Chapter 8

Information for Patients

Aim

This chapter provides “takeaway” information that can usefully be included in practice information leaflets.

Outcome

Practitioners wil be aware of the information that patients may need in relation to bleaching. Making this information available may form part of the consent process.

Nightguard Vital Bleaching

Nightguard vital bleaching involves wearing a customised bleaching tray or mouthguard containing bleaching gel. The gel releases a low concentration of hydrogen peroxide, which bleaches discolouring stains both on the surface and within the body of teeth. The tray, which is a thin version of a protective sports mouthguard, is usually worn overnight with the gel in it. Treatment normally takes about four to six weeks but some discolouration, such as that caused by tetracycline antibiotics taken in childhood, can take many months to lighten. Nightguard vital bleaching offers a safe and effective method of bleaching moderately discoloured teeth.

What Does Nightguard Vital Bleaching Involve?

The treatment usually involves three visits to the dentist. The first visit includes an examination, a medical and dental history, and radiographs (x-rays) of the teeth being taken if necessary. The causes of any discolouration will be established by the dentist. Tests may be undertaken to determine whether the nerves of the teeth to be bleached are alive or dead. If the teeth are dead or have decay these problems need to be dealt with before bleaching.

If there are tooth-coloured restorations present the possible effects of bleaching need to be carefully considered. If bleaching is undertaken it is likely that certain restorations may need to be changed following bleaching. This will need to be discussed as well as the associated fees involved for doing this.

The gums will be examined for gum disease and the possibility of recession. Thin gums are likely to be associated with sensitivity during bleaching.

The teeth will be tested for sensitivity, probably by blowing cold air on them. If they are sensitive to start with, this sensitivity will probably increase temporarily with bleaching.

If it is decided to go ahead with bleaching, impressions and photographs will be taken. It is common practice to treat the teeth in one arch and use the other arch as a control. Patients may or may not want the teeth in both arches bleached. This should be discussed with the dentist.

If a partial denture is being worn and it is desired to bleach the teeth at night and during the day then two separate trays need to be made, from two separate impressions. One impression will be made with, and one without, the removable denture in position.

At the second visit the tray will be tried in position and adjusted as necessary. Instructions will be given on the use of the tray and the appropriate amount of bleaching gel dispensed. The gel should be kept in a cool place. Instructions will be given on how to load the tray with the bleaching gel and how to insert it. A follow-up appointment will be arranged to evaluate progress.

How Long Does it Take?

It is difficult to predict how long it will take for bleaching to be effective but the dentist will be able to give “a best guess” as to how long it is likely to take. The time taken varies between patients and may be influenced by a number of factors.

The more the gel-loaded tray is worn the quicker bleaching will occur. As an alternative to night-time wear the tray can be worn during the day except when eating and cleaning the teeth. The gel needs to be changed every six hours. If the tray cannot be worn continuously for at least two hours then bleaching is unlikely to be very successful if using 10% carbamide peroxide.

Will I Have to Keep Bleaching?

It is not advisable to repeat the bleaching of the satisfactorily bleached teeth unless there is an appreciable relapse in their colour. This is unlikely to happen for quite a few years. It is not advisable to bleach teeth to a level where they become unnaturally lightened.

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