THE DEFINITIVE GUIDE TO PROFESSIONAL

in association with FOREWORD

As consumer demand for tooth whitening increases - part of a wider trend towards aesthetic - the opportunities for dental professionals to capitalise on this growing need are as plentiful as the complexities involved.

From the range of treatments on offer to the tendency “We believe in creating effective, affordable & minimally invasive towards misinformation and dentistry which will improve both health and aesthetics. Using misunderstanding among a combination of tooth whitening and restorative materials, consumers, not to mention dentists can achieve outstanding and predictable results. the legalities involved, dental professionals need a trusted source This is the dentistry that the patients want and more of expertise. Expertise that can importantly can afford. If we can deliver this using great inform and advise quickly and comprehensively on this materials that have long lasting, highly aesthetic results, burgeoning area. then we will have a successful practice with happy customers that recommend us to family and friends”. And, working alongside Style Italiano, this guide is designed - Style Italiano to do just that...

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 2 FOREWORD

We outline the key drivers fuelling We understand that dental the demand for tooth whitening, professionals are busy people introducing and outlining the various with many demands on their options available, and highlight one time, yet being able to effectively of the most popular, affordable and and efficiently service a growing effective treatments: custom tray consumer need is essential for any whitening. We also look at effective practice to continue to thrive. marketing of tooth whitening to consumers, examine the all- We trust that this guide will prove to important bottom line, and how be a powerful tool in enabling you you can expect profits to grow. to deliver what today’s consumers want, while empowering you to stay one step ahead of competitors.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 3 CONTENTS

Foreword 2 Tooth whitening - 21 The bottom line in 40 what, when and how tooth whitening

How tooth whitening 5 The importance of 24 Understanding the legalities 42 is growing in popularity tray design of whitening products

Online activity reflects 8 What causes discolouration - 26 Conclusion 45 growing demand and how whitening works

The tooth whitening 10 Choosing the right gels 30 About us 47 industry in numbers and safety

Tooth whitening 14 Clinical cases 33 and treatment

The options for 17 Patient communication 36 tooth whitening and marketing

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 4 In a world of social media and smartphones, we are only ever one click away from a photo being snapped and shared with the world. It is making people more aware than ever of how their teeth - and their smiles - look…

The global cosmetic dentistry market is expected to reach US$27.95 billion (£22.5 billion) by 2024 (source: Grand View Research, Inc. July 2016), and the demand for tooth whitening is one treatment HOW TOOTH driving this growth.

WHITENING IS With 99.7% of people citing their smile as their most important social asset (source: American Academy GROWING IN of Cosmetic Dentistry), it is clear why whiter teeth POPULARITY are one of today’s most popular dental requests.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 5 HOW TOOTH WHITENING IS GROWING IN POPULARITY

With more people opting for There are multiple benefits to aesthetic dental procedures, consumers, including: treatments are becoming more advanced as well as more • Looking younger affordable. • Improving self-confidence Confidence in tooth whitening in particular is also spreading. As Anna • Boosting career opportunities Salat, Style Italiano says, “Not many people know that tooth whitening • Encouraging people to is safe, easy and inexpensive. smile more When I demonstrate these advantages to patients, they often recommend the treatment to others. This is one of the reasons why bleaching is becoming more popular and the demand is growing.”

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 6 HOW TOOTH WHITENING IS GROWING IN POPULARITY

The procedure has a wide appeal to people of all ages, and the target audience can be broadly segmented into three key types of person:

• Convenience - uninitiated users quick to trust brand advertising

• Clinician lead users

• High expectation - media lead users

The ‘convenience - The ‘clinician lead’ The ‘high expectation - low expectation’ user wants: user wants... media lead’ user wants…

• Best long term effect and • To try whitening without • Immediate results a large investment longevity of the treatment • To push the boundaries • Best aesthetic and • No hassle, no wait, of whitening no messy tray, no worries professional result - and they are willing to invest time and • To pay more for • Affordable treatment that money to achieve this the best results can be repeated regularly • Gold Standard in • A quick fix tooth whitening

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 7 The interest in tooth whitening can be seen from the huge amount of consumer engagement with online content related to the subject. While the quality of the content might be debatable, the interest is clear. For example:

• An article titled ‘You Can Whiten Your Teeth With Baking Soda By Simply Following These 4 Methods!’ from December 2016 has attracted 13k Facebook engagements to date.

ONLINE ACTIVITY • An article from February 2017 titled ‘How To REFLECTS Whiten Your Yellow Teeth Naturally At Home’ has seen 11.8k Facebook engagements to date.

