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Case Study #1

Patient Case Study #1: Moderate fluorosis resulting in "mottled" appearance post-treatment.

Treating Fluorosis Cases
Pre-treatment consultations are extremely important; especially when treating fluorosis cases. The examination will allow the dental professional an opportunity to check for possible fluoride spots and inform patients ahead of the treatment that the tooth enamel will not be entirely even in color immediately following the treatment.

Uninformed patients will be surprised by the mottled appearance of the enamel immediately following the treatment, and may be unhappy with the results. In less severe cases, mottling may be limited to one or two white spots. However in moderate to severe fluorosis cases, mottling can be more noticeable.

The white spots will become less noticeable within the 24-48 hour immediately following the treatment as the post-treatment color settles. Patients should be informed of this before the treatment.

Treatment schedules should be designed based on the severity of fluorosis. Mild to moderate discolorations can be treated during a single, in-office visit. (Vary 8-12 minute cycles depending on severity.) Severe cases should be treated with multiple, in-office visits (Week 1: Three cycles, 8-12 minutes each cycle; Week 2: Two to three cycles, 8-12 minutes each cycle.) Depending on severity, a pre-treatment acid etch of the enamel layer may also be necessary.


Causes of Fluorosis
The ingestion of excessive fluoride levels (higher than 1 ppm) in drinking water, or another medium, before the permanent teeth are fully formed can result in irregular calcification of the teeth formation of the enamel layer.

The higher the levels of fluoride intake, the more serious the individual case will be. Fluoride stains almost always occur balanced on the tooth arch, although this can vary between teeth.

Fluoride rarely affects deciduous teeth because it is not absorbed through the placenta. Premolar teeth, upper incisors, and second primary molars are the most easily affected. The next most likely to be affected are the canine teeth, first primary molars, and lower incisors, in that order.

The appearance of fluoride stains vary depending on which teeth are affected. In premolars and second primary molars, the stains are seen as white spots or stripes. In less severe cases, the discolorations may be yellow, brown, or black in color and accompanied by irregular enamel layer formations, resulting in uneven ridges on the enamel layer.

Clinical observations of teeth discolored by fluoride have produced important findings on the structural irregularities caused by fluoride. On the surface of fluoresced teeth, enamel fractures along the ends of the enamel columns are evident. The result of malcalcification, these damaged enamel cells fail to form a satisfactory enamel base.

Free Bleaching = Practice Growth

We heard about a dental clinic in the US that is offering life-long, free teeth whitening to patients who come in for check-ups twice a year. What a fantastic idea to consider for bringing in new patients, retaining old ones, and providing an incentive to come in for twice-annual health check-ups! With this business plan in place, everyone's a winner!

The original article can be found here, or read below.

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Other popular cosmetic dental treatments, including bonding, enamel shaping, and veneers, can be used to correct dramatic dental defects that cannot be satisfactorily addressed with whitening alone. But dentist supervised teeth whitening remains one of the safest, least invasive, and most effective options for creating the bright and sparkling smiles that will enhance the lifestyles of your patients—and can bring new sources of revenue into your practice.

Free Bleaching for Life

As a practice-builder, teeth whitening should be a no-brainer. Virtually every patient is a good candidate for some form of whitening technique. Whitening the teeth of your staff is a good initial way of showing how great a whiter smile can be—and a way of advertising the service to patients. Many new practices offer some complimentary whitening to attract patients, and established practices have used offers of free whitening to bring new patients through the door. One dentist, Dr. Jaimee Morgan of Salt Lake City, has expanded on this idea to offer free whitening to all her patients for as long as they are her patients. In effect, patients who visit Dr. Morgan for twice-a-year cleanings are eligible to receive free bleaching for life. Dr. Morgan recently opened a new practice, in the process closing 3 satellite practices and moving everything to the new location. “Although there had been satellite offices, this really was a new practice in a new area, so not all the existing patients came to the new office. Our first thought was that we would offer free whitening to bring in new people who might not know us. But it seemed like kind of a slam to our loyal patients that only the new people would be getting the free whitening. Offering it to everyone has brought us about 50% of our current patients—and has really helped in keeping our existing patients happy.”

Better than Advertising

Before offering the free bleaching, Dr. Morgan said that the practice advertised in all the usual ways: through a display ad in the phone book and by placing a lot of local advertising in newspapers and direct-mail shopper guides. She even advertised at the movies. “You know those ads, where you’re waiting for the movie and they throw the ad on the screen? We did one of those. It was very costly.” Yet with the exception of the yellow pages, none of this advertising had much noticeable effect. Offering the free bleaching has been a boon. “It’s worked out well for us because it provides us with fantastic word of mouth. Our patients help to bring in new patients. Your patients’ smiles look better, which makes your dentistry look better, and people want to know, hey, where do you go for that pretty smile? And for what we pay out in bleaching materials we get a great return—it’s better than any other form of advertising that we do.”

