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Title Teeth Whitening: in-office or over the counter?
Clinical Question In healthy patients with good oral hygiene, is in-office tooth bleaching a more effective method for whitening versus over-the counter products?
Clinical Bottom Line Both over-the-counter and in-office products are clinically effective in achieving whitening results however it is difficult to say one method is superior to the other because how one perceives effectiveness is influenced by treatment duration, cost, and convenience. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15853099Auschill/200539 healthy individuals (ranging from 21-68 years old) with unrestored right maxillary canine whose color shade, according to VITA shade guide, was grade A3 or darker. Criteria also required that subjects did not have hypersensitivity or any irremovable orthodontic appliances.Randomized Controlled Trial
Key results39 individuals were randomly placed into one of three study groups-Group A using Crest Whitestrips (over-the-counter), Group B using Opalescence PF 10% (at-home), and Group C using Opalescence Xtra Boost (in-office). To achieve whitening of six shades higher than baseline, each treatment method differed in treatment time and total duration of treatment to establish desired result. The shade value at baseline for individuals of all three groups did not differ significantly (p>0.05) with a mean value of 11.2+/- 1.8 for group A, 11.5 +/- for group B, and 11.3 +/- 2.1 for group C. All three bleaching products were found to be clinically effective, with a six shade increase in baseline for all groups (shade increase was determined using VITA shade guide). Patients were asked to rank their acceptance and side effects from 0 (“best acceptance”, “no discomfort”) to 10 (“no acceptance”, “severe discomfort”) and consequently, those in group A reported a mean value of 2.31+/- 1.93, those in group B reported 1.46+/- 1.33, and those in group C reported 3.31+/- 1.75. Therefore, at-home bleaching was found to be favored over in-office bleaching. When the subjects were questioned as to why that was the case, decreased time spent in the dental chair was their response.
#2) 12670065Zekonis/200320 healthy individuals, over age 18, whose maxillary anterior teeth were lighter in shade than B-85 and darker in shade than B-54 (using the Trubyte Bioform Color Ordered shade guide). Exclusion criteria included no use of tobacco containing products in the last 30 days, no teeth stained by tetracycline, a gingival index score of >1, and no history of the use of any type of bleaching agents.Randomized (split mouth) trial
Key resultsUse of 10% carbamide peroxide at home (for a total duration of 14 days) was compared to the in-office use of 35% hydrogen peroxide (total duration of sixty minutes split into two appointments). Specifically, one side of the maxillary arch was treated with the in-office product while the opposite side was treated with the over-the-counter product. Changes in shade were determined using a shade guide, colorimeter, and color slide photography at the baseline appointment, week one, week two, week three, week six, and week twelve. Lighter teeth resulted in subjects using at-home bleaching versus the in-office method (p=0.0001). Eighty-four percent felt treatment at home was more effective than in-office, sixteen percent reported no significant difference, and none reported that in-office bleaching was superior to at-home bleaching.
Evidence Search Randomized Controlled Trial, English Meta-Analysis, Limits: Randomized Controlled Trial,Search Limits: Meta-Analysis, Search "Crest whitestrips "[Substance Name] Search home whitening treatmentSearch "Dental Care"[Mesh]Search "Self Care"[Mesh] Search "Dental Offices"[Mesh] Search "Nonprescription Drugs"[Mesh] Search "Tooth Bleaching"[Mesh] Less History Clear HistorySearch History Instructions
Comments on
The Evidence
In both studies, groups were similar at the start, >90% completed the clinical study, groups were treated the same, adequate compliance by subjects, no identified competing interests, there was adequate follow-up, and unlikely to have bias in reference to the clinical study. Furthermore, the first study was a double-blind clinical study whereas the second study was a single-blind clinical study.
Applicability In today’s society, esthetics has become significantly more important to dental patients. In particular, over-the-counter tooth whitening agents have become very popular. With the availability of products such as over-the counter tooth bleaching, patients are left wondering if what is available over-the-counter is as effective as what the dentist provides in-office. The evidence found in the referenced articles is applicable to a typical patient in practice, as they suggest that both in-office and at-home products are equally effective in tooth whitening and patient preference is what determines which method to use.
Specialty/Discipline (General Dentistry) (Orthodontics) (Restorative Dentistry)
Keywords tooth whitening, in-office, at-home
ID# 539
Date of submission: 03/26/2010spacer
E-mail pearosez@livemail.uthscsa.edu
Author Zynab Pearose
Co-author(s) e-mail
Faculty mentor/Co-author Joseph Bartoloni, DDS
Faculty mentor/Co-author e-mail Bartoloni@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Aaron Glick (San Antonio, TX) on 04/16/2012
I performed a PubMed search on April 2012, and the publications listed in this CAT represent the current highest levels of evidence.

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