New bleaching considerations compared with at-home bleaching.

184 When our first article appeared in 1989 introducing nightguard vital bleaching (at-home bleaching) in a tray using 10% carbamide peroxide to the world,1 we never imagined the impact this simple procedure would have on the profession and the public. As this technique became accepted as safe and effective, other frontiers were explored. Companies introduced higher concentrations of carbamide peroxide or concentrations of hydrogen peroxide for the tray system.2 A number of over-the-counter (OTC) products were introduced in stores and on television that copied the dentist-prescribed home-applied technique but often made outlandish claims as to their safety and efficacy.3 Also there was a resurgence in the 100-year-old in-office bleaching technique using 35% hydrogen peroxide, with or without light. Various types of lights and lasers were claimed to simplify and shorten the bleaching technique, although the research to date has shown the contrary4,5 as companies sought to find a marketing angle for their product. Although some of the earlier OTC products and light-activation products have gone by the wayside and their manufacturers faded from the forefront, recently some major companies in the dental world have entered the OTC arena with some innovative technology. First introduced was the strip technology, which has 6 to 6.5% hydrogen peroxide on a clear strip of tape, which is applied to the teeth for 30 minutes twice a day for 14 to 21 days.6 Now there is a paint-on 18% carbamide peroxide gel, which is applied twice a day from a brush applicator, much like fingernail polish, and dissolves from the tooth in 30 minutes. Whereas some of the earlier OTC products came from unknown companies with no history of quality of product or service to the patient, both of these recent products have come from companies that have been major players in dentistry for a long time and have made outstanding contributions to the profession. These companies would have a lot more to lose than to gain should these products not live up to their claims in some reasonable manner. So what should be the profession’s response to these products?