Do dentists really understand teeth whitening?
Dr. Linda Greenwall talks to us about teeth whitening and whether or not dentists actually understand the science behind it.
The colour of teeth is now a primary concern for many patients, which then begs the question is teeth whitening an exact science? And do you understand it? Read on as Dr. Payman Langroudi, marketing expert Prav Solanki and the legendary Dr. Linda Greenwall speak on this controversial topic.
Dr. Payman Langroudi: What do you say to dentists who say “whitening isn’t rocket science and it’s not a subject anyone should choose to focus on because it’s not real dentistry?”. I mean I know what my response is to that, what’s yours?
Dr. Linda Greenwall: The biggest issue I have when I teach dentists is that they’ve never bothered to learn about the science of whitening, not the evidence or research. They do not know whitening. They make it up as they go along. They make up random facts, a new associate will join the practice, the principal hasn’t learned whitening and they’ll give them fake news.
They say: this is what’s done and nobody is the wiser, and whitening programmes are not successful because they are just making it up with random nonsense. But there is a lot of scientific evidence on whitening and certain protocols that need to be followed.
If the dentists take the time to learn it properly themselves, they can be better teachers for the associates and the hygienists and everything else. The biggest problem is they’re just making it up as they go along.
Prav Solanki: So it’s more than just taking an impression, whacking some gel in there and telling the patient to go home. Because I speak to a lot of dentists about different whitening products mainly from a marketing perspective. And it’s the same attitude that Payman has just mentioned. They don’t differentiate between products apart from price and they say, “Oh, well this does the same as that.” All you’re doing is sticking bleach in there, sending them home and it’ll do the job and their results tend to be variable. So they get some cases that go really well, usually cases using Enlighten, in my personal experience.
I only need to wear my tray for a couple of nights and my teeth glow. And that’s as far as I need to go even though the instructions say 14 nights.
There is a lot of scientific evidence on whitening and certain protocols that need to be followed
Dr. Payman Langroudi: The funny thing in our industry is everything’s named by percentage.
And a lot of people like to think they know what’s going on. And so they think Nurofen 200 milligrams is the same as Ibuprofen 200 milligrams. But whitening is so flexible because you’ve got a physical situation with a tray. And then you’ve got a chemical situation with a chemical.
Dr. Linda Greenwall: And you’ve got a patient with anatomy.
Dr. Payman Langroudi: And bruxism. The difference is in the physical things that can happen there and a volatile liquid. The whole point about it is it breaks down and so it’s very, very different depending on the patient.
But for me when someone says it’s not rocket science, generally that guy doesn’t know what he’s talking about.
Dr. Linda Greenwall: Exactly.
Dr. Payman Langroudi: But secondly, we know the colour of teeth is the number one concern of our patients. By far it’s way bigger than orthodontics, caries, etc. That’s what they care about the most.
Dr. Linda Greenwall: Absolutely.
Dr. Payman Langroudi: And often you see these full examinations that the practices sell and market. Examinations that last an hour and a half, they have two pages on the internet about what’s covered, they’ll look at TMJ’s, lymph nodes and manifestation and all of this is good stuff. And yet shade’s not mentioned.
The primary concern of our patients culturally isn’t in our examinations. And it needs to be. And so whitening needs to be talked about more, not less.
Obviously I haven’t got a horse in the game, right? I’m biased. But this idea that it’s not real dentistry. Well, you’re not treating real patients then if you don’t think its real dentistry.
Dr. Linda Greenwall: It’s good to listen to all the objections because from a hearing all that stuff you can have a strategy to change, to move forward. So here’s the thing, we say: number one take a shade on every single patient. It’s a science actually. And that’s part of your exam. That’s the first thing.
And we teach the dentist to just start with the basic shade, which is called A3. Just have loads and loads of A3 shades and measure every single patient. The patient wants to know, “Oh, is that a good thing or a bad thing?”. So it starts the opening discussion. Some dentists say, “Oh, I’m not really, I’m not good at selling, so I can’t sell whitening.” This is not a sales thing. This is a scientific measure.
Colour of teeth is the number one concern of our patients
Dr. Payman Langroudi: It’s a service thing.
Dr. Linda Greenwall: It’s a service and a scientific measure.
You measure the A3, are they lighter or darker? You record it. And the patient goes, “Can I see the shade guide? What’s lighter than A3? So my teeth are A3”.
And the dentist goes, “Well, 90% of patients may have that shade.” The patient says, “What’s lighter?”; “A1″. “Well, that’s quite a nice shade. Can I have that? Would that be appropriate for me?”
And I teach the dentists to do an audit. Everybody hates doing radiology audits, which is fine, but do an A3 audit. And say: For the next hundred patients had come in, we’re going to measure shade and see who uptakes on whitening. Six months later the patient comes back, they go, “Could you just check my shade because I think my teeth might’ve got darker. I’m interested now in doing whitening.” So it opens the discussion. It’s a scientific measure.
There’s a really nice device now called the VITA Easyshade. I don’t know if you’ve seen it, really excellent. And I think actually many dentists should have that in their practice because it’s a scientific measure. It’s got bluetooth, it’s got an app and you can measure their bleaching percentage and all those things. Dentists love technology, so this is quite a handy piece of kit.
But every patient should have their shade measured and they should know their shade. It’s not a personal question, it’s not an invasive question. It’s a scientific measure.
When they say it’s not rocket science, there is tons of science behind it. But you have to start with basic communication. For example, if you’re about to start restorative dentistry and you ask Mrs. Jones: “In the next five years, were you ever going to consider whitening your teeth? Because we were about to do a crown on your front tooth and we need to keep it at the same shade as your teeth are now. But if you were considering whitening, now is the time so we can choose a lighter shade of your crown.”
There are some basic questions about whitening we need ask patients. It’s not a sales technique
But we want to educate dentists to able to learn the science to be able to provide the service on top of which the oral health benefits of whitening is major.
Dr. Payman Langroudi: Do you tell your patients whitening is good for them?
Dr. Linda Greenwall: I say it has oral health benefits. I say improves the gums, reduces the swelling, makes the mouth feel cleaner and plaque doesn’t stick as much to the teeth. So we talk about those benefits. We also talk about sometimes how we need to integrate it into the whole process of dentistry where we will do cleaning, we’ll start the whitening review and constantly improve their oral health first and then we continue with whatever is needed.
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