Professional Position Paper: In Office Whitening vs.

At Home Whitening

In Office Whitening vs. At Home Whitening

Tabasum Bukhari
Sharon John
Nancy Sahayarajah
EVBP 5500
Carrie Maynard
July 29, 2016

Professional Position Paper: In Office Whitening vs. At Home Whitening

There are many reasons as to why teeth become discoloured. Once teeth become a certain
colour, it is hard to permanently change them back to the original or a more esthetically pleasing
colour (Carey, C. M.,2014). Many individuals choose to whiten their teeth due to esthetics and
dissatisfaction with the colour of their teeth. With a multitude of products on the market and in
dental offices, an individual who may consider whitening their teeth will first wonder which
product is better. There are many different products on the market that claim to be the best
whitening product. However, through many studies and research, it is proven that having your
teeth professionally whitened, whether it would be at home whitening or office whitening is
more effective than an over the counter product (Carey, C. M., 2014). Choosing a whitening
product most often involves comparing price, length of treatment, cost, and effectiveness.
Nevertheless, the question that still remains is, which whitening product is more effective: at
home whitening or in office whitening to gain whiter teeth?
In-office bleaching materials contain high hydrogen peroxide concentrations ranging
from 15-38%, while the hydrogen peroxide content in at-home bleaching products usually ranges
from 3% to 10% (De Geus, D., Wambier, L., Kossatz, S., Loguercio, A., and Reis, S., 2016).
Most Dentists suggest at-home bleaching products as it is more cost efficient and more general
practices carry the at-home whitening products (Dawson, P., Sharif, M., Smith, A., and Brunton,
P., 2011). Although at-home whitening has been shown to be effective, results may vary
depending on certain factors, such as prevalence of stain, age of patient, concentration of the
active agent in the whitening product, treatment time, frequency and patient compliance with the
treatment (Dawson, P., et al., 2011). Therefore, it is assumed that due to the high concentration of
bleaching agents in the in-office whitening products and more patient compliance to in-office

Professional Position Paper: In Office Whitening vs. At Home Whitening

treatment for any treatment, in-office whitening would be more effective in whitening teeth as
opposed to at-home treatment (Giachetti, L., Bertini, F., Bambi, C., Nieri, M., & Russo, D. S.,
2010).
When it comes to whitening teeth, an individual may ask what products are in the
whitening agent and if there is any harm when using the products. The safety concerns regarding
potential systematic effects are no longer a primary issue given that hydrogen peroxide is limited
to the oral cavity and does not reach levels which would induce systematic toxicity (Bernardon,
J., Sartori, N., Ballarin, A., Perdigao, J., Lopes, G., and Baratieri, L., 2010). Within many
whitening products whether it would be at home or in-office whitening, the two most common
bleaching agents are hydrogen peroxide and carbamide peroxide which are essential when trying
to achieve whiter teeth (Bernardon, J., et al., 2010). Carbamide peroxide, used in many bleaching
products, breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active
bleaching agent (Bernardon, K., Ferrari, P., Baratieri, N., & Rauber, B., 2015). A bleaching
product containing 10% carbamide peroxide yields approximately 3.5% hydrogen peroxide
(Bernardon, K., et al., 2015). The most commonly observed side effects with these peroxidebased bleaching agents are tooth sensitivity and occasional irritation of soft tissues in the mouth
(oral mucosa), particularly the gums (J. B. da Costa, R. McPharlin, R. D. Paravina, and J. L.
Ferracane., 2010). Tooth sensitivity often occurs during early stages of bleaching treatment (J. B.
da Costa, R., et al., 2010). Tissue irritation may result from an ill-fitting tray or over filling the
trays used to contain bleaching product which may also blanche the gums causing them to turn
white (J. B. da Costa, R., et al., 2010). Both tooth sensitivity and tissue irritation are usually
temporary and arrest after the treatment (J. B. da Costa, R., et al., 2010). Hydrogen peroxide has
the potential to interact with DNA, creating concerns with carcinogenicity and co-

