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Randomized controlled trial of professional at-home tooth whitening in teenagers

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Kevin J Donly at The University of Texas Health Science Center at San Antonio
Kevin J Donly
Adriana Segura
Adriana Segura
Adriana Segura
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Timothy Henson
Timothy Henson
Timothy Henson
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Matthew Lloyd Barker at Procter & Gamble
Matthew Lloyd Barker
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Abstract

A randomized controlled clinical trial was conducted to compare two professional at-home tooth whitening systems in a teenage population. Informed consent and child assent were obtained from 60 teenagers aged 12-17 (mean age = 14.8). After baseline measurements, subjects were randomized to one of two groups, using either 14% hydrogen peroxide whitening strips or 10% carbamide peroxide in a custom bleaching tray. Strips were used for 30 minutes twice daily, while the tray was worn overnight. Treatment took place for 14 days sequentially, first on the maxillary arch and then on the mandibular arch; all use was unsupervised. Efficacy was measured objectively by L*a*b* color change from digital images obtained at baseline and end of treatment, using combined color measures for both arches. Both professional whitening systems had significant (p < 0.0001) reductions in yellowness (Deltab*) and increased lightness (DeltaL*) after two weeks of treatment on each arch. At the end of treatment, Deltab* or DeltaL* did not differ significantly between the groups (p > 0.28). Tooth sensitivity and mild oral irritation represented the most common adverse events, with only one subject discontinuing treatment as a result. Teenagers who used either bleaching method for two weeks experienced significant tooth whitening without serious adverse events.
Randomized controlled trial of professional at-home tooth whitening in teenage
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Randomized controlled trial of professional at-home tooth whitening in teenage
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Randomized controlled trial of professional at-home tooth whitening in teenage
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... Numerous clinical studies have been conducted to evaluate the efficacy and potential side-effects of inhome whitening treatments. These studies have generally shown effective tooth whitening after in-home treatment, with the most important reported side effects of gingival irritation and dentinal sensitivity occurring in between 6.7-27% and 10-42% of subjects respectively [5][6][7][8][9][10][11][12]. To date, most in-home whitening treatments have been based on hydrogen peroxide or its precursor, carbamide peroxide, as the active ingredient. ...
... One subject in Group 1 reported transient dentinal sensitivity in their daily logs Days 3-5, which did not overlap with the clinical Schiff testing, when this subject did not exhibit any signs or symptoms of hypersensitivity. Subjects in Group 3 reported significantly greater sensitivity, burning mouth, and oral soreness than those in Groups 1 and 2. The level of these side effects in Group 3 was similar to those reported in other studies [5][6][7][8][9][10][11][12]. ...
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... These products originally were based on hydrogen peroxide or its precursor, carbamide peroxide, as the active ingredient, delivering concentrations ranging from 3% to 40% of hydrogen peroxide [1]. However, concerns about potential enamel damage and sensitivity as well as gingival irritation have accelerated the search for alternative active ingredients [2][3][4][5][6][7][8][9]. ...
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... A liberação desses produtos foi estimulada pela Food and Drug Administration (FDA), que justificou o fato de a liberação trazer benefícios a partir da redução de custos e desigualdade no tratamento 9,13 . Na literatura, não há evidências suficientes relatando os efeitos de todos os produtos, devido à grande variedade existente no mercado 10 . Ademais, a utilização de produtos de venda livre pode apresentar efeitos colaterais que podem ser prejudiciais e os resultados podem ser diferentes do esperado em comparação aos tratamentos realizados sob supervisão de um profissional habilitado 9 . ...
