Changes in patient evaluation of completed orthodontic esthetics after dental bleaching

As dental professionals, we tend to assess separately different treatment modalities; our patients, however, may only be aware of the total outcome, not discerning the contribution from each treatment. Orthodontists focus on dentoskeletal positioning, usually leaving other areas of esthetics such as tooth shade to other dental colleagues. Laypeople may not see the same differentiation. We suggested that patients would be more pleased with their orthodontic outcomes when cosmetic bleaching was done afterwards, not discriminating between the benefits derived from orthodontics alone and those derived from bleaching. Seventy-five orthodontic patients were selected for the study. Two experimental groups underwent different bleaching protocols, while the third control group received no bleaching. A visual analog scale questionnaire evaluating different aspects of their orthodontic outcome was given to each participant 2 days after treatment and again 1 month later. The first survey was filled out prior to the bleaching procedure, while the second survey was post bleaching. None of the participants were informed that the questionnaire was related to the bleaching. A calibrated photospectrometer was used to measure the dental shade prior to bleaching and again at 1-month follow-up. The two bleached groups had significant shade improvement and a significant overall increase in their orthodontic evaluation, while the patients in the control group displayed a decrease in their assessment of their orthodontic treatment. Altering smile esthetics through bleaching does not change any of the parameters that orthodontists strive to correct, yet it has a positive effect on the patients' perception of previous orthodontic treatment.

Patients are more satisfied with previous orthodontic treatment when it is coupled with cosmetic bleaching. When providing multidisciplinary treatment, we dental professionals may tend to assess the outcome of each segment separately. To patients, however, there is an additive effect, and their opinion is based on the overall composition of the outcome.