Can whitening cause pulpal damage? A series of studies on pulpal damage indicate that some in-office procedures can damage the pulp, identifies the culprits, and points the way to avoiding the risks.

At risk are the in-office procedures that combine H2O2 and heat. H2O2 is absorbed more quickly than carbamide peroxide allowing the peroxide to reach the pulp more quickly and in greater quantity. Pulpal enzymes are significantly inhibited by H2O2,. .Heat alone can cause pulpal damage. However, the combination of H2O2 and heat is the real problem! The hydrodynamic pressures of a H2O2 exposed pulp under heat can disrupt the metabolic pathway or damage biological membrane. It can evoke an inflammatory response that may result in pulpal necrosis and the need for future endodontic treatment. (1)

Heat can come from such a source as a resin curing light frequency specific lamp. Lamps are good for sizzle but are at risk of pulpal damage and do little for the actual in-office procedure. The heat does accelerate the whitening process but only a few minutes of time is actually saved over in-office non-heat chemical whitening. There are other risks besides actual pulpal necrosis. Acute pulpal sensitivity is common during and/or after treatment when heat and H2O2 are combined. Why subject your patients to pain and pulpal risk?

How do you protect the patient and still have the ability to deliver the fast, in-office results patients demand? Using high-concentration carbamide peroxide is safe as less peroxide reaches the pulp.(2) Use a waiting room carbamide peroxide (i.e. 44%) in a maxillary bleaching tray as a booster and send the patient home with a high-concentration (30% CP) at-home bleaching gel. It will deliver the fast, predictable, and safe results your patients always deserve.

The fact is, it takes multiple in-office treatments, regardless of technique employed to achieve the equivalent of at-home whitening. If your treatment plan is strictly in-office, use 35% H2O2 without the lamp and keep the treatment time to multiple 3-minute paintings. This way, the patient will see the results without the risk of potential necrosis or post-op pain.

1. Bowles WH, Thompson LA, Vital bleaching: the effect of heat and hydrogen peroxide on pulpal enzymes.
J Endodon 1986;12:108-12.
2. Bowles WH, Ugwuneri Z, Pulp chamber penetration by hydrogen peroxide following vital bleaching procedures.
J Endodon 1986;13:375-77.