GROWING • An article from December 2016 titled DEMAND ‘Guaranteed! Whiten Your Yellow Teeth In Less Than 2 Minutes!’ has attracted 5.8k Facebook engagements to date.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 8 ONLINE ACTIVITY REFLECTS GROWING DEMAND

There is clear consumer demand for confirmation - and for action. FAST FACT

Social selfies spotlight smile IN SEPTEMBER LAST Social media also attracts multiple YEAR, AMERICAN selfies each day (more than 24 MODEL AND REALITY billion selfies were posted on TELEVISION STAR, Google’s servers in 2015 alone), KYLIE JENNER and the photo-sharing site, POSTED A PHOTO OF Instagram is one of the most HER POSING WITH A popular sites for posting them. TOOTH WHITENING KIT. THE PHOTO WA S A 2016 survey by London , Elleven even revealed that ‘LIKED’ MORE THAN 84% of respondents felt there was ONE MILLION TIMES ‘more pressure to have a perfect AND RECEIVED OVER smile due to the rise in adults and 82,000 COMMENTS. celebrities seeking orthodontic treatment’.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 9 The global tooth whitening market is anticipated to grow at a steady rate, posting a Compound Annual Growth Rate (CAGR) of close to 4% between 2017 and 2021 (source: Technavio). Behind this growth is the belief that whitening is the least invasive way of improving a smile.

How do people feel about their teeth? Research from a leading toothpaste manufacturer THE TOOTH in 2012 (see pdf here) has shown that: WHITENING • More than one in five people have been shown INDUSTRY to be dissatisfied with the colour of their teeth IN NUMBERS • Literature suggests that younger people are more concerned about teeth appearance than older people

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 10 THE TOOTH WHITENING INDUSTRY IN NUMBERS

As Anna Salat, Style Italiano, In addition, most respondents want • 52% of men admitted to says, “Bleach - with or without their teeth to be two shades whiter, smile envy composites - offers many with three out of four dentists saying • 48% of men wished their advantages. I believe it to be the that yellow teeth is still the biggest teeth were straighter easiest and most affordable way problem with the nation’s smiles. to start the patient’s journey to the What are people doing about perfect smile.” their teeth? SEAPOINT CLINIC IN DUBLIN, Research from Mintel in June 2014 What makes people feel this way? IRELAND, SAW A 25% JUMP revealed that: According to a survey carried out by IN DEMAND FOR TOOTH- a leading toothpaste manufacturer WHITENING IN 2015-16, • 30% of British people use in 2013, many people believe that COMPARED TO A 15% YEAR whitening toothpaste as part of their daily routine, with 55% whiter teeth: ON YEAR INCREASE IN having used it in the previous PREVIOUS YEARS. • Make you look more successful three months.

• More employable • 14% of people had used tooth The dental clinic’s 2015 survey of • More attractive whitening strips and kits in 159 people also found that: • Five years younger the previous month. • 9 out of 10 Irish women envy other people’s smiles and long for whiter teeth

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 11 THE TOOTH WHITENING INDUSTRY IN NUMBERS

How the sector looks

Tooth Whitening Industry Statistics Chemical Balance of Different Tooth Whitening Procedures

Total annual tooth whitening 40 industry revenue Type of Whitening Procedure $11,000,000,000 35 Hydrogen 30 Peroxide Annual spending on tooth whitening products Carbamide 25 $1,400,000,000 Peroxide 30% - % 20 35% 40% Average price of in-office dental tooth whitening procedure 15

$600 10

Up to 0% Average price of home tooth 5 10% 16% whitening kit 10% $34.99 0 PROFESSIONALLY PROFESSIONALLY IN-STORE OR APPLIED DISPENSED OVER-THE- PRODUCTS COUNTER

(source: American Academy of Cosmetic Dentistry)

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 12 THE TOOTH WHITENING INDUSTRY IN NUMBERS

Tooth whitening Surveys

82.5% 63.8% 24.8% 88.8% saw a noticeable saw a noticeable of patients were of orthodontists difference from difference from a recommended tooth had patients an in-office home whitestrip whitening by their request tooth tooth whitening tooth whitening orthodontist whitening procedure procedure

32% 18% 96% 74% say they are say they usually believe an of adults who “concerned by conceal their attractive smile believe an unattractive the look of teeth in photos makes you more smile can hurt chances their teeth” appealing to the for career success opposite sex

(source: American Academy of Cosmetic Dentistry)

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 13 Tooth whitening treatments have grown in numbers as consumer demand has increased. Today there are numerous options on the market, from those carried out at home to those administered in dental surgeries.

