Products directly available to consumers
Over-the-counter (OTC) options include a variety of products from toothpastes to paint-on gels. Products that currently bear the ADA Seal of Acceptance (a voluntary program for products that are available without a prescription), indicating that they are both safe and effective for whitening when used as directed, include toothpastes
and whitening strips
. The toothpastes primarily rely on abrasives to remove surface stains though some also contain low levels of peroxide as well. Whitening strips rely solely on peroxide to bleach teeth.
Products available through dentists
Dentist-supervised methods include at-home and in-office options (whitening products supplied by dentists for use at home or applied by dentists in the office are considered “professional products” and are not eligible for the ADA Seal of Acceptance).
The at-home option involves use of a whitening gel by the patient at home, which they place in customized trays made in the office to fit comfortably and minimize contact of the gel with the gingiva. At-home systems can use a range of peroxide concentrations (e.g., 10 to 38 percent carbamide peroxide); treatment times are dictated primarily by the concentration used.14
A systematic review by de Geus et al. found daily treatment times from 2 to 10 hours for periods of 6 to 28 days.15
The in-office option involves application of a peroxide-containing gel, used with or without a light intended to accelerate and enhance the bleaching process. With regard to the time needed for whitening when a light was used, a systematic review by He16
reported variable results ranging from no effect of the light on speed to the potential for pulpal damage due to the resultant temperature increase. The systematic review also reported variable effects for light on tooth color change. Some studies indicated that light-activated systems produced better immediate whitening than non-light systems when used with lower concentrations of hydrogen peroxide (15-20 percent vs. 25-35 percent). On the downside, the risk of tooth sensitivity appeared to increase when the light and a lower whitening agent concentration was used (OR 3.53; 95% CI [1.37, 9.10]).
Cost may be a consideration for patients when choosing among whitening options. While OTC products are less expensive than at-home or in-office approaches, there is a time trade-off in that OTC products may take significantly longer than do either of the other options for whitening. Auschill et al. found that an OTC bleaching technique took 16 days to achieve the whitening level of a seven-day at-home tray system and a one-day in-office procedure.17