Introduction

The appearance of a white, clean dentition is important to many consumers. A whiter smile builds self-esteem and boosts personal confidence. Tooth whitening also provides patients with the opportunity to counteract the effects of aging and their lifestyle habits on their dentition. The addition of cleansing abrasives and surfactants to toothpastes has provided these topical forms with some modicum of control for the deposition of stains on the teeth for centuries. However, toothpaste, topical mouthrinse and gels are typically limited in the amount of whitening which can be provided to consumers. The removal of tougher stains and the changing of the intrinsic color of the teeth has demanded more effective treatments than typical toothpaste abrasives and surfactants can provide. Oxidative technologies, like tooth bleaches have met this need and provide a useful innovation to assist patients in the achievement of whiter teeth.

While a variety of oxidative whitening approaches had been tried for close to a century, the nightguard vital tooth bleaching technique introduced in 1989 heralded a new era for tooth whitening.¹ The method employed a carbamide peroxide gel which was applied by patients in fabricated trays prepared by the dentist. Subsequently, manufacturers have introduced dozens of tooth bleaching procedures and products to the marketplace including in-office rapid whitening techniques, dentist-fabricated and boil and bite home use whitening trays, whitening strips and a variety of ‘paint on’ whitening products available over-the-counter (OTC). Since their introduction, the challenge for vital tooth bleaching has remained the same, achieving a patient/consumer acceptable whitening response while maintaining good patient tolerability – especially with respect to tooth sensitivity .