Effectiveness of Dentist-Prescribed, Home-Applied Tooth Whitening, A Meta-analysis

Abstract

Introduction Common clinical experience suggests that tooth whitening agents are 100% effective. This study uses meta-analysis of data from published randomized controlled clinical trials to determine the efficacy of tooth whitening agents. Methods A MEDLINE search strategy was developed and implemented to systematically identify clinical trials on dentist-prescribed, home-applied tooth whitening agents, using 10% carbamide peroxide, published between 1989-1999. Inclusion criteria (e.g., in English, human clinical trials) and exclusion criteria (e.g., not placebo controlled) were established and clinical trials that met these criteria were critically appraised for validity and clinical applicability. Meta-analysis was then used to quantitatively integrate the findings. Results Seven studies were identified that met the inclusion and validity criteria. These studies indicated that: Whitening results in a significant mean change of 6 4 shade guide units (p < 0.01), while the placebo control group exhibited little change (0.7 0.6, p > 0.05). 93% of the bleached patients exhibited 2 shade guide unit change, while 20% of the placebo control group exhibited this change. The brand of bleaching agent had a significant effect on tooth whitening, but the daily application time and duration of treatment did not. Whitening is maintained for 6 months for 1/2 of the people treated. Neither gingival indices nor plaque indices were adversely or favorably affected by bleaching. Clinical Applicability The data from the reviewed studies indicate that rather than being 100% effective, on average: 73% (93% for bleached group minus 20% placebo group) of people who whiten their teeth will exhibit a whitening that is 2 shade guide units greater than the placebo. 20% of the people who use dentist-prescribed, home-applied bleaching will achieve a mean whitening effect of 5 shade guide units. Re-treatment for 50% of people may be necessary to maintain this effect longer than 6 months. The methods used here are Internet applicable for other clinical topics.

The bleaching of teeth: A review of the literature

“…In addition, 20% of subjects who used the peroxide product achieved a mean change of five shade guide units. 105 Ishikawa-Nagai et al 106 evaluated the tooth colour change of 80 subjects after using 10% carbamide peroxide in a gum shield over 14 days and found a strong correlation between total colour change and b * values, demonstrating that bleaching works efficiently for teeth with a yellow hue. Further, an analysis of the clinical results with over 600 subjects undergoing tooth bleaching, indicate that the yellower the teeth at baseline, the greater the magnitude of the whitening response.…”

Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis

“…The full texts of these 29 studies were assessed to check if they were eligible. Among them, 16 were excluded due to the following reasons: (1) old systematic reviews [ [13,21]], (2) case series studies [ [22]], (3) placebocontrolled studies [ [23][24][25]], (4) studies that did not compare PC and PH products [ [26][27][28][29][30][31]], and (5) studies that did not employ a control tray-delivered CP product [32][33][34][35].…”

One‐Year Clinical Evaluation of the Efficacy of a New Daytime At‐Home Bleaching Technique

“…At‐home vital bleaching is probably the safest, most patient‐pleasing method of obtaining effective tooth bleaching because of the noninvasive nature of this treatment. The most commonly employed active ingredient is 10% CP gel, which has shown satisfactory clinical results 7–9 . A meta‐analysis of seven clinical studies indicated a significant mean change from baseline of 6.4 shade guide units according to the Vitapan Vita guide scale by the use of tray‐based bleaching systems utilizing 10% CP gels 7 …”

“…The most commonly employed active ingredient is 10% CP gel, which has shown satisfactory clinical results. [7][8][9] A meta-analysis of seven clinical studies indicated a significant mean change from baseline of 6.4 shade guide units according to the Vitapan Vita guide scale by the use of tray-based bleaching systems utilizing 10% CP gels. 7 Although the overnight bleaching with the application of 10% CP exhibited desirable whitening effects, the long duration of the treatment directed the manufacturers toward developing new systems with shorter treatment times and with CP concentrations higher than 10%.…”