IS BLEACHING TEETH FOR EVERYONE?
4. The patient then purses the lips and sucks again, and the
inner tray material containing the bleach is closely adapted to the
5. The bleaching time per session varies according to the bleach
concentration (6% hydrogen peroxide, 60 to 90 minutes; 10% hydrogen peroxide, 30 to 60 minutes; and 15% hydrogen peroxide,
15 to 20 minutes).
6. The patient removes the tray, expectorates the gel debris, and
brushes the teeth.
7. The patient continues this protocol for five to 10 days.
8. Color returns into the teeth over a period of months, and
touch-up bleaching is eventually necessary to maintain the desired
The preceding procedure accomplished solely by the patient or
supervised by a dental professional is a well-proven, simple, relatively
inexpensive technique. It uses research information accumulated
over several decades. When accomplished properly, the procedure is
safe and effective.
WHEN SHOULD A DENTAL PROFESSIONAL BE INVOLVED
WITH THE BLEACHING PROCEDURE?
The following situation shows a challenge present when patients
bleach without professional supervision. You may have placed several
new resin-based composite restorations or a few new anterior crowns
or veneers matching the patients’ tooth color. Patients become more
conscious of the overall appearance of their smiles when these procedures are done. Because of this, they may go to the grocery store
or browse the internet and find a bleaching product that interests
them. They bleach and the natural teeth become lighter, but the
resins or the crowns do not ( figure 2)! Several months are required
before the natural tooth structure darkens and again matches the
When accomplishing a treatment plan for any direct restorations,
crowns, or veneers in the smile zone, patients should be provided with
informed consent about bleaching. The time to bleach is before the
restorations are done, not after ( figure 3).
Figure 2: This patient shows the clinical result of what can happen if
bleaching is done after crowns or direct resin restorations are placed.
The natural teeth are obviously lighter in color than the veneers.
Bleaching and a reasonable bleach maturation period of a few weeks
should be allowed before making new restorations. This concept
shows the positive influence of having a professional consultation
during the bleaching process.
Figure 3: This patient
before a needed
After waiting at least
two weeks after
bleaching for some
color to come back in
the teeth, placement
of the resin matched
the bleached teeth. The necessity for future touch-up bleaches should
be explained to patients before they agree to the bleaching procedure.
HOW LONG TO WAIT AFTER BLEACHING BEFORE PLACING
The research on this topic varies. The conclusion is that a significant
period of time should be allowed for newly accomplished bleach to
mature and to allow some of the color to return to bleached teeth
before placing any new restorations. Although the suggested wait time
varies, it is recommended dentists wait at least two weeks or more
after bleaching has been terminated before placing new restorations.
The longer you wait the better, because the teeth continue to gain
more color as time goes on. At the time of new restoration placement,
the plan is for the color of the restorations to match the color of the
remaining natural teeth, but the color of the bleached teeth continues
What should be done after the bleached teeth begin to appear
darker than the new restorations? This phenomenon usually occurs
several months to one year after the new restorations have been placed.
The remedy is simple: Advise the patient to accomplish a touch-up
bleach with the same or another bleaching product until the color of
the teeth and restorations again match.
Informed consent for patients who are considering new crowns or
direct restorations should include information that bleaching teeth is
a concept similar to coloring hair. Both hair and teeth eventually return
to their natural color, so touch-up applications of the color-modifying
product are necessary on a routine basis. Some patients elect to avoid
bleaching for this reason, while others accept rebleaching to be a small
sacrifice for having whiter teeth and a more appealing smile.
IS IN-OFFICE BLEACHING BETTER THAN BLEACHING AT
Some dentists prefer controlling the bleaching procedure themselves
in their offices. In such situations, a dentist, hygienist, or assistant
usually supervises bleaching. This procedure continues to be a viable