At-Home Teeth Whitening

Authored By: Linda Dyett

Reviewed By: Larry Addleson, DDS, FAACD

• Teeth Whitening Basics
• In-Office Teeth Whitening

When contemporary peroxide-based teeth whitening got under way in the early 1990s, it was limited to custom-made bleaching tray treatments that were only available at dental offices. These whiteners set off what has come to be known as the "Smile Revolution," and today dozens of whitening options are available for every budget and temperament — whether professionally-dispensed, store-bought or sold on the Internet. Many teeth-whiteners are pre-mixed and ready to use; others call for mixing at home.

There is a widespread consensus that dentist-dispensed whitening trays and whitening strips, when used as directed, can be even more successful than in-office bleaching over the long haul. One key reason is their ongoing use, combined with the fact that small amounts of bleach remain within the tooth structure for up to 36 hours. When a new dose of bleach is applied to a tooth retaining the previous day’s peroxide, its effect is more pronounced.

Advantages of At-Home Teeth Whitening

• Long-term results: Dental professionals agree that the only means of maintaining your whitened teeth is with at-home bleaching products, repeated on a regular basis — preferably every four to six months. Lately, however, many dentists are advising patients with very dark-stained or tetracycline-affected teeth to continue home bleaching over a period of months (or up to a year) in order to achieve optimal results. And interestingly, the newest teeth whitening strips on the consumer market are intended for five-minute use on an everyday basis — like brushing or flossing.
• Variety: You have your choice of whitening trays, strips or paint-on products, as well as numerous whitening accoutrements.
• Convenience: Home whitening can be done at any time of the day or night, for short or extended periods.
• Portability: At-home whitening strips can also be used on-the-go or at the office.
• Cost: Over-the-counter whitening products are priced in the $4 to $100 range, while dentist-dispensed products cost approximately $400. By contrast, in-office whitening costs an average of $650 per session.

The Downside of At-Home Teeth Whitening

Easy access to over-the-counter whitening products may lead to over-use, which can weaken and irritate teeth and gum tissues, and cause micro-cracking in the enamel surface. Over-bleaching can also produce an undesirable bluish hue, chalky whiteness or uneven results (otherwise known as “the technicolor effect”).

At-Home Whitening Considerations

• The stronger the peroxide formula, the more rapid its effect; the weaker the formula, the longer it can safely remain on the teeth. A low-percentage bleach used overnight every night of the week will achieve approximately the same results as a high percentage “day-bleach” that is kept on the teeth one hour per day for seven days.
• The optimal time to begin at-home whitening is soon after a dental hygienist’s prophylactic cleaning. This procedure removes the surface layer of plaque and grime that otherwise hinders bleaching efforts.
• Dentists and oral care companies urge brushing and flossing the teeth just prior to any form of at-home or on-the-go whitening.
• For best results, food or beverages (excluding water) should not be consumed for a couple of hours after whitening.

Dentist-Dispensed Take-Home Whitening Trays

According to dental professionals, the best bleaching results are achieved with dentist-dispensed take-home kits — particularly those that are used over extended periods. These kits contain higher percentages of bleach than over-the-counter kits and typically consist of:

• Custom-fitted application trays fabricated from a flexible plastic material. Custom trays have an approximate cost of $100 and offer several benefits, including:
• They help ensure that the bleach stays in contact with the teeth for maximum whitening.
• They help prevent saliva from coming into contact with the bleaching agent (which can dilute its strength).
• They minimize the amount of bleach that can dribble onto (and potentially irritate) the gums.
• Bleaching compounds are either pre-loaded into the trays or stored in syringes and added to the trays just before use. In many cases, your dentist can fine-tune the bleach concentration and add a desensitizing agent to use before or after application. Generally, enough gel is provided for one two-week treatment per year, plus one- or two-day touch-ups every four to six months.

The following tray-bleaching systems are those most commonly dispensed by dentists:

Discus Dental Nite White and Day White ACP: These are the only take-home whiteners that feature amorphous calcium phosphate (ACP), a proven enamel re-builder, and sensitivity-reducing potassium nitrate and fluoride.

Nite White is available in various hydrogen peroxide concentrations to be used overnight or twice daily. Ask your dentist about which concentration and application is best for you.

Cost: $200 to $400.

Discus Dental Nite White Turbo: This is the fastest Nite White system available, containing a mint-flavored, chemically accelerated six percent hydrogen peroxide formulation. It is intended for overnight use, two to four hours twice per day, or one to two hours per day if you have a sensitivity to bleach.

Cost: $200 to $400.

