Comparison of Whitening Dentifrices on the Effectiveness of In-office Tooth Bleaching: A Double-blind Randomized Controlled Clinical Trial

Over-the-counter products in tooth bleaching: A scoping review

OBJECTIVE

To map and summarize the current scientific evidence concerning the active ingredients, effectiveness, and adverse effects of over-the-counter (OTC) bleaching products.

DATA AND SOURCE

This study was conducted according to the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform.

STUDY SELECTION

Database searches were conducted in PubMed/MEDLINE, Embase, and Scopus up to January 2024. All in vitro, in situ, and clinical studies evaluating the effectiveness and adverse effects of OTC bleaching products were included. A descriptive analysis of the included studies was performed.

RESULTS

A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28). The main OTC bleaching products identified were whitening or stain-removing toothpastes (n = 42), followed by whitening strips (n = 39). Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies. The main adverse effects associated with OTC bleaching agents were tooth sensitivity and gingival irritation.

CONCLUSION

A wide variety of OTC bleaching products is available for consumer self-administered use. Clinical studies have mainly confirmed the bleaching effectiveness of whitening strips, while the validation for toothpastes, mouth rinses and whitening trays has mainly relied on in vitro studies. Nevertheless, the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes.

CLINICAL SIGNIFICANCE

Some over-the-counter bleaching products may have whitening properties supported by clinical studies, particularly those containing hydrogen or carbamide peroxide. Nonetheless, clinicians must be aware of the potential risks associated with excessive self-administration of these products, which may result in adverse effects.

Evaluation of total, soluble and ionic fluoride concentration in whitening and desensitizing toothpastes

PURPOSES

Due to the popularity and increasing launch of toothpastes with whitening and sensitivity properties on the market, this study aimed to evaluate the fluoride concentrations in these products, since the concentrations of fluoride directly interfere with the anti-caries potential.

METHODS

This is an experimental, in vitro study, where 37 samples from different batches (n = 3) purchased in different countries, were analysed in duplicate, via the ion-selective electrode technique to verify the concentration (μg/g or ppm F-) of total fluoride (TF), total soluble fluoride (TSF) and ionic fluoride (IF). For a comparative data analysis, ANOVA was applied followed by a Tukey's test for multiple comparisons. The level of confidence adopted was 95%.

RESULTS

In the 37 assessed toothpastes, 45.9% contained NaF and 54.1% sodium monofluorophosphate (MFP). The TF found in the formulations ranged from 902.8 to 1539.4 ppm of F (mean: 1165.2 ± 179.3); fluoride concentration in the TSF fraction ranged from 708.8 to 1306.7 ppm of F (mean: 959.5 ± 162.4); IF results ranged from 101.9 to 1162.3 ppm of F (642.2 ± 294.1). Significant differences (p < 0.05) were found in the concentrations of the 59.5% assessed toothpastes in comparisons between declared and measured total fluoride (TF) concentrations, as well as in 62.2% when total fluoride (TF) and total soluble fluoride (TSF) were compared.

CONCLUSIONS

In this study, most of the samples evaluated showed discrepancies when compared to the information declared by the manufacturers. In addition, the soluble concentrations found in half of the samples were lower than total concentrations and this may affect anti-caries effectiveness.

Correlation between patient satisfaction and color changes after tooth bleaching

OBJECTIVE

This study aimed to investigate the relationship between patient satisfaction of outcomes and tooth color changes during and after tooth bleaching.

METHODS

In this clinical trial, 63 volunteers participated in an in-office bleaching procedure using a 40% hydrogen peroxide gel. The treatment consisted of two sessions, each comprising two 30-min applications of the bleaching gel. The L*, a*, and b* values of six maxillary anterior teeth were measured at baseline (T1), after the first bleaching session (T2), after the second bleaching session (T3), 1 week after the second in-office bleaching session (T4), and 3 weeks after the second in-office bleaching session (T5). The color differences (ΔE00 ) were calculated using CIEDE2000. A satisfaction scale with a score ranging from 0 to 3 was used to record participants' level of satisfaction with their tooth color at each time point. The data were statistically analyzed using repeated measures analysis of variance and logistic regression (α = 0.05).