Treatment options fall into four categories:

• Toothpaste • Air polishing

• Micro abrasion • Peroxides TEETH

WHITENING Peroxide whitening AND Peroxide whitening involves bleaching the teeth, and can be broken down into three TREATMENT distinct categories:

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 14 TOOTH WHITENING AND TREATMENT

• Strips, pens, pre-made trays Prospective patients need It may be surprising just how little • Professional home whitening reassurance the public understand about the dental profession, and there is a big • Professional ‘power’ bleaching While treatment options are more opportunity for dental professionals to in-office: all soft tissues are readily available, the dental industry inform, educate and reassure people. isolated, and chemically still has to work hard to reassure activated gel is applied to the people about going to the dentist. The numbers show that there is tooth’s surface. In some cases Patients want to whiten their teeth some hand holding to be done… a light is then put into position and improve their smiles, but many • Almost half of UK adults have a and directed at the gel to are put off by the thought of visiting fear of the dentist. ‘enhance’ whitening a dentist. They are concerned with • 12% of these suffer from extreme comfort, cost and convenience. dental anxiety.

• Women are more likely to suffer FAST FACT from extreme dental anxiety than men. 8 out of 10 of those who had tooth whitening in the last 12 months, or who planned to have it in the next 12 months, would choose to • Visiting the dentist is ranked have it done at a dental surgery. This compares to 1 in 5 who would number one (22%) for making choose a beauty clinic, salon or other location, or a home tooth people nervous - even more whitening kit. (source: General Dental Council, January 2017) popular than heights (19%). (Source: National Smile Month)

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 15 TOOTH WHITENING AND TREATMENT

NEARLY HALF THE POPULATION ARE UNHAPPY WITH THEIR TEETH (48%), WITH 64% CITING DISCOLOURED TEETH AS THE MAIN REASON FOR BEING UNHAPPY.

(Source: National Smile Month)

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 16 Advising your patients on tooth whitening treatment options

There are many techniques to enhance the appearance of teeth, simply by removing surface staining, lightening the internal pigments or by utilising more complex restorative materials. We have listed the treatment options below, starting with the least invasive and most cost effective solutions, through to more invasive procedures.

You can use this as a guide when helping your patients choose the right treatment for them.

THE OPTIONS FOR TOOTH WHITENING

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 17 THE OPTIONS FOR TOOTH WHITENING

Whitening toothpaste Smile strips and preloaded trays

Easily accessible over the counter, This delivery of Hydrogen Peroxide THE CUSTOM TRAY whitening toothpastes contain is a professional alternative to “ENSURES THE GEL more abrasives or additives which less predictable over the counter IS EVENLY APPLIED, work to break down and remove products. They don’t require AND IT CAN PRODUCE“ SOME PRETTY surface stains and revive the impressions and can be IMPRESSIVE RESULTS. tooth’s natural colour. used immediately.

Scale and polish Custom tray whitening – Dr Matt Messina, A regular scale and polish is often the gold standard American Dental Association spokesperson, enough to keep a natural smile Carbamide Peroxide or Hydrogen time.com, 2014. clean and bright, while maintaining Peroxide gel in a custom fabricated the integrity of the tooth surface. tray is the traditional tried and Prophylaxis treatments such as tested way to lighten the internal AirFlow use a silicone coated pigments of teeth. This approach powder which remove stains improves the appearance of teeth effectively and quickly without without altering any tooth structure. impacting on the surface of the tooth.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 18 THE OPTIONS FOR TOOTH WHITENING

Microabrasion RCT and walking bleach Veneers Using silicone carbide combined This is a very effective way to Porcelain is renowned for its with hydrochloric acid, fluorosis lighten non-vital teeth that have high quality aesthetics, function staining can be gently removed been discoloured by trauma and extensive research. Lab using chemical abrasion in less or over time. Using the ‘walking communication, bonding and than 0.2mm enamel depth. bleach’ technique, the remaining cementation are key elements in tooth structure can be lightened getting the best results. Full smile In-surgery whitening to the required shade in a very design cases can attract higher Hydrogen Peroxide formulations controlled way over several weeks. costs, but can have a significant are generally used for this type impact on patients’ lives. of procedure. Due to their quick Composite restorations penetration, the results are more Composite is an effective Crowns immediate, although this often restorative material for altering Crowns require more severe removal requires an aftercare home shade, shape and surface texture of tooth structure, and this is often treatment to ensure that the of teeth. It wears like natural tooth only recommended when there isn’t change in shade is stable. structure, and occasionally requires a suitable alternative treatment. some maintenance to keep its appearance looking vital with high shine.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 19 THE OPTIONS FOR TOOTH WHITENING

I PREFER THE OPTION OF WHITENING AT HOME WITH A CUSTOM MADE TRAY BECAUSE TIME IN

THE DENTAL CHAIR IS MINIMISED - THIS IS AN “IMPORTANT FACTOR TO TAKE INTO ACCOUNT IN ANY DENTAL PRACTICE. IT IS CONVENIENT “ IN MANY SENSES: THE PATIENT CAN REGULATE THE DEGREE OF WHITENING AND CAN WHITEN AT ANY TIME OF THE DAY OR NIGHT, FOR SHORT OR EXTENDED PERIODS.