Professional Position Paper: In Office Whitening vs. At Home Whitening

carcinogenicity of hydrogen peroxide, although these concerns so far have not been substantiated
through research (Meireles, S., Fontes, T., Coimbra, A., Bona, D., & Demarco, F., 2012).
However, studies have shown that hydrogen peroxide is an irritant and also cytotoxic (Meireles,
S., et al., 2012). It is known that at concentrations of 10% hydrogen peroxide or higher, is
potentially corrosive to mucous membranes or skin and can cause a burning sensation and tissue
damage (Meireles, S., et al., 2012). The amount of products applied during in-office bleaching
treatment and other formulation variables can change the potential to cause damage. However,
severe mucosal damage can occur if gingival protection is inadequate with high strength tooth
whitening products. Clinical studies have also been observed as a higher prevalence of gingival
irritation in patients using bleaching materials with higher peroxide concentrations. Data
accumulated over the last twenty years, including some long-term clinical study follow up
indicate no significant, long-term oral or systemic health risks associated with professional athome tooth bleaching materials containing 10% carbamide peroxide (3.5% hydrogen peroxide)
(De Geus, D., et al., 2016). Office whitening produces results in a shorter period of time as there
is a higher percentage of the bleaching agents within the products which make it more viscous,
however not at levels that are toxic to the body, but can cause more sensitivity than at home
whitening (Bernardon, K., et al., 2015). In-office bleaching materials contain high hydrogen
peroxide concentrations (typically 15-38%), while the hydrogen peroxide content in at-home
bleaching products usually ranges from 3% to 10% (Meireles, S., et al,. 2012). In general, most
in-office and dentist-prescribed, at-home bleaching techniques have been shown to be effective,
although results may vary depending on factors such as the type of stain, age of patient,
concentration of the active agent, and treatment time and frequency (Dawson, P., et al., 2011).

Professional Position Paper: In Office Whitening vs. At Home Whitening

Therefore, due to the high concentration of bleaching agents in the in-office whitening products
we assume that in office whitening would be more effective.
When it comes to which type of whitening is better whether it be at home or in-office
whitening, we have to take into account specific clients and their needs and wants and what
treatment would better suit them. Patients should consult with their dentist to determine the best
treatment method for them, especially those that have tooth sensitivity, dental restorations, dark
stains and single dark teeth (Giachetti, L., et al., 2010). Some staining present on teeth may be
due to a specific problem that either will not be affected by whitening agents or may be a sign of
disease or condition that requires further attention (Giachetti, L., et al., 2010). After the
completion of an exam and bleaching is pursued, the dentist/dental team will then recommend
the appropriate material, technique and delivery system to best suit the patient (Bernardon, K., et
al., 2015). The length of treatment and expected outcome will depend on the cause of the
discoloration, as well as the chosen product and technique (Bernardon, K., et al., 2015). With
tray bleaching, teeth normally lighten in 3 days to 6 weeks (Bernardon, K., et al., 2015).
However, whitening of nicotine-stained teeth may take 1-3 months (Bernardon, K., et al., 2015).
Tetracycline-stained teeth may not respond as well as a normal externally discolourdered tooth,
however, adequate response may require two to six months or more of dentist supervised nightly
treatment (Bernardon, K., et al., 2015). In-office bleaching requires proper isolation and
protection of mucosal tissues (Giachetti, L., et all., 2010). A bleaching light is sometimes used
with in-office bleaching procedures as well (J. B. da Costa, R., et al., 2010). Some reports
suggest that pulpal temperature can increase with bleaching light use, depending on the light
source and exposure time (J. B. da Costa, R., et al., 2010). An invitro study suggests that use of
some lights may result in light radiation exposure levels approaching or exceeding safety limits

Professional Position Paper: In Office Whitening vs. At Home Whitening

(Meireles, S., et al. 2012). Pulpal irritation and tooth sensitivity may be higher with use of
bleaching lights or heat application, and caution has been advised with their use (Meireles, S., et
al. 2012). The average number of in-office visits for maximum whitening is three, with a range
of one to six visits, therefore, the patient should be prepared for additional in-office treatments or
for a combination of office visits and tray delivery to complete the process (Bernardon, K., et al.
2015). It is reported that patients prefer at home whitening more than in office whitening due to
the cost difference, studies have shown that at home whitening products produce the same results
as office whitening and with office whitening you still have to perform home whitening to
maintain the color (Bernardon, K., et al. 2015). Due to the short number of appointments needed
and the immediate results that are given by in-office whitening, and viscosity of whitening
solution, we assume that in office whitening would be more effective (Bernardon, K., et al.
2015).
In most cases, the natural colour of teeth is within a range of light greyish-yellow shades
and darken with age (Dawson, P., et al. 2011). The appearance of teeth can be affected by the
accumulation of surface stains acquired from the use of tobacco products and the consumption of
certain food or drink (Dawson, P., et al. 2011). There are three main types of tooth discolorations:
intrinsic, extrinsic and age related staining (De Geus, D., et al. 2016). Intrinsic staining is when
the inner surface of the tooth such as the dentin darkens, this can be due to fluorosis, tetracycline
staining, trauma to a tooth, and/or having a condition called dentinigensis imperfecta causing
gray, amber or purple discolorations (De Geus, D., et al. 2016). Extrinsic staining is when the
outer layer of the tooth which is the enamel, is stained due to coffee, wine, pop, smoking or other
drinks and foods that cause stain (De Geus, D., et al. 2016). Age-related staining can be caused
by a combination of extrinsic and intrinsic staining (De Geus, D., et al. 2016). As you age the

Professional Position Paper: In Office Whitening vs. At Home Whitening

dentin becomes yellow and the enamel thins allowing the dentin to show through causing that
yellow appearance (De Geus, D., et al. 2016). Intrinsic and age related staining are harder to
remove with whitening products, therefore, it is important to maintain proper oral hygiene and
rinse your mouth after consuming products that cause staining to prevent discoloration (De Geus,
D., et al. 2016). During the bleaching treatment it is important not to eat or drink foods that can
cause staining, especially patients should not consume alcohol or smoke while undergoing
bleaching treatment as it can promote tumor growth with the presence of tobacco carcinogens
(De Geus, D., et al. 2016). When it comes to restorations, the bleaching products can change the
physical properties of them such as change in colour, surface roughness, hardness, ion leakage,
reduce bonding strength and release metallic ions (El-Murr, J., Ruel,D., and St-Georges, A.
2011). Consequently, it is important to use the bleaching products with caution depending on
where the restorative material is as it could impair esthetics if it is within in the anterior region
(El-Murr, J., et al. 2011). In-office whitening treatment would be more effective for an individual
with restorative material as the dental team would be able to protect the restorative material
better than an individual who would be doing at home whitening. We also assume that in-office
whitening would be more effective in removing all types of stains.
Therefore, when it comes to at home whitening versus in-office whitening studies have
shown that at home tray whitening is more effective than in-office whitening and more patients
prefer the at home method (Giachetti, L., et al. 2010). In- office whitening allows for a follow-up
treatment, which is required, as well many visits to the office creating relapse and clients simply
not have the time (Dawson, P., et al. 2011). At home whitening costs less than in office
whitening, and clients have control over how often they want to preform treatment making it
convenient for them (Bernardon, K., et al. 2015). With in-office whitening the results can be seen

Professional Position Paper: In Office Whitening vs. At Home Whitening

immediately, but, the process takes a couple of appointments, cost is more, and use of high
concentrations of bleaching agents can lead to increased risk of experiencing side effect
(Bernardon, K., et al. 2015). Therefore, at home whitening is the best option even though it takes
a couple of weeks to see results and the clients need to have time and patience to perform the
treatment (Bernardon, K., et al. 2015). According to a study that compared both at home tray
whitening with in office whitening, the results had no significant difference that occurred in tooth
color (De Geus, D., et al. 2016). According to another study when comparing at home whitening,
using 10% or 20% carbamide peroxide versus professional treatment using 35% or 38%
hydrogen peroxide, results show that there is no difference in color change (Meireles, S., et al.
2012). Both treatments produced the same results when it came to change in tooth color
(Bernardon, K., et al. 2015). Therefore, studies state that the best option is a dentist supervised at
home whitening using 10% carbamide peroxide (Bernardon, K., et al. 2015).
Prior to doing research, it was assumed that in office whitening would be a better choice
due to reasons such as; higher concentrations of whitening agents in at office treatments could
result in more stain removal, viscosity of in office whitening agents are less runny, leading to
better adhesion to the surface of the tooth and less damaging to tissues, less treatments would
need to be done (time convenient), and control of solution by dental team at an office could
prevent tissue damage and damage to restorations (El-Murr, J., et al. 2011). After researching, it
was found that although in office whitening has higher concentrations of whitening agents, at the
end of the day studies show that there is no significant difference in how white teeth become
when comparing it to at home whitening (Bernardon, J., et al. 2010). It was concluded that home
whitening would be better in the case of how white teeth become and teeth sensitivity since it is
less aggressive as well as cost efficient in comparison to in office whitening treatment (Dawson,

