CATEGORY 24 AUSTRALASIAN DENTIST INNOVATIONS There is a whitening kit in most practices. It gets used when patients ask or inquire, and as we know, less than a third ever do. When they do ask, there is a tendency to reach for the same gel, the same protocol, the same instructions. You get a result. But without a recall built into the system, how do you ever know whether you met that patient’s expectations? Sometimes the result is good. Sometimes it falls a little short. And if you are honest, you have never been entirely sure why. at uncertainty is not a product problem. It is a diagnosis problem. Knowing a patient wants whiter teeth is not the same as knowing how to treat them. ose are two separate clinical steps and most practices blend them into one. at compression is when outcomes become unpredictable, when the clinical team quietly loses con dence, and when a treatment that should be thriving disappears back to the shelf. It is rarely the product. It is almost always what happened before the product was selected. The diagnosis most protocols skip Tooth discolouration is not one thing. It presents in two fundamentally di erent ways and each requires a di erent clinical response, a di erent peroxide, to get the best outcome. Extrinsic staining sits on the surface of the tooth. It is the result of surface deposits that accumulate over time from diet, tea, co ee, red wine, tobacco, chlorhexidine, and other external sources. It responds well to hydrogen peroxide at a shorter contact time. At 6% concentration, it can be worn safely for up to ninety minutes. At 9% a maximum of only 30 minutes, due to sensitivity issues. Hydrogen peroxide, applied consistently for 14 to 20 days, produces predictable results. Intrinsic staining, on the other hand, originates from within the tooth structure itself. It sits much deeper in the microstructure of the tooth and needs more contact time to address. Tetracycline staining is a clear example of this. Carbamide peroxide (10 or 16% maximum), worn overnight for four to six hours, gives the chemistry the conditions it actually needs to work on those deeper discolourations. Hydrogen peroxide, which is active for up to 90 minutes and is generally worn for 30 to 60 minutes, requires signi cantly more applications to achieve a comparable result for intrinsic staining. Consider two patients who present with the same desire for whiter teeth. One has extrinsic staining from years of co ee and tea. e other has deeper structural discolouration that has been building since their early twenties. Prescribing an identical protocol to both is not clinical decision-making. It is guesswork with good intentions, and like the gym member who wants to run a half Why your whitening outcomes vary Identifying that a patient wants whiter teeth is the first step. Knowing how to treat them is a different clinical problem entirely. By Stephen Douglas, Teeth Whitening Systems Educator, National Manager, Boutique Whitening Australia, Twenty-two years building teeth whitening systems across the UK and Australia. marathon but is put on the same programme as someone wanting to lose three kilograms, the result will almost certainly fall short of what was possible. And that leads to disappointed patients. is is not a product limitation. e distinction between the two peroxides is activity time and the wear protocol built around it, not which stain type each can treat. Both can address extrinsic and intrinsic presentations. e question is whether the protocol selected gives the chemistry the time it actually needs. Without identifying the stain type rst, that question never gets asked. And it was never your fault. Teeth whitening was not taught as a diagnostic discipline at university and it did not form part of dental education. It arrived in practice as a product. A clinician who applies a uniform protocol across all whitening presentations is not cutting corners. ey just did not know any di erently. ey learned from peers. ey worked with what they were given. The moment that changes the conversation Most patients have no awareness of how gradually their tooth colour changes. ey do not wake up on a Monday with yellow teeth. at stain creeps up over the years. e shade guide, when used correctly, simply makes it visible for the rst time, placing the patient’s tooth against a clinical spectrum of dark to light. at is when patients realise their teeth could be whiter. A patient sits in your dental chair, and one day, because you have Stephen Douglas “ e most cost-e cient, safe and e cacious technique for both the dental o ce and the patient is generally recognised as tray bleaching.” Van B. Haywood DMD, Dental Practice Success, 2016 The gel is rarely the problem
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