Teeth Whitening Secrets for Success – PDP058

Jaz’s Introduction: Hello, Protruserati. This is Jaz Gulati, and welcome to Episode 58 of the Protrusive Dental podcast. I appreciate you for joining us. Today is such an impactful hour that we have on teeth whitening. Now a lot of you thinking teeth whitening, come on, Jaz that’s so basic. Just get a tray, wax, some gel in and that will whiten the teeth, right? Well, no, there’s so much more to it than that. And this is going to be probably the most impactful Real Talk 60 minutes of teeth whitening content you ever heard. I think everyone needs to hear it because today’s guest is Payman Langroudi. He was a dentist. And then he founded Enlighten Whitening, which is the premium brand of teeth whitening in the UK. And what he’s doing is amazing. He’s such a massive supporter of young dentists and dental education. So it was an absolute honor to have him on and he really covers it in a real talk fashion, right? We don’t know it’s not to scientific, it’s not to blah, blah. It’s actually so easy to listen to Payman Langroudi talk about these things. I hope you enjoy and follow along with great ease. We talk about all the important things that you should know as a practitioner for teeth whitening like comparing the different tray designs, what might surprise you is that a gel is not a gel is not a gel so all the gels may not be the same and you know we’ll look into why that might be the case, how to maximize success by reducing sensitivity and how and why you should be doing more teeth whitening right now. The Protrusive Dental Pearl I have for this episode is whitening related. Did you know that you could be whitening your patient’s teeth during tooth alignment. So a lot of my Invisalign patients will be whitening as they go along. But the magic really happens at the end like some of my patients will whiten so well during their aligner phase that there’s hardly anything to do at the end. But that’s rare. That’s when they got all the best enamel and their protocol is really good and everything just aligned. But a lot of patients will need the final teeth whitening at the end in their retainers. But the Vivera retainers by Invisalign and this is not sponsored by Invisalign or anything. They are fantastic, right? We all know how good Vivera retainers are. And because the seal is so good, that enlighten whitening actually guarantees a B1 shade if you use their enlighten whitening system in the Viveras. So the first time I learned that I was like whoa That is crazy because it speaks volumes about Vivera retainers, but also speaks volumes about an enlightened, the fact that they understand that hey, it’s not just their high quality trays they respect that, there’s another system out there in Viveras that will produce a good seal and that’s why with that gel that able to guarantee that B1 shade and sometimes right when I told dentists about this they said you know where the attachments are, don’t need get like a tan line where where the tooth has not whitened it’s just not the case you know, we know that the teeth whitening gel goes under the enamel if you like and it’s not gonna leave any patchy areas that didn’t whiten so that’s not a concern that I have and it hasn’t been for my patients but certainly but especially in the retention phase if using the Viveras they make fantastic whitening trays. This episode is sponsored by Enlightened Whitening and I really appreciate their support for the podcast. Payman is one of the Protruserati and I’m ever so grateful for that. So it was really great for that reason to have him on as well. And I hope you enjoyed this episode but I just want to say what a few more words about my experience with Enlightened. Everything from the branding to even the courses that they put on with the mini smile makeover has that premium feel and patients can really sense it when they go on their website for Enlightened Whitening or when they get the packaging. Even the trays when you get the trays from Enlightened, you can tell there’s something a level above for their trays. So I just want to say thanks so much to Enlightened for sponsoring the show. Really appreciate it. And I hope you all enjoy this episode.

Main Interview:

[Jaz]
Payman Langroudi, Welcome to Protrusive Dental Podcast. How are you?

[Payman]
I’m very good, man. Thank you very much, Jaz. As one of the Protruserati myself, I’m very proud to be on the show you know my favorite podcast, my favorite dental podcast.

[Jaz]
That’s really awesome to hear and I really appreciate that with your what you and probably doing with their DLP, Dental Leaders Podcast is amazing as well. So many great guests you’ve had on the, international superstars from us, here. I mean, that’s been probably going on for just over a year now with DLP?

[Payman]
Yeah, but you know, we talk about this, Jaz. Yeah, we’ve perhaps got a 20 man marketing agency. I’ve got five people in my marketing team and yet you managed to do more on your podcast than we do. Now, let me tell you they’re not all 100% working on our podcast. But it goes to show, that passion is where us at. You know,

[Jaz]
I appreciate that. I have got two guys working for me now, though. So thank you, John Ali media and Paris Kahn, who do this all the bits on the side for me. So it allows me to have more time with family and stuff. Because it’s great, fun and passionate. Before the beginning, it was all me. But then you know, there comes a point we need to let others do the work so you can have more time with family and stuff. So So yeah, it’s a much more automated process now, thankfully, otherwise, where would I find the time. Right? It’s one of those crazy things. So I don’t know how you guys squeeze it in, you know, you’ve run, Enlighten, MSM and Prav with, you know, not eating or drinking anything for 21 days. All the crazy things he does. I don’t know where you guys find the time.

[Payman]
Yeah, he’s a totally different animal to me, man.

[Jaz]
It’s just amazing. So it’s so good to have you on because I want to talk about teeth whitening, particularly the bits that, you know, when I’ve done your one hour training before, used Enlightened before. I’ve done whitening, I feel I’ve done more complex cases, as you’ve seen as well, some really horrible brown marks I’ve created with purely whitening and micro abrasion. I use whitening as part of my icon protocols. I use whitening alongside clear aligner therapy. So what I want to tackle is the controversies, that troubleshooting, the bit when things don’t go right, and how we can identify and help dentists with that. And who better than to you but you know, there are some people who may be listening from around the world who don’t know who you are. So Pay, just tell us a little about your backstory, and why you are a great person, in my opinion to talk about whitening.

[Payman]
Yeah, so I’m a dentist, but I haven’t practiced now for 10 years. I we started a whitening company. And we started off actually with light activated whitening, which I’m sure you’ll get to. But back in around 2005 we stopped with the light activated, and we decided to move into tray-based whitening. And yeah, so we’ve got a tray based system, it’s probably at the higher end of the different systems. It guarantees results, you know, we get very, very good results every time. The, for your listeners in the US the closest thing would be the KöR system. So we did collaborate a lot with Rod Kurthy. Back in the day, when he had written his book and all of that, so yeah, that’s kind of the whole story.

[Jaz]
Brilliant. Well, you mentioned it straight away. So let’s not you know, let’s go straight for the kill. Light based systems, okay? Let’s do some myth busting. Okay? What it’s all that about? Because we, you know, early on dental school, we get taught that it’s a load of BS, and it’s just a sales ploy. It’s that sort of stuff. So what could you say to the dentist? I mean, are we right? In our interpretation that is all BS? Or is there some positive benefits that perhaps we’re not really stopping listening for?

[Payman]
No. It’s all BS. You know, dude, like I say, we started with light activated, and we believed it at the time. And then, you know, it came down to cover half the light over and see. But if you go to the research, then no, it really doesn’t make, the real shame of it is that while there is still dental systems out there that used lights, then all of the sort of over the counter, things that people are seeing pop up on their on their feed, you know, the high smiles, the snow whitening, all of those ones are sort of referring back to the light of the dentist. And, you know, I guess that’s not doing harm to patients. But, you know, at the time when we were isolating the teeth, and then putting these UV lights on and all that often nothing, often nothing.

[Jaz]
I think you raise a good point that there was at the time, a belief that hey, you know what this could be helping, this is activating. So it’s not that from the beginning, it was all like, hey, let’s scam people. It wasn’t I’m sure it was never like that. I’m sure there was a belief system, but then the evidence came out actually, it doesn’t make a difference. And so I admire the fact since the last 15 years, you guys are trained by systems. So you have that’s much to be admired there. So we’ve hit that one on the head where we can move on now. So light base is rubbish. And I guess you raise a good point, the high smile and those little lights that people show. Conor, Who’s that boxer the Irish guy?

[Payman]
Yeah. McGregor.

[Jaz]
Yeah, he had a little Instagram ad I saw of him showing it off or whatnot. That little light you stick on him. Yeah, that just shows there’s a lot of marketing to be done. People perceive it as a high quality system because they still think that hey, there’s that whole laser whitening, the light whitening, you know, all that sort of stuff. So there has that history behind it, I guess. So.

[Payman]
The over the counter stuff has changed the way things trend on the internet. But you know, we also the charcoal trend that came and kind of is going. But that didn’t have any basis in professional, you know, there’s no dentists using charcoal to do anything and yet it trended. Whereas these light ones, because you know, people can see that there are dentists using light, then it somehow makes it much more like it’s a real thing. I honestly, you know, since I was involved in the business myself, and I fully believed in it, I think even the people behind these lights believe in them, because they know no better, you know, I don’t think they go out to scam people, most of them. But they don’t make any differences as he asked the question.

[Jaz]
And what about these? over the counter whitening systems? I know, they’re all like, you know, they’re not going to be as clinically efficacious? Or as your hydrogen peroxide or carbamide peroxide? No way, it’s impossible. But is there a black horse in there? I’m sure you guys have looked well into this, maybe test some stuff out? Is there something out there that actually is looking promising? Maybe something enzymatic or any, anything that could be good?

[Payman]
well understand, first of all that outside of Europe, you can use up to 6% hydrogen peroxide over the counter. So you know, the, you know, the same concentrations that we’re using in the clinic, are available over the counter, all over the world, outside of Europe, and certainly for me as a [?] on a developer of teeth whitening systems, that’s a goal. Yeah, you know, I feel like I have two goals, one to really make that one hour thing, work, you know, to make teeth white within an hour. And two, to produce the best system that’s possible without actually visiting a dentist. That’s not gonna be possible in Europe. In Europe, people still have to go and buy that from a dentist without making a tray or whatever. But there’s a long way to go. Because the first one of trying to make teeth actually white within an hour, we’re nowhere near that. You know, we’re sort of trying to get the difficult cases down from four weeks down to three weeks. And that’s a massive achievement for us. we’re nowhere near an hour. But on the other side,.

[Jaz]
Is that because we’re limited to the gels, or do you mean like any gel, any percentage, that for an hour?

[Payman]
Any way, I don’t think it’s possible. But the other one of creating a system that people can buy, and actually make their teeth white. You know, people are spending millions on these high smile and snow and over the counter products that do nothing at all. I think there’s the space there for improvement. And certainly, you know, I’m working on that I’m you know, I see that as my two goals.

[Jaz]
Let’s kill it. Let’s ask a question. Hopefully, you don’t, Pay, I know you won’t mind you take these really cool. What do you feel about them? Because you know, dentists feel hard done by that, hey, beauticians do what they do, or the fact that people can spend their hard earned money and on stuff on the pharmacy, that doesn’t really work. But what you’re trying to say is what if you could make something that people could buy? That would work, but then what about those people who will never bother going to the dentist and now are potentially if a successful product exists? Whitening without having seen a dentist in that potential scenario, if you want to be successful with point number two?