Produtos clareadores de venda livre:: uma revisão de literatura
Article
Full-text available
  • Apr 2024
Objetivo: Revisar a literatura quanto aos efeitos dos produtos de venda livre destinados ao clareamento dental disponíveis no mercado brasileiro. Revisão de literatura: Foram consultadas as bases de dados PubMed, Scielo e Google Scholar, além de busca manual de referências. A incessante busca pelo sorriso perfeito aumenta a procura por procedimentos estéticos, como o clareamento dental, recomendado por cirurgiões-dentistas devido à sua segurança e eficácia comprovadas. Contudo, em meio à demanda por alternativas mais acessíveis e que dispensem o acompanhamento profissional, surgiram no mercado os produtos clareadores de venda livre ou OTC (do inglês over-the-counter), que são opções alternativas ao clareamento profissional. Discussão: A predominância de estudos laboratoriais destaca que a eficácia dos produtos OTC difere dos tratamentos profissionais. Os dentifrícios branqueadores contendo peróxido demonstram eficácia na redução de manchas extrínsecas, com desgaste semelhante ou inferior aos dentifrícios regulares, dependendo do substrato avaliado. Já os enxaguatórios clareadores apresentam evidências limitadas de eficácia em comparação aos produtos de concentrações mais elevadas de peróxido. As receitas caseiras e produtos naturais para clareamento dental mostraram-se ineficazes em comparação aos tratamentos profissionais, levantando preocupações sobre sua segurança devido ao potencial de causar danos irreversíveis à estrutura dental. O carvão ativado não possui efeito clareador, apresenta potencial abrasivo e causa manchamento em mucosa bucal. Conclusão: Produtos clareadores OTC, embora atrativos pela autonomia oferecida, não demonstram, em sua maioria, eficácia significativa, devendo seu uso ser recomendando com cautela, preferencialmente com orientação profissional. Salienta-se a importância da educação contínua para que cirurgiões-dentistas acompanhem as tendências nesse campo.
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... A 15 percent carbamide peroxide home bleaching gel was utilized, slightly higher than the typical 10 percent preferred by pediatric dentists treating adolescent patients. 18 Although lower concentration regimens are reported to be safe and efficacious for adolescents, typically causing only mild and transient sensitivity with minimal color relapse over time, 18,[33][34][35] the findings suggest limited efficacy, even with the higher concentration used. This indicates that a regimen with only 10 percent carbamide peroxide would likely be even less effective. ...
Impact of Carbonated Beverages on Color Stability and Home Bleaching Efficacy of BulkFill Composite Resins
Article
  • Jul 2024
  • Pediatr Dent
Purpose: The purpose of this study was to assess, in vitro, the color stability and bleaching response of three bulk-fill composite resins—Activa™, Tetric®-N-Ceram Bulk-Fill, and Filtek™ One Bulk-Fill—and one conventional composite resin, Filtek™ Z250, after immersion in commonly consumed carbonated beverages and subsequent home bleaching with 15 percent carbamide peroxide. Methods: Ninety-six samples (two- and four-mm thick) of the materials were immersed in malt drink, energy drink, cola, or distilled water for one day, one week, and two months. After two months, samples underwent home bleaching with 15 percent carbamide peroxide gel. Spectrophotometric analysis measured color and whiteness changes pre-immersion, post-immersion, and post-bleaching. Statistical significance was determined using factorial mixed analysis of variance (ANOVA), three-way ANOVA, and Bonferroni post hoc tests (P<0.05). Results: All tested composite resins exhibited unacceptable discoloration (color change greater than 3.3) after two months in carbonated beverages. Filtek™ One Bulk-Fill and Filtek™ Z250 displayed the most significant discoloration, particularly when immersed in the malt drink (P<0.05). In contrast, Activa™ samples reached unacceptable discoloration within just one week in malt and cola drinks. Home bleaching yielded limited whiteness recovery, with Activa™ presenting acceptable whiteness post-bleaching after staining with cola and energy drinks. Conclusions: This study highlights the aesthetic risks of prolonged carbonated beverage consumption and the limitations of the assessed home bleaching technique using 15 percent carbamide peroxide. Enhanced dental education on the dietary effects of some beverages on restorative materials is indicated by these findings.
