Tray bleaching status and insights

Objective: To provide an update on tray bleaching for various tooth discoloration conditions, including a complete examination form as well as an information and consent form. Clinical considerations: Since the bleaching process was first documented in 1989, it has become a safe, successful, and conservative treatment for consistently whitening the color of patients' natural teeth. Though initially used on a limited basis, the process has expanded to include bleaching nicotine and tetracycline stains, single dark teeth, brown spots, reducing white spots, caries control as well as color change from aging. Ten percent carbamide peroxide is the material most used in research and has shown to be the most effective with the least amount of adverse side effects, including sensitivity or gingival irritation. Bleaching overnight using a smooth nonscalloped, nonreservoir vacuum-formed tray has been shown to be the method of choice for most clinicians, leading to greater patient compliance and an overall successful treatment. When possible, conservative bleaching treatment should be considered prior to more invasive, irreversible procedures such as veneers, or crowns to meet patients' esthetic requirements. Because of its basic pH, and potential for caries inhibition, complete restorative treatment does not have to be performed prior to initiating bleaching, making it an extremely flexible treatment. Conclusion: With a thorough bleaching analysis, proper treatment of appropriate discolorations over an ideal timeframe, tray bleaching is a powerfully predictable tool in restorative dentistry. Clinical significance: Tray bleaching with 10% carbamide peroxide should be the first consideration for treatment of discolorations of any type, with varying times of treatment, even in the presence of mild decay.