Which Comes First? Whitening or Caries Removal?

Similar to the question “Which came first? The chicken or the egg,” many dentists wonder, “What should I do first?

Whiten or treat caries?” Unfortunately, not a lot of research has been published on the subject. On the other hand, Dr. Rod Kurthy, CEO and founder of KöR Whitening, has years of experience (backed by science, logic, and feedback from thousands of KöR customers) to help provide some insight.

Let’s start with his bottom line: “Within reason, I recommend whitening prior to restorative treatment.”

Now, let’s look at his reasoning:

· If you restore teeth before whitening, what shade will you select for the restoration? Because you can’t know for sure what shade whitening will lead to, the restoration shade may not match the final whitening result. That certainly won’t end with a satisfied patient and you may need to eat the cost of placing new restorations to match the whitened shade.

· Another option is to place a temporary restoration, whiten, and then place the final restoration. That’s three treatment steps for your patient, two of which require anesthetic. Dr. Kurthy also points out that typical temporary/provisional materials simply don’t seal well, which could allow bleaching factors to seep under those provisional restorations, causing sensitivity during whitening.

· Also consider that carious tooth structure is a thermal insulator and the amount of time it takes to whiten wouldn’t result in significantly deeper caries. In fact, carbamide peroxide in custom-fitted trays has long been used to reduce caries.

Dr. Kurthy does offer a couple of caveats:

· If existing restorations are loose, whitening gel can get under them and lead to sensitivity. In that case, Dr. Kurthy recommends removing the old restorations first and then whitening.

· Deep caries may be accompanied by acute or chronic pulpal inflammation. Whitening before removing caries in this situation may result in painful pulpitis.

Other than situations that require immediate attention, Dr. Kurthy sees no reason why you can’t whiten and then restore. The result will be a satisfied patient and a streamlined workflow.