considerations prior to teeth whitening procedure
Around the national holidays and school vacations we tend to see an uptick in emergencies after tooth whitening procedures. Almost all, in the past 4 years, have been people with active tooth decay (cavities), gum recession or enamel abrasion who went to have the whitening procedure done at a cosmetics studio (or to a dental office where the procedure was performed solely by a nurse) without first addressing those dental problems (or getting a fluoride prior to). A recent case, however, was very different and prompted me to share it here so that, hopefully, others can avoid the pitfall.
The case involved a mid-20s Swiss female. She was on vacation in Turkey, saw a promotional flyer for power bleaching for 250 euros at a local office and went for the treatment. It turned out to be a laser whitening procedure. At the onset of the procedure no gum shield was placed; she started feeling a sharp pain, raised the issue, but was re-assured by a nurse that it was pretty normal and would subside. So she stayed on for the entire procedure enduring consistent and sharp pain. Upon completion of the procedure, she felt with her tongue that her 2 front teeth on the upper jaw were wiggling. She brought this to the attention of the nurse, who called in the dentist. After examination, the dentist told her the teeth will get better in a few days and glued in a metal wire at the back of the teeth to hold them temporarily in place. She came in on emergency appointment upon returning to Switzerland.
Sadly, there is nothing that could be done to save those teeth; they will have to be removed and replaced with implants. Worse, she had severe gum burn along pretty much the entire gum line, and extensive stripping of the enamel at the gum line on several adjacent teeth (will see significantly increased decay on those teeth). She did not see a possibility for recourse towards the Turkish dentist.
In hindsight it is easy to see where things went wrong. Teeth whitening/ bleaching (whether by laser or peroxide) is a fairly low-risk procedure, but only in the hands of a trained professional or supervised by a dentist adept to such procedures. Because of the irreversible outcome if things go wrong, one should never rush into such treatment without researching the provider, without inquiring about the treatment and who would perform it, and without a consultation on risks and outcome. Although many people have sensitivity during and after the procedure or may experience some gum burn (particularly those that cannot avoid talking after the peroxide was applied), a prolonged sharp pain is quite unusual and should be a red flag to stop the procedure. Last, but not least, the choice of the treatment provider should also depend on whether there is warranty should things go wrong.