A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

Providing Patient-Focused Whitening Approaches


Tooth whitening is frequently requested by all types of patients, regardless of the status of their oral health. Before considering any over-the-counter (OTC) products or starting any professional treatments, a thorough examination is indicated to assess for caries, existing restorations, white spots, discolorations, sensitivity issues, and status of occlusion.1 Radiographs can reveal reasons for dark teeth such as abscesses, calcific metamorphosis, caries, and internal or external resorption.2–4

The exam should include explanation of treatment options and the expected results. Patients with restorations must be informed that the restorations will not bleach, so if they are visible in the smile, consideration will need to be made for replacement. Additional considerations include patient preference, treatment time, and financial commitment.

For professionally supervised at-home options, tray bleaching with 10% carbamide peroxide is well-researched, safe, and effective. Trays can be fabricated in the dental office with vacuum-formed materials or thermoplastic materials.5 A thermoplastic tray requires less chair time, lab work, and materials, thus, fabrication is less expensive. Instructing patients to bleach one arch at a time, starting with the maxillary arch, can improve patient compliance as he or she can compare the progress over time.

Charging a per-arch fee option offers less of an initial investment and allows the patient to decide whether to pursue treatment for the mandibular arch. Some offices may also offer disposable prefilled bleaching tray kits. If the patient already has a tray that covers the teeth, then the office can supply the bleaching materials after the examination.

Offices should be aware that patients can purchase professional dental products from online retailers. As such, advise them to check the expiration dates before using. Remind patients they will not find the American Dental Association (ADA) Seal of Acceptance on these products since the ADA only approves consumer products.

For patients interested in OTC options, whitening strips are less expensive than tray bleaching. Although the treatment time may take longer, the results are comparable.6 Other OTC products do not change the internal color of the tooth but may be useful to maintain the results once patients have bleached their teeth.

Whitening toothpastes tend to be more abrasive than regular toothpaste so use caution when recommending. Guide patients away from the use of charcoal or oil pulling as they are not evidence-based and may harm the enamel and gingiva.7,8


  1. Haywood VB. Pre-bleaching exam vital for optimum whitening. Compend Contin Educ Dent. 2012;33:72–73.
  2. Haywood VB, Delash J. Determining appropriate fees for tooth bleaching. Inside Dentistry. 2019;15(6):34–41.
  3. Haywood VB, Bergeron BE. Bleaching and the diagnosis of internal resorption. Decisions in Dentistry. 2018:4(8):20–25.
  4. Haywood VB, Fortney LA. Diagnosis and prognosis for dark tooth bleaching. Decisions in Dentistry. 2019:19;5(3):10–14.
  5. Haywood VB, Delash J. Novel bleaching tray fabrication techniques. Inside Dentistry. 2021;17(1):31–36.
  6. Auschill TM, Hellwig E, Schmidate S, et al. Efficacy, side-effects, and patients’ acceptance of different bleaching techniques (OTC, inoffice, at-home). Operative Dent. 2005;30:155–163.
  7. Brooks JK, Bashirelahi N, Reynolds MA. Charcoal and charcoal-based dentifrices: a literature review. J Am Dent Assoc. 2017;148:661–670.
  8. Brooks JK, Bashirelahi N, Reynolds MA. More on charcoal and charcoal-based dentifrices. J Am Dent Assoc. 2017;148:785.

From Decisions of Dentistry. October 2023; 9(9):46

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