Extrinsic Stain Removal Tips and Tricks
Last week, I had a patient come into my operatory and before sitting down in the patient chair, turned around and looked me in the eyes. She said “I’ve noticed a bit of black stain on my teeth that I’ve never had off before. I’m excited to have it all off and them looking white again.” I instantly froze. Where did this black stain come from? How bad was it? How tenacious was it? Would I be able to get it off in the short time frame I had during the appointment with the instruments I had? Would the patient be happy with the results with her high expectations? It instantly brought back memories of when I was a brand new dental hygienist and I had an extremely difficult, heavy stain patient and I was definitely in over my head. I did as much as I could in the hour appointment, then sent the patient on his way. 6 months later, he came back and was in my chair. He must not have remembered me, because after this second appointment was completed, he immediately stood up to check out his teeth in the mirror hanging in the corner of the operatory. After a few seconds of an up close look, he turned around and said “this was much better than last time.” I was sweating that entire appointment.
My patient last week laid down in the chair, put in her AirPods, and was ready to have the stain removed. It was definitely a tricky case with 6 months of home brewed raspberry kombucha stain, but I felt more comfortable than I did so many years ago. Here are a few helpful tips I’ve learned throughout the year with stain removal.
Triple Bend Ultrasonic Insert. Stain is above the gingival margin, on the lingual, and usually on enamel. Since it’s on this harder surface, don’t be shy to use a triple bend tip with a high power. If the stain is on the dentin, keep your power a bit lower as the high power can make the tooth pretty sensitive after treatment.
Air Powder Polishing. Of course, this is the gold standard when it comes to removing stains. We love using the air powder polisher as it’s a gentle and quick way for removal, but with the newer guidelines of reducing aerosol production in operatories, we haven’t been using it as much. Hopefully, we can go back to using it more regularly soon! Another big part of using the APP is management of the powder. Check out this video to help keep powder out of your patient’s face, eyes, and nose, and make the procedure a bit more comfortable for both you and your patient.
Vera Advanced Bright Prophy Paste. Have you found that sometimes prophy paste works great on one patient, and then doesn’t budge the stain with the next? It’s so hard to gauge if prophy paste will actually be an effective treatment option. The best one we’ve used is the Vera Advanced Bright. The active ingredient is baking soda, which when combined with water, other minerals, and the small amount of abrasiveness tends to work a bit better on stain. I keep a box in my op, and pull them out on patients with stain instead of using them on everyone. Regularly I’ll polish first with this paste to see how much or how little stain will be removed, and then move onto a different treatment based on how much stain is left over.
Recommend 3 month recalls instead of every 6. I tell my patients that come in for appointments with heavy stain and they know where it’s coming from, like from diet, to come in more regularly. They don’t have to have an exam and radiographs at that appointment, but use it as an in between cosmetic prophy to keep the stain at bay. Do you do Zoom whitening at your office? You could totally add that one and complete both treatments at that 1 appointment to remove the stain and whiten up the teeth in general.
Even though this heavy stained patient threw me a bit off last week, I definitely know it isn’t the last patient I’ll have with this same situation.
What do you use for stain removal with your patients?