Discus Dental Zoom! Weekender Kit: This fast-acting whitening system has a six percent hydrogen peroxide gel and a time-release booster agent that enhances bleach penetration. The Weekender Kit is intended for overnight use, two to four hours twice per day, or for one to two hours per day for those with a sensitivity to bleach.

Cost: $200 to 400.

Opalescence by Ultradent: Incorporating a viscous carbamide peroxide whitening agent known for its staying power over extended periods of time, the Opalescence gel also contains a patented mix of sensitivity-reducing potassium nitrate and fluoride. Pre-packaged in syringes, the gel is inserted into the custom-made trays prior to each use. Four concentrations of carbamide peroxide are available for use during the day or overnight.

The Opalescence kits are available in mint, melon and flavor-free formulations. Optimal bleaching effects are likely to appear after 10 days of directed use.

The average cost of Opalescence whitening ranges from $150 to $200 per tray. Dental offices make gel refills available at the six-month checkup, as a way of ensuring that patients return for this visit. These refills are offered free of charge by some dental offices, but typically cost upwards of $50.

Opalescence Trèswhite Supreme: This is an innovative one-size-fits-all system, designed for those seeking a quick, convenient and relatively inexpensive whitener — with no wait for custom-made trays. Many people opt to use this system while traveling or just before a major business meeting or social event.

Trèswhite features a two-layer tray system that guarantees automatic alignment. The delivery trays are pre-loaded with a membrane-like inner tray coated with a 10 percent hydrogen peroxide whitener containing the same sensitivity-reducing mix of potassium nitrate and fluoride as is found in Opalescence systems with custom-made trays.

The wear-time for Trèswhite is 30 minutes, twice a day, or 60 minutes, once a day. Ten-packs of Trèswhite Supreme (10 uppers and 10 lowers), intended for use over the course of five to 10 days, are available in mint, peach or melon flavors.

Cost: $55 to $125.

Whitening Strips

Coated with a whitening gel, these thin, flexible membranes are designed to conform to the shape of the teeth. They are extremely convenient and easy to use — no mixing or molding is required. What’s more, they are unobtrusive enough to be worn on the job or while commuting or shopping.

However, whitening strips have been shown to be less effective than trays for removing between-the-teeth stains, and are not suitable for crooked teeth. Additionally, saliva can more easily find its way beneath whitening strips, diluting their potency; some whitening strips aren’t long enough to cover a wide smile, and they have a tendency to slip and slide.

Crest Whitestrips Supreme, containing 14 percent hydrogen peroxide — the highest dose currently available in whitening strips — are dispensed at dentists’ offices. These strips are wide enough to cover up to six teeth.

Approximate cost for a box of 84 strips (three-week supply): $44.98. Over-the-counter whitening strips cost in the $19.98 to $44.99 range.

Brush-On Whiteners

Pens with brush-on or foam-tip applicators provide what has been billed as fuss-free instant whitening. Used directly after meals or in daily regimens (as alternatives to whitening trays and strips), these whiteners are frequently thought of as instant “antidotes” to new stains from food — especially red wine that has just been consumed.

But dental professionals are divided as to the efficacy of paint-on whiteners. Some regard them as useful adjuncts to in-office or tray bleaching. Others have yet to see any meaningful results with these whiteners.

Cost: $12.99 to $99.95

Whitening Toothpaste

Technically speaking, all toothpastes are whitening toothpastes, since they remove surface plaque and debris. But only a limited number contain key whitening ingredients — chemical bleaching agents and abrasives in high concentrations. When used on a regular basis, these dentifrices may offer backup support for tooth whitening. Of course given that brushing time is limited to a minute or two, that support is minimal. But since we all brush every day, whitening toothpastes are considered by some to be potential whitening enhancers.

Toothpastes with Peroxide

Because toothpaste foams all over the mouth and is swallowed, the percentage of any bleach it contains is kept low to avoid irritation.

Toothpastes with Abrasives

Most toothpastes clean the teeth with the use of finely ground abrasives such as silica, aluminum oxide, calcium carbonate or baking soda. Whitening toothpastes contain more of these abrasives — though the paradox here is that overuse can result in an increase in stains, and can also dull the surface of dental crowns and veneers.

Whitening Floss

Floss may seem like an unlikely addition to the tooth-whitening regimen, particularly as it is kept in contact with the teeth for only a second or two. But over the long haul, the daily use of whitening floss may assist with stain-removal in the narrow space between the teeth — an area that even in-office bleaching has a hard time reaching.

Whitening floss differs from standard dental floss in its use of mild abrasives, typically silica.

• Teeth Whitening Basics
• In-Office Teeth Whitening

[Updated July 2008]

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