Three fundamental bleaching approaches exist: dentist-supervised nightguard bleaching, in-office bleaching, and OTC bleaching. The most popular dentist-administered technique clearly has been nightguard vital bleaching (Fig 1). This approach typically uses a relatively low concentration of whitening agent delivered in a custom fabricated tray. In-office bleaching, by contrast, generally involves the use of 25–35% hydrogen peroxide, but requires only short treatment times. It is important to note that in-office tooth whitening usually requires multiple treatment appointments.4 It is a rare for one in-office treatment to result in maximum whitening. OTC whitening is less costly than either of the two dentist-supervised bleaching approaches, but can be equally effective if products from reputable manufacturers are used.

Figure 1
figure 1

Significant whitening of the maxillary arch following nightguard vital bleaching is readily evident when compared to the untreated lower arch and a pre-op shade tab.

One reason bleaching has been less popular in Europe, in my opinion, is because of lingering concerns about safety. Literally hundreds of millions of teeth in the US have been bleached over the past 15-20 years without one credible account of any significant untoward effect appearing in the literature. Dozens upon dozens of clinical trials over this same time period also have affirmed the safety of vital tooth whitening when used in a short-term treatment duration according to manufacturer's instructions. There have even been long-term clinical trials by Dr. Van B. Haywood and others that have evaluated the safety and efficacy of bleaching. One such study involved daily bleaching in patients in whom tetracycline-stained teeth were treated for a period of approximately six months.2 No clinically significant problems were noted even when long-term results were reported after 7½ years.3 Although this study involved a fairly small sample size, it nonetheless is one of the first to document long-term safety of tooth whitening even after daily use of a 10% carbamide peroxide material for a period of six months.

That being said, valid concerns still exist regarding individuals who may ignore manufacturer or dentist instructions, and overuse whiteners for months or years. Long-term adverse effects on soft tissues or hard tissues cannot be totally ruled out when these products are badly abused or overused. However, as noted above, clinical experience and a very large number of clinical trials conducted over the past 20 years have demonstrated that these products are indeed quite safe and effective when used properly. In my opinion, vital tooth bleaching, when administered correctly, is one of the safest, most effective conservative aesthetic procedures available to patients today.

The British Dental Conference & Exhibition 2005 is being held at the Glasgow SECC between Thursday 19th and Saturday 21st May 2005

Contact: DMS (Delegate Management Services) for further information:

Tel: 0870 166 6625 or +44 (0) 1252 771 425 (overseas)

Fax: 0870 522 8890 or +44 (0) 1252 771 790 (overseas)

For the latest update on the agenda and to download the programme visit: