Considerations and variations of dentist-prescribed, home-applied vital tooth-bleaching techniques.

Tooth-bleaching procedures became widely available with the 1989 introduction of a dentist-home technique. Over-the-counter home systems were put on the market shortly thereafter, but safety concerns led to a sales ban by the Food and Drug Administration (FDA) in 1991. That ban has been lifted while companies continue to supply information to the FDA. Information on bleaching safety has often been skewed because the high 35% hydrogen peroxide concentration used in the dentist-office procedures has sometimes been compared out of context with dentist-home formulas with 10% to 15% carbamide peroxide or 1% to 10% hydrogen peroxide. Earlier studies have also failed to put the risk level of tooth bleaching into perspective with other routine dental procedures. More recent studies show that 10% carbamide peroxide is safe when appropriately administered. Haywood does state that there is a risk level in any type of bleaching, and that the dentist-home system provides the best way to minimize the risk because the dentist can: (1) diagnose any problems or special needs; (2) plan appropriate treatment; and (3) fabricate, fit, and adjust the prosthesis used to apply the formula. A success rate of 96% (excluding tetracycline stain) has been achieved. Currently, most marketed systems use a carbamide peroxide in a thickened glycerin base. A new product is being introduced with 10% carbamide peroxide, a peroxide stabilizer, a thickener, and tooth-cleansing technology ingredients.