[Payman]
Well, we can see it with the the white strips, right? That they’re selling. There’s not harm being done to patients. Okay, it would be good if they visited a dentist just for their dental health. But I don’t think that you know, as a dentist, obviously, I would like people to come see dentists. Yeah. But I don’t think that strips are doing harm to people. You know, my thing is, there could be improvement on the strips themselves, a better over the counter system. As I say in Europe, you still have to buy that from a dentist. And the way I’m thinking about it is if we do manage to make a breakthrough there, it would be something through a hygienist you know, like do you want fries with that? From the scale and polish? You know that you can have your teeth cleaned? Hygienist, do you want fries with that? Just go home with this box. Yeah, and whiten the teeth? And you know, the biggest problem in whitening I’m sure we’ll get to it Jaz is that we don’t do enough of it. We don’t..

[Jaz]
Absolutely I want to talk about that. Absolutely.

[Payman]
That you know that we’ve got a massive opportunity. Now the public want this. They’re probably more interested in the color of their teeth than everything else put together, you know, outside of a missing tooth. I really think they’d be more interested in the color of the teeth than alignment you know, anything where you know all the stuff that we look into in examinations, man, I mean your occlusion expert, you look you know, the dentist will look into slides, interferences, center line, shifts and all that and then not mentioned shade to the patient, the number one thing on the patient’s mind. We’ve got to get over that. We’ve got to see it as education.

[Jaz]
Let’s go straight for that. Let me there are so many questions I’ve got to ask you about that. That was one of them. Right? How can we do more whitening? Is it basically as simple as we are, as dentists as clinicians, not communicating in the best way possible to be able to give our patients the shade they deserve?

[Payman]
Yeah, we’re not discussing shade. We’re not discussing shade. I mean, I know you’re a progressive dentist, Jaz. So maybe you do, maybe with every single patient, in every single examination.

[Jaz]
I’m not doing that. And I’ve listened, I’ve heard this, I read and I’m listening to you say before I went to your online training, and you said that right? Discuss shade with every patient, probably for about two weeks after you told me I did it. But guess what happens? You know, you get a habit and you don’t and you know, it’s a hands on. But say you’re right now, but

[Payman]
There are good reasons for it. Yeah, and the reasons are, we don’t want to annoy people. We don’t want to offend people, we don’t want to come across as pushy salesmen. We don’t want to embarrass people. And you know, those are all really good reasons. But the My thing is, it should be part of the education, it should be like oral hygiene instructions. But you know, if we don’t talk about this, where is the dentist, where’s the patient going to get this information from? They’re going to get it from the hairdresser, they’re going to get it from high smile in the internet, they’re gonna get it from their best friends, and they’re gonna look for this information, there’s no doubt about that. You don’t even need to be in the dental field to understand that the color of teeth is the most important thing to our patients. And that’s the sort of the massive elephant in the room the disconnect, the most important thing to the patient isn’t being talked about by the dentist, you know, and

[Jaz]
You’re so right, so what is it, is it as simple as just taking a photo with a shade tab with for every patient and saying, hey, you are here on this scale? And then let the patient make the comments or you know, is it as simple as that?

[Payman]
There are different ways. Linda Greenwall, she advocates using an a three shade tab only, and saying, look, this is average, you’re either average, you’re slightly below, you’re slightly above and introducing it that way. For me, the reason why I think the reason why we don’t ask lots of patients about it, is because there is a type of patient who may get offended, embarrassed or annoyed. Anecdotally, I would say one out of 20 is like that. But we see, you know, pre COVID, a lot of us would see 20 patients a day. And so that’s one a day. And the problem we’ve got is we don’t know which one, we don’t know which one it’s going to be, is it going to be the first patient or the third patient or the eighth patient? Who’s going to feel that way. And because of that we sort of tiptoe around the issue. We don’t discuss it anywhere near as much as we should. And then I don’t know what you think. But I would think anecdotally, that half your patients would be interested in whitening one day, maybe? Yeah? But those guys never get to hear about it. Because we’re so worried about that one. And so we’ve put a process in place in these, you know, our regional centers, the ones where we really focus on those practices to try and get over this issue. And the way that I’ve figured about it is for the for the receptionist to get over this issue. So before the patient even sees the dentist, the receptionist takes permission for shade taking. And she says in a very simple way, she says, we’re going to take shade on all our patients, so no one feels like they’re being singled out or embarrassed. Or, you know, we’re taking shade on all our patients, because we’ve become a whitening center or because the color of teeth changes. The color of teeth change, you know, because we want to monitor that, because we’ve got whitening offers whatever it is, as long as there’s a because in there, we’ve seen, we’ve done this 140 times now. And we’ve seen 80% of patients say yes to that.

[Jaz]
So this is you giving permission to the receptionist to inform the patients that part of their examination will involve a shade analysis?

[Payman]
Yeah. And 20% say no to that. And that’s super cool. The whole thing is there to filter that 20% out. But then 80% say yes to that get a piece of paper that then positions the practice as a whitening center, maybe offers or on their scheduling, you know, timing, patient comes in with a piece of paper. Now the patient’s asking you for shade taking, there’s no excuse you know, there’s no reason not to do it. I’ve seen dentist go from doing two a month to doing 20 a month because of that one change. And you know, there’s massive unmet demand for whitening in most practices.

