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