Effectiveness of Whitening Strips Use Compared With Supervised Dental Bleaching: A Systematic Review and Meta-analysis

Abstract

Clinical Relevance Bleaching performed at home while under the supervision of a dentist provides greater color alteration compared with whitening strips when evaluated with a spectrophotometer, although the color alteration was undetectable by unaided human eyes. SUMMARY Objective: A systematic review and meta-analysis were performed to answer the following research question: Does the use of whitening strips (WS) lead to an equivalent color change compared with supervised dental bleaching in patients with permanent dentition? Methods: A search was performed on August 10, 2017 (updated on March 22, 2019), in PubMed, the Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature database, Cochrane Library, Scopus, Web of Science, and SIGLE, without restrictions regarding date or language. Abstracts from the International Association for Dental Research, unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (parallel or split mouth) in patients with permanent dentition that compared WS with dentist-supervised dental bleaching performed at home (AH) or in office (IO) were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A meta-analysis with subgroup analysis (low and high peroxide concentration) was conducted for color change ΔE* (spectrophotometer) and ΔSGU (shade guide units), risk and intensity of tooth sensitivity (TS), gingival irritation (GI), and patient satisfaction using a random effects model. Heterogeneity was assessed with the Cochrane Q test and I2 statistics. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of the evidence. Results: After the removal of duplicates, followed by title and abstract screening, 20 studies remained. Only two studies were considered to have a low RoB; 11 had a high RoB, and seven had an unclear RoB. For WS versus IO, data were not available for the meta-analysis. For WS versus AH bleaching, a significant difference in ΔE* favoring the AH group was observed (standardized mean difference [SMD] = −0.50, 95% confidence interval [CI] −0.79 to 0.21), but the risk (risk ratio = 0.78, 95% CI 0.65 to 0.93) and intensity of TS (SMD = −0.30, 95% CI −0.56 to −0.04) were lower in the WS group. Color change in ΔSGU, risk and intensity of GI, and patient satisfaction were not significantly different between groups (p>0.20). The quality of evidence for ΔE*, risk and intensity of TS, and intensity of GI were graded as moderate. Conclusion: Although the risk and intensity of TS were lower in the WS group, dentist-supervised at-home bleaching led to a better color change when measured with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.

Pilot study on the applicability of boron‐doped diamond electrodes for tooth whitening

“…The use of a digital spectrophotometer (e.g., VITA Easyshade V; VITA Zahnfabrik H. Rauter, Bad Säckingen, Germany) or an intraoral scanning device (TRIOS 4; 3Shape A/S, Copenhagen, Denmark) would have been an alternative for objective shade determination (Preethi Suganya et al, 2020 ; Revilla‐León et al, 2021 ; Tabatabaian et al, 2021 ; Youssef, 2021 ). While these advanced shade selection methods unanimously are described as being more precise, the clinical relevance of such measurements has been questioned in a recent meta‐analysis as these may be too sensitive and differences recorded with such instruments may not be detectable by the unaided human eye (da Rosa et al, 2020 ).…”

“…Tooth whitening has been described as one of the most noteworthy advancements in esthetic dentistry (Blatz et al, 2019 ) and has become one of the most requested dental treatments (Rodríguez‐Martínez, 2019 ). Several approaches (Carey, 2014 ) with respect to materials and application modes such as in‐office bleaching, home bleaching (da Rosa et al, 2020 ) and internal bleaching (Frank et al, 2021 ) are available (Epple et al, 2019 ).…”

Excessive Dental Bleaching with 22% Carbamide Peroxide Combined with Erosive and Abrasive Challenges: New Insights into the Morphology and Surface Properties of Enamel

“…However, the action of peroxides appears to be intricately linked to the concentration of the gel and primarily to the time of exposure. With an increase in these variables, the oxidation process is more Materials 2022, 15, 7496 2 of 10 intense, possibly resulting in complications and exacerbated effects [4,[10][11][12][13]. However, other studies have shown that lower concentrations of bleaching gel do not change the mass measurement [6] or surface roughness (SR) [5], but can affect the enamel microhardness (MH) [5].…”

“…Low concentrations of peroxides (10–22% carbamide peroxide or 3.5–10% hydrogen peroxide) are used for a longer application time compared to the office technique [ 2 , 3 ]. However, in some countries, these bleaching products do not require a prescription, thus the patient can easily use them without professional supervision, and may exceed the usage time in an attempt to obtain whiter teeth [ 4 ].…”

Effects of prolonged use of over‐the‐counter bleaching agents on enamel: An in vitro study

“…In general, at‐home bleaching products provide lower concentrations of active bleaching agents to minimize the health risks linked to the use of hydrogen peroxides (da Rosa et al, 2020; Rezende, Ferri, Kossatz, Loguercio, & Reis, 2016). Those products can be either supplied by the dentist and delivered in customized trays or purchased directly by the patient without professional guidance.…”