Anna Salat, Style Italiano.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 20 When it comes to whitening agents, the two key choices are Hydrogen Peroxide (HP) or Carbamide Peroxide (CP). These come in different strengths. Have a look at some of the facts…

6% Hydrogen Peroxide (equivalent to approx. 18% Carbamide Peroxide) – the strongest EU accepted whitening gel can be used at home by the patient in a custom fabricated tray for 30-90 minutes at a time.

TOOTH WHITENING 16% Carbamide Peroxide – this gives very similar - WHAT, WHEN results as the 6%HP. However, due to the make up of Carbamide Peroxide, it breaks down slower AND HOW meaning the ideal time to wear this treatment is around 2-4 hours.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 21 TOOTH WHITENING - WHAT, WHEN AND HOW

10% Carbamide Peroxide – this is Patients that have dark staining - the original percentage of gel used a VITA shade of C&D – may require 10% CARBAMIDE in NGVB (Nightguard vital bleaching a longer treatment plan due to “PEROXIDE IN A - also known as ‘tray bleaching’ or CUSTOM-FITTED TRAY the nature of the pigments in

‘at-home bleaching’) as advised by IS GENERALLY THE the dentine. Dr Van Haywood, Professor in the SAFEST, MOST

COST-EFFECTIVE Department of Oral Rehabilitation, TIP: The length of the WHITENING “ School of Dentistry, Medical College TREATMENT treatment will vary, depending of Georgia (MCG). This has been AVAILABLE on the specific case, but will proven to be very effective when not usually exceed three weeks. worn in a custom tray overnight, (The first week to treat the or for up to 8 hours at a time. upper arch, the second week Dr Van Haywood, Professor in the Department of Oral Rehabilitation, School of to treat the lower arch, and the – this 5% Carbamide Peroxide Dentistry, Medical College of Georgia (MCG). third week in which both arches is ideal for patients who suffer are treated to reinforce and from sensitive teeth, however Most patients that have a shading stabilise the final result). only one company currently has of A&B (according to the VITA shade a product this strength. It has a standard) will be very responsive to patented chemistry which makes whitening and will often reach very it as effective as a 10%CP due to light shades in one to two weeks. an active alkalinity boost. (Source: NOVON)

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 22 TOOTH WHITENING - WHAT, WHEN AND HOW

GREGORY CAMALEONTE - TOOTH WHITENING

The patient visited the practice hoping to improve the colour of their teeth. Following Style Italiano’s tray protocol and using a 6% Hydrogen Peroxide whitening solution, the teeth were bleached for enhanced results. This started with treating the upper arch, followed by the lower arch.

FAST FACT Some people do not carry pigments in the body, and up to 5% of the population may not respond to bleaching at all. This can be discussed with your patients in order to manage expectations prior to treatment.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 23 The design of the tray is just as important as the gel itself. The tray needs to fit snugly around the patient’s teeth. If it doesn’t, the gel can escape or become diluted. If the tray is not finished correctly, it can also irritate the gums and be very uncomfortable.

It is generally recognised that the most efficient and effective methods of applying whitening products to natural teeth is via a custom made whitening tray. To be as effective as possible, this THE IMPORTANCE tray must be professionally made.

OF TRAY DESIGN Customised trays can accommodate virtually all patients’ requirements. This can include a ‘full mouth’ tray or a modified tray, which can be designed to whiten selected teeth only.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 24 THE IMPORTANCE OF TRAY DESIGN

Making an impression The laboratory recommends a As with the advent of any new An accurate impression is finished tray thickness of 1mm. technology, it’s important for dental important. A whitening tray can This allows sufficient flexibility professionals to consider new only be effective when certain of the tray when the patient is alternatives. In the case of 3D dental criteria are met. Ideally, impressions inserting and removing it from their imaging, the advantages are clear, should only be taken in a rigid mouth. A correctly made tray will offering practitioners and patients impression tray. This prevents any help the patient to achieve optimum alike a better clinical experience. risk of distortion, which can lead results from the whitening gel, to a poor fit. When the laboratory without any of the problems that A 3D dental image can also be receives an impression, it can can be experienced with ‘one size used multiple times, offering a fast, accurately cast models in a fits all’ home whitening products. accurate approach that is consistent highly permeable model stone. and reliable. 3D Imaging The dentist chooses to go with Digital Impressions through 3D or without reservoirs, and the imaging are becoming more tray must be scalloped correctly widely used, and this is particularly followed by flaming and smoothing effective in ensuring accurate tray of the trimmed margins. This will design. Most good laboratories will help to ensure that an accurate have this service available. sealing at the gingival margins is achieved.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 25 There are numerous causes of teeth discolouration. Key factors include:

