Re: Behind that beautiful smile

What is the role of the dentist in identifying patients who may benefit from tooth whitening procedures?
The media has influenced our patients tremendously over the years and currently, white teeth are the standard of care. Most people are embarrassed to have dark teeth so they either want laminates or bleaching. I normally ask patients if color is a concern and if they say they would like their teeth to look whiter, the door is opened. Even if patients say no, you can ask them if they could wave a magic wand over their teeth, would their current color be their color of choice? Most people say no. Then you can discuss the options. I believe the dentist can and should play a prominent motivating role in every dental office. The quality time the dentist spends with patients helps build a sense of trust that can encourage patients to obtain the esthetic restorations they desire. So certainly bleaching is just one way the dentist can help patients achieve a better looking smile.

Are there conditions where bleaching is contraindicated?

Bleaching is not indicated for patients with gray teeth, heavy tetracycline stain, and teeth with a great deal of incisal staining. Bleaching is very successful for patients with yellow teeth. Yellow/brown is the next indication, followed by brown. Moderate results are possible with the brown teeth. Gray generally becomes translucent, which can appear to the patient as if the tooth is getting darker not lighter, so you need to be careful. Bleaching is not as effective for patients with tetracycline stain because the final result doesn’t provide the esthetic appearance most patients desire.

Are any esthetic restorative materials adversely affected by bleaching?

Not that I know of, but it is best to wait a period of time after bleaching before bonding. Before performing the bleaching treatment, a hygiene appointment should be scheduled so the tissue is healthy and in good shape.

What can be done about excessive wear facets on anterior teeth?

Dentists are in the perfect position to look at the incisal edges of the anterior teeth. If patients are wearing down the cusp tip, they can lose a great deal of their attractiveness. It is important to diagnose wearing early and not wait until the patient is older. Patients can be counseled about their habits that may cause wear. A biteguard can be recommended and cosmetic contouring can be done to make these teeth look better.