Guiding asks in esthetics: whitening addicts and other factors

Date: August 01, 2021

Author: Louise Sinclair

Tooth whitening is the typical go-to esthetic treatment for patients looking to give their smile (and their confidence) a boost. In a study published in the Journal of the American Dental Association (JADA), among the more than one-third of respondents who were dissatisfied with their appearance, tooth color was cited as the most common reason for smile dissatisfaction and 88.2% of these participants stated that they wanted to undergo whitening treatment. Similarly, a study at Brazil’s Araçatuba Dental School found that tooth whitening was the esthetic treatment wanted the most for 85% of patients.

Both in-office and over-the-counter whitening options are readily available and affordable, but for some patients this can mean too much of a good thing. Here, we discuss how dental hygienists can identify patients who are over-bleaching, guide them towards safer practices and help them to achieve their esthetic goals.

The dangers of over-whitening

Tooth whitening is an effective way to improve smile esthetics. Research shows that there is no significant difference in the effectiveness or risk of sensitivity for in-office and at-home bleaching. However, overuse or incorrect use of whitening products, whether administered at home or in the chair, can cause significant harm.

Carbamide peroxide and hydrogen peroxide bleaching agents can cause temporary sensitivity and gingival irritation, even when administered professionally in the recommended concentrations. This can be managed during treatment, and resolves. However, aggressive bleaching has been reported to lead to changes in the surface enamel and to increase its susceptibility to demineralization.

Here, we discuss how dental hygienists can identify patients that are over-bleaching, guide them towards safer practices, and still help them achieve their esthetic goals.

Identifying over-bleachers

Over-whitening can mean whitening too much, too often, or with inappropriate products. When your patient enquires about whitening, consult their records and ask them questions to find out:

  • When they last had an in-office treatment (with you or another provider)
  • Which over-the-counter whitening products and/or home remedies they use
  • How closely they follow the directions (e.g., frequency and duration).

In addition, look for clinical signs that could indicate excessive or inappropriate use of whitening products:

  • Gingival inflammation
  • Sensitivity
  • Discoloration
  • Excessive abrasion.

Find out your patient's motivation

Start a conversation about why your patient is requesting tooth whitening so you can judge how best to provide support. You may be able to help your patient achieve their desired results without the need for bleaching. You may also discover some underlying motivations that could be better addressed by a different course of treatment or in another manner. When you can encourage patients to share their deeper motivations around whitening treatment, you can help guide them towards the most satisfying outcome.

Simply ask and listen!

RDH Magazine recommends leading with open-ended questions. These might include:

“Is there any particular reason you’re looking to whiten your teeth?”

“Do you have any other concerns about your teeth?”

“If you could change anything else about your smile, what would that be?”

When your patients open up about their esthetic goals, the importance of active listening cannot be understated. In the article, the following are recommended: “listening between the lines”, or observing the patient’s non-verbal responses for signs of fear, frustration or want. The importance of your own non-verbal cues is also emphasized, including maintaining positive eye contact with the patient and avoiding discussions when the patient is reclined or when you are standing.

Course-correct and counsel where necessary

Is your patient generally unhappy with the appearance of their smile (e.g., alignment or shape of teeth)? If what the patient really wants is a straighter, more uniform smile, they’ll never be truly satisfied with the relatively “easy win” of tooth whitening. By identifying this need and guiding them towards the appropriate solution, you’ll win their trust and help them to achieve a smile that’s esthetically pleasing and addresses their main concern.

It may simply be that your patient is trying to look their best for an upcoming special occasion. Rather than repeated bleaching, you could recommend a single session accompanied by maintenance whitening in the lead-up to the event. This might include:

Is your patient really self-conscious about the color of their teeth? Patients with self-image concerns may be especially vulnerable to over-whitening. Counsel these patients on careful use of whitening products, including the risks of using unregulated products. It may be helpful to emphasize that there are risks associated excessive whitening and that over time this can cause teeth to appear discolored – the very outcome they’re trying to avoid.

Has your patient had limited success with other whitening options? Check that the patient has been using the appropriate whitening products for the type of discoloration, and has been using them correctly. With your guidance, they can get the desired results from a in-office whitening treatment or the use of recommended home products.



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