The Dentist Richard Luczak, DDS, MPH


Published on August 10, 2011 by

Bleaching is the most frequently ask for cosmetic procedures in dental offices.  In office vs home bleaching systems (over the counter (OTC) or dentist dispensed).  Which products are the best and can any damage the teeth.  Hopefully I can shed some light on the subject.  There are so many systems on the market today that choosing the best one for you can be daunting.

Bleaching systems have one common active foundation, peroxide.  Whether it is carbamide or hydrogen peroxide, they all bleach in the same manner.  Hydrogen peroxide is the actual bleaching material.  Carbamide peroxide is transformed into hydrogen peroxide in the presence of  saliva, hence all systems bleach with the same chemical. 

The differences are the concentration of bleach and the exposure time to the tooth surface.  The choice of concentration should take into account the patients sensitivity and depth of bleaching desired.  The higher the concentration of bleach the greater the reduction in shade and the more likely sensitivity side effects will be observed.  The sensitivity can be controlled with home kits by limiting the the time exposure or the frequency, as well as, the concentration.  If sensitivity persists 1.1% neutral sodium fluoride dentifrice (toothpaste) placed in the the trays for 20 minutes following bleaching helps reduce that sensitivity.  Also, verifying that the gel is removed from the gingival tissue will significantly reduce post procedural sensitivity.

There are may in office gimmicky systems out there.  Laser, light or heat activated gels.  These are only for show and the experts show it boils down to the concentration of bleaching material, length of exposure and depth of shade change desired not the so called activators.  The concentrations can range from 27% to 40%+ .  They all carry with them the increased risk of sensitivity post procedure. 

The at home systems returns the control to the patient and thus allows him to bleach as little or as much as he would like with the initial kit.  45 minutes for 7 to 10 days typically will give the desired results.  This is only a guideline and can be modulated by the patient and the doctor addressing the individual desired results.  The OTC systems typically are design for perfect or near perfect arch forms with low concentrations of bleach. 

All the bleaching systems bleach in the same manner but can it be damaging?  Yes it can.  Increasing the concentrations increases the possible post procedure sensitivity, thus the in office systems would be the most likely to have that effect however the at home systems can also.  The in office systems have immediate result partly due to the dessication or drying of the enamel.  Once the teeth are re hydrated a darkening can be observed and home bleaching kits are dispensed in conjunction. 

I hope this addresses some of the questions that come up about bleaching.  Come in and we can discussed the system that might suit you best.

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