• Drinks (cola, coffee, tea, wine)

• Tobacco (cigarettes, chewing)

• Ageing (due to enamel thinning)

• Medicines (tetracycline, fluoride)

• Trauma

The extent of the patient’s discolouration will determine how long the whitening treatment will WHAT CAUSES take to work. The following times are a guideline: DISCOLOURATION • Normal discolouration: one to two weeks

- AND HOW • Tetracycline: two to six months

WHITENING WORKS • No stains or pigments: no whitening

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 26 WHAT CAUSES DISCOLOURATION - AND HOW WHITENING WORKS

The mathematics of tooth The following figures detail the whitening and peroxide amount of Hydrogen Peroxide In accordance with the British released by a set amount of 6% Dental Association (BDA), the Carbamide Peroxide: HYDROGEN maximum concentration of PEROXIDE Hydrogen Peroxide that may be • 10% Carbamide Peroxide = used in the EU is 6% present or approx. 3.3% Hydrogen Peroxide released. 10% Carbamide Peroxide content produces a maximum of • 16% Carbamide Peroxide = 3.6% Hydrogen Peroxide. approx. 5.3% Hydrogen Peroxide Commonly used products containing 16% Carbamide Peroxide • 6% Hydrogen Peroxide = are therefore permitted because approx. 18% Carbamide Peroxide 16% they would normally be releasing CARBAMIDE PEROXIDE less than 6% Hydrogen Peroxide.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 27 WHAT CAUSES DISCOLOURATION - AND HOW WHITENING WORKS

Four steps to whiter teeth… Tooth whitening works because Hydrogen Peroxide breaks down into water and an oxygen free radical. There are four key steps in the process:

H202 breaks down into H20 1 and O free radical

The oxygen free radical 2 passes through enamel into dentine

The oxygen free radical 3 oxidizes into a double LARGE SMALL conjugated bond STAINING BLEACHING COLOURLESS MOLECULE ACTION MOLECULES Tooth structure is unaltered 4 during this process and only the chroma and value of the Oxygen Hydrogen tooth is changed

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 28 WHAT CAUSES DISCOLOURATION - AND HOW WHITENING WORKS

Ensuring the correct PH The pH scale is a measure of pH 14 ALKALINE For good stability and shelf-life, acidity or alkalinity: the product must be manufactured at pH <7.0. Yet for Hydrogen • pH = 7.0 is neutral Peroxide to bleach effectively, • pH < 7.0 is acidic pH 7 NEUTRAL it needs: pH > 7.0. In other words, the bleaching action of Hydrogen • pH > 7.0 is alkaline Peroxide is influenced by its surrounding conditions. In acidic conditions Hydrogen Peroxide is stable, therefore pH 0 ACIDIC ineffective as a bleaching agent. But it is unstable in alkaline conditions, prompting the release of Perhydroxyl ion. Perhydroxyl ion is responsible for bleaching by breaking down large staining molecules into smaller colourless Oxygen Hydrogen molecules.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 29 In the growing field of dental aesthetics, there are numerous companies marketing and advertising products to the industry. But as with any other dental product, seeing evidence of efficacy is a leading requirement. Dental professionals will rightly expect a high standard from all their materials, including their whitening gels.

There are a number of key considerations to bear CHOOSING THE in mind when choosing the right gel... RIGHT GELS AND SAFETY

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 30 CHOOSING THE RIGHT GELS AND SAFETY

• pH level - Peroxide is most • Tray design - Tray design is • Desensitiser - Some gels contain efficient and active at a important in any bleaching desensitisers such as Potassium neutral pH of 7.0 or above. procedure. There must be a good Nitrate and Fluoride, which Some companies struggle seal around the gingival margin, are very effective at reducing to stabilise the product and, regardless of reservoirs on the sensitivity during the treatment. therefore, reduce the pH level labial surface. The gel will not It is advisable to bear this in mind to compensate this. This makes run out of the trays if it is the when making a decision. it more acidic and increases the right viscosity. chance of sensitivity and possible • Flavour - Many products contain damage to the enamel. Make • Water content - It is important glycerine to prolong the shelf sure you choose a gel with a for gels to be water based, life of their products. This can near neutral pH that has as an as peroxide dehydrates the negatively impact the taste of increased alkalinity once applied. teeth. Look for a gel with the gel and can be hard to mask. a high water content of Choose something that has a approximately 20% that still fresh flavour and will make the retains optimum viscosity. treatment more pleasant for your patients.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 31 CHOOSING THE RIGHT GELS AND SAFETY