[Jaz]
I love that. And you know what? I like I said, I went to your online training. I applied it a little bit. I didn’t continue. So I’m going to give it a go. So by time this episode comes out, I will maybe in the intro when I record it I can tell people it’s different. So, tomorrow so Zoe, my nurse Zoe if you’re listening, my nurse, Daria now if you ladies are listening, make sure I’m on this. And we’re going to do it as a practice. So that’s amazing. I love that. And I also, I mean, I don’t want to let this gem let go that you just mentioned. You said as long as you mentioned, because, yeah, because that is important. Okay? Because we know there’s a there’s a famous study, I don’t know, for me referring to that study, the photocopier study in Harvard or something..

[Payman]
Cialdini.

[Jaz]
Yes please tell us about the study.

[Payman]
Basically, as long as there was a because 80% of the people let the person in front of them, when they said, Can I jump in front of you in the queue? They said, because it didn’t matter what they say after because..

[Jaz]
it was a cue for photocopying, basically. And it was you know, if you just ask, you get to get many yeses people don’t get annoyed. And when you add a because that becomes so much more powerful.

[Payman]
Yeah. If you don’t put a because it actually flips it and 80% say no. And 20% say yes. That’s a simple, call it a trick of the mind. But actually, it’s getting over the dentists, variability. I mean, there’s variability between dentists and even within the one dentist as your say, so that you know that some dentists will mention it to lots of patients, many dentists won’t, when patients come in with this piece of paper, then, you know, you’ve already got permission to talk about this.

[Jaz]
I think I can immediately think it’s so easy, I think to apply this to new patients, because you can have it as part of your new patient. And obviously, more difficult now pandemic, paperwork and sheets and stuff with because now I’ve just started working in practice where they had the same dentist for 32 years. And now I’m the new guy, right? So this might for my situation a bit more challenging, but doesn’t mean I can’t do it, you know, because they’ve already seen new changes, we have now got intraoral scanner, we’ve got Telly in the room, we’ve painted the damn wall now that I’m here. So there’s so many changes, I’m sure they can accept one more that, hey, I’m doing a shade analysis, because color of teeth changes. It’s important to keep an eye on this and they’ve already used to be taking photos. So let’s do it. I will definitely do that. And I think if anyone’s listening, and you want to do more whitening cases, because let’s admit it, whitening is fun to do. And patients like it. And it’s good for the gingiva. I mean, let’s be honest, has health benefits as well, and for root caries, and there’s so many health benefits to discuss in that respect. So I think we can all, Protruserati crack on. And let’s see if as a group, we can be doing more whitening. So thanks for sharing those gems.

[Payman]
One other thing, but we, A lot of us do mention whitening when we’re doing a treatment plan or some sort. Yeah. So you’re going to do some aligners, you’re going to do some composites, when you smile making whatever it is, you’re going to mention whitening in that situation. The ones that get missed a lot of patients who need nothing at all. There’s many of those in some practices where there’s you know, the hygiene team are doing their job properly. There’s loads of it, the majority of patients come in every six months without need nothing at all. That patient gets ignored from the whitening perspective all the time. And that’s perverse patient to do whitening or who’s you know, the reason that guy’s brushing his teeth too well, isn’t to keep his gums pink. The reason is brushing his teeth so well is because he wants to keep his teeth white. And for the dentist or the hygienist to say to that guy, Look, you’ve done so well with your brushing, that it’s that affirmative thing, that’s what he wants to hear is, you know, valid. So you’ve done really well with your brushing, you need nothing because you’re brilliant. What about stuff you might want, like whitening? A majority of those patients will go ahead. But you know, we’re so stuck on the reason I’m asking you this. I’m so worried about asking you this, because, you know, I don’t want to offend you. But the reason I’m asking is this, because you can’t have your whitening after these fillings. That’s a very easy and obvious thing. So stuck on that one that we forget, you know, those guys who need nothing too healthy patients are most likely to go ahead with whitening.

[Jaz]
That’s so true. I never even thought about it that way. Because it’s so easy for me to say, Hey, we’re going to build up your lateral incisors. Why don’t we improve a shade and a matte shade? That’s an easy conversation. Now we know I think every dentist should be able to have that conversation. But you’re right, these are people who are doing great. They obviously care. They’re maintaining oral hygiene and a whitening will do wonders. I think so that’s another group you’ve identified that we can definitely help. Now that leads nicely to the next question I will ask you is sometimes you help these patients with all your best intentions. And something doesn’t go to plan. They come back and they all know it has happened to me before they say it’s not as white as I was expecting or haven’t found the result. And I think I know where I’ve gone wrong in the past. And it’s a diagnosis issue that I’ve had, and I’ve overcome it. But can you think of some good two, three points, Why whitening is not as successful as it is? As we know, as we know we can because we all got great cases in our hands and photos of that. So let’s tackle that one.