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... The 'DIY 'nature of OTC products, however, arouses concerns about the risk of misuse, overuse and/or abuse [9,10]. OTC products are available in shops, pharmacies and online stores and customers can obtain and use them easily without any medical / dental diagnosis or supervision [11,12]. This approach ignores important clinical interventions including a thorough dental examination, diagnosis and determination of the aetiology of the discoloration, caries susceptibility / management, replacing failed restorations and hypersensitivity management [13]. ...
Evaluating the efficiency of two different over-the-counter tooth whitening systems: a randomised controlled clinical trial
Article
Full-text available
  • May 2024
Objectives To compare whitening efficiency and tooth sensitivity (TS) of two different over the counter (OTC) whitening systems in comparison to conventional at-home bleaching using 20% carbamide peroxide. Materials and methods A randomised controlled clinical trial was conducted with three parallel groups ( n = 13): (A) at-home whitening using 20% carbamide peroxide (20% CP), (B) OTC ready-to-use gel trays and (C) OTC-paint on gel. Clinical colour change values (ΔE) were measured using spectrophotometry at T0: baseline, T1: 7-day and T2: 14-day from whitening start, T3: 2 weeks and T4: 6 months after whitening end. TS was recorded using a visual analogue scale (VAS). ΔE and TS values were statistically analysed. The level of significance for all tests was 5%. Results Significant differences in ∆E values were recorded between the experimental groups. ∆E values were significantly higher in the 20% CP conventional at-home whitening group. TS measurements were significantly higher in the 20% CP whitening group ( p < 0.05). Conclusion Conventional at-home whitening revealed significantly improved colour change when compared to the OTC-paint on gel and OTC ready-to-use gel tray whitening systems. There was a significant colour relapse in OTC systems. Clinical relevance The use of tested OTC systems is not recommended as they are not effective in a clear and prolonged improved shade change. Conventional at-home whitening using 20% CP showed higher whitening efficiency and colour stability. This trial was registered with a International Standard Randomised Controlled Trial Number (ISRCTN23096480), Registration date: 12/04/2023.
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... Although many studies have confirmed their effectiveness in lightening the teeth, the side effects of these formulations have provided a strong impetus to find alternatives. The most important side effects are gingival irritation and dentinal sensitivity, which are reported to occur in 6.7-27% and 10-42% of subjects respectively [4][5][6][7][8][9][10][11]. ...
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... In this section, the Youtubers' comments on the prices of the whitening products were also reviewed. OCTW products are considered as an alternative to treat tooth discoloration with lower cost than traditional professional-prescribed products (Donly et al., 2007). These products could reduce inequity in the access to the health system, reducing the cost of treatments. ...
Public's perceptions on over-the-counter tooth whitening: a YouTube™ videos review and analysis Percepções do público sobre o clareamento dentário de venda livre: uma revisão e análise de vídeos do YouTube™ Percepciones del público sobre el blanqueamiento dental de venta libre: revisión y análisis de videos de YouTube™ Tamires Timm Maske Matheus dos Santos Fernandez Letícia da Silva Pires Lívia Mund de Amorim Rafael Ratto de Moraes Françoise Hélène van de Sande
Article
Full-text available
  • Aug 2022
This study aimed to explore the public's perception on the use of over-the-counter tooth whitening (OCTW) from the analysis of videos deposited in a social media service. A cross-sectional, qualitative, and quantitative study was developed using YouTube TM as a search platform. Videos with personal reviews on the use of OCTW products (toothpaste [WT], strips [WS], whitening pens [WP], and charcoal-based products [WC]) were selected, visualized, and transcribed in verbatim. Transcriptions were analyzed using a content analysis model including seven thematic categories: perceptions of results, adverse effects, using aspects, financial aspects, sensorial perceptions, expectations, and truthfulness in video production. Variables related