Quality Resource Guide l Effectiveness and Safety of Tooth Whitening Agents 1st Edition 5 www.metdental.com Whitening treatment may take longer depending on several factors. Patients with yellowing teeth have better whitening results than those with blue/gray discoloration. Blue/gray teeth can be whitened, but the treatment may take longer. Patients with intrinsic stains such as tetracycline staining may also require a longer (two to six months) tooth whitening treatment time to get the desired result. Some intrinsic discoloration may not respond to whitening treatment and clear expectations should be communicated to the patient and included in the consent form. Teeth with white spots may also appear whiter with whitening treatments, especially early on in treatment. 36 Tooth whitening should be delayed for 3 to 6 months after orthodontic brackets are removed and orthodontic bonding should be done 2-3 weeks after in-office whitening procedures. 48–50 Whitening may also fade after the initial treatment. This is called a rebound effect. It is essential to educate patients that this is likely to occur and is normal. Even with rebound effects, patients can expect their whitening treatment to last one to three years, depending on personal and dietary habits. 36,51 In addition to completing an exam and providing proper education to the patient, dental professionals should document the shade of the teeth through photographs and a shade guide before whitening treatment begins. Further documentation of shade should continue through the treatment and during subsequent recalls. Summary There are multiple options for patients who seek out tooth whitening treatment. Before beginning whitening treatment, patients should have a dental exam completed to identify dental disease or other issues that could affect the treatment. There are numerous OTC options, and patients should be educated on the expected results and side effects of each. The most effective OTC option is strips. In-office treatments are effective at tooth whitening and allow dental professionals to provide correct instructions for use and monitor the whitening progress. The most common side effects of tooth whitening are tooth sensitivity and gingival irritation. Dental professionals should provide evidence-based information and recommendations to patients interested in whitening treatment. Documentation including photos and shade identification should be made before and after tooth whitening treatment. Setting clear expectations of tooth whitening outcomes is vital to successful treatment. 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