Troubleshooting

Technology
In-Office Bleaching Procedures
Shannon L. Pace, DA II
Shannon L. Pace, a DA II and a 1994 graduate of the Dental Assisting Program at
Bowman Gray School of Medicine, works
with Ross W. Nash, DDS, in his private practice in Charlotte, North Carolina. She also
works with Dr. Nashs faculty in the Esthetic
Epitome Seminar Series. She is the main
instructor of the Dental Assistants Hands-on
Program with Nash Institute for Dental
Learning. Shannon is the past president of the
Metrolina Dental Assistants Society in
Charlotte and a member of the Academy of
Dental Assistants Association. She is also
chairperson of the advisory board for the dental assistant program at Central Piedmont
Community College. With 372 AGD continuing dental education credit hours, Shannon
assists Dr. Nash with product evaluations.
Shannon has published articles in Contemporary Dental Assisting and is a consultant
to a number of dental materials manufacturers. For more information on Dental Assistant
Programs, please contact the Nash Institute at
888.442.0242 or visit www.NashInstitute.com,
or email Shannon at asstdentl@aol.

office power bleaching required

several hours in the dental chair.
With todays in-office bleaching
systems, patients can see results in
as little as one office visit. Because
whitening is considered one of the
most conservative procedures offered by dentists, in-office and athome bleaching products are a
win-win situation for everyone.

Ideal Candidates for

In-Office Power
Bleaching

hanks to reality television

shows portraying beauty
pageants and life-altering
makeovers, dental patients now
request tooth whitening more than
ever. In the past, conventional in-

The dentist must first make an

assessment as to whether the patient
is an ideal candidate for bleaching.
The patient will then typically have
a thorough dental hygiene visit
removing extrinsic stain, calculus,
and plaque. Dental x-rays, periodontal charting, digital photography, and preoperative study models
and shade determination are also
recommended before scheduling the
first power-whitening appointment.

Teeth that are yellowishbrown and typically stained from

aging tend to whiten more rapidly
than teeth that range from gray to
grayish-brown. Patients who consume large quantities of dark soft
drinks, tea, coffee, grape juice, red
wine, and/or use tobacco will
achieve greater success with the inoffice procedure as compared with
an at home-bleaching procedure.
Significant whitening can be
achieved in most cases, but there is
no definitive way to predict how
white a patients teeth will get.
Teeth with tetracycline stains,
decalcifications, traumatic injuries,
or root canal therapy may require
further treatment. Shade change
results vary for every patient. Inoffice power bleaching is not recommended for women who are
pregnant or breast-feeding.

Figure 1Block out facial and lingual of

the anterior segments with the AcquaBlock.

Figure 2Seat the tray and have the

patient bite down with cotton rolls in place.

Figure 3Compare teeth with A3 shade

guide.

April 2005

Optimal Results Begin

with a Comprehensive
Oral Examination

Contemporary Dental Assisting

39

Troubleshooting Technology
Directions for In-Office Power-Bleaching
Agents Requiring a Dental Dam
1.
2.
3.

4.
5.
6.
7.
8.

Ensure that teeth are cleaned thoroughly with prophy paste or pumice.
Protect gingival tissue using AcquaDam (AcquaMed Technologies, Inc).
Using the static mixing tip, apply AcquaBrite directly on teeth. Agitate
with an applicator brush. Option: some whitening gels may need to be
placed in a cup of hot water (120F) for 10 minutes if they have been
refrigerated.
Suction material off after 20 minutes. Do not rinse.
Reapply solution and bleach for additional 20 minutes.
Remove AcquaDam and rinse.
Apply AcquaSeal (AcquaMed Technologies, Inc) per instructions.
Disinfect syringe and store.

Directions for In-Office Power-Bleaching

Agents Not Requiring a Dental Dam
1.
2.
3.
4.

5.
6.
7.
8.

9.
10.
11.
12.
13.
14.
15.
16.
17.

Take preoperative impressions to fabricate in-office trays.