to engagement and features of the videos were collected and descriptively analyzed. In total, 104 videos were included in the study. Videos about WS (43.9%), followed by WT (22.7%) and WC (16.0%) were the most viewed on the platform. Tooth sensitivity was frequently reported for WS (57.1%) and WT (18.2%). Periodontal tissue disorders were specially noticed in WC and WS videos (16% and 14.3%, respectively). WC showed the highest level of satisfaction in the results (88.8%) and sponsorship for its use. In conclusion, OCTW products can be marketing influenced and applied without professional counselling and they may cause adverse effects. This fact points out the importance of qualified recommendations specially informing the buyer about undesirable or harmful effects to the dental and periodontal tissues. 2 Resumo Este estudo teve como objetivo explorar a percepção do público sobre o uso do clareamento dentário sem prescrição (CDSP) a partir da análise de vídeos depositados em um serviço de mídia social. Foi desenvolvido um estudo transversal, qualitativo e quantitativo, utilizando o YouTubeTM como plataforma de busca. Vídeos com comentários pessoais sobre o uso de produtos de CDSP (creme dental clareador [CDC], tiras [TC], canetas clareadoras [CC] e produtos à base de carvão [PC]) foram selecionados, visualizados e transcritos na íntegra. As transcrições foram analisadas por meio de um modelo de análise de conteúdo que incluiu sete categorias temáticas: percepções de resultados, efeitos adversos, aspectos de uso, aspectos financeiros, percepções sensoriais, expectativas e veracidade na produção do vídeo. Variáveis relacionadas ao engajamento e características dos vídeos foram coletadas e analisadas descritivamente. No total, 104 vídeos foram incluídos no estudo. Os vídeos sobre TC (43,9%), seguidos de CDC (22,7%) e PC (16,0%) foram os mais vistos na plataforma. A sensibilidade dentária foi frequentemente relatada para TC (57,1%) e CDC (18,2%). Distúrbios do tecido periodontal foram especialmente notados nos vídeos de PC e TC (16% e 14,3%, respectivamente). O PC apresentou o maior nível de satisfação nos resultados (88,8%) e patrocínio para sua utilização. Em conclusão, os produtos de CDSP podem ser influenciados pelo marketing e aplicados sem aconselhamento profissional e podem causar efeitos adversos. Este fato ressalta a importância de recomendações qualificadas, especialmente informando o comprador sobre efeitos indesejáveis ou prejudiciais aos tecidos dentários e periodontais. Palavras-chave: Clareamento dental; Mídias sociais; Internet; Medidas de resultados relatados pelo paciente. Resumen Este estudio tuvo como objetivo explorar la percepción del público sobre el uso de blanqueamiento dental de venta libre (BDVL) a partir del análisis de videos depositados en un servicio de redes sociales. Se desarrolló un estudio transversal, cualitativo y cuantitativo utilizando YouTube TM como plataforma de búsqueda. Se seleccionaron, visualizaron y transcribieron textualmente videos con reseñas personales sobre el uso de los productos BDVL (pasta de dientes [PD], tiras [TB], bolígrafos blanqueadores [BB] y productos a base de carbón [PC]). Las transcripciones fueron analizadas utilizando un modelo de análisis de contenido que incluye siete categorías temáticas: percepciones de resultados, efectos adversos, aspectos de uso, aspectos financieros, percepciones sensoriales, expectativas y veracidad en la producción de videos. Se recopilaron y analizaron descriptivamente variables relacionadas con el compromiso y las características de los videos. En total, se incluyeron en el estudio 104 videos. Los videos sobre TB (43,9 %), seguidos de PD (22,7 %) y PC (16,0 %) fueron los más vistos en la plataforma. La sensibilidad dental se informó con frecuencia para TB (57,1%) y PD (18,2%). Los trastornos del tejido periodontal se notaron especialmente en los videos PC y TB (16% y 14,3%, respectivamente). PC mostró el mayor nivel de satisfacción en los resultados (88,8%) y patrocinio para su uso. En conclusión, los productos BDVL pueden verse influenciados por la comercialización y aplicarse sin asesoramiento profesional y pueden causar efectos adversos. Este hecho destaca la importancia de recomendaciones cualificadas que informen especialmente al comprador sobre efectos indeseables o nocivos para los tejidos dentales y periodontales. Palabras clave: Blanqueadores dentales; Medios de comunicación sociales; Internet; Medición de resultados informados por el paciente.
