What is the difference between a custom made tray and OTC whitening strips?

With each new televised Hollywood Smile Makeover episode or the appearance of a supermodel in a magazine advertising sizzling new lipsticks, the popularity of esthetic dentistry has been rising as people become more concerned about the appearance of their smile. So it should come as no surprise to learn that the most sought-after dental treatments in modern history, are requests for Implants, Veneers, and Tooth Whitening.

There are several key factors that contribute to a beautiful smile, but many would agree that tooth color is one of the most important. In today’s selfie-obsessed world we will find so many people who are not happy with their smile and the option that is the quickest, easiest and most affordable, is for patients to consider tooth whitening as this gives an instant and pleasing result.

There are a number of methods available to improve the color of your teeth:

1. Professional Home Whitening custom-made kits - dispensed by your dentist or hygienist
2. Over-the-counter (OTC) teeth whitening strips - obtained over the counter or made at home without the oversight of your dentist
3. Whitening Pens
4. Whitening toothpaste
5. Professional stain removal using Guided Biofilm Therapy/Airflow
6. Professional In-Office Whitening - administered by your dentist or hygienist
7. Vital and non-vital tooth bleaching
8. Crowns and Veneers

To know which whitening system is the most suitable for your teeth, you need to know what type of stain you are trying to remove.

Differences between intrinsic vs. extrinsic tooth stains

Extrinsic Tooth Stains:

When the tooth is only stained on the outside (the enamel layer), it is considered an extrinsic discoloration. These stains are typically yellow or brown in color, and they affect mostly the surface of the teeth (enamel). Extrinsic tooth discoloration is caused by exposure to certain foods (blueberries, curry, soy sauce) and drinks (green tea, coffee, red wine), as well as tobacco products (shisha, cigarettes, vaping, and cigars).

Intrinsic Tooth Stains:

Intrinsic stains are less common, and more difficult to treat because they affect the inner structure of the teeth (dentine). This can develop after a tooth trauma or from taking certain medications, such as tetracycline antibiotics, antihistamines, antidepressants, and high blood pressure drugs that can discolor teeth. The natural aging process can also contribute to intrinsic staining. As we get older, our tooth enamel wears thin and reveals more of the inner dentin of the tooth, which happens to be more yellow than white.

We always advise you to discuss with your dentist or hygienist the different whitening methods before trying one as they are familiar with your dental condition and history and will recommend the best treatment plan to address your needs. As patients are not always aware that some of these products can have several side effects, I will discuss and focus on the first two methods listed, namely the Professional Home Whitening custom-made kits VERSUS the OTC Whitening strips.

Over The Counter (OTC) Whitening strips

Over-the-counter teeth whitening strips are affordable and easy to use and are readily available without a prescription. But personally, I feel the disadvantages far outweigh the advantages. Here are the reasons why I would reconsider buying OTC products:

• Failing even before you start – Teeth whitening treatments may not be right for you to try while you have active cavities or certain dental work in progress.
• Only slight improvement in color – Because whitening strips don’t contain high levels of peroxide, the results are seldom satisfactory. So whitening strips are best suited to those with only light discoloration, staining, or maintaining an already whitened smile.
• Results don’t last as long – Often the peroxide dehydrates the teeth and makes them appear whiter than they actually are, leading to patients stopping the treatment way too early. This results in an easy and fast fade-back to the original tooth color.
• Whitening is not permanent – However white your teeth appear after using whitening strips, the results will normally only last for a few weeks or months, particularly if you revert back to old habits of drinking coffee or smoking.
• More suitable for Extrinsic stains – whitening strips will not work on intrinsic stains unless you try an extended period of whitening with the strips which might make a marginal improvement on any intrinsic stains.
• Uneven results – The strips only sit well and work well if the teeth are even, with no crowding or rotations. So, unless you’ve got perfectly even teeth, there’s a big chance that the strips won’t sit evenly across your teeth meaning that parts of your teeth may not come into contact with the whitening agent. As a result, you could end up with unattractive blotches of white.
• Partial arch whitening – A lot of the strips only cover the first 6-8 teeth at the front. If you have a full or wide smile, this means that some of the teeth that you are unable to whiten, will be very distinct and visible when you smile. Not all “One-Size For all” actually fit everyone.
• Not full tooth coverage – If you have a particularly large tooth structure, the strip might not reach right up to the gum and allowing for partial tooth whitening to happen
• Damage to gum or often gum sensitivity occurs – If you have very small/short tooth structure, the strip will over-reach onto the gum. It’s possible that your gums even turn white after becoming exposed to the whitening solution, also having a burning feeling occur. If you continue to expose your gums to your whitening product, this can cause bleeding or severe pain.
• Tooth sensitivity– If the peroxide comes in contact with dentine, erosion/abrasion/carious lesions, or fracture lines, you will experience sensitivity!
• Variable treatment time – Most packets of whitening strips contain only enough product for 2 weeks. But more likely than not, for a successful whitening result you will need more whitening strips to achieve a noticeable result
• No / questionable results – Depending on what caused the stains eg: tetracycline stain or Root Canal treated tooth, whitening strips may not work.
• Erosion of dental restorations, such as amalgam fillings
• Changes in tooth enamel, such as increased roughness or softness. The whitening chemical is only stable for a period of time. If wearing the strips for longer than the intended period, the pH of the peroxide can change, causing damages to the enamel structure. When you use a whitening product that is not prescribed to you by the dentist, you put your enamel at risk.
• Not all whitening strips are ADA or FDA approved. Always check labels for a list of ingredients. Some rely on chlorine dioxide, a chemical oxidizer that can erode tooth enamel and damage teeth. This ADA or FDA seal is meant to give you more confidence to make buying decisions and to ensure what you’re using is safe. Because many OTC teeth whitening products have not gone through the rigorous testing seen with professionally dispensed products, some overstate their effectiveness, and many are under scrutiny for their lack of safety and supervision.
• Speech impediment – Does affect speech while wearing the whitening strips
• Sore throat – The increase in salivary flow often leads to the patients swallowing a lot of the product, leading to possible nausea and a sore throat.
• Occasionally the adhesive fails, making the strip(s) unusable
• Hydrogen peroxide won’t whiten composite fillings and crowns – The patient often forget that they have crowns of composite bonding on their teeth. You might end up with a multicolor smile instead of the perfect smile if all your teeth do not whiten evenly.
• Accidental chemical burns on hands and face – while preparing the strips for placement on the teeth, you must be very careful not to touch the gel. This will leave a chemical burn on your fingers and you might accidentally touch your face while placing the strips. Please wash your hands straight after seating the whitening strips.
• Lack of professional guidance often leads to abusive and incorrect use of products that can cause serious side effects.