[Payman]
So first thing is most dentists you’ve done quite a lot of whitening will have some cases that were amazing. But the teeth went off the charts right? That sensitivity was low. The teeth stayed white, there weren’t lots of white patchiness or opacities and so on. Maybe the patient was delighted and referred a friend or whatever it is. What I would say to you is, on those occasions, everything went right by mistake. And really what you’ve got to try and do is try and make everything go right on purpose. So from the, if we stay away from the clinical factors, what actually makes things more difficult from the patient perspective, just if we’re talking about what you’re doing, there’s four key areas that go wrong. And it’s the impression or scan, and we should get to it, but we still prefer impressions to scans. So the data capture whichever way you do that, the lab work, the gels, and the desensitizing protocol, whatever that is for you. Any one of those four goes wrong, the treatment will go wrong. And so from the operative perspective, you know, we’re getting hundreds of impressions in every day and lighter. There are, you know, I’m sad to say, quite a lot of poor impressions come in. And I think it’s something to do with, it’s your mindset, when you’re using alginate, isn’t an alginate mindset, you sort of may be in a hurry and thinking of study models, where it really doesn’t matter what that gingival margin looks like, I think the same dentist, if it was taken an impression for Invisalign with silicon would be paying a lot more attention to making sure that gingival margin’s perfect. So the best thing you can do as a dentist in the operative senses take a really good impression. It sounds obvious, but we do get quite a lot of poor ones we do. So that’s the first thing, then, the lab work. And we should get on to that you know what tray, and what doesn’t. And what I can tell you about that is that as important as the protocol is the technician themselves. So you know, it takes us six months to train the technician to the standard that we’ll need. And a lot drop out before or get kicked out before they get to that point. Sometimes you can tell within a month that someone’s not right, for the job. And in technician circles when I tell them that they balk at it because from a technicians world, making bleaching trays is like the lowest of the low. But to make a really good bleaching tray, the technician is key. There’s a lot of sort of flaming of the edges going on, which actually, instead of you know pushing it in lifted out, there’s lots of things you can do wrong, you can manhandle the thing too much in the finishing and ruin it that way. But the protocol is also important the amount of pressure in the machine, that the material you use, a bunch of things like that. So a good tray.

[Jaz]
I mean, essentially, the most important factor of the tray is the seal, right? I mean, the ability to keep saliva out, Am I right in saying that?

[Payman]
Absolutely. And you know, for me, Jaz, the best way to test that, if I’m testing two different designs, the best way for me to know the answer to that question is to make them both for myself. And try I mean, it sounds unscientific here. But when I say myself there’s a few of us in the office, let’s say there’s six, eight people, will make the same mouth will make three different designs for and all of us will try them in and you can tell, you can tell I was very focused on the front of the mouth as far as retention and so forth. But as I’ve got more experience, I’ve noticed the back is more important even you know that flapping about of the thing. Get saliva in, you know, it just makes it a problem. So, you know, the right tray, the right retentive tray that keeps the gel where it is absolutely right. Well, let’s go to the gel. Right?

[Jaz]
Yeah, sorry, I just got up. Yep,

[Payman]
And the gel, look that the end, it’s this common thing that surround that peroxide is peroxide. And this one is the one that kind of annoys me the most of all of the different myths out there. Because, you know, I can see when what happens when we get batches of our gels delivered to us. And then those are used by the users. And the ask, this is why we changed our whole protocol regarding how it’s shorter, the distances between the factory and the dentist, because we were finding that near the end of the batch. We were getting problems. We were getting problems with sensitivity and with whitening at the same time. And it’s counterintuitive because you think, well sensitivity is a function of more oxygenation. And yet we were getting more sensitivity and less whitening at the same time at the end of the batch. And, you know, talk to a bunch of people about it. I’m no chemist, but what I can tell you is that it goes beyond the sort of GCSE chemistry, which is the two h2o, 2 goes to 2 h2o + O2, oxygen, it goes beyond that, you know, we’re in the sort of the hydroxyl radicals and peroxyl radicals, the oxygen ions, and then there’s a hydrogen ion that happens. So as this thing breaks down, it becomes acidic. And it’s that acidic nature of a broken down gel, which increases sensitivity in the process. So we’re very focused on this. But even if, even Enlightened gel is different, in different parts of the batch, and we try and really minimize this batch variability, by ordering small amounts, using it up on in small amounts, reusing it up, we had a problem over lockdown that some was left, some was left over, you know, over that three month period, we had to get rid of. So the idea that Enlightened is the same as Polas, the same as Boutique is the same as Zoom is magnificent, because you know that they’re there, the viscosities are different. You know, the, if you’ve done, if you’ve used any number of gels, you should know, I mean, some cause more chalkiness, some cause more sensitivity, some take you to the grayer kind of angle of white, some take you to the yellower angle of white, there’s so much variability. It’s not even, you know, a close, but I think this dentist, you know, we named these things by concentrations. And for that reason, we think it’s like 200 milligrams of ibuprofen, you know, this is totally stable, solid. Yeah. Whether you buy it from, you know, ibuprofen or from boots should be stable. Bleaching, the reason why the thing whitens teeth is it’s a volatile liquid, it breaks down and this isn’t that breakdown, where the action happens. So, you know, the same syringe, two syringes are different, depending on how you keep them and what you do with them, let alone different brands. You know, it’s,..

[Jaz]
I think that’s a busted that myth. And I really appreciate it because I saw a recent I mean, we see these threads all the time, and they use exactly what you say on Facebook, whatever. Oh, it’s all the same [inaudible] It’s a 6% hydrogenperoxide. Right? And there’s that mentality that we have, but recently, just three days ago, someone said, on a Facebook page, which is the best etch, right? And then people were like, acid, like as a joke, right? I think what might make gossip like it, whatnot. But then but then my buddy, Rajiv, who has also been a guest on his podcast before he said, Listen, it’s the same — right? It’s acid etch that 87% of phosphoric acid, with a lot of people said actually don’t have, you should the UltraDent one versus this one was that one, some are running some of this and I get a better etch pattern with that. So as you mentioned that I was thinking this is similar, but different. Chemistry is different.

[Payman]
We all accept it with composites, right? You know, we will have our favorite composites, but they all got the Bis-GMA, the glass filler, the silane coupler, and if you want to talk about the ingredients of them, they’re basically the same. But we all agree hopefully, that you know, no offense, — composite is different to — hopefully.

