In-Office 35% H202 Vital

1. This material is caustic to soft tissue. Use appropriate protection.
   • Patients
     1. Eyewear
     2. Protect soft tissue with Rubber Dam & Ligation
        (Optional: light activated liquid dam)
   • Staff
     1. Gloves
     2. Eyewear
     3. Gowns
2. Clean the teeth (prior to applying gel)
   • Pumice or prophy paste
   • Rinse and dry the teeth
   • Use retractors
   • Prep with 2×2’s, Liquid Dam or Rubber Dam
     (Do not rely upon the dam for 100% protection. Always work as if you have no protection) 

     (There is no need to etch the teeth prior to bleaching)

3. Applying 35% H2O2 and # 9 Enhancer
   • Express 1cc of 35% H2O2 gel into dappen dish, add .2cc’s of #9 Enhancer, mix with brush for 8 seconds.
   • Lightly air-dry the area to be treated before application.
   • Paint a thin coat of the mixed 35% H2O2 gel on the tooth surfaces, avoiding soft tissue. Gel should remain on tooth surfaces for 12-15 minutes.
   • Clean the dappen dish and prepare for second application by mixing a fresh batch of bleaching gel within the dappen dish.
   • Remove bleaching gel with low vacuum before reapplying.
     (Optional: use dry swab 2”x2” in conjunction with vacuum)
   • Repeat above steps/application 3 to 4 times.

(should blanching of gingiva occur: treat with topical application of vitamin E oil)

CONSIDERATIONS

Avoiding Pulpal Sensitivity: In areas of exposed dentin (i.e. chipped teeth or enamel fractures), sensitivity is often caused by H2O2 leaching into pulpal chambers, and thus causing the sensitivity. This can be easily reduced by taking appropriate measures.

Placing a protective barrier such as light cured dental dam on any exposed dentin will effectively preclude H2O2 access to pulpal chambers. Painting a thin protective barrier such as light cured liquid dam on enamel fractures, chipped teeth, or any exposed dentin, has shown great clinical success in preventing such undesired dental sensitivity.

Generally speaking, hydrogen peroxide bleaching gels penetrate the enamel rods, and then progress into the dentinal tubules, penetrating and diffusing laterally throughout the tubules.

Effective whitening will still take place even when exposed dentin areas are covered by a thin protective barrier.

Checking Shade: It is important that the patient takes an active role in this procedure. Example: Call out or announce the shade number. Use a mirror and let them see the shade comparison.

By the end of the treatment, the patient’s teeth will be dehydrated to some degree and this will affect the end result by providing a false lighter shade. Inform the patient that the teeth will rehydrate and the actual brightness will be accurate in a few days. One could recall the patient in three to six days to assess the end result.

Soft Tissue Protection: Avoid contact with soft tissue. H2O2 is extremely caustic and will burn soft tissue. You can use retractors or have patient rest teeth on a “bite-block” in the molar region and place cotton rolls into vestibule when using liquid dam.

For lower arch one can use saliva ejector and cotton rolls in the sublingual area to prevent saliva from flowing on to the facial surface of the teeth.

Testing the dam with a light blast of air can help reassure a good seal. If air can get in, then the hydrogen peroxide can too.

Follow up at-home: In-Office whitening should be followed up with at-home whitening. Patients can be instructed to use at-home whitening for 3 to 5 days or as necessary for desired results. Remaining bleach can be used for future touch-ups.