Case Scenario 1: Whitening – High School Reunion

Mr. Jim Hartwell, is a 38-year old accountant. His chief complaint is the yellowing of his front teeth, which he feels is getting worse as he gets older. He would like them whitened within three weeks before he attends his 20-year high school reunion. When reviewing his health history and behaviors, you learn that Mr. Hartwell drinks coffee and enjoys red wine.

After reviewing his health history and completing an oral assessment, you determine his only treatment needs are preventive care and suggest re-evaluating the discoloration at the end of the appointment since the yellow stain could be removed during his prophylaxis. If additional whitening is needed, making him custom trays for use with an at-home whitening/bleaching system will meet his time requirement. He asks if there are any other options and mentioned he tried whitening strips about 10 years ago, but said he wasn’t very compliant since he experienced some sensitivity. However, he now claims to be very motivated and wonders if he should try them again.

You explain several options, including the whitening strips and present the pros, cons and cost.

• In-office – most expensive, quickest results, compliance is not as necessary.

• Custom take-home trays – medium expense, compliance is necessary, 10% CP may have least side effects.²¹

• Whitestrips – least expensive option, compliance is necessary.

All options could get him to his desired whiteness, but he has to take into account time, cost and compliance factors. You also inform him that all options may have side effects, such as tooth sensitivity and/or gingival irritation. If these are a concern, then 10% carbamide might be best option at home with compliance.¹⁷ In addition, fluoride varnish is recommended fluoride for sensitivity as is switching to a sensitivity toothpaste while going through the procedure.²⁵