[Jaz]
I might beep that one out this one. I’ll beep that one out. So no offense, unnamed, composite brand. And then the last one was of you going all the four things were important to get right sensitivity, tell us about what’s the best way to manage sensitivity?

[Payman]
Yeah, so one important thing is that, you know, I’m preoccupied by improving the tray. Now, as you improve the tray, you keep the gel against the tooth for longer, that makes whitening better. But that does increase sensitivity. And every time we improve the tray, we’re waiting for a problem with sensitivity. We’ve done it enough times now, and that is the case, sensitivity is a common side effect. From our perspective, we like external desensitizers. Desensitizer that are not in the gel, and we have the absolute bare minimum of desensitizer within the gel. It’s actually doing an opaquing of the teeth is that’s there for a different reason. But we desensitize externally. What that means is you can target your desensitizing the say exposed dentine, for instance, but it also means it’s almost like the way I think of it is, you know, that famous thing about shampoo and conditioner. One’s doing one thing, the conditioners doing the opposite thing, the it’s similar thing, but the gel is kind of opening the tooth up, the desensitizers kind of closing the tooth and having them within the same format. If you can’t optimize on both is the way I think of it. So we do use external desensitizers, we have a dentist applied one and the patient applied one and the 10 desensitizing toothpaste. Those things altogether, minimize sensitivity but but as important is the tray and the gel, as we said, if the gel is broken down in this acidic, that’s gonna cause lots of sensitivity to.

[Jaz]
It can mean it goes without saying that the patients I found who have struggled to get on with whitening due to sensitivity. They’re sort of doing one day and then two days off, then one day is two days off. And then eventually they get bored, and they only really get a one week like a whitening. And then they’re the ones later on is that Oh, yeah, I tried whitening once. It was okay, it wasn’t as good as I expected. It’s because they weren’t able to be consistent and get enough whitening time in, Why? Because sensitivity. So that’s an obvious one, obviously, that needs to be managed so that you can get the response.

[Payman]
A lot of times we’ll blame the patient in that situation. Right? And it’s an attractive idea. But compliance is the patient’s responsibility. It sounds like it should be right, the patient’s not compliant. But compliance is definitely sensitivity related. You know, if you can manage sensitivity properly, you’ll get compliance, there’s, that’s a key thing. And you know, you’ve got to manage sensitivity. We’ve got to anyway, I mean, as a dentist, right, you might treat 100 patients with really 1000s of patients, it’s important for us to be able to, to manage sensitivity. As I say, it’s linked to all the different parts of it. It’s the kind of the one that goes wrong when everything else goes right. The perfect impression, a perfect tray, a perfect gel means you’re gonna have these high concentrations for long periods, sensitivity goes up. So you’ve got to manage sensitivity as well.

[Jaz]
I’m surprised you didn’t mention three other things, which I was thinking that you would mention in what makes effective whitening and helps you to reduce those patients who are left unhappy, and those three for me are two are diagnosis related. One is communication related. So one diagnosis related for me is parafunctional patients, nocturnal parafunction, surely they should be having the daytime hydrogen peroxide and not the Carbamide Peroxide, your views on that?

[Payman]
So certainly look, parafunction is by far the biggest problem but I was focusing on system relations. So let’s get to the patient. From the patient there are six things but the by far the most important one is parafunction. We still prefer carbamide over hydrogen peroxide, even for daytime bleaching.

[Jaz]
Okay, on a daytime. Right.

[Payman]
But and we still go for nighttime first, for two weeks, if it’s not working switch to day time, simply because an hour during the day is different to an hour at night. As far as muscle movements, saliva production.

[Jaz]
Means you’re dry mouth. Absolutely.

[Payman]
Obviously, in parafunction, you’ve got more muscle movements at night. But it’s difficult to diagnose always that the pattern of parafunction. You’re the expert, right? It’s one of those things that you do we’ve I would say three quarters of whitening issues. Once you fix the other part, the impression, the tray, the gel and the desensitizing, three quarters of problems are bruxism or parafunction related. And when you’re examining your patient, number one on your question list should be, is this patient a bruxist? Yes or No? That are by far the most important variable as far as the patient factors. The secondary ones..

[Jaz]
Are you asking the patient?

[Payman]
Well, you asking yourself. [conversation overlapping] [Jaz]
Absolutely. I was gonna say the patient’s completely unreliable, they’re oblivious, but you’re spot on. So as a dentist, you should be identifying the wear facets, and also looking at whether it’s active, look at the tongues, it’s masseter. Oh, absolutely. muscle tone. So you’re completely right.

[Payman]
And, you know, I’ve been asking people that what percentage of the population brux? You must have the answer here. I think 10% you know, all the time. But the people I would be asking Raj Ahluwalia where he thought about it. He said, 100% some of the time. Yeah. And so..

[Jaz]
I completely agree with Raj.

[Payman]
So it’s really interesting, because you know, there could be a patient who has shown no history of parafunction, going through a crisis. And then bleaching the teeth during that crisis is then grinding their teeth. It’s not working, it’s a young patient, everything looks like there aren’t wear facets yet because a young patient and you haven’t identified it as a default when whitening doesn’t work we do switch to daytime and that does work a lot of the time to do that. The second thing I would say is enamel thickness. Enamel thickness, the where it comes into play more is in the gingival. And you know that by far the most common complaint in whitening is the neck isn’t as white as the tip or the canines not as white as the lateral, that’s the other one and we’ll get to the canine later. But but the neck isn’t as white as the tip. And if you don’t notice that the enamel is particularly thin on this particular patient at the neck of the tooth, and you don’t warn the patient and the way I would do is I say “Look your tooth, naturally, the neck is darker than the rest. So once they’re bleached, the neck will be darker than the rest of all. And there’ll be a natural whiteness.” You prepare them for that issue. If you don’t prepare that patient with the very thin enamel at the neck for that issue, you have constant problems on this subject. And you know, then you’re into, “Hey, come on, you can’t even see it.”