Choosing your preferred The British Dental Association percentage SAFE WHITENING (BDA) says whitening is perfectly 10% Carbamide Peroxide is the safe if carried out by a registered THE EFFECT OF A original formula used in many dental professional. But the BDA studies with proven results. TOTAL BLEACHING also warns that those who are not This can be worn overnight. TREATMENT ON registered dental professionals will The NGVB gel gives predictable ENAMEL IS EQUIVALENT lack the right training or knowledge and long lasting results. and could cause permanent damage TO ONE CARBONATED to a patient’s teeth and gums. Hydrogen Peroxide or higher DRINK concentrations of Carbamide (source: McCracken MS,et Peroxide usually have less wear al.Demineralisation effects of 10% time which can be convenient for CP. & cola on enamel. J Dent Res those who don’t like to wear the 1993;72:215) tray while sleeping.

Choosing a brand that has flexibility ensures greater patient choice.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 32 The dental industry is continually working to develop new techniques in aesthetics and , and help dentists offer an unbeatable patient experience.

To demonstrate some of the latest techniques in professional tooth whitening - and how you can achieve excellent clinical results - here are two cases from Style Italiano’s Anna Salat and Stefan Koubi.

CLINICAL CASES

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 33 CLINICAL CASES

ANNA SALAT - TOOTH WHITENING

The patient wanted to improve the appearance of their smile, particularly the shape of their teeth. Ahead of the restorative treatment, Dr Anna Salat recommended bleaching the teeth to achieve the best aesthetic results.

To provide the fast acting and stable results the patient required, Dr Salat used a whitening gel with Hydrogen Peroxide as this breaks down quicker than Carbamide Peroxide.

Using 6% Hydrogen Peroxide which was applied for 30 minutes a day using a tray, the patient’s teeth improved from A35 to 0M1 in just two weeks. The teeth were now successfully prepared for the next step of the treatment - direct composites.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 34 CLINICAL CASES

STEFAN KOUBI - TOOTH WHITENING

Before receiving restorative treatment for diastema and microdontia, Dr Stefan Koubi improved the colour of the patient’s teeth improve the aesthetic integration.

Using a unique 5% Carbamide Peroxide whitening solution, the patient’s smile was enhanced over two weeks. Due to the patented chemistry in the bleaching system (NOVON), the results were just as effective as alternative solutions with higher percentages of CP - and with less sensitivity.

Following the whitening treatment, a combination of composite bonding and porcelain cementation facilitated the end result.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 35 Asking the right questions allows you to better understand your patients’ needs and give them what they want. Without knowing the range of aesthetic options on offer, patients will be unable to consider how their teeth - and their smile - could be enhanced.

There are eight steps to effective communication and marketing of tooth whitening:

PATIENT 1. Work as a team Because of the enormous appeal of tooth COMMUNICATION whitening, the treatment can be used to attract new patients as well as retaining existing ones. It can be AND MARKETING used to reward patients for completed treatments, motivating them and enhancing their natural teeth shades alongside or prior to restorative work.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 36 PATIENT COMMUNICATION AND MARKETING

As a team driven strategy, this questions thoroughly is key to requires very little of a dentist’s FAST FACT offering exceptional customer time because all members of staff service, and will enable patients to While the entire dental can educate and prepare the properly consider the treatment team is involved in initiating patients, arrange procedures, deliver options. Make sure your team dialogue about cosmetic instructions and follow up to ensure understands the brochure content, dentistry and recommending everything has run smoothly. your practice’s commitment to procedures, dentists the treatments on offer, and the instigate the large majority Now that hygienists are able importance of patient satisfaction. of new business (82%), but to deliver different whitening hygienists (42%) are playing treatments following a dentist’s 3. Appoint a champion a large role in treatment prescription, there are huge Identify one person in the practice conversations as well. opportunities to better utilise team to be the whitening / cosmetic (source: AACD, 2015) members. This frees up dentists’ treatment consultant - or champion. time to concentrate on administering They can answer all patient additional and perhaps more concerns, start discussions and demanding procedures. 2. Stimulate - and answer - help to generate interest. questions The hygienist appointment presents Brochures and marketing materials the perfect environment to discuss are designed to stimulate questions. and perform such aesthetic Ensuring that the practice team treatments. is well prepared to answer these

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 37 PATIENT COMMUNICATION AND MARKETING

It is also a good idea to give your Once dental practices consider 5. Use real people with real stories practice team the opportunity themselves to be experts in tooth Make a gallery of your cases: before to whiten their teeth. They are whitening, confidence in the and after pictures are a great selling a powerful walking advert for practice grows. tool. Illustrating real cases helps to the treatment and can speak manage patients’ expectations, and from experience. Figures from Optident in 2017 most people would rather see other show that 40% of those who patient’s results than unrealistic