RESULTS

Significant correlations were observed between ΔL*, Δb*, and ΔE00 values at T3 and patient satisfaction (all p < 0.05). The regression model indicated a more pronounced impact of Δb* on patient satisfaction compared to ΔL*. The established regression models were as follows: Logit (PL*b* ) = -4.354 + 0.271ΔL* - 0.585Δb* and Logit (PΔE00 ) = -2.552 + 0.521ΔE00 . The findings suggested a minimum ΔE00 value of 4.90 for satisfactory results. A minimum ΔE00 value of 3.9, 5.0, and 6.8 was necessary for central incisors, lateral incisors, and canines, respectively, to achieve a satisfactory result.

CONCLUSIONS

The ΔL*, Δb*, and ΔE00 values were found to be significantly correlated with patient satisfaction after bleaching. Δb* was identified as having a greater influence on patient satisfaction than ΔL* values in the regression model. Furthermore, attaining a minimum ΔE00 value of 4.90 is necessary to achieve satisfactory outcomes. A greater ΔE00 value is needed for canines than for incisors to achieve equivalent patient satisfaction.

CLINICAL SIGNIFICANCE

This study emphasizes the importance of considering the extent of color change needed to achieve patient satisfaction after tooth bleaching procedures.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

OBJECTIVES

This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration.

METHODOLOGY

A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained.

RESULTS

CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD.

CONCLUSIONS

CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Effect of smile esthetics on the quality of life in a Han Chinese population

OBJECTIVE

This study aimed to explore the influence of smile esthetics on the quality of life in a Han Chinese population.

METHODS

A total of 110 Han Chinese volunteers (52 males and 58 females, mean age 26.7 years) were recruited, and frontal images of their smiles were collected. A photoediting program was used to evaluate the following components of smile esthetics: the buccal corridor ratios, the angle between the interpupillary and commissural lines, the number of visible teeth, and width-to-length ratios of the maxillary central incisors. Oral health-related quality of life (OHRQoL) in these volunteers was evaluated using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile-14 (OHIP-14). Statistical analyses were performed by using Pearson's correlations and multiple linear regression (α = 0.05).

RESULTS

Compared to males, females scored higher on psychological impact (p = 0.017). Moreover, the number of visible teeth had a significant effect on social impact, psychological impact and esthetic concern (all p < 0.05). However, the buccal corridor ratios, the angle between the interpupillary and commissural lines, and the width-to-length ratios of the maxillary central incisor did not correlate with the OHRQoL (all p > 0.05).

CONCLUSIONS

The number of visible teeth significantly influenced the quality of life in a Han Chinese population. Smile esthetics had a significantly greater psychological impact on females than males.

CLINICAL SIGNIFICANCE

This study highlights the effects of smile esthetics on the quality of life in a Han Chinese population. Female patients may raise more esthetic concerns in clinical practice.

Does the application of whitening dentifrices during at-home bleaching affect the bond strength of resin composite to dentin?

AIM

This study aimed to evaluate the effect of using whitening dentifrices during at-home bleaching on the shear bond strength (SBS) of resin composite to dentin, and investigate whether the increased polymerization time would improve SBS.

METHODS

Ninety-six bovine incisors were divided into 4 groups of 24, according to the whitening treatment applied as follows: group 1, at-home bleaching + brushing with a regular dentifrice; group 2, at-home bleaching + brushing with a whitening dentifrice containing ozone; group 3, at-home bleaching + brushing with a commercial whitening dentifrice; and group 4 (control), no whitening/brushing treatment. Each group was divided into two subgroups (n = 12) to assess the effect of curing time (20 versus 80 s) on SBS. A self-etch adhesive was bonded to dentin, and after 2-day water storage, SBS was determined.

RESULTS

SBS was significantly affected by the whitening treatment (P = 0.03), but increasing the curing time had no significant effect on SBS (P = 0.137). Bond strength in group 1 was comparable to the control group (P > 0.05). The specimens in group 3 displayed significantly lower SBS than either group 4 or group 1 (P > 0.05). No significant difference was observed between the SBS of group 2 compared to any other group (P > 0.05). There was no significant association between the treatment group and failure type (P > 0.05).

CONCLUSION

The bonding interface was not negatively influenced by the at-home bleaching procedure. However, using a commercial whitening dentifrice during at-home bleaching produced a significant detrimental effect on SBS. Extending the curing time would have no beneficial effect on adhesion to a whitened dental substrate.

Whitening Optical Effect of New Chewing Gums

Background:

Today, many treatments are available to enhance the color of teeth, but they require a few days to weeks to deliver this effect.

Objective:

To evaluate the instantaneous optical whitening effect of two new sugar-free chewing gums and one dentifrice of proven efficacy versus one placebo chewing gum.

