Page 12 - GP Fall 2025

In–Office Bleaching: An Overview of the Current Evidence

Authors: Geri Robin, DMD, FAGD, Dipti Wakode, and Analia Veitz-Keenan, DDS, FAGD

(A Measurement Tool to Assess Systematic Reviews) tool was used to assess the quality of
whitening properties all contribute to our understanding of dental
Abstract
2
aesthetics. These historical developments laid the groundwork for
3
the systematic reviews.
Background: Office whitening products are widely used for dental modern tooth whitening procedures, which are now safer and more
bleaching, but their effectiveness and safety vary. Systematic effective than ever. Today, a wide variety of in-office whitening
reviews provide comprehensive evaluations of available evidence, products are available. To help clinicians and patients navigate these
Results 1 choices, systematic reviews offer valuable evidence on efficacy,
helping clinicians and patients make informed decisions.
Objective: This overview of systematic reviews aims to synthesize safety, and patient satisfaction. This article presents a synthesis of
recent systematic reviews on in-office bleaching.
existing evidence on the efficacy, safety, and patient-reported
Seven studies met the inclusion criteria and were included in this overview. Table 1 shows
outcomes of office whitening products.
the PICO elements (Population-Intervention-Comparison and Outcome) for each of the
4
Methods
Methods: A structured search of systematic reviews from major
For this rapid overview of the evidence, PubMed was searched
databases was conducted, focusing on studies evaluating the
reviews was also compiled to facilitate comparison.
using keywords “tooth whitening” or “bleaching.” The search was
whitening efficacy, adverse effects, and patient satisfaction of in-
office bleaching agents. Quality assessment of the reviews was limited to systematic reviews, and the AMSTAR (A Measurement
Tool to Assess Systematic Reviews) tool was used to assess the
2
performed using AMSTAR criteria. 2
quality of the systematic reviews.
Each review was appraised using AMSTAR criteria. Newer reviews (2016 and later)
Results: The included systematic reviews highlight that hydrogen
generally demonstrated high-quality methodologies (comprehensive search strategies,
Results
peroxide and carbamide peroxide are the most common active
Seven studies met the inclusion criteria and were included in
agents, with varying concentrations influencing whitening
duplicate study selection, risk-of-bias assessment, and, in several cases, GRADE (Grading of
this overview. Table 1 shows the PICO elements (Population-
4
effectiveness and side effects. Studies consistently report significant
Intervention-Comparison and Outcome) for each of the reviews was
color improvement, though transient tooth sensitivity and gingival
5
Recommendations Assessment, Development and Evaluation) evaluation and protocol
also compiled to facilitate comparison.
irritation are common adverse effects. Patient satisfaction is generally
high, though long-term effects require further investigation.
registration), whereas the older review (He et al. 2012) was of moderate quality (adequate
6
Each review was appraised using AMSTAR criteria. Newer reviews
(2016 and later) generally demonstrated high-quality methodologies
Conclusion: Office whitening products effectively enhance dental
meta-analysis but with some limitations in search scope and study selection).
(comprehensive search strategies, duplicate study selection, risk-
aesthetics, but sensitivity and gingival irritation remain concerns. of-bias assessment, and, in several cases, GRADE (Grading of
Future research should focus on optimizing formulations to balance Recommendations Assessment, Development and Evaluation)
5
efficacy and safety while improving patient comfort.
All high-quality reviews showed rigorous methods and a low risk of bias, supporting
evaluation and protocol registration), whereas the older review (He
6
Introduction / Background
con(idence in their (indings. et al. 2012) was of moderate quality (adequate meta-analysis but
with some limitations in search scope and study selection).
The pursuit of a brighter, whiter smile has existed throughout
history, from ancient civilizations to modern times. Early tooth- All high-quality reviews showed rigorous methods and a low risk
cleaning rituals in ancient Egypt, the ammonia-based solutions of bias, supporting confidence in their findings.
of the Romans, and the later discovery of hydrogen peroxide’s
Light activation improved immediate whitening with low-peroxide
gels (15-20% HP) but not with high-peroxide (25-35% HP), and it
significantly increased the risk of tooth sensitivity.
No significant differences were found between in-office and at-
home bleaching in terms of tooth sensitivity (risk or intensity) or
bleaching efficacy (shade guide units or ΔΕ* color change).
No significant difference in tooth color change (ΔΕ*, shade guide
units) or tooth sensitivity (incidence or intensity) was observed
between bleaching with vs. without light activation.
No difference in tooth color change or sensitivity incidence were
found between light-activated and non-light activated in-office
bleaching; however, using light was associated with lower intensity
of tooth sensitivity.
Lower peroxide concentrations achieved similar tooth whitening
(no signficant shade difference) with significantly less tooth
sensitivity compared to 35% HP.
Low/medium HP products produced the same color change efficacy
as high-concentration HP but with a significantly lower rish and
intensity of bleaching sensitivity.
Limited evidence suggests that 37% carbamide peroxide is similarly
effective to 35% hydrogen peroxide for in-office whitening and
causes less tooth sensitivity.

www.nysagd.org l Fall 2025 l GP 12
1. The analysis revealed several key (indings:

Ef>icacy of In-Of>ice Whitening Products
In-of(ice bleaching using hydrogen peroxide or carbamide peroxide is effective for
achieving noticeable tooth color improvement. Across studies, no signi(icant clinical
difference was found between:

○ High vs. low/medium concentration hydrogen peroxide

○ Hydrogen peroxide vs. carbamide peroxide

○ Light-activated vs. non-light-activated in-of>ice protocols