For the free bleaching program, Dr. Morgan offers an inoffice power bleaching session or 12 syringes of a 10% carbamide peroxide solution for take-home bleaching for each patient who wishes to participate. She says, “We want to make the program adaptable to what each individual wants, whether they want the power bleach or the take-home product. It’s just as easy either way for us and if it makes them happy, well, that’s better for us and for them.” For patients who want to maintain their white smiles, Dr. Morgan offers a bleaching maintenance program, for which she charges a fee. “We didn’t want to get into nickel and diming our patients by selling the product out of the office, but we did want to provide them with the product if they wanted it, so this seemed like a good compromise. We also provide the adaptable bleaching trays, and if they want a custom tray we are also happy to sell them those as well.”

Bleaching and Beyond

Dr. Morgan says she’s found that patients who have whiter smiles look for other ways to improve the way their teeth look. “Whitening tends to prompt the patient to think more cosmetically about their teeth. They’ll say, ‘wow, they’re so white, they look great! Now, let’s go and fix that little chip in that tooth or fill that space, or let’s get them straightened.’” Bleaching opens the door to may practice growth opportunities. It can help you retain the patients you already have and create word-of-mouth to attract new patients. And the positive results of bleaching can encourage patients to ask for other esthetic and restorative treatments to continue improving their smiles

Safety and Comfort = Our Priorities

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Oral Healthcare Can't Wait

The latest buzz in the online dental community is revolving around a push for more campaigns to educate the public on the importance of regular and preventative oral healthcare. A new campaign being launched by the Dental Trade Alliance (DTA), titled Oral Healthcare Can't Wait, promises to be an aggressive and effective marketing tactic to educate the American public on the importance of oral healthcare and it's impact on other health concerns such as diabetes, heart disease, stroke, and serious gum disease.

One of the most important steps in an in-office whitening treatment is the pre-treatment check-up and consultation. This gives the dentist the opportunity to examine the patient and determine any obvious oral health issues ahead of the treatment time. Before beginning any cosmetic dental treatment, it is important to ensure the patient is in good oral health. Educating the patient on the importance of regular check-ups, brushing, and flossing can also be emphasized during this time. The explanation that good oral health will maintain the whitening results for a longer time is an excellent argument for any patient who is concerned about the appearance of his or her smile.

Orange Juice Worse for Teeth than Whitening

With the increasing popularity of whitening one’s teeth, researchers at the Eastman Institute for Oral Health, part of the University of Rochester Medical Center, set out to learn if there are negative effects on the tooth from using whitening products.

Eastman Institute’s YanFang Ren, DDS, PhD, and his team determined that the effects of 6 percent hydrogen peroxide, the common ingredient in professional and over-the-counter whitening products, are insignificant compared to acidic fruit juices. Orange juice markedly decreased hardness and increased roughness of tooth enamel.

Unlike ever before, researchers were able to see extensive surface detail thanks to a new focus-variation vertical scanning microscope. “The acid is so strong that the tooth is literally washed away,” said Ren, whose findings were recently published in Journal of Dentistry. “The orange juice decreased enamel hardness by 84 percent.” No significant change in hardness or surface enamel was found from whitening.

Weakened and eroded enamel may speed up the wear of the tooth and increase the risk for tooth decay to quickly develop and spread. “Most soft drinks, including sodas and fruit juices, are acidic in nature,” Ren said. “Our studies demonstrated that the orange juice, as an example, can potentially cause significant erosion of teeth.”

It’s long been known that juice and sodas have high acid content, and can negatively affect enamel hardness. “There are also some studies that showed whitening can affect the hardness of dental enamel, but until now, nobody had compared the two,” Ren explained. “This study allowed us to understand the effect of whitening on enamel relative to the effect of a daily dietary activity, such as drinking juices.

“It’s potentially a very serious problem for people who drink sodas and fruit juices daily,” said Ren, who added that dental researchers nationwide are increasingly studying tooth erosion, and are investing significant resources into possible preventions and treatments. “We do not yet have an effective tool to avert the erosive effects, although there are early indications that higher levels of fluoride may help slow down the erosion.”

A Texas-based company, Beyond Dental and Health, sponsored the trial in part by providing the 6 percent hydrogen peroxide.

In the meantime, Ren advises that consumers be aware of the acidic nature of beverages, including sodas, fruit juices, sports and energy drinks. The longer teeth are in contact with the acidic drinks, the more severe the erosion will be. People who sip their drinks slowly over 20 minutes are more likely to have tooth erosion than those who finish a drink quickly. It’s also very important to keep good oral hygiene practices, Ren added, by brushing twice daily with fluoride toothpaste, and see a dentist for a fluoride treatment at least once a year if you are at risk.

Eastman Institute for Oral Health is a world leader in research and post-doctoral education in general and pediatric dentistry, orthodontics, periodontics, prosthodontics, and oral surgery. Patients are seen at many sites throughout the Rochester community.

Republished from the URMC website.

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