Methods:

This was a single-blind, parallel trial. 424 participants entered the study and were randomly allocated to four groups. They received a personal silicone mask with a calibrated hole at one upper incisor to apply a dental colorimeter. The tools tested were chewing-gum containing indigotine (E132-FD&C Blue 2) and spirulina, chewing-gum containing only spirulina, chewing-gum placebo, and dentifrice containing Blue Covarine. Vita® Easyshade scored the tooth color, and the WIO and WID whiteness indexes were calculated. For chewing gums, the color of the teeth was scored before the assumption and after 2’30” of mastication. For dentifrice, participants brushed for 1’30”, then rinsed, and the color was scored before brushing and after 2’30”. Statistical analysis was performed by ANOVA and Tukey post-hoc.

Results:

The two experimental whitening chewing gums and the dentifrice significantly increased the WIO and the WID indexes from the baselines (p<0.001). Moreover, their effects were statistically greater than those reported for the placebo chewing gum (p<0.05) but not significatively different among them (p=NS).

Conclusion:

All the tested whitening tools showed an instant optical whitening perception. Further studies are required to assess the intensity of the effect over a prolonged time to meet the people's request for fast whitening tools.

The clinical trial registration no. is PVM-2020-01.

In vivo evaluation of whitening toothpaste efficiency and patient treatment satisfaction: a randomized controlled trial

OBJECTIVES

To assess the whitening efficiency and patient satisfaction after usage of commercially available toothpastes with the different whitening ingredients.

MATERIALS AND METHODS

This randomized controlled trial study comprised 161 participants who were randomly divided into eight groups based on used whitening or control/conventional toothpaste (Colgate Max Expert White [CMEW], n = 20; Signal Daily White [SDW], n = 20; Himalaya Sparkly White Herbalis [HSWH], n = 20; Signal White System [SWS], n = 20; Rembrandt Deeply White + Peroxide [RDWP], n = 20; Splat Extreme White [SEW], n = 20; Splat White Plus [SWP], n = 21; and Kalodont Multi Repair [control], n = 20). Tooth color and color change were evaluated using a spectrophotometer (CIELAB coordinates, ΔE_ab*, ΔE₀₀, whiteness index change [ΔWID]). Measurements were performed at baseline, 30 days and 60 days after the beginning of treatment, and 30 days after completing treatment - follow-up. Side effects and satisfaction with the whitening outcome were reported throughout the questionnaire.

RESULTS

The results for ΔL*, Δa*, and Δb* showed an increase in lightness and decrease in yellowness for all tested whitening toothpastes compared to the control group after 30 days of use (p ≤ 0.05). Also, significant tooth color difference (ΔE_ab*, ΔE₀₀) and whiteness index change (ΔWI_D) were recorded for all tested whitening toothpastes 30 days and 60 days from the beginning of use (p ≤ 0.05). Toothpaste containing a combination of urea peroxide and enzyme ingredients (SEW) demonstrated the highest and the longest whitening effect.

CONCLUSIONS

Whitening toothpastes can show perceptibly whitening effect after a short time of usage, but without a long-lasting impact.

CLINICAL RELEVANCE

Toothpaste containing a combination of enzymes and peroxides showed the best whitening performance compared to those containing only enzymes, peroxides, or abrasives.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04460755.

A Comparative Evaluation of Nanohydroxyapatite-Enriched Hydrogen Peroxide Home Bleaching System on Color, Hardness and Microstructure of Dental Enamel

This study aimed to evaluate two hydrogen peroxide (HP)-based at-home bleaching systems in order to analyze whether nano-hydroxyapatite (nHA) addition may represent a reliable and safe solution for tooth whitening without altering dental microstructure and hardness. Human third molars (N = 15) were treated with two bleaching agents, one containing 6%HP (6HP) and the other 6% HP nHA-enriched (6HP-nHA) with average particle diameter ranging from 5-20 nm. Their effects on enamel were assessed using a spectrophotometer, Vickers microhardness (VMH) test and Scanning Electron Microscopy (SEM), comparing the treated groups with the non-treated control group (CTR). Color analysis revealed improvement in whiteness in both groups compared to CTR. VMH test results showed no differences among the groups. SEM analysis highlighted no evident changes in the enamel microstructure of tested groups compared to CTR. At high magnification, in 6HP group, a slight increase in irregularities of enamel surface morphology was observed, while 6HP-nHA group displayed removal of the aprismatic layer but preservation of the intact prismatic structure. These results suggest that the 6HP-nHA agent may be recommended to provide reliable whitening treatment, without damaging the enamel micromorphology and hardness.

