CATEGORY 36 AUSTRALASIAN DENTIST INNOVATIONS When providing stunning teeth whitening outcomes for your patients, one tendency is to believe that a failure to meet a patient’s high expectations must be caused by the whitening gel, e.g., carbamide or hydrogen peroxide. A common mistake to resolve this (that still doesn’t work) is to prescribe a higher-strength peroxide, believing it will get better outcomes. While an incorrect tooth stain diagnosis and a failure to prescribe the correct peroxide impacts the outcomes, it fails to consider all the critical components of take-home whitening. The problem of peroxidase during teeth whitening treatments Various factors can hinder the success of teeth whitening, one of which is the enzyme peroxidase found in saliva. Understanding how peroxidase interferes with peroxide-based whitening agents, particularly when saliva ingress occurs due to poorly fitting trays, is crucial for dental professionals. The role of peroxidase in whitening Peroxidase is a natural enzyme in saliva that breaks down peroxide compounds, the key ingredient in most whitening gels. Whitening agents like hydrogen peroxide and carbamide peroxide work by releasing oxygen radicals that oxidise and remove stains. However, when peroxidase comes into contact with these agents, it accelerates their breakdown, reducing the gel’s whitening effect before it can fully act on the teeth. The issue of saliva ingress Saliva ingress occurs when saliva seeps into poorly manufactured whitening trays that fail to create a tight seal around the teeth. The result is a compromised whitening process, as the saliva neutralises the peroxide before it has sufficient time to whiten the teeth. The combination of saliva dilution and peroxidase activity severely reduces the effectiveness of the treatment, leading to unsatisfactory results. Furthermore, uneven exposure to the whitening gel may cause inconsistent results, such as patchy or incomplete whitening. Importance of professionally manufactured whitening trays The best way to prevent saliva ingress is using high-quality, custom-fitted (dentinspecific) whitening trays. Professionally manufactured trays are made from impressions or a scan of the patient’s teeth, ensuring a precise fit that minimises gaps where saliva can enter. This tight fit is created using a semi-rigid 1.5 mm EVA bleaching tray, hybrid pressure and vacuum formed with sealed gingival margins. Adding a unique patient gel ‘dosing dot’ reduces the amount of gel wastage and gingival irritation by not over-filling the whitening tray. The high impact of peroxidase in teeth whitening By Stephen Douglas – The New Generation Teeth Whitening Mastery Program, sponsored by Boutique Whitening. This helps keep the whitening gel in place, allowing it to fully interact with the tooth surface and achieve consistent results. In contrast, over-the-counter ‘boil n bite’ or poorly fitted trays often allow saliva to mix with the whitening gel, reducing its potency and causing uneven application. Moreover, these trays may allow the whitening agent to leak into the gums, causing sensitivity and discomfort. Clinical implications of poor-fitting trays When trays are not custom-made, the reduced effectiveness of the whitening treatment can lead to extended treatment times, increased chair time, and potential patient dissatisfaction. Patients may require additional sessions to achieve their desired results, increasing costs and time spent on treatment. Additionally, poorly fitting trays can irritate soft tissues in the mouth, such as the gums, leading to further discomfort. Optimising whitening outcomes To optimise results, dental professionals should emphasise the importance of custom-fitted trays in both at-home and in-office whitening treatments. Educating patients about the risks of poorfitting trays, including saliva ingress and reduced efficacy, will help manage expectations and improve compliance. A combination of well-made whitening trays, understanding what has caused the tooth stain, prescribing the ideal peroxide, minimalising tooth sensitivity, and maximising patient compliance will over-deliver on the outcomes for your adult patients. Incorporating custom tray fitting into a professional whitening service enhances patient satisfaction and ensures more reliable and consistent outcomes, leading to better overall patient experiences. Conclusion The peroxidase in saliva can significantly reduce the effectiveness of teeth whitening treatments, especially using poor-fitting trays. A trained technician should manufacture high-quality whitening trays; it can be a false economy as a dental practice to ask a team member to manufacture your patient’s whitening trays without the correct training and supervision. What quality control checks does your dental practice have in place, or when were they last reviewed? u If you would like to review your existing teeth whitening services or learn how to easily create a teeth whitening centre of excellence in your practice book a complimentary online review with Stephen Douglas at the New Generation Teeth Whitening Mastery program on 0416 629015 or email stephen@thewhiteningproject. com.au. Sponsored by Boutique Whitening (Australia). Stephen Douglas What makes a good whitening tray
RkJQdWJsaXNoZXIy MTc3NDk3Mw==