4. Get Educated consider themselves to be ‘experts’ magazine images that have Practices who have engaged in offer tooth whitening every day, been airbrushed. learning about tooth whitening compared to only 7% of those in depth have more successful who consider themselves treatment conversions. There TOP TIP: When doing any ‘less knowledgeable’. are many ways of gathering and restorative case, ask the patient if they are happy with the shade sharing best practice within the In addition, once people have before proceeding. They could dental community, both online successfully engaged in tooth lighten their smile first and then and in person. whitening treatments they are have the restoration made lighter much more likely to consider other As Anna Salat, Style Italiano says, to match. “Going to courses and sharing cases cosmetic dental work, and are often with colleagues is a valuable way to more engaged in maintaining their learn more about tooth whitening oral health. techniques, and Facebook is my new university.”

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 38 PATIENT COMMUNICATION AND MARKETING

6. Tap into digital marketing 7. Display the product Tooth whitening creates patients Engaging your patients while Use point of sale material and who are more invested in their smile they are visiting your practice is a display the products and packaging. and who are more likely to keep that great way to interest them in tooth People like to see what they are smile healthy. It may also encourage whitening, but there are numerous buying. If the packaging denotes a patients to opt for elective cosmetic other marketing opportunities luxury or high quality item, people services at a later date. outside the practice. will feel good about their purchase. Giving them something tactile when By making a few small changes Use your website and social media they leave the practice - as well as and committing to promoting to let patients know about your whiter teeth - is going to give them tooth whitening, your practice can whitening services. Ask whitening a greater sense of value. reap the benefits of a successful patients if you can take ‘before’ and whitening programme. And your ‘after’ photos for your website and 8. Make whitening an integral patients can enjoy their whiter, Facebook page, and ask if you can part of your offering brighter smiles. tag them in any social media posts. Whitening is a great tool for This will not only show off what you growing your practice and making can do to current patients, it will it stand out from competitors, but connect you to plenty of potential only if you take the time to make new patients who may be interested the treatment an important part in what whitening can do for of your everyday routine. their smile.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 39 In order to continue to offer an exceptional service to your patients, and keep up with the costs of running a busy practice, you must consider your ROI and profit margins.

Here we have outlined some examples of how a moderate increase in your tooth whitening business could have a significant effect on your practice turnover.

THE BOTTOM LINE FAST FACT Research from the AACD in 2015 IN TOOTH revealed that the average cost of tooth bleaching/whitening procedures was WHITENING $US357.33 (£288.42). 35% of respondents expected this cost to increase in 2016.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 40 THE BOTTOM LINE IN TOOTH WHITENING

How tooth whitening can impact on the bottom line As an example of how to calculate your ROI you can consider the following calculations based on your own costs.

For Example: Item Cost Tooth Whitening Kit £50 Trays costs = £25 each arch £50 Impression cost £30 Total £130

Selling treatment @ £275 Profit Profit per treatment sold £145 Profit margin 53% After selling 5 per month £725 Over year £8700

… Just selling two or more treatments per week at these costings could increase profits by over £15,000.

This is just an example and overall results will vary depending on your own costs.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 41 The EU law relating to tooth whitening changed on 31 October 2012, effectively increasing the percentage of Hydrogen Peroxide contained or released in tooth whitening or bleaching products to 6%.

(This subject to conditions which include first use by a dental practitioner or under their direct supervision and that the patient is 18 years of age or over.)

The change follows as an amendment to the UNDERSTANDING EU Directive 76/768/EEC concerning cosmetic products. The amending Council Directive 2011/84/ THE LEGALITIES EU was published in September 2011 requiring the UK Government to amend the law. The Cosmetic OF WHITENING Products (Safety) (Amendment) Regulations 2012 PRODUCTS (The ‘Regulations’) amend the previous regulations relating to tooth whitening.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 42 UNDERSTANDING THE LEGALITIES OF WHITENING PRODUCTS

The Regulations allow the use Conditions For each cycle of use, first use of Hydrogen Peroxide and other The Regulations set out that by a dental practitioner compounds or mixtures that products containing or releasing Dental Protection advises release Hydrogen Peroxide, up to 6% Hydrogen Peroxide can members to make a detailed including Carbamide Peroxide be used, subject to the following contemporaneous record of the and Zinc Peroxide, to be used for conditions: examination and the instructions tooth whitening. The maximum given to the patient at the first concentration that may be used An examination is required first appointment. is 6% present or released. The dentist should carry out an examination before embarking Under direct supervision In broad terms, 10% Carbamide on a course of tooth whitening to The General Dental Council’s Scope Peroxide content would yield determine whether it is a suitable of Practice sets out that hygienists a maximum of 3.6% Hydrogen treatment option. and therapists can provide tooth Peroxide. Thus, the commonly used whitening under the prescription products containing 16% Carbamide To only be sold to dental of a dentist, if they are trained Peroxide are permitted because they practitioners and competent. Thus hygienists would normally be releasing less Only dental practitioners can and therapists can administer the than 6% Hydrogen Peroxide. purchase tooth whitening products first use of tooth whitening, if an containing or releasing more than appropriate level of safety 0.1% Hydrogen Peroxide up to 6% is ensured. Hydrogen Peroxide.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 43 UNDERSTANDING THE LEGALITIES OF WHITENING PRODUCTS

