Home-based chemically-induced whitening of teeth in adults
ABSTRACT During the last decade tooth whitening products have become widely available in the USA for sale over-the-counter or dispensed by dentists for use at home. With the current rapid growth in demand for tooth whitening it is imperative that the dental community base its recommendations to patients on sound scientific evaluations conducted in well-designed and independent studies.
To evaluate the effectiveness (versus a placebo or another active product) and side effects of over-the-counter or dentist-dispensed chemically-based tooth whitening products designed for home use.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); MEDLINE (January 1966 to September week 2 2005); and EMBASE (1988 to week 39 2005). The tables of content of selected dental journals published since 1995 were searched for additional references. Written requests for additional studies and information were mailed to experts in this area of research. After a final set of studies was identified, the list of references reported in the included reports was reviewed to identify additional studies. Studies published in English and non-English were considered in this review.
Randomised controlled trials and quasi-randomised controlled trials of dentist-dispensed or over-the-counter tooth whitening products with a chemical action (rather than abrasive action), for home use.
Screening of titles and abstracts, data extraction and quality assessment were undertaken independently and in duplicate.
A total of 416 articles were identified, 25 of which met the inclusion criteria and presented data that could be used in the analysis. All included trials measured effectiveness immediately after 2 weeks of product application. Only 13 studies reported outcome data 1 week after the 2-week application period, and of those only six reported outcome data after 1 month or longer. Four of the included trials were assessed as at moderate risk of bias and the remainder at high risk of bias. All trials were sponsored by the manufacturers of tooth whitening products. Six trials compared different whitening products (gel in trays, paint-on films and whitening strips) with placebo/no treatment and all analyses showed the products to be effective, although most comparisons were based on single trials. Nineteen trials compared different whitening products with each other. There was only one meta-analysis which included more than one trial which showed statistically significant differences between the different whitening products. Strips (5.5% to 6.5% hydrogen peroxide(HP)) are more effective than gel in tray at 10% carbamide peroxide (CP) mean difference 1.82 (95% confidence interval (CI) 0.26 to 3.38). All of these trials were assessed as of high risk of bias. 'Mild' to 'moderate' tooth sensitivity and gingival irritation were the most common side effects. The whitening strips and products with high concentrations of HP caused more users to complain from tooth sensitivity. The protocols for preparation of participants prior to bleaching were inconsistent among the studies. Data on baseline scores of whiteness were not reported by the majority of the studies. The current evidence base on tooth whitening products suffers from methodological and publication biases.
There is evidence that whitening products work when compared with placebo/no treatment. There are differences in efficacy between the products, mainly due to the levels of active ingredients, hydrogen peroxide and carbamide peroxide. All trials were however short term and the majority of the studies were judged to be at high risk of bias and were either sponsored or conducted by the manufacturers. There is a need for pragmatic long-term and independent clinical studies that include participants representing diverse populations. There is also a need to evaluate long-term harms. Several studies reported (where measured) the common side effects of tooth sensitivity and gingival irritation, and people should be informed of this.
Full-textDOI: · Available from: Gisele Neiva, Jun 23, 2015
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ABSTRACT: Objectives: The present study is aimed at evaluating the effectiveness of a fluoride- and potassium nitrate-containing gel and toothpaste in reducing dentinal hypersensitivity due to dental bleaching. Materials and methods: Specific inclusion and exclusion criteria were used to recruit patients for the study. They were randomly allocated to a test or a placebo control group. Patients underwent a treatment of home dental bleaching with 10% carbamide peroxide. Dental shades were evaluated in a standardized environment and dentinal hypersensitivity was valuated by means of evaporation stimuli. A nominal scale was used to score the painful reaction. The patients were recalled 8, 15 and 28 days after the baseline for both shade and sensitivity assessment. Statistical analysis was performed using the Student’s T-test. Results: The patients recall rate was 96.9%. The statistical analysis demonstrated a significant reduction of the painful symptoms in the experimental group (p=0.031) while no statistically significant differences were evidenced in the control group at any follow-up recall (p>0.05). Discussion: The tested agents proved to be safe and effective in the short term. Neither pigmentations nor interferences with the bleaching action of peroxides due to the desensitizing agents were observed. The compliance of the patients to the proposed protocol as well as the motivation to maintain good oral hygiene were paramount in the achievement of the reported results. Conclusions: The use of a desensitizing gel and toothpaste containing fluoride and potassium nitrate was effective in reducing dentinal hypersensitivity due to dental bleaching and did not interfere with the bleaching action of peroxides. Clinical significance: Desensitizing gels and toothpastes containing fluoride and potassium nitrate can be considered safe and effective in the control of tooth sensitivity after dental bleaching.
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ABSTRACT: The aim of this split-mouth, randomized controlled trial was to compare the whitening results of at-home and in-office tooth bleaching techniques and the longevity of their effects at nine months after teeth had been bleached. The authors conducted a study involving a 14-day bleaching period, during which the first maxillary premolars of 17 participants, who were 20 to 25 years of age, were bleached by means of either an at-home technique involving 10 percent carbamide peroxide or an in-office technique involving 38 percent hydrogen peroxide. The authors recorded color variables as proposed by the Commission Internationale de l'Eclairage-lightness (L*), redness (a*) and yellowness (b*)-by using a spectrophotometer at baseline and at one week, one month and nine months after bleaching. They also calculated a whiteness (W) index that was based on the distance of the color value in the color space from a nominal white point. At the nine-month recall visit, comparison between the at-home and the in-office techniques did not show significantly different values for L* (P = .448), a* (P = .350), b* (P = .144) and W (P = .151) color variables. None of the participants experienced any adverse events related to the bleaching during the treatment period. The study results showed no clinically significant difference in bleaching efficacy. Both techniques produced satisfactory and long-lasting bleaching results. In young adults, either the at-home or the in-office technique can be used effectively.Journal of the American Dental Association (1939) 11/2010; 141(11):1357-64. DOI:10.14219/jada.archive.2010.0081 · 2.24 Impact Factor
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ABSTRACT: The use of light as an adjunct to in-office bleaching is a controversial topic in dentistry because of the equivocal outcomes of the research conducted in studies using light compared with no light treatment. The proper diagnosis and treatment planning of discolored teeth is of primary importance when managing the outcomes and setting expectations for patients undergoing in-office bleaching with supplemental light. Although no study is conclusive on all bleaching lights, research evidence provides guidelines for the responsible use of in-office bleaching lights in dentistry.Dental clinics of North America 04/2011; 55(2):241-53, viii. DOI:10.1016/j.cden.2011.01.002