Intervention Review

Home-based chemically-induced whitening of teeth in adults

  1. Hana Hasson*,
  2. Amid Ismail,
  3. Gisele Neiva

Editorial Group: Cochrane Oral Health Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 20 AUG 2006

DOI: 10.1002/14651858.CD006202


How to Cite

Hasson H, Ismail A, Neiva G. Home-based chemically-induced whitening of teeth in adults. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006202. DOI: 10.1002/14651858.CD006202.

Author Information

  1. School of Dentistry, University of Michigan, Department of Cariology, Restorative Sciences and Endodontics, Ann Arbor, Michigan, USA

*Hana Hasson, Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, 48109-1078, USA. hanahass@umich.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

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 methods

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

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.

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 (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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

Home-based chemically-induced whitening of teeth in adults

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

背景

成人之居家化學牙齒美白

在美國,過去10年內,不需處方籤的或是由牙醫師配方的家用牙齒美白產品已經變成很容易買到的。由於現今對於牙齒美白需求的快速成長,牙醫界基於設計良好且獨立研究之科學結論給予大眾建議是有必要的。

目標

評估市售或由牙醫師提供含化學成份之牙齒美白產品的效用(與安慰劑或其他有效的產品相比較)以及副作用。

搜尋策略

我們搜尋了the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3);MEDLINE (January 1966 to September week 2 2005); 以及 EMBASE (1988 to week 39 2005)。也從1995年以後出版之選定的牙科期刊目錄中去搜尋其他的參考資料。亦以書面郵寄向此研究領域的專家求取進一步的研究報告與資料。在最終的一組研究報告被確認後,去檢閱被包含的研究報告之參考資料清單,來找出進一步的研究。用英文或是非英文出版的研究報告均被考慮在此報告內。

選擇標準

由牙醫師提供或市售之化學家用牙齒美白產品(不是研磨(abrasive)作用)的隨機對照試驗(randomised controlled trials)以及類隨機對照試驗(quasirandomised controlled trials)。

資料收集與分析

題目以及摘要之篩選,資料萃取及品質評估是獨立且重複的進行。

主要結論

共找到416篇文章,其中25篇符合標準,其所呈現出來的資料可供用於分析。所有試驗均於產品使用2週後作成果檢測,只有13個研究指出產品使用兩週後1個星期的觀察結果,而僅6個研究顯示1個月或更久之後的情形。有4個試驗被評估具有中度風險之偏差(bias),其它均具高度風險之偏差。所有的試驗均由牙齒美白產品製造商贊助。6個試驗比較不同的美白產品(模拖裝凝膠(gel in trays),膠片(painton films),美白條(whitening strips))與安慰劑或不治療的效果。所有的分析均顯示產品有效,儘管大部份的比較均是以單一試驗(single trials)為基礎。19個試驗是把不同的美白產品彼此之間作比較。只有1個統合分析(metaanalysis),其包括多於1個的試驗,顯示出不同美白產品間有統計上的顯著差異。美白條(5.5%至6.5%hydrogen peroxide (HP))比模拖裝凝膠(at 10% carbamide peroxide (CP))有效,平均差異為1.82(95%CI為0.26至3.38)。這些研究均被評為具高度風險之偏差,輕微至中度的牙齒敏感(tooth sensitivity)及齒齦刺激(gingival irritation)是最常見的副作用。美白條和含有高HP的美白產品造成較多使用者抱怨牙齒敏感。對於漂白前準備參加者之草案,在眾多研究中,是不一致的。關於美白的基本評分(baseline scores of whiteness)數據在大多數的研究中沒有被報告出來。目前關於牙齒美白產品的證據基礎均受限於方法與出版的偏差。

作者結論

有證據顯示在與安慰劑或不治療比較時,美白產品很有用。美白產品間效用有差異,主要是因為有效成份的含量不同,例如HP,CP。所有的試驗均為短期,且大部份的研究均被判斷有高度風險之偏差,以及所有的試驗全部由製造商贊助或主導。有必要做長期、實用的獨立臨床研究,其包括可以代表不同族群的參與者。也有必要針對長期傷害做評估。應告知社會大眾,根據一些研究報告或測量指出,常見的副作用為牙齒敏感及牙齦刺激。

翻譯人

本摘要由臺灣大學附設醫院朱想想翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

家用牙齒美白產品在很短的時間內就有效,但使用者應被告知常見的副作用,並且要提及目前還沒有關於長期使用這些產品的報告。家用牙齒美白產品可由市售或向牙醫買到。此篇報告著眼於牙齒美白產品是否有作用,哪種產品比較有用。此篇報告的重點在於具有化學的、漂白的作用之產品,而不是研磨劑作用之產品。研究結果顯示,在一段短的作用時間內,這些產品就有作用;其作用在產品與產品間有差異,主要是由於有效成份的含量不同,諸如HP,CP。人們應知道一般常見之副作用,諸如牙齒過敏以及對於牙齦之刺激,以及提及目前尚無關於使用這類藥物的長期資料。

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

Izbjeljivanje zubi kod kuće kemijskim preparatima kod odraslih osoba

Izbjeljivanje zubi kod kuće kemijskim preparatima kod odraslih osoba

Proizvodi za izbjeljivanje zubi za primjenu kod kuće djeluju nakon kraćeg vremenskog perioda ali korisnici trebaju biti svjesni čestih nuspojava i uzeti u obzir da još nisu dostupni dugoročni podaci o njihovoj primjeni. Proizvodi za izbjeljivanje zubi kod kuće dostupni su ‘bez recepta’ u prodavaonicama ili kod zubara. Ovaj pregled sagledava da li su takvi proizvodi za izbjeljivanje zubi učinkoviti i, ako jesu, koji su učinkovitiji. Pregled se fokusira na proizvode koji imaju kemijski i učinak izbjeljivanja, a ne abrazivno djelovanje. Rezultati pokazuju da ovi proizvodi doista djeluju tijekom kraćeg vremenskog perioda, te da postoje razlike između proizvoda, uglavnom zbog razine aktivnih sastojaka, hidrogen peroksida i karbamid peroksida. Ljudi bi trebali biti svjesni čestih nuspojava kao što su osjetljivost i iritacija desni te uzeti u obzir da još nisu dostupni dugoročni podaci o primjeni ovih proizvoda.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre