Highlighted review: Home-based chemically-induced whitening (bleaching) of teeth in adults

Prashanti Eachempati, Sumanth Kumbargere Nagraj, Salian Kiran Kumar Krishanappa, Puneet Gupta, Ibrahim Ethem Yaylali

Plain language summary: Home‐based chemical bleaching of teeth in adults

Review question
What evidence is available regarding the different home‐based chemically‐induced bleaching agents in whitening teeth?

Background
There has been an increasing demand for whiter teeth. Home‐based whitening products with a bleaching action have become popular and are prescribed to people by the dentist or purchased over‐the‐counter.

A variety of whitening products are available which include hydrogen peroxide, carbamide peroxide, sodium percarbonate, sodium hexametaphosphate, sodium tripolyphosphate, and calcium peroxide.

These agents are supplied in different concentrations and are used with different methods of application (gel in tray, strips, paint‐on gel, chewing gum, and mouthwash), which have varying application times and duration of treatment.

Study characteristics
Authors from Cochrane Oral Health carried out this review of existing studies and the evidence is current up to 12 June 2018.

We included 71 trials that involved 3780 adults who underwent tooth whitening procedures with various bleaching agents using different methods of application, length of application and duration of treatment.

26 studies compared a bleaching agent to placebo and 51 studies compared one bleaching agent to another bleaching agent.

Key results
The bleaching agents whitened teeth compared to placebo over a short time period (from 2 weeks to 6 months), however the certainty of the evidence is low to very low.

The evidence currently available is insufficient to draw reliable conclusions regarding the superiority of home‐based bleaching compositions or any particular method of application or concentration or application time or duration of use.

The most common adverse events were tooth sensitivity and oral irritation, which were reported with higher concentrations of active agents, although the effects were mild and transient.

Well‐planned randomised controlled trials need to be conducted by standardising methods of application, concentrations, application times and duration of treatment.

Certainty of evidence
The overall certainty of the evidence was low to very low for all comparisons. This was because most of the comparisons were reported in single trials with small sample sizes and event rates. There was an unclear risk of bias in most of the trials.

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Citation: Eachempati  P, Kumbargere Nagraj  S, Kiran Kumar Krishanappa  S, Gupta  P, Yaylali  IE. Home‐based chemically‐induced whitening (bleaching) of teeth in adults. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD006202. DOI: 10.1002/14651858.CD006202.pub2.