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WhitePaper Blog

Tuesday, September 6, 2011

Developing Personalized Teeth Whitening Treatment Plans

Each individual client or patient needs to have a special teeth whitening plan developed for them in order to ensure that they receive the absolute best service and whitening results from their BEYOND® treatment. Tooth discolorations can be the result of extrinsic or intrinsic stains, aging, or a combination of all three. The following includes a brief description of the differences between extrinsic and intrinsic stains and several recommended treatment plans.*

*Note: These treatment recommendations are specific for the in-office BEYOND® Whitening Accelerator Professional Edition with 35% hydrogen peroxide. 

Extrinsic Discolorations
Extrinsic discolorations are caused by a variety of factors. These include oral bacteria, the use of tobacco products, consumption of colored food and drinks, gingival bleeding, restorations, or certain medications.

Intrinsic discoloration
Intrinsic discoloration is usually the result of irregularities in the structure and thickness seen during the formation of tooth enamel. Other factors contributing to irregularities in tooth structure can be irregular dentin formation and excessive consumption of fluoride. Intrinsic stains can also be the result of abnormal colorations caused by hyperbilurubinemia, porphyria, and tetracycline during the formation of the teeth.

Recommendations for Single In-office Treatment Sessions
The following are examples of discolorations that require only one in-office whitening session to achieve optimal results:
Recommendation #1: Teeth with an even color and well-formed enamel will only require one in-office treatment to achieve ideal results. The recommended treatment time is eight minutes, three times, for a total of 24 minutes. This treatment time can be varied depending on the individual. Patients who use tobacco products may want to extend the treatment time to 10-12 minutes per cycle.
Recommendation #2: Teeth with minor stains from medications, but with well-formed enamel should see the treatment cycles extended to 12-15 minutes each.
Example A: Patient has teeth stained by tetracycline, translucent enamel, and gray dentin. Recommended treatment: Extend treatment cycle to 12 minutes, three cycles.
Example B: Patient has teeth with gray discoloration. Recommended treatment: Extend treatment cycle to 15 minutes for the first two cycles and shorten the third cycle to eight minutes to minimize sensitivity.
NOTE: When the treatment cycle time is extended to 12-15 minutes, new whitening gel should be applied halfway through the cycle to keep the gel from drying too quickly.

Recommendations for Multiple In-office Treatment Sessions
For patients with teeth that have medium-levels of discoloration from medications, more than one in-office treatment will be necessary to achieve the best results. The treatments also need to be spaced out so that tooth shade and enamel formation can be re-evaluated following each treatment. The time between the first and second treatment should be one week (no more than two weeks) and a third treatment (if needed) should be four weeks after the second treatment. Each cycle should be extended to 12 or 15 minutes for per cycle.

Recommendations for Combination In-office and At-home Treatments
For patients with severe intrinsic discolorations and uneven extrinsic stains, it is recommended that they do a combination of in-office and at-home whitening treatments. There are several at-home whitening options for the patient to consider, including a tray system, or the e-Bright Tooth Whitening Accelerator Home Edition. The patient should begin their at-home treatment within 24 hours after their last in-office treatment. After one week for the tray system, or three days for the e-Bright, an optional second in-office treatment can be performed. Following this treatment, another round of the at-home bleaching should be repeated.

Recommended Treatment Protocols for Special Cases (Enamel hypoplasia, Fluoride spots, and Pre-restorations)
For patients with enamel hypoplasia, it is better to whiten the teeth before undergoing a resin restoration procedure because the resin can then be matched to the new whitened enamel. There are two options for performing the treatment on patients with enamel hypoplasia:
Option A: Apply the gingival barrier to the area on the tooth with enamel hypoplasia. This will protect against sensitivity. Take care to shorten the treatment time if the patient has any sensitivity.
Option B: The patient can whiten their teeth at home with the tray system or the e-Bright Tooth Whitening Accelerator. This option is recommended for those patients with fluoride stains.

Patients who have just undergone orthodontic treatments can whiten their teeth beginning four weeks after removing their braces. The treatment will remove any yellow discolorations that formed due to inadequate brushing habits. Take care to ensure that all cement composite from the brackets is removed completely before beginning the whitening treatment.

Patients who are scheduled to undergo a restoration procedure should whiten their teeth one week before the restoration procedure to allow the whitened color to settle so that a proper color match can be made. 

Need help with a difficult case you've got scheduled soon?  Call us, or email us at, and if we'll give you a detailed recommendation. Happy whitening!   

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