The color of white

by Victoria DaCosta

"Did my teeth really get whiter?" "Can you see a difference?" "I'm not sure I can see a difference." How many times have we heard these questions or comments? Our patients see white teeth on movie stars, billboards, their friends, and even their dental hygienist. They all want to have exactly what they see. They're confident that, if they spend between $300 and $500, they will achieve "the same look." While I believe in giving a patient what they want, how do we know, or how does our patient know there is a difference before and after a teeth-whitening treatment?

Until recently, we had to use the plastic shade guide. What I find most amazing about this method is that it is most subjective. The color I choose to match my patient's teeth usually depends on the lighting inside my operatory. But I recently read this is not the only factor. For example, eye fatigue, glare, and lighting conditions are some of the factors we cannot control. Also, no two people see color the same because human eyes are all different. With this in mind, one can clearly see that patients will view the results of teeth whitening different than us. Even when I send patients home with the upper arch tray for whitening, and have them return one week later for the bottom tray to compare top to bottom, I still hear complaints!

I recently came across an electronic shade-taking hand-held device. There are two methods that measure the color of teeth accurately and use two types of technology. One, called a spectrophotometer, measures visible energy for each hue of the spectrum. The other, called a colorimeter, measures radiant energy for each primary color. In this article I will discuss the value of the colorimeter hand-held device method.

The future of better communication is here. We email, import, export, click, and delete - all with a keyboard and mouse! Using an electronic shade-taking device is no different. The electronic shade-taking device takes the guesswork out of results. No more, "Well, it looks whiter to me" comments from your co-workers to your patient, all while your patient is not convinced with the results.

Four companies sell electronic whitening devices: Cynovad ShadeScan, Vita Easyshade, Shofu ShadeEye, and X-Rite ShadeVision. The devices retail for about $4,000 to $6,000 including the software. I suspect in the future these devices will be available bundled along with your practice management software. But until that happens, we are limited to purchasing it separately.

Using the device as a communication tool is key to accurate shade taking. The colorimeter technology existing in X-Rite ShadeVision gives an accurate reading of the teeth color. You will receive a tooth color map. Not only can you see the different shades on one tooth, but so can the patient.

Features

• Press a button, and the device captures the image of the tooth on a mini-viewing screen.

• It provides an original view of the tooth in the upper left, an image of the color breakdown in the upper middle, and incisal/gingival definitions in the upper right.

• When ShadeVision's periscope is calibrated and placed against the patient's tooth contacting the gingiva, you get three readings on the screen after the measurement is downloaded. This is the only device to do this.

• Shade measurements - Chroma refers to the intensity of color. Value describes the brightness (lightness or darkness) of color. Hue refers to the basic color of the tooth, such as blue or yellow.

• Light filters - The colorimeter's hand-held device contains filters that register the reflected light, capturing thousands of measurements of tooth's hue, value, and chroma. A colorimeter works just like the human eye.

A colorimeter reacts to light reflected off the tooth and captured by a receiver, converting it into a color map.

• Color mapping - This view provides shade mapping to various regions of the tooth. Three separate databases correlate to the gingival, incisal, and body of the shade guide offered by the X-Rite ShadeVision device, and one database is offered for Cynovad ShadeScan, Vita Easyshade, and Shofu ShadeEye.

Also, some systems display value, hue, and chroma for color analysis and maps of up to 50 regions of the tooth, providing necessary color information to build an accurate restoration for communicating with dental labs.

Value map also indicates areas of translucency and development of the natural tooth, which is of particular interest to us for calibrating the effectiveness of teeth whitening prior to our patient's investment.

• Run reports - In choosing an electronic device, the report feature is very important for communicating with patients and the dental lab.

Look for the device which automatically uploads images directly from the hand-held device to the PC. It is a communication feature that allows images and detailed work orders to be sent to the lab via email or from a disk. All color image files are conveniently organized and orders can be printed out as needed.

Benefits

• More accurate shade is taken, minimizing subjectivity
• Gives your patient greater confidence because the proof is in the data
• Training curve is lowered with CD and online training
• Using the Chroma measurement can determine progress of your patient's whitening because over-whitening can turn a patient's teeth gray
• Learning curve on device is about 10 to 25 measurements

Advantages

♦ Easy to see different colors of each tooth on the screen with a color map
♦ Frees up the doctor's time in shade taking so the assistant can take accurate shades
♦ Independent of lighting, clothing, makeup, fatigued eyes
♦ Improves communication between the lab and office
♦ Standardizes shade taking
♦ Dental lab can visually try in the shade without the patient present
♦ Less time patient must spend on redo
♦ Active video can be viewed while taking a shade measurement through the hand piece. You have the ability to see the glare live on the tooth

Disadvantages

• Does not show chroma value (translucency) on some devices
• Spot measurements (not seeing the whole picture, just a tip)
• Vita Easyshade guide, one database
• Cynovad shade scan measures one database on a tooth
• Shofu ShadeEye exhibits spot measurement
• Learning curve in the beginning with all systems

o Take the shades before bleaching, if whitening

o Have on hand enough plastic replacement tips for shade taking

o Cannot sterilize the plastic tips

o Make sure you are at the same distance every time you take a shade

o Make sure the glare is at the uppers cervical third, middle third, and the lower incisal middle third

o Look for the electronic shade guide company that is HIPAA protected with dental labs

o Qualify patients for whitening with pre-shade taking

Victoria DaCosta, RDH, BS, is founder and president of Hy-Tech Solutions. A practicing dental hygienist for 18 years, DaCosta is a speaker, author, consultant, and an expert in the design of medical/dental software. She is also on the new technologies committee for the California Dental Hygienists' Association. DaCosta can be contacted at www.hy-techsolutions.com.