The White Board

Sensitivity Tips

  • Use a pre-procedure protocol of NSF toothpaste with 5%KNO3 to prep the teeth before the appointment.

  • Offer 400-600 mg Ibuprofen immediately preceding treatment.

  • Offer KNO3/ACP take-home gel post-treatment.


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The New Paradigm:

Chairside Whitening
Pre-Screening & Sensitivity Protocol

by Marilyn Ward, D.D.S., FAGD

Pre-Procedure | During the Procedure | Post-Procedure

The Etiology of Sensitivity

As with all bleaching procedures, transient tooth sensitivity is a possibility with chairside whitening; this is one of the topics you will want to cover at your pre-screening meeting with the patient. It is important for the patient to understand that you will be achieving in 45 minutes what normally takes 1-2 weeks to achieve with a take home bleaching procedure. Inform the patient that sensitivity comes from the pulpal nerve being stimulated by the hydrogen peroxide and the heat from the whitening lamp. An "awareness" of the teeth is to be expected and can last from 4-24 hours after treatment. This can range from a dull "all over" ache to a localized "shooting" pain (zinger). It is important that the patient understand that NO damage is being done to the teeth and this is a reversible pulpitis. Pain is caused by fluid movement within the dentinal tubules caused by the influx of H2O2. The odontoblast near the pulp and the "A" Delta nerve fibers are stimulated resulting in pain. 5% Potassium Nitrate (KNO3) is the best chemical to stop this pain. It prevents re-polarization of the nerve fiber.

Patient Selection

Patient selection is a very important part of managing sensitivity. You may want to disqualify any patient that: 1) is perio-involved, 2) has excessive wear, 3) exhibits micro leakage around amalgams, 4) is a gagger, or 5) is otherwise in an unhealthy oral state. You will want to treat these issues before recommending the chairside procedure. Patients with A3 or darker, gray shades, tetracycline or severe staining should use chairside whitening in conjunction with take home products to achieve the greatest results.

There are a number of options available for addressing patient sensitivity at every stage of the procedure. Back to top of page

Pre-Procedure

  • If the patient is concerned about sensitivity before the procedure, deliver Neutral Sodium Fluoride toothpaste with 5% KNO3 after the pre-screening appointment. Instruct use of 2x/day, minimum one week, until 3 days after the chairside treatment. We also recommend that impressions be taken at this time to make trays. A patient that is given a product and has impressions taken will feel that the "treatment" has begun, and is much less likely to change their mind or cancel their chairside appointment.
  • If take-home trays are ready or foam trays available the patient can wear 5% KNO3 in the trays 10-30 minutes before the procedure.
  • The day of the chairside procedure, give the patient 400-600 mg of Ibuprofen or other anti-inflammatory drug before the procedure begins, it will be in their system by the time the procedure is complete. Back to top of page

During the Procedure

  • Protect worn incisal edges on the lower teeth Canine to Canine (#22-#27) with a bonding agent only (no etch) and cure. This will help reduce any sensitivity they may have.
  • Patients with recession are good chairside whitening candidates, provided the exposed dentin is covered with liquid dam. Place TWO layers of liquid dam around teeth #7-#10 to protect from heat. Back up the lamp head if patient complains about heat.
  • Check the patient for any tissue blanching or irritations after the dam is removed, applying Vitamin E oil to the patient's lips to promote re-hydration. Aloe Vera gel or Orabase with benzocaine is good to apply to any burns.
  • KNO3/ACP gel can be applied to the lingual surface of the teeth during the chairside procedure. This way the KNO3 can begin working to "numb" the nerve. Back to top of page

Post-Procedure

  • If trays are ready, place KNO3/ACP gel in the trays for the patient to wear home. The longer they wear this gel, the better it works. In addition, you can send the patient home with a tube KNO3/ACP gel. This is the BEST method to reduced post-op pain.
  • Additional Ibuprofen can be taken but do not exceed 1200mg within a 24-hour period. Stronger pain medicine could be prescribed (if needed). Back to top of page

Dr. Marilyn Ward received her D.D.S. degree from the University of Texas Health Science Center at San Antonio Dental School. Dr. Ward has published and presented nationally and internationally on porcelain restorations, tooth whitening, dental materials and lab communications. She is the former Director of Esthetics in the Department of Restorative Dentistry and Biomaterials at the University of Texas Dental Branch at Houston. She is a Fellow of the Academy of General Dentistry, and has memberships in the American Dental Association, American Academy of Cosmetic Dentistry and the International Association of Dental Research. Dr. Ward maintains a cosmetic dental practice in Houston, Texas. She is the Global Director of Education at Discus Dental, LLC.


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