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Title 6.5% Hydrogen Peroxide and 10% Carbamide Peroxide Effectively Treat Tetracycline-Stained Teeth
Clinical Question In a patient with tetracylcine staining, does the at-home bleaching system successfully whiten teeth as compared to no treatment at all?
Clinical Bottom Line 6.5% hydrogen peroxide and 10% carbamide peroxide effectively treat tetracycline-stained teeth. This is supported by a clinical trial that successfully showed patients improved their tooth shade over a 6 month period of time of using a take-home tray-less kit of 6.5% hydrogen peroxide gel. Carbamide peroxide is also an effective treatment that has shown to have lasting effects for at least 90 months after a 6 month treatment course. These treatments are effective options that many patients will likely accept rather than no treatment at all.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22073810Kugel/2011N= 30 participantsRCT
Key results“The 6.5% hydrogen peroxide strip provided significant improvement in subjects with tetracycline stains.” After the 6 month trial was completed, 65% of the subjects reached a B1 color using the expanded VITA shade guide.
#2) 12859112Leonard/2003N= 15Case Study Survey
Key results10% Carbamide Peroxide for 6 months has shown to have long lasting effects for at least 90 months with minimal shade reduction over that time frame. Also showed that the patients were very positive about the lack of post-treatment side effects.
Evidence Search Tetracycline staining AND peroxide OR Haywood
Comments on
The Evidence
The first article is an RCT that was not a double-blind study, and included a group of subjects that all had symptoms of tetracycline staining on their teeth. The results were followed monthly for a 6-month period and compliance seemed to be adequate stating that the treatment was “generally well-tolerated.” The downside to this evidence was the lack of information regarding the degree of staining the subjects had prior to treatment. The 2nd article was a post treatment survey for patients who received a 6 month treatment of 10 % carbamide peroxide, which was useful to determine long-term results and side effects.
Applicability This study shows that offering this treatment is very applicable for general dentists encountering these types of patients. The general dentist should warn the patient of the possibility of tooth sensitivity while using the 6.5% hydrogen peroxide strips or the 10% carbamide peroxide tray system.
Specialty/Discipline (General Dentistry)
Keywords Tetracycline Bleaching, hydrogen peroxide,
ID# 2237
Date of submission: 04/12/2012spacer
E-mail davenportm@livemail.uthscsa.edu
Author Matthew Davenport
Co-author(s) e-mail
Faculty mentor/Co-author Robert A. Kaminski, DDS, MS
Faculty mentor/Co-author e-mail KaminskiR@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Erin Kern, Erin Son (San Antonio, Texas) on 11/28/2017
The PubMed database and TRIP database were searched for the above terms in November 2017, and a more recent study was found comparing the two forms of at-home whitening discussed in the CAT. Botelho/2017 (PMID: 28478214) is an RCT on the effects of at-home bleaching on tetracycline-stained teeth. The trial found that 6% hydrogen peroxide and 15% carbamide peroxide both had whitening effects on tetracycline-stained teeth without any adverse reactions. This supports the original findings of the CAT and does not change the answer to the previously published clinical question.

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