Trained and competent Medical Devices Directive the Regulations, they are advised to Dental Protection advises members We are aware that some contact Dental Protection for advice. that it is appropriate that the dentist manufacturers in Europe are is on the premises when the first marketing tooth whitening products Breach of the Regulations The maximum penalty for breaching use of the tooth whitening product containing or releasing more than the Regulations is a sentence of is provided to the patient by 6% Hydrogen Peroxide as medical imprisonment not exceeding a therapist or hygienist. devices. Even if a tooth whitening six months. product is marketed as a medical Completing the cycle device, it falls within the Cosmetic The dentist’s duty extends to Above 6% Products (Safety) Regulations If a member is considering using continuing to monitor the provision 2008, the 2012 Regulations and products that release or contain of top-up gels and ensuring this the EU Directive. This means it more than 6% Hydrogen Peroxide is in accordance with the patient’s is not possible to circumvent the and thus breaching the Regulations, treatment plan. Regulations by using a product Dental Protection advises members Advertising that has a CE mark. to contact Dental Protection Dental practices can advertise for advice. Under-18s tooth whitening procedures using The Regulations and EU Directive products containing or releasing Reporting of adverse effects specifically state the product must If members are treating a patient up to 6% Hydrogen Peroxide. not be used on patients aged under who experiences an adverse effect 18. If a member wishes to provide they are advised to keep a record treatment to a child in breach of of this.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 44 CONCLUSION

Tooth whitening is a key driver behind the predicted growth of the wider cosmetic dentistry sector. Public awareness of how teeth look is much more acute in today’s media-centric world, an awareness which is fuelled by high profile people sharing images of their beautiful smiles online. It is an appetite that is only likely to increase.

As consumers become more There is a need to inform and Among the various tooth whitening educated about the tooth whitening educate consumers, as well as an treatments available, custom options available - and, critically, opportunity to offer a range of tray whitening using Carbamide learn which of these treatments professional treatments, affording Peroxide or Hydrogen Peroxide has are both safe and effective - the dental practices the chance to really emerged as one of the most popular dental industry should be prepared stand out from competitors. and effective treatments on the to meet increased demand. market. Aside from the customer The potential audience is diverse - convenience this approach offers from those who want an affordable - not to mention minimising the option or a quick fix, to those all-important demand on a dental who are willing to invest a professional’s time - this has also greater amount of money for been endorsed by a number of exceptional results. pre-eminent dental specialists.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 45 CONCLUSION

Not least Dr Van Haywood, A good level of knowledge is also But, as with any emerging field, Professor in the Department of Oral critical if dental professionals are success will hinge on working Rehabilitation, School of Dentistry, to pre-empt common patient with trusted partners who can Medical College of Georgia (MCG), questions and concerns, informing demonstrate expertise, credibility who cites 10% Carbamide Peroxide and reassuring consumers about and reliability in this fast in a custom-fitted tray as“generally the right treatment for them. moving space. the safest, most cost-effective Such knowledge is also pivotal whitening treatment available.” in effectively marketing tooth whitening inside and outside As in any burgeoning industry, there the practice. are numerous companies marketing and advertising tooth whitening Tooth whitening is a swiftly products, and it is key that dental maturing market in which profit professionals see for themselves margins are healthy for any the safety and efficacy of any well-run dental practice. As the product before making a choice. audience grows, so will profits, Having a good understanding particularly as economies of of how whitening works and the scale take effect. various options available is therefore essential if the right choices are to be made.

DEFINITIVE GUIDE TO PROFESSIONAL TOOTH WHITENING 46 White Dental Beauty is a worldwide leading tooth whitening brand, known for high quality products with clinically proven results.

White Dental Beauty We work with the world’s leading clinicians and top opinion leaders IDC Valley to ensure we stay at the forefront of tooth whitening innovation. Ilkley All of our products are safe, effective and unique. West Yorkshire LS29 8AL • Proven and predictable results United Kingdom • Intelligent pH Acceleration formula E: [email protected] • Four different concentrations to suit every patient’s needs T: +44 (0) 1943 605050 whitedentalbeauty.co.uk • Full marketing support package

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