Effects of Aging on the Color and Translucency of Monolithic Translucent Y-TZP Ceramics: A Systematic Review and Meta-Analysis of In Vitro Studies

Background

Monolithic restorations made of translucent yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) have become popular over the past few decades. However, whether aging affects the color and translucency of monolithic translucent Y-TZP is unclear.

Objective

The aim of this systematic review and meta-analysis of in vitro studies was to evaluate the effects of aging on the color and translucency of monolithic translucent Y-TZP ceramics.

Materials and Methods

This systematic review/meta-analysis was reported according to the PRISMA statement and registered in the OSF registries (https://osf.io/5qjmu). Four databases including Medline via the PubMed, Embase, and Web of Science databases and the Cochrane Library were searched using no publication year and language limits. The last search was executed on November 20, 2020. In vitro studies comparing the translucency and/or color of monolithic translucent Y-TZP ceramics before and after simulated aging were selected. Meta-analyses were performed using Review Manager software (version 5.3, Cochrane Collaboration, Oxford, UK) with random-effects models at a significance level of 0.05. A risk-of-bias assessment was also performed for the included studies.

Results

Of the 188 potentially relevant studies, 13 were included in the systematic review. The hydrothermal aging duration ranged from 1 to 100 h at relatively similar temperatures (~134°C). In the general meta-analyses, the aged Y-TZP ceramics exhibited similar translucency parameter (TP), L^∗, and b^∗ values compared with the nonaged controls (P = .73, P = .49, and P = .62, respectively). Moreover, there was a significant difference between the aged and nonaged Y-TZP ceramics in the a^∗ value (P = .03; MD = −0.26; 95% CI = −0.51 to − 0.02), favoring the nonaged Y-TZP ceramics. The subgroup analyses showed that the duration of aging contributed to changes in the translucency and color of the Y-TZP ceramics.

Conclusions

The optical properties of monolithic translucent Y-TZP ceramics were stable after hydrothermal aging at 134°C and 0.2 MPa for ≤20 h. Moreover, clinically unacceptable changes in the translucency and color of monolithic translucent Y-TZP ceramics were found after hydrothermal aging for >20 h.

Efficacy of whitening toothpaste containing blue covarine: A double-blind controlled randomized clinical trial

OBJECTIVE

This randomized clinical trial evaluated the efficacy and safety of a blue-covarine whitening toothpaste on tooth bleaching.

SUBJECTS AND METHODS

Seventy-five subjects with shade mean C1 or darker were randomized into three groups (n = 25): CT-conventional toothpaste, WT-whitening toothpaste, and CP10-10% carbamide peroxide. Subjects from CT and WT brushed their teeth twice/day for 2 weeks. CP10 used bleaching gel for 4 hours/night for 2 weeks. Tooth shade and CIELab parameters were measured at baseline, after the first application, 2- and 4-week. ΔE*_ab and ΔE₀₀ were calculated. Subjects' perception about tooth color appearance, tooth sensitivity (TS), and gingival irritation (GI) were also assessed.

RESULTS

At all evaluation periods, it was not observed differences between WT and CT considering tooth shade (P > 0.7) or CIELab parameters (P > 0.3). At 2- and 4-week, ΔE*_ab and ΔE₀₀ were higher for CP10 than WT or CT (P = 0.001). WT and CT reported major dissatisfaction with tooth color appearance than CP10 (P = 0.001). At 1- and 2-week, WT experienced GI and TS similar to CT, both lower than CP10 (P < 0.01).

CONCLUSION

There were no significant differences in the whitening efficacy between whitening and conventional toothpastes. Neither of the dentifrices was as effective as at-home bleaching.

CLINICAL SIGNIFICANCE

The silica-based toothpaste containing blue covarine evaluated in this study did not give significant tooth whitening benefits over 2 weeks of use.

Short-term effects of stain-causing beverages on tooth bleaching: A randomized controlled clinical trial

OBJECTIVES

To evaluate the short-term effects of stain-causing beverages on the effectiveness of in-office tooth bleaching.

METHODS

Participants were recruited and randomly divided into 3 groups based on beverages used for rinsing during and after the bleaching procedure: group N (tap water, control group), group C (coffee), and group T (tea). Participants were instructed to rinse with the respective solutions for 30 s, 4 times daily for 4 weeks. All participants received two in-office bleaching treatment sessions with 40 % hydrogen peroxide (Opalescence BOOST PF 40 %, Ultradent); the sessions were separated by a 1-week interval. Tooth colour was assessed using a spectrophotometer (Easyshade, Vita ZahnFabrik) before the bleaching procedure (T0), immediately after the first session of bleaching (T1), immediately after the second session of bleaching (T2), as well as one week (T3) and three weeks after (T4) the end of bleaching. Tooth sensitivity (TS) was ranked using a numerical rating scale (NRS) and a visual analogue scale (VAS) at different time points.

