Home-based chemically-induced whitening of teeth in adults

University of Michigan, Department of Cariology, Restorative Sciences, and Endodontics,1011 N University, D2361, Cariology/Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, USA.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 4(4):CD006202. DOI: 10.1002/14651858.CD006202
Source: PubMed


Tooth whitening products for use at home work over a short period of time but users should be aware of common side effects and note that long-term data on their use are not yet available. Products for whitening teeth at home are available 'over-the-counter' or from dentists. This review looks at whether such tooth whitening products work and, if so, which are more effective. The review focuses on products which have a chemical, bleaching action rather than an abrasive action. Results found that over a short period of time these products do work, and that there are differences between the products, mainly due to the levels of active ingredients, hydrogen peroxide and carbamide peroxide. People should be aware of common side effects such as tooth sensitivity and irritation to the gums and note that long-term data on the use of such products are not yet available.


Available from: Gisele Neiva
Home-based chemically-induced whitening of teeth in
H Hasson, AI Ismail, G Neiva
Background: 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.
Objectives: 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.
Search strategy: 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. Selection criteria randomized
controlled trials and quasi-randomized controlled trials
of dentist-dispensed or over-the-counter tooth
whitening products with a chemical action (rather than
abrasive action), for home use.
Data collection and analysis: Screening of titles and
abstracts, data extraction and quality assessment were
undertaken independently and in duplicate.
Main results: 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
Australian Dental Journal 2007;52(1):71-72
Australian Dental Journal 2007;52:1. 71
The Cochrane Collaboration is an international organization that aims to help people make well-informed
decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews
on the effects of healthcare interventions. The Cochrane Oral Health Group aims to produce systematic
reviews which primarily include all randomized control trials (RCTs) of oral health, including prevention,
treatment and rehabilitation of oral, dental and craniofacial diseases and disorders. Full copies of the review
papers can be accessed electronically at, clicking on ‘Login to the Cochrane
Library’, followed by clicking on ‘Cochrane Reviews’, and selecting the appropriate review. This is a free service
provided by the Australian Government.
The Australian Dental Journal publishes selected abstracts in each issue for our readers’ interest. A detailed
description of the activities of the Cochrane Oral Health Group, written by the Review Group Co-ordinator,
Dr Emma Tavender, was published in the June 2004 issue of the Journal (Aust Dent J 2004;49:58-59). Also, for
explanations of abbreviations and terminology please see Appendix 1 on page 59 of the aforementioned article.
Page 1
Reproduced with permission of H Hasson, AI Ismail, G Neiva. Home-based chemically-induced whitening of teeth in adults. In: The Cochrane
Library, Issue 4, 2006. Art. No. CD006202 2006. Copyright Cochrane Collaboration, reproduced with permission.
(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.
Authors’ conclusions: 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.
Key Words Plus: Carbamide peroxide; clinical-
evaluation; hydrogen-peroxide; potassium-nitrate;
bleaching agents; tooth whiteners; colour-change; at-
home; gel; efficacy.
72 Australian Dental Journal 2007;52:1.
Tooth whitening procedures are increasingly in demand
from patients, and the dental profession continues to
embrace and recommend various tooth whitening
procedures to patients, despite the clinical outcomes
being highly unpredictable and variable. The aim of
this Cochrane Review is to provide practitioners with
some evidence regarding the use of over-the-counter
(OTC) and dentist dispensed whitening products for at-
home use in adults. The review is limited to at-home
use products and does not cover in-office treatments
and should not be used as an indicator of the
performance of any in-office treatments. The authors
note that of the 416 relevant articles identified, only 25
(6%) met the inclusion criteria for review and all of
these research articles were sponsored by
manufacturers of the whitening products. The review
reports that there is evidence that home-use whitening
products are effective when compared with placebo or
no treatment, however there is no clear indication of
how effectiveness is evaluated. The difference in
efficacy of the products appears to be related to levels
of the active ingredients. An important comment made
in the review is that studies reviewed suffered from
methodological and publication biases which make
comparative analysis between products difficult.
While this review identifies that whitening products can
be effective, all oral health care professionals need to be
careful in their recommendation of at-home use tooth
whitening products and advise patients on the
variability and unpredictable nature of the final tooth
outcome. There are a multitude of factors which may
influence the final result of any tooth whitening
procedure, which have not been a consideration of this
review, and it is difficult to isolate all these factors
unless very large clinical trials are undertaken. The
abstract identifies the importance of informing patients
of the common side effects of tooth sensitivity and
gingival irritation and this is an essential responsibility
of all oral health professionals. In many instances with
OTC products the individual may decide to proceed
with using the product without consultation from any
dental professional. For those patients requesting
advice and evidence on the use of at-home use tooth
whitening products, this Cochrane Abstract, while not
conclusive, does provide a basis to commence informed
Professor of General Practice Dentistry
The University of Queensland
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    • "Tooth-whitening treatment is the most commonly performed procedure in esthetic dentistry and is currently achieved using a large range of bleaching techniques (Hasson et al., 2006). Several techniques include the use of hydrogen peroxide (HP; H 2 O 2 ), a powerful oxidizing agent known as an effective bleaching instrument (Joiner, 2006), however, the products have different concentrations, and other different characteristics such as pH and application mode. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to determine the erosive potential of hydrogen peroxide (HP) containing mouthwash on dentin assessed by Focus variation three-dimensional (3D) microscopy. Twenty dentin slabs were selected and randomly allocated into two groups (n = 10): DW-Distilled water (pH = 7.27) and HP-1.5% (pH = 3.78). Each specimen was cyclically demineralized (4 × 60 s/day, 10 days) with HP or DW and brushed 3×/day (200 g, 150 strokes-toothpaste with 1,450 ppmF as NaF). Between the challenges, the specimens were exposed to artificial saliva. Afterward, dentin loss was analyzed using focus variation 3D microscopy, and the data were submitted to unpaired t-test (α = 0.05). Statistically significant difference was found between the mean wear rate (μm, ±SD) of HP (1.98 ± 0.51) and DW (1.45 ± 0.39). The results suggest that the use of HP-containing mouthwash associated to brushing may increase the risk of tissue loss and focus variation 3D microscopy may be used as a technique for quantifying dental wear. Microsc. Res. Tech., 2013. © 2013 Wiley Periodicals, Inc.
    Full-text · Article · Sep 2013 · Microscopy Research and Technique
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    • "Tooth bleaching has become one of the most popular cosmetic procedures offered in dental practice.1 Several products and techniques are available for vital tooth bleaching, and vary in concentration and type of end products released.2,3 The whitening procedures can be performed in the office by the dentist or at home by the patient without dentist supervision. "
    [Show abstract] [Hide abstract] ABSTRACT: This review investigates erosion and abrasion in dental structures undergoing at- home bleaching. Dental erosion is a multifactorial condition that may be idiopathic or caused by a known acid source. Some bleaching agents have a pH lower than the critical level, which can cause changes in the enamel mineral content. Investigations have shown that at-home tooth bleaching with low concentrations of hydrogen or carbamide peroxide have no significant damaging effects on enamel and dentin surface properties. Most studies where erosion was observed were in vitro. Even though the treatment may cause side effects like sensitivity and gingival irritation, these usually disappear at the end of treatment. Considering the literature reviewed, we conclude that tooth bleaching agents based on hydrogen or carbamide peroxide have no clinically significant influence on enamel/dentin mineral loss caused by erosion or abrasion. Furthermore, the treatment is tolerable and safe, and any adverse effects can be easily reversed and controlled.
    Full-text · Article · Jul 2011 · Clinical
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