 hours in the mouth, the adhesive begins to break down, making the strips easier to remove. Our other choice is Opalescence Go from Ultradent. These strips come in 10% or 15% hydrogen peroxide. Go comes in packages for each arch, and the strips are easy to place. The strip is contained inside a mouthguard. The patient creates suction in their mouth that pulls the strip against the teeth, and the mouthguard is removed, leaving the strip in place.

Therasmile from Mavrik

Since the idea of teeth whitening came into existence, the profession has been looking for a simple in-office system that will provide bright results within a single appointment. Dentistry has tried different ways to provide this service. We have tried activating the whitening agents with lights, heat, lasers, chemistry, and sometimes a combination. Now there is a new company in the in-office teeth whitening market called Mavrik and their product is TheraSmile.

TheraSmile is an entire automated system. It consists of a device, a mouthpiece, and chemistry. The device is freestanding, connects to the mouthpiece, and circulates the chemistry through it. The chemistry is warmed and circulates so that there is always fresh material coming into contact with the teeth. The mouthpiece creates a fluid seal, utilizing a vacuum that keeps the chemistry from escaping into the mouth.

Often with in-office systems, the patient must keep their mouth open for the entire treatment time, which leads to dehydration. Although the teeth appear whiter at the end of the appointment, they often rebound and lose much of the whitening as they rehydrate. Because of this, many offices provide take-home trays as an adjunct to make sure the whitening remains. With TheraSmile, the teeth do not dehydrate, which means that the shade achieved at completion remains. Because the liquid chemistry constantly rehydrates the teeth, results are much more predictable. Also, the chemistry is provided in unidose treatment kits that prevent cross-contamination.

We’ve been beta-testing the device for about 3 weeks. The initial results have been very nice. My wife is always my test subject for whitening products. She tends to develop sharp sensitivity when whitening, so whenever I get a new product to try, she is always the first test subject. I am happy to say that she had a beautiful result from the treatment as well as no sensitivity issues.

Wrapping Up

I am not sure who thought of the phrase, but it’s true that “a beautiful smile never goes out of style.” As we reenter a world where people can show their smiles, many of our patients are anxious and excited to do just that. Offering them even more reasons to smile is one of the great things about our profession. After all we have been through, we all need a reason to smile.