Pour study models.
Fabricate and trim the in-office tray, same as at-home bleaching trays.
Block out facial (Figure 1) and lingual of the anterior segments with the
AcquaBlock (AcquaMed Technologies, Inc). Make certain to apply the
material to the interproximal areas.
Trim the stint as if making a traditional at-home bleaching tray.
Prophy with AcquaPro (AcquaMed Technologies, Inc) or pumice and
rinse.
Fully load the tray with AcquaBrite 20% gel.
Seat the tray and have the patient bite down with cotton rolls in place
(Figure 2). (It is important to hold the tray in place, stabilizing the material in the tray.) Remove excess power gel that has extruded out of the
tray.
Remove the tray after 20 minutes.
Suction AcquaBrite off the teeth. Do not rinse.
Place AcquaBrite solution in the tray.
Seat the tray, place 2 new cottons rolls, and have the patient bite down.
Bleach for additional 20 minutes.
Take out tray. Suction and rinse.
Apply AcquaSeal (AcquaMed Technologies, Inc).
Disinfect syringe and store.
Compare teeth with A3 shade guide (Figure 3).

Medications
The dentist must be aware of
medications commonly considered
to be photoreactive, which may
cause an adverse condition if used
in conjunction with certain powerbleaching solutions. To check
photoreactive properties, please

40

consult the most recent edition of

the Physicians Drug Reference.

Surrounding
Dentition
The dentist must take the patients surrounding dentition into
consideration. Porcelain crowns,

Contemporary Dental Assisting

veneers, and direct bonding do not

lighten when bleached. Patients
must also understand that the current restorations may need to be
replaced if teeth become whiter
after successful bleaching.

Penetration of the PowerBleaching Solutions

Most in-office bleaching
solutions contain hydrogen peroxide or a buffered version such as
carbamide peroxide or urea peroxide. Studies show that carbamide
peroxide has antibacterial abilities
that can lead to reduction in
plaque accumulation and gingivitis
in some patients.1 The peroxide
method of whitening reduces internal stain or discoloration by oxidation. The thickness of the enamel
and dentin may influence the penetration of the active ingredient into
the pulp chamber. Thinner layers
of the tooth may permit increased
hydrogen peroxide penetration.1

Strategic Planning for

Less Than Ideal Results
Patients who have tetracycline-stained dentition or intrinsic
pigmentation will require more
visits and possible home tray
alliance to achieve optimal results.
My offices case studies have
shown that patients with these
stains may require a 10-second,
35% phosphoric acid etch to assist
in the breakdown of the tetracycline band. This will help the carbamide peroxide break through
the enamel more quickly, thereby
causing a color change. Be sure
that if acid etch is used in the
bleaching process, an enhance cup
is used to polish the enamel surface.
Most in-office bleaching systems
contain an at-home counterpart to
maximize results and help meet
patient expectations.

April 2005

 }i "i
Maintaining Your Results
For the next 48 hours, avoid substances containing
dark pigments such as colas, tea, soy sauce, coffee, grape
juice, red wine, curry powder, and tobacco products.

Tooth Sensitivity
Some patients may experience tooth sensitivity. This
sensitivity is usually mild and transitory. However,
patients with exposed root recession from periodontal
disease and/or postorthodontic surgery may experience
hypersensitivity and hyperemia after the in-office bleaching procedure. Cracks and enamel loss may allow the
bleach to enter the tooth structure causing sensitivity.
The in-office bleaching procedure tends to dehydrate
enamel, and the water loss may have a direct effect on
sensitivity. Using a product that contains adequate water
will, in most cases, reduce the color change. AcquaSeal
(AcquaMed Technologies, Inc) has been specially formulated to dramatically reduce this rebound effect that seals
the enamel and dentin substrates. Short-term irritation or
swelling of the soft tissues is sometimes experienced.
Typically this is the result of the whitening gel coming in
contact with the soft tissues.

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In-office power bleaching is not a skill

it is a science. The bleaching technique
is the answer to a successful
bleaching process.

Conclusion
With so many in-office whitening/bleaching products to choose from, how do you make the right decision
about which systems work for each patient? In-office
power bleaching is not a skillit is a science. The
bleaching technique is the answer to a successful bleaching process.

Acknowledgment
The author would like to thank Al Bevilacqua, president and CEO of AcquaMed Technologies, Inc for his
clinical contributions.

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Reference
1.

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Goldstein RE, Garber DA. Complete Dental Bleaching.

Philadelphia, Pa: Quintessence Publishing Company; 1995.

Circle 20 on Reader Service Card

April 2005

Contemporary
Dental Assisting
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