Over-the-Counter or In-Office Whitening: What’s the difference?

by Dr. Julie Melbinger-Wagner
ORIGINALLY PUBLISHED IN THE MEQUON BEACON

As you stroll through the oral health care isle of Target there is not a toothpaste, rinse, or toothbrush on the market that does not advertise the ability to whiten or give you a brighter smile. According to a 2020 study, over 6.14 billion dollars was spent on tooth whitening worldwide and it is projected that by 2026 this market is projected to grow to 8.21 million dollars. Consumers of all ages, are looking the anything that can give them the Hollywood Smile. Everyday as an oral health care provider I have patients asking for a brighter smile to make them look more youthful, or teenagers just out of braces wanting to see their smile brighter for HOCO or Senior photos. The first question asked is, “what can your office offer that I cannot get at the grocery store?”

Believe it or not, people have been looking for teeth whitening solutions for over 4000 years. The ancient Egyptians would create a whitening paste mixing wine vinegar with ground pumice stone. As you can imagine, this paste was quite abrasive as well as acidic, potentially a cause for the high cavity risk at this time. By the 17th century, barbers commonly treated dental issues of any origin and their method to whiten was even more barbaric. No pun intended, but Barbers would file down teeth and apply an acid that would whiten them, which obviously lead to even great erosion and decay.

Fortunately, the Dental “Barber” has evolved into the 21st century as the Doctor of Dental Surgery, utilizing evidence-based dentistry to validify any dental treatment performed. Most studies have concluded that tooth whitening is only effective utilizing high concentrations of hydrogen peroxide or carbamide peroxide to remove extrinsic enamel stains. In a 2019 study reported in “Dentistry Journal”, researchers found that over-the-counter whitening products, such as toothpaste, whitening strips and gels, contain a hydrogen peroxide ingredient of less than 1%. Due to the instability of hydrogen peroxide, the low concentration, and dilution from saliva, from a chemical point of view it is questionable that there would be sufficient oxidizing power to remove extrinsic stains. Also, in this study it was found that whitening toothpastes often contain harder abrasives than traditional formulations aiding in the removal of stains, and these additional abrasives were not only found to damage enamel but increase sensitivity. The most important take away from this study is that whitening of intrinsic and is only effective using high concentrations of hydrogen peroxide or carbamide peroxide at long increments of time.

In short, as you walk the oral health care isle of your local grocery store and see the amazing value in purchasing an over-the-counter product versus the estimate you were given from you dentist for custom tray or in-office whitening, please remember only a dentist can fabricate custom trays and administer the correct dosage needed to give you the bright smile you were looking for.