The White Board

Treating Patient Sensitivity

By Nick Conte, D.D.S.

One of the more challenging parts of whitening is dealing with patient sensitivity. When a patient begins an elective treatment without sensitivity and experiences discomfort during whitening, it is often uneasy for both the patient and doctor.

Predictors
There are a couple of things to remember. The best predictor for sensitivity is previous sensitivity. Patients that experience sensitivity after routine prophylaxis or have a low threshold for thermal sensitivity are more likely to experience sensitivity during the whitening process. Whitening via tray delivery can take 2-6 weeks to reach a desired shade, and sensitivity usually starts, but is not limited to, the first two weeks of treatment.

Treatment
It is essential to prepare these sensitive patients prior to beginning treatment. Utilizing a relief gel containing potassium nitrate and sodium fluoride in conjunction with tray whitening can be a great solution. For pretreatment, have the patient start with the desensitizing gel or a toothpaste containing potassium nitrate in a tray for a week. When the whitening treatment begins, start the patient off on a regimen of using the whitening gel one day and the desensitizing gel the next. This will control sensitivity and allows the patient to be actively involved in dealing with potential sensitivity issues. Have the patient gradually introduce the whitening gel, starting with as little as 30 minutes a day and increasing intervals by 15 minutes if no sensitivity arises. Also, advocate wearing the trays during the day rather than at night. This will allow the patient to immediately remove the gel upon any discomfort and counteract with a desensitizer. It is also a good idea to have the patient avoid extremes in hot or cold as well as consumption of acidic drinks such as colas and juices during the process to minimize potential discomfort.


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