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Heavy stain and whitening

I have had several patients in the past who come in the office with severe stain from wine and coffee. I usually try to numb patient for comfort and use lots of cavitron Polish and air polish, but it doesn’t remove all the stain of course in the time allotted. What can I recommended these patient to use at home to maintain their smile stain free and whiter? They do come 2-3 months.



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The notorious stain! Tightening up their recall schedule is a great first step. It’s important the patients are doing all that they can at home; brushing twice per day, if not more, with an electric toothbrush with the correct technique. So if you haven’t already gone over brushing technique with these patients, its worth doing. Having the patients use toothpaste such as Colgate Optic White can help too. Patients can also whiten their teeth with custom trays to break up the stain chemically. It doesn’t even need to be for a full two weeks, just for a few days here and there.
 
You mentioned you were air polishing; if you are using glycine or a smaller particle size powder, it might be worth trying sodium bicarbonate, as it is about 4 times larger in particle size and might do better on heavy stain. Of course, this is if the patients have no contraindications for the use of sodium bicarbonate; such as a sodium-restricted diet, renal disease, hypertension, exposed dentin, implants or restorative work that could be scratched. Also make sure your instruments are sharp so you aren’t just smudging the stain around, but instead removing it more efficiently, after air polishing and/or ultrasonic use. You can also mix a little hydrogen peroxide in with your prophy paste and try polishing with a phophy angle to break up stain.
 
Lastly, if you aren’t getting enough time to provide thorough treatment, it may be a concern you want to address with the doctor. Either you need to be given more time with these patients or the patients need to come back for another appointment. Having more time is ideal as patients don’t like coming back and having them come back uses up chair time which = loss of production for the office (unless you charge, which again, patients won’t necessarily like).
 
I hope some of these things will help a bit!

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