Professionally Applied In-office
Description: Many dental offices offer chairside bleaching options for patients. Typically, in-office bleaching is performed with a high concentration of HP ranging from 25-40%.7 This procedure is monitored by a dental professional and precautions are taken to minimize sensitivity and gingival irritation by protecting the soft tissues with isolation techniques.3,7 Whitening may occur after one treatment, however the desired results may take several visits. After initial in-office bleaching there may be some rebound of the color, which explains why multiple visits may be necessary and why some dentists may fabricate take-home trays for patients to use to lock in the shade.3
Light sources, including lasers, light emitting diodes (LEDs), plasma arc lamps (PACs) and halogen lamps are used with some in-office techniques and products in combination with in-office HP whitening procedures.22 The theory behind using a light source is that by heating the HP gel, the free radicals are made available faster, thus resulting in more effective whitening. However, results of a recent meta-analysis did not confirm this outcome for in-office bleaching gels with either high or low levels of HP, and the authors stated that it allowed them to “…determine that light-activated bleaching (regardless of light source and protocol) is similar to the use of HP alone (regardless of protocol) in terms of color change.”22 In addition, they found that the risk of tooth sensitivity was not influenced by light sources. However, a new systematic review found some evidence that laser may reduce sensitivity, especially when higher concentrations of HP are used, but offers comparable bleaching results without use of laser.20 Overall, lower concentrations of HP should be considered for in office bleaching since they have similar color change efficacy with less risk of adverse reactions.21 When comparing in-office to at-home bleaching, there is no conclusive evidence of increased risk or intensity of tooth sensitivity or better efficacy for in-office bleaching.14,18
Pros: Initial assessment to determine causes of discoloration and clinical concerns; professional supervision and soft tissue protection; and, quickest results.
Cons: Most expensive option; may result in more sensitivity when a high concentration of HP is used;7,14 the dentist (not patient) controls the outcome when bleaching is completed in the office; and, may need multiple sessions and supplemental take-home trays to accomplish desired results. 3,7