- A case study by Dr. Clarissa Jänig 

The desire for whiter teeth and attaining the associated ideal of beauty are probably as old as mankind itself. However, it is interesting to note that many patients are still hesitant and critical when it comes to tooth whitening. Questions about the possible risks for enamel and general oral health keep coming up. There are also concerns about irreversible sensitivities and related complaints. In these cases comprehensive counseling is particularly important. We inform patients that, contrary to numerous rumors, the enamel is neither removed nor damaged, because when professional whitening products are used, molecules are exchanged during the whitening process. During this process, oxygen radicals decompose the color pigments in the tooth and start the whitening process. In our practice, it is important for us to exclusively use products that do not cause enamel damage, as their mode of action is based on the exchange of molecules. Furthermore, we are careful to choose products based on potassium nitrate, which reduce dehydration of the teeth and thus counteract the formation of sensitivities during treatment. In our experience, sensitivities can thus be virtually ruled out. Should sensitivities nevertheless occur, they usually disappear again within a few days by themselves. To accelerate this, patients should drink plenty of water, particularly in the morning, to compensate for dehydration. In some cases, additional treatment can be carried out with a desensitizer based on potassium nitrate, such as UltraEZ ^TM, if necessary.

As a dentist with a focus on esthetics, periodontics and orthodontics, I have had many positive experiences in the field of whitening since my studies. The success of professional tooth whitening speaks for itself and is clearly reflected in the number of treatments and the satisfaction of the patients: in our practice with three practitioners, approximately 30% of all patients regularly receive tooth whitening - and the trend is increasing. Patients are made aware of our whitening offer in the waiting room with the aid of patient brochures and posters. In addition, our advice during professional dental care is not only limited to information on general dental cleaning and oral health. Rather, we discuss the topic of tooth whitening in this context, with all its benefits. To keep the entry threshold to tooth whitening as low as possible, we also offer temporary special offers for our patients from time to time. These are always well received.

Only recently, a 32-year-old patient came to our practice with a general desire for whiter teeth. The initial situation demonstrated pronounced yellowing of the teeth in the shade range A3. Ideally, this patient had no visible fillings in the anterior region, which would have necessitated replacing the fillings afterwards. The enamel layer and the thickness of the hard substance were also absolutely satisfactory. Thin, eroded incisal edges, which can often develop a grey cast when teeth are whitened due to shining through of the oral cavity, were fortunately not present. As the patient attached great importance to a lasting and long-term result, treatment with Opalescence^TM PF from Ultradent Products appeared appropriate.

The initial tooth shade A3 is determined before the treatment. ©Dr. Clarissa Jänig

Following professional tooth cleaning and a thorough visual check for possible carious lesions and enamel thickness, the patient was informed extensively about the whitening treatment. We not only focus on the expected results here, but also on the individual needs and objectives of the patient: How sensitive is the patient? Why does he wish to have whiter teeth? Or does he perhaps wish to have his teeth whitened for a specific event, such as a wedding or other special occasion, which may require corresponding scheduling? Which expectations are associated with the treatment? etc. In addition, it is essential to provide patients with comprehensive information on the subject of sensitivities and not to conceal the fact that, as mentioned at the beginning, these can occur, but usually subside after a few days.

After informing the patient and fabricating the individual trays, we started with treatment in the practice. The patient was very positively surprised by the result, already a brightening of about half a shade after initial treatment. During the initial treatment, the patient was instructed on the handling of the trays and the whitening gel and was then able to return home motivated to continue the treatment at home with Opalescence PF in 16% concentration. Usually we only give the patients a few syringes to take home, as we want to support them closely and therefore prefer to schedule them to return to the practice a few days later for a check-up. In this case we gave the patient 3 syringes, but sometimes we only hand out 2, depending on the patient and the initial tooth shade. This procedure has proven to be very successful so far. After all, this is the only way to ensure continuous optimal advice and to initiate countermeasures should any problems occur.

From left to right: An individual deep-drawn tray is fabricated for the treatment with Opalescence PF. The trays are filled with tooth whitening gel. After receiving initial instructions in the practice, the patient then fills the tray himself/herself at home. ©Dr. Clarissa Jänig

In the case described here, the patient returned to the practice after a total of four applications (including initial treatment). The result so far has been quite impressive: in the meantime, the tooth shade A3 had turned to A2. After a further four applications at home, a wonderful final result was obtained, which can be judged as being slightly brighter than A2. The color shade is very beautiful, brilliant and natural and the patient was so enthusiastic and satisfied that further measures did not have to be considered. If, after some time, a slight darkening or yellowing of the teeth should reoccur, a fresh-up with the existing trays (maxilla/mandible) can be performed at any time.

Left: The interim results after 5 days already show good outcomes. Right: The final result. The patient is very satisfied with the tooth shade, which is slightly brighter than A2. ©Dr. Clarissa Jänig

This is just one of many cases in which cosmetic tooth whitening with Opalescence PF has led to convincing success quickly and easily. We also like using the product in special cases, such as after orthodontic treatment or always after the application of Opalescence ^TM Endo to perfect the overall impression. In case of a visible prosthesis which is brighter than the actual tooth shade, the adjacent teeth can be whitened without concern. Particularly in the field of dental prosthesis advice, this is a good introduction to information and counseling on tooth whitening methods. Here it should be noted that the composite restoration should not be renewed or performed until 7-10 days after whitening; the same applies to dental prostheses that are bonded adhesively. In the case of new dentures, however, the surrounding teeth would always be whitened first before inserting the dentures.

Even after more than 10 years, Opalescence PF is still the method of choice for teeth whitening in our practice and at home. The gentle and effective formulation with potassium nitrate and fluoride (PF) hardly ever leads to sensitivities. Furthermore, the treatment can be continued flexibly and easily at home - while watching television, doing housework or simply overnight. To benefit from the results for as long as possible, the patient must of course be informed beforehand about the adverse effects of some foods and beverages, such as coffee, tea, red wine or nicotine. During the whitening treatment and a few consecutive days afterwards, the treating professional should refrain from using products containing dyes.

An interesting and cost-effective alternative for tooth whitening at home is Opalescence Go^TM. Opalescence Go is already available in prefilled trays for single use. This dispenses with the need for fabricating individual trays as well as filling by the patients themselves. We always recommend Opalescence Go during professional tooth cleaning and, as mentioned at the beginning of this article, we also provide posters and flyers in the practice. The consultation itself is initially conducted by the dentist. The subsequent instructions and treatment can be delegated fully to the assistants. The low expenditure involved results in considerable time and cost savings as we do not require any chair time. This efficient procedure is in turn very attractive for our practice from a purely economic point of view.

For the interested patient, Opalescence Go is extremely attractive not only because of its ease of use but also because of its affordable price. For example, many younger patients from the age of 18, who may not yet be earning their own money, are happy to receive treatment with Opalescence Go as a birthday or Christmas gift.

From our experience as long-time users we do not want to work without the Opalescence system any more. It consists of a broad product range with products for every indication and patient’s needs. In addition to cosmetic tooth whitening (Opalescence PF and Opalescence Go) there are several products for medical tooth whitening treatments available. Products with higher concentrations, such as Opalescence ^TM Quick PF with 45% carbamide peroxide or Opalescence ^TM Boost^TM with 40% hydrogen peroxide, are suited for medical indications. We also use Opalescence ^TM Endo for the whitening of devitalized teeth. True to the motto "Never change a winning team", the safe and simple handling of the Opalescence tooth whitening system also represents a reliable and practicable component in our practice. For our patients, the whitening results represent a significant motivating factor for improving general dental hygiene and care and are often a reason to visit our practice more frequently than usual.

Opalescence PF was the first whitening product introduced by Ultradent Products almost 30 years ago. Today Opalescence is the leading whitening brand worldwide and offers a full menu of whitening products.

About the author:

Dr. Clarissa Jänig is a practicing dentist at the practice of Dr. Gereon Josuweck and Dr. Jörg Weiler in Cologne, Germany.

In 2015 she specialized in orthodontics. In 2019 she received her doctorate (PhD) at the Rheinische Friedrich-Wilhelms-Universität on the topic "Fixation of CAD-CAM restorations".

Learn more about Opalescence tooth whitening systems here.