The choice of bleaching agent to use will be influenced by several factors. For specific staining it is important to determine the location and source, particularly whether it is within the enamel or extending into dentine. The form, shape, depth and extent of the discoloration will also influence the type of bleaching to be carried out. The darker the stain, the longer it will take to bleach and the stronger the preparation that will be required. A number of patient factors also need to be considered when choosing a technique. These include the presence of any pre-existing tooth sensitivity, the patient’s lifestyle, their dexterity and whether they are prepared to administer a preparation themselves. In addition, the chemical constituents of the base material (H2O2, carbamide peroxide or perborate), the dispensing method, tissue tolerance, ease of use, application and the flavour will all influence a clinician’s choice of agent.
There are many types of bleaching product available on the market for use by the dentist or the patient at home. These include over-the-counter bleaching kits, H2O2 strip systems, home bleaching, power bleaching, assisted bleaching techniques or waiting room bleaching techniques . Currently, whilst there is some evidence that home-based tooth-whitening products do work when compared to a placebo or no treatment, there are differences in efficiency between these products. In addition, the studies carried out to date have been short-term and at a high risk of bias.
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