[Jaz]
Yeah, definitely have to warn them beforehand. Otherwise, you know that Yeah, you don’t have anything to fall back to except that.

[Payman]
Exactly. After that, the other things after that are much less problematic. And we all know about age. We know about tetracycline banding and then you know, problems near the gingival margin of any sort, white spots, brown spots but that again goes to enamel. Thinner enamel over there, saliva getting in in that point as well. So that’s it. Those are the things.

[Jaz]
One thing I want to cover for sure this episode because there might be dentists out there who do whitening or carrying out whitening but they don’t take photos and I don’t know if you find it hard to believe what you find the easiest [inaudible] because you know, everyone who whitens I suppose. What percentage of dentist you think are doing whitening but are not taking photos? Because it seems ridiculous to me.

[Payman]
A good percentage. [overlapping conversation] [Jaz]
I just don’t get it because I’ve had so many patients before, who I’ve whiten before, and they say and they literally said to me, “Hey, I think my whitening cause recession.” And it’s just because they’ve noticed it, now that they’re paying so much more attention. Or they say that, you know what, it hasn’t worked. And I show them their photo and I you know, one of my pet peeves is seeing photos on Instagram. Where the you know, there’s before and after whitening, but not only are the teeth whiten, skin is whiter, the lips are different shade everything’s going whiter. [inaudible] My hack I can give to dentists is to use manual flash not ETTL when you’re doing a whitening cases, because if you use ETTL with the white or substrate it feel it will you know,.

[Payman]
It’s difficult to get it right. It’s still, the thing is with you, Jaz, you take it for granted that everyone can take photos. Probably you take it for granted that everyone can use rubber dam. But that’s not the case. When I was a dentist, I you know, I have trouble keeping still with a camera with one hand and all that. Yeah. And then I saw Minesh, I see Dipesh when they pick it up just one hand and it’s completely still. You know, not everyone can take photo, man. That’s a really important factor.

[Jaz]
But nowadays with the phone, but I mean, medical legally, put that aside, but just sort of imagine patient expectations because you do get those patients who feel as though they haven’t had a good whitening effect, but they generally just don’t they, people patients often forget where they’re coming from. And they often have to be reminded hang on out you actually here before?

[Payman]
Yeah, over although you know, Linda talks about, Van Haywood talks about the bleaching the top arch and not the bottom arch to show them this. For me, if you’ve got to do that, then you’re really not whitening teeth enough? You know, the teeth need to go whiter then for you to have to prove it that way. You’re right, they do kind of get used to it. And in the photography, it makes sense to put the before shade in the after photo. Yeah. Not a normal thing is to say, what’s the shade now, I’m going to put that shade in it. And you do need to do that. But to put the before shade in the after photo, to show the patient how far it’s come from that original point. Makes a lot of sense, as well.

[Jaz]
Absolutely, it’s something I’ve been doing good to know. So that’s a great little tip there. Pay, you’ve answered all my questions. So that the last thing I know is what message do you want to give to everyone out there about anything that annoys you, that dentist could be doing better with teeth whitening tomorrow.

[Payman]
You know, the communication message really, that I really, really do believe that we could all be doing a lot more whitening, I mean, I can be selfish about it dude, and say it’s you know, to do with the company. And don’t get me wrong, it helps the company as much easier for us to have all our users double their whitening, than to find another set of users or double the number of users. But the reason I say it is that our patients are super interested in it. We’re the experts in this area. And we’ve got this this issue around embarrassment. And you know, your patients are not going to ask you for it. You know, some will, some will. But you need the information, you need to understand what it is you’re asking for before you cannot. I mean, I’m getting these not getting because I’m not suitable, but I’m looking for laser eye treatment. I was amazed by how little I understand about, you know, is it harmful, Isn’t it? Is it reversible, isn’t it? Is that surgeon the key point or is the system the key point? You know, unfortunately, when a brand gets stronger, like for instance, like Invisalign, people start going after the system. And we all know that the dentist is even more important than the system. So is that you know, which laser is right? Should I go for expensive or cheap? You know, which way should I go? All of that. What are the risks? How much does it cost? Didn’t know any of this stuff. So I doubt that your patient knows. I mean, unfortunately for me, most dentist don’t know the difference between Enlightened and normal. I’m doing my job right. But most dentists don’t know that. And so the idea that your patient will and your patient will come out and ask you, it’s not in the culture in the UK, for the patient to come out and ask you. The patient comes in ask you for an examination, the vast majority and tiny minority of dentists mentioned shade in that examination, that tiny minority end up doing a lot,

[Jaz]
Not anymore, because the Protruserati are going to get on it and talk about shade. Because I doubt there’s any dentist listening to this right now, who doesn’t want to do more whitening? It’s impossible, you know, unless you just only make complete dentures and even then you’re prescribing whiter teeth on your dentures. So, you know, there’s no dentists out there who wouldn’t benefit from from having that communication aspect. It’s interesting point, you mentioned, actually, that so many patients that I do have that conversation with now and again, about whitening where they didn’t mention to me but I just think you know what, they would be good to speak to them about whitening and so many of the things “Oh, doesn’t that damage your enamel?” So these are just misconceptions that a lot of patients have, is it a generational thing? or I don’t know what, but to them, it’s almost like a dirty thing, like it’s damaging. They see, you know, Katie Price’s teeth on TV or [name of artist] and they think, you know, somehow that’s associated with whitening.