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... In this section, the Youtubers' comments on the prices of the whitening products were also reviewed. OCTW products are considered as an alternative to treat tooth discoloration with lower cost than traditional professional-prescribed products (Donly et al., 2007). These products could reduce inequity in the access to the health system, reducing the cost of treatments. ...
Public's perceptions on over-the-counter tooth whitening: a YouTube™ videos review and analysis
Article
Full-text available
  • Apr 2022
This study aimed to explore the public's perception on the use of over-the-counter tooth whitening (OCTW) from the analysis of videos deposited in a social media service. A cross-sectional, qualitative, and quantitative study was developed using YouTubeTM as a search platform. Videos with personal reviews on the use of OCTW products (toothpaste [WT], strips [WS], whitening pens [WP], and charcoal-based products [WC]) were selected, visualized, and transcribed in verbatim. Transcriptions were analyzed using a content analysis model including seven thematic categories: perceptions of results, adverse effects, using aspects, financial aspects, sensorial perceptions, expectations, and truthfulness in video production. Variables related to engagement and features of the videos were collected and descriptively analyzed. In total, 104 videos were included in the study. Videos about WS (43.9%), followed by WT (22.7%) and WC (16.0%) were the most viewed on the platform. Tooth sensitivity was frequently reported for WS (57.1%) and WT (18.2%). Periodontal tissue disorders were specially noticed in WC and WS videos (16% and 14.3%, respectively). WC showed the highest level of satisfaction in the results (88.8%) and sponsorship for its use. In conclusion, OCTW products can be marketing influenced and applied without professional counselling and they may cause adverse effects. This fact points out the importance of qualified recommendations specially informing the buyer about undesirable or harmful effects to the dental and periodontal tissues.
View
... In response, over-the-counter (OTC) bleaching products soon became popular when they were introduced in the market at the beginning of the 2000s. 1 Hydrogen peroxide, the active agent in the OTC bleaching products, has potential adverse effects such as post-bleaching hypersensitivity, gingival irritation, alteration in enamel microhardness, and even genotoxicity and carcinogenicity. [2][3][4] Concerning those adverse effects, the EU Council Directive 2011/84/EU stated that only the products containing up to 0.1% of hydrogen peroxide were safe and could be sold as cosmetics to consumers without the supervision of dentists on 31 October 2012. ...
Biomimetic tooth-whitening effect of hydroxyapatite-containing mouthrinses after long-term simulated oral rinsing
Article
  • Dec 2021
  • AM J DENT
Purpose: To investigate the tooth-whitening effects of mouthrinses containing different sizes of hydroxyapatite (HAP) particles after prolonged application time and compare them with a commercial whitening mouthrinse. Methods: 50 bovine incisors were stained and randomly distributed into five groups: the HAP groups with 3 µm, 200 nm and 50 nm particle size, the commercial whitening mouthrinse group and the distilled water group. The teeth underwent prolonged mouthrinse applications that were equivalent to simulated 3- and 6-month mouthrinsing. Tooth color was measured and calculated before and after mouthrinsing. The group and application time effects were analyzed with a nonparametric analysis of longitudinal data using the nparLD package in R and ANOVA-type statistic was reported. Pairwise Wilcoxon rank-sum tests with BH correction were performed to compare the tooth color changes of individual groups. The mouthrinse-treated enamel was observed by SEM. Results: The whitening effect of HAP mouthrinses after the prolonged application time was confirmed. The HAP mouthrinses exhibited similar whitening effects to the commercial mouthrinses. The particle size and application time could significantly affect the whitening performance of HAP mouthrinses. The 50 nm HAP group exhibited significantly higher ΔE values than the 3 µm group after the 6-month-equivalent application (P= 0.024). A longer period of application increased significantly the ΔE and ΔL values (P< 0.05). The HAP-treated enamel surfaces were entirely covered with HAP after the 6-month-equivalent application. Clinical significance: The HAP nanoparticles showed better tooth-whitening performance after a longer period of mouthrinsing than the microsized HAP particles. This should be taken into consideration by dental manufacturers for optimizing the particle size for their HAP-containing products. To achieve a better outcome in tooth-whitening, the patients should apply the mouthrinse regularly for an extended period of time.
