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Professional Whitening Services: Prioritizing and Implementing for Success a Peer-Reviewed Publication Written by Author Richard Nagelberg, DDS

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Professional Whitening Services: Prioritizing and Implementing for Success a Peer-Reviewed Publication Written by Author Richard Nagelberg, DDS Earn 2 CE credits This course was written for dentists, dental hygienists, and assistants. Professional Whitening Services: Prioritizing and Implementing for Success A Peer-Reviewed Publication Written by Author Richard Nagelberg, DDS Abstract Educational Objectives: Author Profile The demand for tooth whitening continues to increase At the conclusion of this course attendees will be Dr. Richard Nagelberg has been practicing general dentistry in suburban Phila- in the US. Whitening is available as an in-office able to understand: delphia for over 30 years. He has international practice experience, having provided treatment, as a take-home treatment utilizing custom 1. The primary responsibilities of dental dental services in Thailand, Cambodia, and Canada. He is co-founder of PerioFrogz. fabricated trays or with many over the counter professionals com, an information services company, and an advisory board member, speaker, key products. There has been considerable advancement in 2. The different types of tooth stains opinion leader and clinical consultant for several dental companies and organizations. whitening technology since its inception, making the 3. The mechanism of take-home and in-office Richard has a monthly column in Dental Economics magazine, GP Perio-The Oral- results more predictable and reducing the incidence tooth whitening Systemic Connection”. He is a recipient of Dentistry Today’s Top Clinicians in CE, 2009 of post-op sensitivity. The primary types of tooth 4. The potential benefits and side effects of - 2013. Richard lectures extensively on a variety of topics centered on understanding discoloration are intrinsic and extrinsic. Extrinsic stains tooth whitening the impact dental professionals have beyond the oral cavity. can become intrinsic by seeping into the interior of the tooth through pits, fissures and surface irregularities. Extrinsic discoloration is effectively removed during a Author Disclosure prophylaxis. Intrinsic discoloration is improved with Richard Nagelberg discloses that he is Editorial Director of Dental Education the use of peroxide containing whitening agents. for the PennWell Corporation Dental Division. He further discloses that he has This course discusses clinician responsibilities, ethical no commercial or professional relationship Phillips Corporation the commercial considerations, mechanism of action, side effects supporter of the activity. and management of patient expectations with tooth whitening procedures. Go Green, Go Online to take your course Publication date: Mar. 2013 Supplement to PennWell Publications Expiration date: Feb. 2016 This course has been made possible through an unrestricted educational grant by Phillips Oral Healthcare. This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content. PennWell designates this activity for 2 Continuing Educational Credits Requirements for Successful Completion: To obtain 2 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%. Dental Board of California: Provider 4527, course registration number CA#: 02-4527-13006 “This course meets the Dental Board of California’s requirements for 2 units of continuing education.” CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at [email protected] The PennWell Corporation is designated as an Approved PACE Program Provider by the Educational Disclaimer: Completing a single continuing education course does not provide enough information Academy of General Dentistry. The formal continuing dental education programs of this to result in the participant being an expert in the field related to the course topic. It is a combination of many program provider are accepted by the AGD for Fellowship, Mastership and membership educational courses and clinical experience that allows the participant to develop skills and expertise. maintenance credit. Approval does not imply acceptance by a state or provincial board of Registration: The cost of this CE course is $49.00 for 2 CE credits. dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full (10/31/2015) Provider ID# 320452. refund by contacting PennWell in writing. Educational Objectives: including whitening, veneers, porcelain crowns, orthodontics At the conclusion of this course attendees will be able to etc. on diseased gums and bone or in the presence of other understand: lesions. According to the American Dental Association, it is 1. The primary responsibilities of dental professionals acceptable and ethical to provide cosmetic dental services. 2. The different types of tooth stains The ADA’s position on veneers states; “There’s no reason to 3. The mechanism of take-home and in-office tooth put up with gaps in your teeth or with teeth that are stained, whitening badly shaped or crooked. Today a veneer placed on top of 4. The potential benefits and side effects of tooth whitening your teeth can correct nature’s mistake or the results of an injury and help you have a beautiful smile”. Abstract: The demand for tooth whitening continues to increase in Regarding tooth whitening, the US. Whitening is available as an in-office treatment, the ADA indicated in April 2012; as a take-home treatment utilizing custom fabricated trays “Statement on the Safety and Effectiveness of Tooth Whiten- or with many over the counter products. There has been ing Products: considerable advancement in whitening technology since its The ADA recommends that if you choose to use a bleach- inception, making the results more predictable and reducing ing product, you should only do so after consultation with a the incidence of post-op sensitivity. The primary types of dentist. This is especially important for patients with many tooth discoloration are intrinsic and extrinsic. Extrinsic stains fillings, crowns, and extremely dark stains. A thorough oral can become intrinsic by seeping into the interior of the tooth examination, performed by a licensed dentist, is essential to through pits, fissures and surface irregularities. Extrinsic determine if bleaching is an appropriate course of treatment. discoloration is effectively removed during a prophylaxis. The dentist and patient together can determine the most ap- Intrinsic discoloration is improved with the use of peroxide propriate treatment. The dentist may then advise the patient containing whitening agents. This course discusses clinician and supervise the use of bleaching agents within the context of responsibilities, ethical considerations, mechanism of action, a comprehensive, appropriately sequenced treatment plan.” side effects and management of patient expectations with The ADA clearly accepts the appropriateness of cosmetic tooth whitening procedures. dental procedures and recommends them as well. Perhaps Cosmetic dental procedures have been developed over the most important part of the ADA’s statement is the last a relatively short period of time, with virtually continuous sentence regarding the importance of a [“comprehensive, refinements to materials and procedures. The desire of many appropriately sequenced treatment plan”]. Failing to exam- in the US population for smile enhancement is not diminish- ine, treatment plan and execute the highest priority dental ing. Recent estimates indicate that Americans are spending services prior to providing cosmetic procedures, would be 1.4 billion dollars annually on tooth whitening, utilizing ethically questionable. Similarly, it would be ethically ques- various take-home, in-office and over the counter strips, trays tionable for a physician to provide Botox® injections or a face and brush-on products. Maximizing results and minimizing lift for a patient with uncontrolled diabetes, hypertension, potential side effects are best accomplished when whitening liver or kidney disease among many other conditions. This is procedures are provided and monitored by a dental profes- clearly why the ADA appropriately recommends a thorough sional. Since whitening materials are not considered drugs, examination by a dentist to determine if and how tooth whit- they are not regulated by the Food and Drug Administration. ening should be provided after other oral health needs have Every patient who desires a whiter smile is not necessar- been addressed. ily a good candidate for tooth bleaching. There are medical It is possible to provide necessary and elective treatment and dental contraindications that need to be considered in simultaneously, depending on the particular needs of the advance. Patient expectations need to be addressed as well. patient. If a patient has caries on a limited number of teeth, Esthetic procedures including whitening must be considered proceeding with in-office whitening, impressions for take within the context of the primary responsibilities of dentists, home whitening or orthodontic
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