Introduction

Over the last decade, the demand for esthetic dentistry has grown tremendously as people seek to improve their smile.  The introduction of the first paper on at-home tooth whitening by Haywood and Heymann¹ in 1989 helped to revolutionize esthetic dentistry.

With the increasing popularity and rapid development of bleaching agents, questions also arose concerning their efficacy, longevity, and safety.  Since 1989 over 600 articles on tooth bleaching have been published.  Numerous studies suggest the effectiveness of dental products using 3% hydrogen peroxide (10% carbamide peroxide) in whitening teeth.^2,3  To achieve these benefits, bleaching agents are used for weeks at a time.  Long-term use, however, increases the safety concerns that hydrogen peroxide containing agents may cause pulpal damage and/or gingival inflammation.^4-5

The American Dental Association responded to these concerns by releasing "Guidelines for the Acceptance of Peroxide-Containing Oral Hygiene products"⁶ in 1994.  According to these Guidelines, clinical efficacy may be demonstrated by a change of two value-oriented shade increments.  A perceptible color change should be maintained in 50% of the recall population at 6 months as compared to the control to reflect duration of efficacy.

In this study, we systematically reviewed the published literature on dentist-prescribed, home-applied tooth whitening agents to assess the efficacy and safety of this procedure.  In particular we were interested in capturing this information in a quantitative way that can be conveyed to the patient.

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