Professional Home Whitening custom- made kits

When you get a home whitening kit manufactured by your dentist or hygienist, you can be assured that the custom trays will fit your teeth like a glove. This means that you get even coverage across all your teeth and there’s less chance of any product spilling/leaking onto your soft tissue, causing damage to your surrounding tissues.

• You have access to an expert in tooth whitening – Your clinician is an expert in tooth whitening and will guide you in choosing the right shade that will fit your features, face, age, and skin tone. Your dentist will also determine if you are a suitable candidate for whitening and whether you have cavities that might make you dentally unfit for any whitening treatments
• Use of appropriate products – Your clinician will assess what type of stain you have (extrinsic or intrinsic) and which product would be appropriate to make a noticeable difference in your tooth color. If you have sensitive teeth, an appropriate concentration of whitening gel and the period of wearing the trays will be assessed.
• Great results – On average most teeth will improve 6-8 shades given time, patience, correct and suitable whitening product, and concentration
• Results last longer – Using a custom made tray ensures a more full and even coverage of the enamel with whitening gel, giving a deeper and longer-lasting effect with slower fade-back
• Suitable for Extrinsic AND Intrinsic stains – The higher hydrogen or Carbamide peroxide concentrations in professional dental whitening gels allows for removal and or improvement in both extrinsic and intrinsic stains
• Even results – custom whitening trays are hand made by a dental lab technician using an exact impression of your teeth. Custom-fit whitening trays allow the whitening gel to coat your teeth evenly which ensures that your whitening result is even so that all teeth become whiter with each application.
• Full arch whitening– The custom made tray ensures that all teeth, right up to your second molars (if you so wish) are whitened.
• Full tooth coverage – The tray has a perfect fit that seals against your gum margin, allowing the product to cover the full enamel surface
• No chemical burn or gum sensitivity – The tray has been designed to trap the whitening gel on the tooth surfaces with no product seepage onto the gum
• Minimal Tooth sensitivity – Your clinician will design or give instruction for the design of your whitening trays after doing a complete evaluation of your dentition. If designed correctly, your whitening product will not leak or touch any areas where your dentine is exposed or your enamel is not intact, thus greatly reducing any sensitivity
• Predictable results and treatment time – Your dentist or hygienist would have given you a full whitening consultation, discussing and managing your expectations and predict a total treatment time to achieve optimal results
• Stable formula – All whitening gels recommended by your dental professional will carry the seal of approval by either ADA or FDA. This means the product formula has been rigorously tested and the pH will be neutral or alkaline
• Speech perfection – Your tray was made for YOU. Now you can continue with everyday life while whitening your teeth at the same time, no alteration is speech.

Professional teeth whitening performed in the dental clinic is by far the best way of getting your stained or discolored teeth whitened. However, people perceive the procedure to be time-consuming and expensive which is why custom-made trays and OTC whitening products are so popular.

Considering all the points noted above regarding OTC whitening strips, I would recommend patients stick to dentist-approved and recommended methods of whitening their teeth.