Title

Tooth Bleaching: Safety and Efficacy Of In-Office Versus At-Home Treatment

Clinical Question

In healthy adult patients with discolored teeth, does in-office tooth bleaching compared to at-home tooth bleaching systems, differ in safety and efficacy?

Clinical Bottom Line

In-office and at-home treatment appear to be comparable to each other both in terms of efficacy and safety; however the current evidence available is weak. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
19953771	Bizhang/2009	Adults (n=75)	RCT
Key results	Using an objective color measurement device to compare shade change, “home bleaching (illumine Home, 10% carbamide peroxide, trays, overnight, for two weeks) and in-office bleaching (Illumine Office, 15% hydrogen peroxide, trays for 45 minutes, three times over three weeks) were [determined to be] equally efficient for bleaching teeth and maintaining the results for up to three months.” No P values were given.
12670065	Zekonis/2003	Adults (n=20)	RCT
Key results	A 14-day at-home treatment was compared with 60 minutes of in-office treatment (two appointments, each with three 10-minute applications). The at-home treatment was determined to produce significantly lighter teeth (p=0.0001) according to objective and subjective measures, however it was initially associated with higher gum sensitivity than the in-office treatment (p=0.0378). There was no significant difference in tooth sensitivity between the two treatments (p=0.0631).
15853099	Auschill/2005	Adults (n=39)	RCT
Key results	Both Opalescence PF 10% (at-home bleaching technique; one cycle=8 hours) and Opalescence Xtra Boost (in-office bleaching technique; one cycle=15 minutes) are capable of producing a whitening of six tabs compared to baseline, however, it took significantly less cycles for the in-office technique (3.15 +/- 0.55) to produce the desired shade compared to the at-home technique (7.15 +/- 1.86). Patient-reported discomfort was minimal and there was no significant difference between the two techniques in terms of producing gingival irritation and tooth hypersensitivity according to visual analog scale values. No P values were given.

Evidence Search

Pubmed: "Tooth Bleaching"[Mesh] AND ((Meta-Analysis[ptyp] OR Randomized Controlled Trial[ptyp]Pubmed: “at-home and in-office tooth bleaching”

Comments on
The Evidence

Compliance, completion rate, and follow-up were adequate for all the clinical trials. Long-term effects (>3months) were not monitored. The treatment groups were similar at start, however, the group sizes were relatively small (n=75, n=20, n=39) and the treatment techniques tested in each trial differed in type, duration, and concentration of active ingredients used. Also, it is not clear if these studies were conducted using a double-blind method or if there were competing interests involved. Overall, the evidence available is weak.

Applicability

This evidence applies to adult patients who undergo tooth bleaching procedures. Patients should be made aware that both in-office and at-home bleaching systems are equally capable of whitening teeth and that minor tooth and gum sensitivity may occur using either system. Variability in results comes from the type, duration, and concentration of active ingredients used.

Specialty

(General Dentistry) (Dental Hygiene)

Keywords

ID#

579

Date of submission

04/01/2010

E-mail

tongkn@livemail.uthscsa.edu

Author

Kimberly Tong

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Kevin M. Gureckis, DMD

Faculty mentor e-mail

gureckis@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?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Sheela Farooque, Jason Kim (San Antonio, TX) on 01/07/2013
A PubMed search on teeth bleaching efficacy between in-office treatment and at-home bleaching was performed on January 2013. A more recent publication was found: PMID #23082382. This double-blind RCT had a 2 year follow up and showed similar results to this published CAT. In addition, the intensity of tooth sensitivity for in-office treatment was significantly higher than at-home treatment.