July 3, 2018
by Myles Holt, BDS, LLM, FIADFE
Over the last few decades, teeth whitening has become the foundation of cosmetic dentistry, representing one of the most cost effective, minimally invasive, entry level options for patients wishing to enhance the appearance of their smile. When looking at developing a complete intra- and extra-oral, Dento-Facial Aesthetic treatment plan for patients, teeth whitening should be high on the list of proposals. Indeed, it is prudent to start the extra-oral examination, for every patient, by taking a tooth shade. The importance of whitening in achieving the best overall aesthetic result and in driving business success cannot be overstated.
However, recent years have also presented greater challenges to dental practices in maintaining the perceived value of in-office procedures, in the face of growing competition from non-dentist teeth whitening services.
At the same time, to provide more comprehensive dento-facial care to patients, many dentists (where permitted) have made the move to offer facial rejuvenation therapies, such as Botox and Dermal Fillers, within their practice, alongside traditional dentistry. These services have long been thought of as diversifying our dental businesses to ensure new streams of revenue at a time when traditional dental business is getting tougher. However, if used wisely, facial rejuvenation procedures can also help to revitalise the demand for waning intra-oral dental procedures as well.
One such example is the unique protocol, developed by the team at the Australasian Academy of Dento-Facial Aesthetics (www.AADFA.net), in Australia. The AADFA team have pioneered the use of LED skin therapy with in-office teeth whitening. Adopting this procedure allows Dental practices to set themselves apart and market a novel treatment that kills two birds in one appointment, providing skin rejuvenation at the same time as teeth-whitening. It enables dentists to once again create a point-of-difference with respect to non-dentist whitening services, as well as justifying the higher cost of treatment.
See the Light!
Many of the available in-office teeth whitening systems have promoted the use of light based technologies to enhance results. While such an approach has seen much debate around the need for, or the effectiveness of, the light itself, there is little doubt that in the eyes of a paying patient, there is the perception that a light provides a more high-end, scientifically advanced therapy, together with better clinical results (Fig. 1). However, with non-dental services now offering similar looking therapies, these traditional approaches fail to stand out.
Therefore, it is high time for dental practices to see the benefit of a new type of light.
Low-Level Light Therapy (LLLT) is the therapeutic use of incident light to photomodulate cellular function. Several brands exist, providing devices consisting of an array of Light-Emitting Diode (LED) technology. These devices harness the properties of different wavelengths of light and, depending on the wavelength selected, can stimulate various tissue responses in the skin (Fig. 2A).
Each LED device allows the operator to switch easily between different wavelengths or even blend wavelengths for synergistic effects (Fig. 2B). For example, selecting “yellow” light at a wavelength of around 830nm, provides improved tissue healing and relief of pain. This treatment has been shown to be beneficial in the treatment of Temporomandibular Joint Disorders and in post-surgical healing. 1
Research has shown that using “blue” light at a wavelength of 415nm is anti-bacterial and aids in the resolution of active acne. 1 Several orthodontists are now utilising such a device for their adolescent patients during each orthodontic adjustment appointment.
However, when it comes to the unique skin rejuvenation-teeth whitening combination developed by AADFA, interest lies in utilising “red” light at a wavelength of 633nm. Extensive research demonstrates that this wavelength is optimal for stimulating fibroblasts and collagen synthesis in the skin, leading to generalised tissue rejuvenation. 1
Patients expect a light to be used with in-office teeth whitening, but by restricting the light to just the oral cavity, dentists are missing an opportunity offer more unique services to patients and to stand out in a competitive market.
Fig. 2A, 2B
A and B LED therapy addresses a broad range of clinical issues, depending on the wavelength selected and its tissue penetration profile. Often a combination of wavelengths, used synergistically, is the best approach.
When performing the combined therapy, it does not matter whether the practice currently utilises a lamp for in-office teeth whitening or a purely chemical based process. If using a chemical approach for teeth whitening, then simply apply the whitening agent as normal and position the LED skin rejuvenation device over the patient’s entire face. If using a lamp for whitening, then the agent is applied to the teeth; the whitening lamp focused on the teeth; and the LED device positioned over the top of it all, to cover the full-face area (Fig 3).
The procedure for LED therapy is like that for most in-office teeth whitening systems, in that results are best achieved with several cycles of exposure, each approximately 15 minutes. This enables the two treatments to be performed simultaneously with the minimum of additional effort.
An LED device, positioned over the entire patients face, can be used as a dual treatment of skin rejuvenation combined with in-office teeth whitening.
While Dentists are familiar with the results that can be achieved using in-office whitening treatments, they may not be aware of the dramatic improvements that can be obtained through the concurrent use of LED therapy.
The great attraction of LED-based technologies is that they are cost-effective, pain-free methods for achieving real improvements in skin health, for almost any patient, without the side effects, physical trauma or thermal damage that we see with many other light and laser based skin rejuvenation technologies. This makes LED devices among some the best options for dental clinics wishing to introduce skin rejuvenation therapies for the first time, where the focus is on achieving visible results for patients, across a range of clinical indications, with minimal downtime and low complication rates – key factors in successfully expanding the practice’s clinical offerings (Fig. 4).
Indeed, LED devices are so simple to use, that many practices delegate this responsibility to trained hygienists, assistants or therapists. The treatment is so versatile that it can also be used as a stand-alone therapy, or at the end of a hygiene visit (Fig. 5).
Generalised improvement in skin health and quality following several treatments using red LED therapy and a visible reduction in lines and wrinkles.
A dramatic improvement in acne following several treatments using green LED therapy.
This dual approach raises the perceived level of service in the patient’s eyes, allowing dentists to justify the necessarily higher cost of in-office whitening treatment and to differentiate the practice in a competitive market by promoting a service involving a unique approach of dual skin rejuvenation and whitening in the same appointment. It is essential to remember that the driving force behind patients choosing to undergo facial rejuvenation services in the dental chair rather than in other cosmetic clinics (eg. Botox, Dermal Fillers, etc) is the convenience of being able to tick several items off a busy “to-do” list, at one location, in a single appointment.
By allowing dentists to effectively become a “one-stop-shop” for patients’ needs, these simple LED devices re-energise in-office whitening procedures and allow dentists to stay ahead of the game by truly enhancing the entire smile from the inside, out. OH
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About the Author
Dr Myles Holt is the Director and Head Trainer at the Australasian Academy of Dento-Facial Aesthetics. He has authored the Facial Aesthetics Module and is an Honorary Lecturer for the Masters of Aesthetic Dentistry program at King’s College London and is a Regent of the International Academy of Dental and Facial Esthetics in New York. Dr Holt has a Masters in Health and Medical Law and is a sought after global presenter on the incorporation of various skin health and facial rejuvenation procedures in dentistry.