Professional Position Paper: In Office Whitening vs. At Home Whitening

P., et al. 2011). Due to the higher concentrations of hydrogen peroxide in at office whitening
treatments, the solution is more viscous in comparison to at home whitening treatments which
allows for better adhesion on teeth surfaces and does not run, which can spread to gums/mucosal
tissues, resulting in more tissue damage (De Geus, D., et al. 2016). The higher viscosity allows
better control of the solution alongside with the dental team using techniques that prevent the
whitening agent to come in contact with tissues or existing restorations, hence we assumed this
would be a good reason as to why in office treatment would be a better option (El-Murr, J., et al.
2011). The upside to higher concentrations of hydrogen peroxide is that results can be seen more
immediately which saves time, but after looking into how much more aggressive in office
whitening is to the teeth, the downfall is that teeth are prone to more sensitivity in the long run
which some people cannot tolerate as well as the light beam from the in office whitening
treatment can cause irritation to the tissues (Bernardon, J., et al. 2010). In conclusion, at home
whitening is a better option as it is more cost efficient, safer and less aggressive to teeth, and
when used consistently based on treatment planned, the results are just as effective as in office
whitening (Bernardon, K., et al. 2015). The only overall benefit of in-office whitening treatment
is that it is time convenient as results are more immediate which would be the main reason why it
would be recommended if someone is looking to whiten their teeth for instant results (Dawson,
P., et al. 2011). Otherwise, at home office whitening is the better option.

Professional Position Paper: In Office Whitening vs. At Home Whitening

References:
Bernardon, K., Ferrari, P., Baratieri, N., & Rauber, B. (2015). Comparison of treatment time
versus patient satisfaction in at-home and in-office tooth bleaching therapy. The Journal
of Prosthetic Dentistry, 114(6), 826-830.
Bernardon, J., Sartori, N., Ballarin, A., Perdigao, J., Lopes, G., and Baratieri, L. (2010). Clinical
Performance of Vital Bleaching Techniques. Operative Dentistry. 35(1), 3-10.
Carey, C. M. (2014). Tooth Whitening: What We Now Know. The Journal of Evidence-Based
Dental Practice, 14 Suppl, 7076. http://doi.org/10.1016/j.jebdp.2014.02.006
Dawson, P., Sharif, M., Smith, A., and Brunton, P. (2011). A Clinical Study Comparing the
Efficacy and Sensitivity of Home vs Combined Whitening. Operative Dentistry. 36(5),
460-466.
De Geus, D., Wambier, L., Kossatz, S., Loguercio, A., and Reis, S. (2016). At-home vs In-office
Bleaching: A Systematic Review and Meta-analysis. Operative Dentistry. 37(4), 2902964.
El-Murr, J., Ruel,D., and St-Georges, A. (2011). Effects of External Bleaching on Restorative
Materials: A Review. Canadian Dental Association. 71:b59, 1-6.
Giachetti, L., Bertini, F., Bambi, C., Nieri, M., & Russo, D. S. (2010). A Randomized Clinical
Trial Comparing At-Home and In-Office Tooth Whitening Techniques. The Journal of
the American Dental Association, 141(11), 1357-1364.
J. B. da Costa, R. McPharlin, R. D. Paravina, and J. L. Ferracane (2010) Comparison of At-home
and In-office Tooth Whitening Using a Novel Shade Guide. Operative Dentistry. 35(4),
381-388.
Meireles, S., Fontes, T., Coimbra, A., Bona, D., & Demarco, F. (2012). Effectiveness of different
carbamide peroxide concentrations used for tooth bleaching: An in vitro study. J. Appl.
Oral Sci. Journal of Applied Oral Science. 20(2), 186-191.

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