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Bleaching primary teeth with 10% carbamide peroxide
Article
Full-text available
  • Nov 2001
  • Pediatr Dent
Bleaching teeth with 10% carbamide peroxide in a custom-fitted tray has been popular for more than 10 years. However, primary teeth are seldom considered for bleaching due to the need for compliance by the child and the natural whiteness of the primary teeth. This report describes an indication-teeth darkened from trauma-as well as the technique and outcome for bleaching discolored primary teeth.
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Vital bleaching with a thin peroxide gel - The safety and efficacy of a professional-strength hydrogen peroxide whitening strip (vol 135, pg 98, 2004)
Article
  • Feb 2004
  • J AM DENT ASSOC
Background: Use of higher peroxide concentrations for professional at-home vital bleaching often balances two factors in patient compliance: whitening and tolerability. Development of a polyethylene strip coated with a very thin (0.10-millimeter) layer of 14 percent hydrogen peroxide gel (Crest Whitestrips Supreme, Procter & Gamble, Cincinnati)--which represents an increase in concentration and a decrease in amount of gel--was believed to allow for greater at-home whitening with little additional oral soft-tissue exposure to peroxide. Methods: The authors conducted a randomized, double-blind, two-week clinical trial with 38 adults to evaluate the safety and efficacy of twice-daily use of the thin, concentrated bleaching gel strip versus the effects of a control product (Crest Whitestrips, Procter & Gamble). The two products differed only in concentration (14 percent versus 6 percent) and gel layer thickness (0.10 mm versus 0.20 mm). The authors measured efficacy from digital images using the Commission Internationale de l'Eclairage L*a*b* color scale. They assessed safety via subject interviews and clinical examination and compared treatments using analysis of covariance. Results: Relative to baseline color, both strip groups exhibited significant (P < .001) improvement in yellowness, brightness and composite color change. Between-group comparisons after two weeks demonstrated significant (P < .003) color improvement for the experimental strip relative to the control. Both products were well-tolerated generally. Despite the concentration differences, clinical examination of each group showed a similar low level (11 percent) of "minor oral irritation." Conclusion: Use of the thin 14 percent hydrogen peroxide gel strip resulted in greater whitening, including 42 to 49 percent greater improvement in tooth color and faster whitening onset than that seen with a 6 percent hydrogen peroxide whitening strip, without clinical evidence of increased oral-tissue irritation. Clinical implications: Use of whitening strips with a thin, concentrated layer of hydrogen peroxide gel may represent a useful approach for professionally directed at-home vital bleaching.
