Tooth whitening: facts and fallacies

Since the introduction of nightguard vital bleaching (tray bleaching) in 1989, dentistry has witnessed an astronomical rise in the interest in tooth whitening.1 As a result, the most frequently asked question is, 'what bleaching technique works best?' Virtually all of today's whitening approaches work, because bleach is bleach. Whether a nightguard bleach is used with only 10% carbamide peroxide (which contains only 3% hydrogen peroxide), over-the-counter (OTC) whitening strips are applied containing 6% hydrogen peroxide, or an in-office bleach is employed using 25–35% hydrogen peroxide, the end results can potentially be the same. Similarity of results is possible because the mechanism of action is the same: oxidation of organic pigments or chromogens in the tooth. Granted, some bleaching approaches are more expeditious than others, owing to differences in concentration or exposure time. But as just noted, the most important factors in the efficacy of any bleaching treatment are concentration of the bleaching agent and duration of the exposure time.