Virtually all Americans believe that a good smile is an important social asset, with unattractive smiles widely considered to make a person appear less desirable, confident and successful. On the other hand, whitening teeth has been shown to have a significant positive impact on patients’ oral health-related quality of life, self-perception, and psychosocial wellbeing. It’s perhaps unsurprising, then, that a survey published in the Journal of the American Dental Association reported tooth color as the biggest source of smile dissatisfaction, with 81.8% of people expressing the wish to undergo tooth whitening.
The importance of managing whitening expectations
When a patient approaches us about teeth whitening, they are often emotionally and socially invested in the results. However, their expectations for their new smile, and for the process required to achieve it, may not have been formed with the benefit of professional insight. If their expectations are unmet, their disappointment can be detrimental to both the patient and the dental professional. In order to avoid this outcome, it’s important to take the time to understand what the patient is hoping to achieve and use your expert knowledge to guide patient expectations.
Your patient may hope to achieve the bright, white smiles they see on their social media feeds. However, there are certain factors like genetics, age, stain type and severity of stain, that can influence the end result and how long it takes.
To manage expectations, first ask the patient what made them consider whitening. Their motivations will give you valuable insights into their expectations, and you can assess whether tooth whitening can attain the results they are looking for.
You can use a shade guide to show your patient the shade of their teeth when they ask about tooth whitening, and at the same time check on what shade they are expecting to achieve. Together, you can look at where the patient is now, whether their desired outcome is realistic and, if not, what other options are available to them. Typically, patients can expect to achieve results several shades lighter than their starting point, but it depends on their natural tooth color. While whitening products remove intrinsic stain, they don’t alter the underlying natural tooth color.
Taking the pre-whitening shade at the beginning of treatment and referring back to that can also help patients realize that their teeth really are several shades whiter, as can before and after pictures. Otherwise, patients may not remember what shade they had, leading to the perception that not much changed and therefore disappointment.
Duration of treatment
Depending on what the patient already knows about whitening, their expectations of treatment duration can vary widely. Some patients may overestimate the time required while others will underestimate it. Patient motivations for requesting tooth whitening also vary. Many patients will pursue whitening in time for special events or occasions, such as vacations, holidays, or weddings, so this could lead to disappointment if the selected whitening treatment takes longer than your patient expects.
Make sure to ask your patient how long they think whitening will take and when they need whiter teeth. Be sure to enquire about any upcoming events that may have prompted their whitening visit so that you can ensure you’re both working to the same realistic schedule.
Knowing the event deadline also helps when advising patients on in-office versus take-home whitening kits. In-office treatment will provide a faster result than take-home options, which is important for really tight timelines.
If a patient has severe or resistant staining, such as tetracycline stains, it is essential to let your patient know that it will take longer for their teeth to whiten than for other individuals. One way to address this (in the case of tetracycline stains) is the following: ‘Your stains are due to tetracycline. I want to explain that this type of stain is more difficult to remove. This is perfectly normal for the type of stain you have. It may take several weeks to remove it, or in really difficult cases even months, depending on how resistant the stain is. Is this acceptable or would you prefer we look at a different option?’
Patients should be made aware that the whitening treatment will not change the color of any crowns, veneers or implants they may have. Make a point to discuss any existing tooth-colored restorations that the patient has and whether the patient is happy with them. If your patient says they are happy with them, you need to discuss the fact that the existing restorations will be unlikely to match their whitened teeth.
It is also important to consider any planned tooth-colored restorative work, and to discuss with the patient that this should be performed after tooth whitening for shade matching purposes. Patients should also be advised that the restorative care should be performed a short time after tooth whitening, with some time between them.
The American Dental Association notes that gingival irritation and sensitivity are the most common side effects of tooth whitening treatments. In addition, your patient may believe that home whitening always involves uncomfortable trays, custom fitting, and/or long (sometimes overnight) wear time. If your patient is concerned about side effects or uncomfortable trays, they may be pleasantly surprised to have their expectations unmet in this case!
The Colgate Optic White Professional Take-Home Whitening Kit is designed for no sensitivity or gingival irritation. No-mess application is achieved by using a pen to apply a serum that dries to a thin film. An LED device that is included in the kit is then worn by the patient for a short 10-minute wear time, which accelerates whitening. Repeated daily, and in accordance with the instructions, dramatic results can be seen in just 5 days.
Duration of results
Whitening is not a permanent solution, and gradual relapse does occur. To ensure lasting satisfaction with their whiter smile, make your patient aware that they will need to have periodic maintenance whitening. Ask your patient if they smoke, drink tea/coffee/red wine, or eat heavily colored or spiced foods. If they do, you can sensitively explain the impact this will have on their whitening results and that they can reduce this impact by avoiding or limiting these. It’s also an opportunity to suggest smoking cessation for smokers. For patients with less than satisfactory oral hygiene, explain that this will also contribute to staining and provide oral hygiene coaching.
Tooth whitening has the potential to increase the patient’s confidence and sense of wellbeing, and may even motivate them to invest more time and care in maintaining a healthy smile. Don’t let the disappointment of unmet expectations stand in the way! Start the conversation today and guide your patient towards impactful and achievable smile goals.