RESULTS

No significant difference in the whiteness index (W), △E, △a* and △b* values among the 3 groups was observed at any time interval (P for all > 0.05). At T4, the △L* value in group C was significantly lower than that in groups T and N (P = 0.022 and P = 0.001, respectively), though no significant difference in △L* values was observed among the 3 groups at T1 (P = 0.402), T2 (P = 0.643) and T3 (P = 0.177). Additionally, no significant difference was found in the TS values among the 3 groups at any of the evaluation time points (P for all > 0.05).

CONCLUSIONS

Exposure to coffee or tea during the bleaching treatment period did not affect the effectiveness of the treatment. However, exposure to coffee after the bleaching treatment did affect the effectiveness of the treatment. Exposure to stain-causing beverages did not affect the bleaching-induced TS (ClinicalTrials.gov Identifier: NCT03933527).

CLINICAL SIGNIFICANCE

The consumption of coffee or tea during tooth bleaching may not interfere with the colour change produced by the treatment. However, clinicians should advise their patients to refrain from, at least to some extent, consuming coffee after the bleaching procedure to maintain the effectiveness of the treatment.

Effect of whitening dentifrices containing optical agent on the variation of color, roughness and mass of a nanoparticulate composite resin

Abstract Introduction Blue covarine is a pigment that promotes optical changes in dental surfaces, providing whitening. Objective To evaluate in vitro the effect of bleaching dentifrices containing Blue covarine in nanoparticulate composite resin subjected to artificial darkening. Material and method One hundred sixty (160) specimens (PBs) of FILTEK Z350XT nanoparticulate composite resin were randomly divided into two experiments: Experiment I - 8 groups (n=10) submitted to brushing with an electric toothbrush for 1 month; Experiment II - 8 groups (n=10) submitted to simulated brushing for 6, 12 and 24 months. Groups were distributed according to the solution/dentifrice tested: CG (distilled water) and 7 test groups (GT1- Coltene Herjos, GT2- Colgate Total 12 Clean Mint, GT3- Colgate Luminous White Brilliant Mint, GT4- Oral B 3D White Perfection, GT5- Close Up White Now Glacier Fresh, GT6- Close Up White Attraction Diamond and GT7- Sorriso Xtreme White Evolution). Result In Experiment I, there was greater ∆E in GT6 in relation to CG, GT2, GT4 and GT5, with no differences among them. In Experiment II, after 24 months of brushing, there was greater ∆E in groups GT6 and GT7. After 24 months of simulated brushing, there was no change in roughness or loss of mass in any group. Conclusion The whitening effect promoted by dentifrices containing the agent Blue covarine seems to be related to the association of this agent with the abrasives present in the formulations of whitening dentifrices.

Influence of different types of whitening tooth pastes on the tooth color, enamel surface roughness and enamel morphology of human teeth

Background: Tooth whitening usually includes the direct use of gels containing carbamide or hydrogen peroxide on the tooth enamel surface through a wide variety of products formulas. A generally new advancement in whitening of teeth uses the significant importance of the tooth color shift from yellow to blue in delivering a general enhancement in the observation of tooth whiteness. The aim of the current work was to measure the tooth whitening effects, surface roughness and enamel morphology of six different types of blue covarine-containing and blue covarine-free toothpastes using in vitro models. Methods: A total of 70 sound extracted human premolars were randomly and equally divided into seven groups, and each subjected to tooth brushing using different toothpastes. Tooth color and enamel surface roughness were measured before and after the brushing procedure using a white light interferometer, and scanning electron microscopy (SEM) was used to assess tooth surface after the procedure. Results: Toothpaste containing blue covarine resulted in the greatest improvement in tooth color amongst all groups as well as a statistically significant color difference when compared to blue covarine-free toothpaste.  Furthermore, blue covarine-containing toothpaste resulted in fewer morphological changes to the enamel surface. This was confirmed with SEM images that showed smooth enamel surfaces with fine scratches.   Conclusions: The results from the present study show that blue covarine containing toothpastes are reliable, effective in tooth whitening and produce less surface abrasion when compared to blue covarine-free toothpastes.