The most requested cosmetic dental service today is tooth whitening. Modern tooth whitening techniques have made it possible to remove stains and other discolorations from the teeth in a short period of time. For years I have preferred the dentist supervised at-home bleaching systems because of their effectiveness and relatively low cost. While at-home systems are still an excellent option, I have recently decided to provide in-office tooth whitening as a standalone treatment or used in conjunction with the at-home tooth whitening systems.
The at-home systems generally use 10 top 20% carbamine peroxide gels to oxidize stains on the surface of the teeth. The dentist makes impressions (molds) of the mouth, and then has soft, comfortable trays made. The patient is then fitted with the trays, and then is instructed to place a thin ribbon of gel into the tray, which they will then wear while sleeping, or for several hours during the day. Most whitening will occur in two weeks. This system can routinely achieve at least 12 to 15 shades of whitening.
The in-office systems use a hydrogen peroxide paste to remove surface stains on the teeth. The procedure involves the dentist gently cleaning the patient’s teeth with pumice and then putting a protective barrier on the gums. The hydrogen peroxide paste is then placed on the teeth for several minutes, rinsed off, and usually reapplied three times. The procedure can achieve about four to six shades of whitening after only one 30-minute treatment. Nearly all in-office systems recommend that an expensive halogen or laser light (hence “laser bleaching”) is needed to activate the hydrogen peroxide to increase whitening. Recent research from several sources has now determined that the light has little positive whitening effect, but may increase sensitivity during the procedure.
For several years, I have not offered in-office tooth whitening because I felt that the system was not cost effective, and patients could achieve the same or better results with the at-home systems. Now that research has shown that the light is not necessary, I have begun to include this procedure for select patients.
Good candidates for in-office whitening are patients who are extreme gaggers and cannot tolerate the bleaching trays and those who want to see immediate whitening of their teeth. I generally recommend that patients who receive the in-office whitening also do the at-home whitening as well. Tooth whitening is one of the most simple, painless, and inexpensive ways to improve the appearance of the teeth.