[Payman]
It’s almost the magic chemical, hydrogen peroxide. It’s good for the gums. It’s produced in the body, you know, it’s not like, you know, like, compared to something like Botox, right? Poisoning your face. It’s a whole different. Patients are really into it. We’ve got the answers, everything’s in place. And yet, when you talk to a beautician, who does whitening, which I have, I’ve talked to them. Talk to them, “How many whitenings you do?” “Four a day, five a day?” And he said, “Wait a minute, what’s actually going on here?” That, you know, a dentist, we’re doing one a week. And the beauticians doing three or four a day. It’s that communication, all right, people come to the beautician for wants not needs and they come to the dentist for needs not wants and you know, we try and flip them around, or whatever it is, you know, but that communication problem, it’s in our heads more than anything else. If you feel like you’re pushing something on your patient, they don’t need, that’s how you’ll come across. If you feel like you’re educating your patient or something they’re super concerned about, that’s how you’ll come across. And the hack for it if you want a hack is talk to your patient as if it was your family member. If they look like your mother, not physically, but you know, age and sex wise, if they look like that person, your sister, your mother, your daughter, your friend, talk to them as if they are your family. When it comes to this, particularly, it’s kind of like the daughter test, but in kind of in communication. Because, you know, hopefully, you’re not going to be selling this hard at your family. You just if your family member comes in and say, “Hey, you ever thought of whitening, then we’ve got this amazing thing that does it”, you know that? That doesn’t hurt. That’s you know, all you know, that doesn’t harm. That’s a nice hack. Think of it that way.

[Jaz]
Thanks so much Pay. And listen, a few episodes ago, I did give one of the Pearl to check out your one hour training online. And now you can go to protrusive.co.uk/enlightened will take you straight to your page to get the one hour training. So yeah, a little bit of geekiness in the background. But you know, I’m hoping a lot of people have jumped on to learn. I mean, a lot of the evidence of the point you actually covered in this podcast, I really appreciate that. But there are a few more things that you go over, a bit more about branding, and how to get the team on board as well, which is so important. So that’s great. But is there anything else that you’d like to know? Where can people maybe if they’ve never tried online before, how they even bought their first case?

[Payman]
Well, you know, just do that training, do that training. So either through your link, there’s enlightenedonlinetraining.com. And by the way, the majority of people who have that training don’t end up becoming Enlightened users, t’s a useful bit of CPD. Anyway, whether or not you end up doing Enlightened, you’ll improve whitening I think by coming on that of course. But I honestly mean it’s a real real honor that you asked me on this because I really love your show. And you know, I feel really honored that you’ve actually asked. Thank you so much man.

[Jaz]
But no, but it was a great I mean, look at an hour an hour almost went like that. And I feel as though we have just a normal organic chat. And I you know, I probed you a little bit, twisting your arm a little bit. We said a few things about some people maybe we shouldn’t have who knows. We’re trying to bleed those bits out where we can but it was very real chat. And I do feel dentist, typically young dentist will gain out of that. I mean, I’ll be honest with you. They don’t teach us anything about whitening at dental school like nothing. I don’t know how much you know that but they don’t teach us. Back when I qualified back when I was only seven years ago, but they didn’t teach us anything. I didn’t do a single whitening case during dental school and then you suddenly come out And you think, hang on a minute. So you just asked your principal, so I just order a whitening tray and NHL and

[Payman]
It goes back to that legacy that you know, it was illegal for that period until 2012. So dental schools just stayed away from it. I think that’s the reason also dental schools are very slow, you know, to include new things. Hopefully, they’re talking about scanning now. I don’t know whether did they mentioned scanning, though it was..

[Jaz]
Definitely not then. But I’m hearing some promising things that some dental schools are starting to introduce that. But again, like you said, it’s going to be a slow movement. You know, big establishment, universities are going to be, they’re both pioneering, but on a research scale, but in terms of actual students and stuff using it is a bit far behind. But anyway, I mean if you’re young dentist, fresh out of dental school, or if you’re a dentist to listen to this, you will learn so much about teeth whitening, and what makes teeth whitening effective and loads of communication gems. So Pay, thank you so much for sharing those with us.

[Payman]
Really, thank you, man. Really, thank you for your infectious enthusiasm. But anyone who can make me listen to four podcasts on splints?

[Jaz]
Oh my god, I can’t believe I listen to those. Thank you.

[Payman]
You really one of the best teachers. And don’t get me wrong. You’re an educator and you know if this is what going forward education might be like this. Yeah, it’s a really wonderful. One of the amazing who wants me, that makes me want to pick up my drill again.

[Jaz]
That’s an honor. Thank you so much, Pay. Cheers.

Jaz’s Outro: Thank you so much for listening all the way to the end. I told you it’d be a very impactful episode. I hope you went away with lots of new knowledge and lots of confirmation of ideas that you already probably had. Payman’s a great speaker, so easy to listen to and speak to. So he was a great guest. Payman, thanks so much for listening all the way to the end as well. I really appreciate you as well. So guys, the next episode is also going to blow your mind, it’s Nik Sethi on ceramic onlays like he does not hold anything back. It’s just an absolute jam packed episode. A bit like Paul Tipton when he gave every sentence was a pearl on fixed removable bridges in that episode. Nik Sethi is one not to be missed as well. So Catch you next week. Same time. Same place.