Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Take-home Versus In-office Whitening Techniques Dr. Joseph Banker

View Comments (4)


Whitening is one of the most common cosmetic procedures. Studies have shown that people with whiter teeth look younger and there is a correlation between high self-esteem and a bright, confident smile. There is a debate between the benefits and risks of takehome versus in-office whitening techniques.

There are many in-office whitening systems that were purchased with the best intentions. Like your treadmill, many of these have found a nice spot in the corner collecting dust. Some systems use a light source and some do not. What they all have in common is that they are designed to achieve rapid whitening results.

I really want to “like” in-office whitening procedures. They are easy, profitable, your staff can perform most of the procedures, and you can see another patient at the same time (or surf the Web depending on your level of motivation). But, it scares me – not the whitening, but the side effects.

As a practitioner, it’s often a stressful task to use in-office whitening systems when the risks and benefits are often unpredictable. A patient comes in for this elective procedure, and begins by signing a consent form, taking an NSAID, applying sunblock and donning the protective glasses. Ready to go? Not quite. We have to cover every bit of soft tissue before we apply a highly potent whitening gel to the teeth.

Once it’s finally under way, we give the patient a bell to ring if he or she feels any discomfort. It might be a little zap or it can feel as painful as someone sticking an ice pick in his or her tooth. Patients then sit and wait, and wait, and wait. Will they get through it or will they need to stop halfway?

Once the whitening process is complete, we remove the isolation. Oops, the isolation leaked and there’s a white line on the gums? Don’t worry, it won’t stay white. It will turn bright red, and after it’s done sloughing off, it will look normal again. The patient’s teeth will most likely be dehydrated, so now he or she is advised to stay away from red wine, dark sauces, tea, coffee, among other things, for the next day or two so they don’t stain. Sometimes this is the worst case, but there have been cases when patients will call the next day complaining that their gums are blistering. Maybe the light was a little too close and burned the tissue (while you were surfing the Web).

There are plenty of cases when the procedure goes smoothly, but the whitening was inadequate. The patient needs to return for another session or continue whitening at home. The results are white teeth, but the complications of in-office whitening can be significant.

Let’s consider an alternative. Professionally fabricated whitening trays with a whitening gel appropriate for the specific case. Quality trays can easily be fabricated by a well-trained staff member. Trays should be made from accurate models with smooth, sharply trimmed gingival margins. I can’t stress the importance of quality trays enough. If dental experts are going to charge an appropriate fee for this service, the product must look and feel like something special.

Not every patient should receive the same whitening gel. There are many systems available with various ingredients designed to desensitize, but all have one common ingredient – peroxide. There are also a couple of different types of peroxide to use – hydrogen peroxide or carbamide peroxide in varying concentrations. Whatever gel you dispense, an appropriate concentration for each case should be selected.

The amount of time and frequency that the gel is applied should also be varied. Personally, I like 22-percent gel for up to one hour for most patients, but I always instruct my patients to remove the trays at the first sign of sensitivity. I would prefer that they waste gel rather than have discomfort.

Recently, I had a new patient come to me because she had been unsuccessful in her attempts to have her teeth whitened by two previous dentists. She was getting married in three months and desperately wanted whiter teeth. Her previous attempts included one in-office whitening procedure, but she experienced significant pain and had to stop after only 10 minutes. Her second attempt was a takehome system that she could also not tolerate due to teeth and gum pain. She needed well-made trays and a concentration of gel appropriate for her very sensitive teeth. I instructed her use a 10-percent gel (her previous attempt was 22-percent) and she used it for only 10-15 minutes per day for two months. This was a very slow procedure that required a significant amount of gel and excellent patient compliance, but she comfortably obtained the results that she wanted and was happy to show off her white smile at her wedding. This is a great example of how this procedure can be modified to suit each individual’s needs.

Many of the over the counter (OTC) products look similar to those that we dispense. It is important to educate patients on the difference between OTC products and professionally dispensed products. We have the ability to use materials that are far more effective, but require our supervision to prevent potential damage. If patients are reluctant to have professional whitening, I encourage them to try an OTC product. In most cases, they ultimately return for treatment.

I asked 40 local dentists their opinions on inoffice versus take-home techniques. The overwhelming majority agree with me. They have varying results from in-office techniques and prefer the predictability of take-home techniques. I am sure there are plenty of offices that have great success with in-office techniques, but they seem to be the minority.

There is no shortage of data evaluating whitening techniques. A 2012 study by The International Journal of Periodontics and Restorative Dentistry that compared the efficacy of take-home versus inoffice techniques, among others, stated that there were no significant differences in the results, regardless of the technique. The study also found the use of the light did not change the results of the in office whitening.

Other studies have shown that the heat from the lights might contribute to dehydration of the teeth and therefore might cause the temporary appearance of a whiter tooth. The heat from the light can also contribute to pulpal sensitivity and soft-tissue irritation.

The time a whitening agent is in contact with the teeth and the duration that it is kept in contact are the main variables that affect whitening. They are also the two variables that affect the most common side effect, sensitivity.

Regardless of the technique used, the results were virtually identical and there was no significant difference in the longevity of the resulting whitened teeth. It is an individual preference to select the technique that is best for the dental professional and the patient.

To me, it really comes down to predictability. I perform predictable procedures with consistent results. I don’t like to do a costly elective procedure and have less-than-ideal results, including pain or an unsatisfied patient. I have been able to achieve comfortable whitening that can be customized for every patient to obtain great results and maintained for years. This leads to happy, satisfied patients as well as referrals.

It is safe to say that what works best in one practice might not be the best for another. For now, I’ll stick to the take-home technique, but I will keep an open mind and look forward to predictable, faster, comfortable techniques.

Author's Bio
Dr. Joseph Banker of Creative Dental Care is a veteran cosmetic dentist who has been named "Top Dentist" by New Jersey Monthly Magazine for four consecutive years. He studied at the UMDNJ, and trained at The Las Vegas Institute for Advanced Dental Studies and the Rosenthal Institute of NYU. He is a member of the American Academy of Cosmetic Dentistry, The Crown Council and a number of other dental organizations. Dr. Banker treats patients from all over the country at his office in Westfield, New Jersey. Dr. Banker has contributed to numerous media outlets including Newsweek, Shape Magazine, Dentaltown Magazine, and has previously served as a dental consultant for the show Extreme Makeover. For more info, visit www.creativedentalcare.com.
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450