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Application of digital imaging in tooth whitening randomized controlled trials
Article
  • Oct 2007
  • AM J DENT
The development of novel peroxide-based bleaching systems during the last several years has prompted the need for robust clinical methods to evaluate whitening response. Advances in digital camera technology and image analysis software provided the basis for an instrumental method to assess tooth color closely following a technique previously used to quantify plaque on tooth surfaces. In vitro and in vivo research was conducted to determine reproducibility of color measurements using this objective, digital imaging method. Each of the 16 tabs in a standard shade guide system was mounted in a jig, and measurement reproducibility was assessed in vitro from paired digital images collected over a 2-day period. Separately, clinical measurement reproducibility was assessed in vivo from paired images of 14 healthy adult volunteers collected over a 2-day period. From these digital images, mean L*, a*, and b* color values were derived for each of the 16 individual shade tabs (in vitro study), or the facial surfaces of the maxillary six anterior teeth (in vivo study) of the 14 subjects. For each data set, variability was determined using ANOVA, and between-visit color measurement reliability was determined from intra-class correlation coefficients (ICCs). In the in vitro study, shade tab yellowness (b*) ranged from 9.0-18.6, lightness (L*) ranged from 63.4-76.2, and redness (a*) ranged from 0.9-3.6. Overall daily means differed by 0.08 units or less, and intra-class correlations for the image pairs were 0.998 for L*, 0.996 for a* and 0.998 for b*. In the in vivo assessment, the 14 volunteers exhibited considerable range in tooth color. Yellowness (b*) ranged from 13.5-21.3, lightness (L*) ranged from 69.2-78.0, and redness (a*) ranged from 5.2-8.8. Clinical measurement of mean tooth color from digital images was highly reproducible across visits. Intra-class correlations for the image pairs were 0.989 for b*, 0.970 for L* and 0.979 for a*.
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Tooth bleaching for children and teens: a protocol and examples
Article
  • Jan 1995
  • QUINTESSENCE INT
Even though there has been much interest in dental bleaching in recent years, little has been reported about patient-applied carbamide peroxide tooth bleaching for children and adolescents. This technique article describes "at home" tooth bleaching for young patients and offers a proven protocol for the procedure. Representative cases are documented with pretreatment and posttreatment photographs. Bleaching in conjunction with enamel microabrasion is also reviewed.
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Tooth color improvement for children and teens: Enamel microabrasion and dental bleaching
Article
  • Jan 1996
Enamel microabrasion and carbamide peroxide-dentist supervised home applied dental bleaching are conservative methods of improving the appearance of teeth. Children and teens can benefit from these procedures. This article describes the step-by-step clinical technique of enamel microabrasion and a protocol for custom-tray-applied, home tooth-bleaching. Representative case histories are documented with photographs.
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A randomized clinical trial comparing a novel 5.3% hydrogen peroxide whitening strip to 10%, 15% and 20% carbamide peroxide tray-based bleaching systems
Article
  • Jul 2000
A randomized and controlled, parallel-group clinical trial compared the whitening benefits of a novel 5.3% hydrogen peroxide bleaching strip to 10%, 15%, and 20% carbamide peroxide tray-based bleaching systems. A total of 36 healthy adults were randomized to a 14-day regimen in which both arches were whitened for 1 hour per day in the whitening-strip group or 2 hours per day in the tray groups. Efficacy was measured objectively using digital images of the anterior teeth at baseline and after 14 days of treatment. Overall tooth color (L*a*b*) was derived from individual pixel values, and then mean levels of delta b*, delta L*, and composite color (delta E*) were compared using analysis of covariance. After 14 days of treatment, all groups experienced a greater than 1-unit mean improvement in delta b*, delta L*, and delta E* relative to baseline. For the primary study variable, reduction of yellow (delta b*) outcomes after 14 hours of using the experimental strip were comparable to those observed with the 10% tray group after 28 hours of use. These two treatment groups did not differ statistically with respect to any of the color measurements used in this study. For the tray groups, there was a reasonable dose relationship for the primary end point, delta b*, with the 15% and 20% tray groups averaging 17% and 68% improvements in yellow, respectively, over the 10% group. Except for the 20% carbamide peroxide system, where sensitivity was relatively common, all test products were well tolerated. In this first comparative evaluation vs marketed controls, use of the whitening strips twice daily for 14 days yielded a highly significant improvement in tooth color vs baseline.
