AAPD Policy Statement on the Use of Dental Bleaching

Resident: Swan
Article Title: Policy on the Use of Dental Bleaching for Child and Adolescent Patients
Author: AAPD Council of Clinical Affairs
Journal: AAPD Guidebook
Volume (Number): Revised 2009
Major Topic: Dental Bleaching
Type of Article: AAPD Guideline
Main Purpose: To help professionals make informed decisions about bleaching in both the primary and permanent dentitions.
Method: Medline/Pubmed systematic literature search of last 10 years regarding bleaching in patients up to age 18. 62 articles met the criteria.
Findings: Bleaching is becoming more and more popular and parents/patients are inquiring more and more about it. Clinical indications for external or internal bleaching include discoloration from trauma, irregularities in permanent tooth enamel due to infection or injury to the primary predecessor, or intrinsic discoloration/staining (tetracycline, fluorosis). Bleaching is not recommended during the mixed dentition stage because it would result in a mismatched appearance once the permanent dentition is complete.
Two options available, professional or at home. Advantages of professional, in-office bleaching include
1. initial professional evaluation to determine the cause of the discoloration and discuss clinical concerns (other existing restorations, side effects, etc) 2. Professional control (accelerant use) and soft tissue protection 3. Patient compliance 4. Rapid results 5. Stability of results. In office bleaching formulations range from 10% to 38 % carbamide peroxide.
At-home bleaching options include bleaching gels, whitening strips, and brush on pastes. Their main advantages are convenience and lower cost.
The more common side effects associated with bleaching vital teeth include tooth sensitivity and soft tissue irritation. Both are temporary and resolve when bleaching is discontinued. Another documented side effect is increased marginal microleakage of existing restorations. When internally bleaching nonvital teeth, the most common side effect is external root resorption due to the formation of hydroxyl free radicals. Use the lowest effective concentration.

Key Points/Summary:
AAPD Policy Statement:
1. AAPD recommends judicious use of bleaching for vital/non-vital teeth
2. patients should consult their dentists for appropriate timing of and methods for whitening within a comprehensive treatment plan
3. side effects need to be considered
4. further research needed regarding children.
The AAPD discourages full arch bleaching in the mixed dentition.