Professional ("laser") teeth whitening

- Which works best: In-office or At-home bleaching? / What does research report? / Advantages & disadvantages comparison.

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Link to At-homve vs. in-office advantages and disadvantages section.
Link to At-Home Bleaching Materials graphic.

If you want whiter teeth, you generally have two options.

  • One is to have treatments performed by your dentist in their office (this is termed professional, in-office, "laser" or power whitening).
  • The other is to perform treatments on your own (this is referred to as at-home whitening).

Between these two very different approaches, you may wonder which one gives the better results.

Spoiler alert: You can get the same outcome using either method.

That's right, research shows (see below) that in terms of the tooth-lightening effect created, neither one of these approaches is the "best." Both methods can be used to create the same end result.

How is this possible?

The effectiveness of peroxide-based tooth whitening (the process we're talking about here with both of these methods) is primarily a function of the following two factors:

  1. The concentration of the peroxide in the whitener.
  2. The amount of time the whitener is in contact with the teeth.

That means, to produce the same whitening results, a system can either:

  • Utilize a low concentration whitener that's applied to the user's teeth over an extended time frame. (The method used by at-home products.)
  • Utilize a high concentration whitener that's applied for a much shorter period of time. (The method used by dentists in their office.)

Since either method can be used to create the same total amount of exposure of the whitener to the person's teeth, they can produce the same end result.

So, based on this criteria (the potential to lighten teeth) neither an in-office or at-home system (especially a tray-based one) is necessarily best nor even better. It's a draw.

Evidence (dental research).

Using a dental shade guide.

Making a shade evaluation.

A) As documentation for what we've stated, consider the conclusions drawn by Matis (2009) [reference sources].

This review compared the findings of 9 published studies conducted at the Indiana University School of Dentistry involving 25 in-office, at-home and OTC (over-the-counter) whitening products.

This paper's conclusions were:

  • Overnight use of an at-home tray-based system created the most effective tooth whitening.
  • In-office systems produced immediate results but 2 weeks after treatment even OTC products (whitening strips / wraps) were shown to be as effective.

    The whitening relapse typically associated with in-office results was given as the reason why many professional systems recommend the use of an at-home tray-based product as follow up treatment. (The various rationales associated with the use of this type of combined treatment approach is an interesting read in itself, see below.)

B) The comparative effectiveness of at-home whitening was also confirmed by Dawson (2011).

This study evaluated at-home tray-based whitening with a combined approach (in-office and at-home treatments).

  • Its conclusions were that the in-office aspect of combined therapy contributed no significant difference in tooth color over at-home whitening alone.

C) The conclusions of another study (Tay 2012) were similar.

60 participants having a Vita tooth shade of C2 or darker (a relatively dark color) were randomly assigned to groups where they either received in-office (35% hydrogen peroxide whitener) or at-home (tray-based system/16% carbamide peroxide whitener) treatments.

  • The findings of the study were that both techniques produced equivalent (and significant) color change.
  • No significant color rebound occurred after 2 years with either method.

D) The findings of this study (Basting 2012) were in line with those of the above.

One goal of the study was to determine the comparative effectiveness of at-home tray-whitening technique (using either 10 or 20% carbamide peroxide) and professional treatments (utilizing either a 35 or 38% hydrogen peroxide whitener).

  • The study determined that all of the bleaching methods were effective and there was no difference in the color outcome among them.

E) A final publication we'll report about (Basson 2013) reviewed the findings of 49 papers published between 1998 and 2011.

It stated that, in general:

  • Dentist-dispensed at-home bleaching and in-office treatments produced approximately the same initial color improvement.
  • When measured at 4 weeks or longer after treatment, in-office bleaching showed significantly more color relapse.

They concluded that the treatment of choice should be a dentist supervised at-home system using a 10% carbamide peroxide whitener (which is the technique we outline here.)


When does having in-office treatments make the best choice?

Since either bleaching approach (at-home or in-office) can be used to get the same whitening results, the bigger question then becomes which approach makes the better choice for you? Which one fits best with your personal characteristics and lifestyle?

Advantages and disadvantages of each method.

In-office bleaching treatment.

In-office tooth whitening.

1) In-office systems:

  • Results can be seen immediately after each treatment. (This can provide a big psychological boost for the patient.)
  • The whole process is accomplished in just a few appointments. (Possibly just one but more likely not.)
  • Professional whitening usually costs more than performing at-home treatments.
  • The use of high concentration whiteners is typically associated with an increased risk for experiencing side effects.

2) At-home systems:

  • Treatments are unsupervised. The user must be capable of performing them (which almost anyone can). And comply with the guidelines stated in their product's instructions (some people overuse at-home whiteners).
  • The person must have the time and motivation to perform their treatments.
  • It can take some weeks, or even months, before the final results are achieved. During the treatment process, the minute improvements that occur each day are usually imperceptible.
  • Using an at-home product usually cost less than having professional sessions.
  • Having charge over how often you perform treatments makes it easy to adjust your level of exposure to the peroxide so you can keep side effects to a minimum.

Which makes the best approach for you?

Are you long on time, and short on money? If so, it sounds like an at-home method might make the best choice.

Do you have a big event coming up soon that you want a bright white smile for? Or maybe you just don't think you can incorporate do-it-yourself treatments into your busy lifestyle?

If that's the case, then treatments performed by your dentist might provide the best solution.

Side note: What are your options?

If you're thinking that having professional treatments may not make the right choice for you, use these links for information about the at-home options you have.

Tray teeth whitening -
As documented by the research findings above, this method can be expected to deliver the same or better results as a professional system. (If you're serious about whiter teeth, this is the type of at-home product that you should consider first.)
Teeth whitening strips (Whitestrips®) -
Most dentists probably wouldn't consider using whitening strips to be quite as effective as tray whitening. But for many people, using them does the job just fine.
Paint-on tooth whiteners -
For the most part, paint-on whiteners typically have less whitening potential to offer than tray or whitening strip products. This method should typically be considered to be a (distant) 3rd choice.


Why do some professional whitening systems follow up with an at-home whitener?

Bleaching trays and whitening gel.

Tray-based tooth bleaching.

As mentioned above, many in-office systems include the continued use of an at-home product (usually a tray-based one) after the completion of a bleaching session. Here's why this combined approach is used:

  • The in-office treatment is used to create a rapid, noticeable color change. (A "jump start" so to speak for the at-home process.)
  • The at-home system is used to compensate for the color relapse that typically occurs after a professional session. (This relapse is often due to the dehydration effect this method frequently creates.)
  • Over time the use of the at-home system progresses the whitening process to its level of "maximum whiteness" (that point where further exposure to the whitener creates no further whitening effect for the teeth), thus avoiding the need for additional (costly) in-office sessions.
  • In the case where back teeth weren't included in an in-office session, utilization of tray-based treatments can help to lighten them so they blend in better with the new shade of the front teeth.
 

Continue reading about Professional Teeth Whitening -

At-home methods -

 
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