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Tooth Whitening In Children
Article
  • Feb 2002
  • Comp Cont Educ Dent
Although there are several case reports of vital tooth bleaching in children, there is limited clinical trial evidence of the safety or efficacy of this practice. Accordingly, a new clinical trial was conducted to evaluate the effects of 2 different bleaching systems, a 6.5% hydrogen peroxide strip system and a 10% carbamide peroxide tray system, in a population of preteens and teens. A total of 106 volunteers, aged 11 to 18 years, took part in this 8-week study. Patients were randomized by a ratio of 2:1 to the strip or tray groups, with each group treating the maxillary arch first and then the mandibular arch for 4 consecutive weeks each. Individuals assigned to the strip group used the system twice daily for 30 minutes (a total of 56 contact hours over the 8-week study). Those assigned to the tray group used that system overnight (approximately 448 contact hours). Digital images were obtained at baseline and after every 2-week treatment period. Average tooth color was determined in L*, a*, b* color space, where L* indicated lightness, a* indicated red-green, and b* indicated yellow-blue. Both systems significantly whitened teeth (P < 0.0001). While there were no significant differences between groups with respect to the primary whitening response (delta b*) on the maxillary teeth, 4 weeks of overnight treatment with the 10% carbamide peroxide tray (approximately 224 contact hours) yielded statistically significant whitening (P < 0.05) on the mandibular teeth compared with the 6.5% hydrogen peroxide strip used for 28 hours. Both tooth-whitening systems had similar sensitivity/irritation reported after instructed use. This research demonstrates that tooth whitening in teens may be safely accomplished using either the short-contact-time hydrogen peroxide bleaching strips or the overnight carbamide peroxide tray systems tested in this study.
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Clinical trials on the use of whitening strips in children and adolescents
Article
  • Nov 2005
  • Gen Dent
Vital tooth bleaching is becoming increasingly popular. Both professionally supervised and over-the-counter tooth whitening systems are being utilized. Recently, a tooth whitening system became available where a gel containing hydrogen peroxide was delivered via a flexible polythene strip. Three clinical trials were conducted using whitening strips to treat tooth discoloration on 132 children and adolescents. Results indicated the strip bleaching system to be an effective means for tooth whitening. Minimal sensitivity was associated with this whitening system, with most of the reported sensitivity being noted as mild. All sensitivity was relieved upon discontinuance of the whitening agent.
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Extended at-home bleaching of tetracycline-stained teeth with different concentrations of carbamide peroxide
Article
  • Nov 2002
  • QUINTESSENCE INT
The degree of color change and the dental sensitivity associated with the use of different concentrations (10%, 15%, and 20%) of carbamide peroxide every night for 6 months was evaluated in tetracycline-stained teeth. Fifty-nine subjects were shown how to place two different concentrations of carbamide peroxide in the custom trays with reservoirs. For a period of 6 months, the patients were to insert the tray every evening before retiring. Patients returned in 1 and 2 weeks and at 1, 2, 3, 4, 5, 6, 7, 8, and 9 months for evaluation of the degree of color change by subjective shade matching and by photographic means. Sensitivity of hard or soft tissues was self-reported. Fifty-two subjects attended more than 90% of the recalls. A colorimeter was used to convert shade guide tabs to Commission Internationale de l'Eclairage color spaces (CIELAB). The most rapid whitening occurred in the first month. At 3 and 9 months, 91% and 85% of the subjects, respectively, were at least "a little pleased" with the results of the bleaching. In the professional evaluation, 90% of the teeth were deemed to have an excellent or satisfactory esthetic result. The higher the concentration of carbamide peroxide, the more rapidly the lightness value and color difference changed. There was no difference among the three concentrations in resulting gingival sensitivity. Patients experienced less tooth sensitivity with 10% gel than they did with 15% and 20% gels. Bleaching with 10%, 15%, and 20% carbamide peroxide is effective for removing tooth staining caused by tetracycline. The 10% concentration has the most advantages and the fewest disadvantages.
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