Title

Longitudinal Efficacy of At-Home Teeth Whitening Systems

Clinical Question

For adults, ages 18 and older, does an at-home whitening treatment lead to an increase in staining post-treatment?

Clinical Bottom Line

At-home whitening treatments exhibited significant whitening effects throughout the study periods (up to 18 months). The studies showed that tooth whitening was sustainable to a large degree up to the 18 month threshold. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
19723943	Meireles/2009	92 patients; ages 18-55 with mean shades of C1 or darker; no smokers included.	Randomized, double-blind clinical trial
Key results	Even with the consumption of staining beverages and foods, teeth retained a 71% whitening effectiveness after 1 year. The study calculated a P<0.001 for both whitening products compared to baseline.
19681255	Bizhang/2007	72 patients; ages 18-60 with shades A2 or darker; some smokers and coffee/tea/cola drinkers included.	Randomized, placebo-controlled clinical trial
Key results	Shade remained significantly lighter than the baseline 18 months post-treatment; the study calculated P<0.0001. The treatment exhibited an 88.5% whitening effectiveness over the 18 month study period.
12074226	Gerlach/2002	57 patients; ages 18-71 including smokers and coffee/tea drinkers.	Randomized, double-blind, placebo-controlled clinical trial
Key results	Patient’s maintained a significant difference from baseline after 6 months. The whitening effectiveness remained near 91.7% with a P<0.0001 when compared to baseline shade.

Evidence Search

(("tooth bleaching"[MeSH Terms] OR ("tooth"[All Fields] AND "bleaching"[All Fields]) OR "tooth bleaching"[All Fields]) AND ("longevity"[MeSH Terms] OR "longevity"[All Fields])); (("tooth bleaching"[MeSH Terms] OR ("tooth"[All Fields] AND "bleaching"[All Fields]) OR "tooth bleaching"[All Fields]) AND ("colour"[All Fields] OR "color"[MeSH Terms] OR "color"[All Fields]) AND ("retention (psychology)"[MeSH Terms] OR ("retention"[All Fields] AND "(psychology)"[All Fields]) OR "retention (psychology)"[All Fields] OR "retention"[All Fields])) Filters: Humans; Randomized Controlled Trial, Systematic Reviews, Meta-Analysis; English

Comments on
The Evidence

No meta-analysis or systematic reviews on the subject were found. The studies did have small sample sizes, but there was very little drop-out. Both of the Gerlach et. al., and Bizhang et. al., studies were sponsored by The Proctor & Gamble Company; a potential bias.

Applicability

This evidence is applicable to patients and dental professionals concerned with the longitudinal efficacy of tooth whitening treatments.

Specialty

(General Dentistry) (Dental Hygiene)

Keywords

Tooth whitening, tooth bleaching, color retention, color stability, longevity

ID#

2500

Date of submission

07/08/2013

E-mail

kelso.crystal@gmail.com

Author

Crystal Kelso

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Ronald Sakaguchi, DDS, MS, PhD, MBA & Eli Schwarz, DDS, MPH, PhD

Faculty mentor e-mail

schwarz@ohsu.edu; sakaguch@ohsu.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?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Jaanki Patel (San Antonio, TX) on 08/09/2013
I conducted a PubMed search on this topic in August 2013 and found a more recent publication by Giachetti L. in 2011 (PMID 21037194 ). The primary goal of this RCT was to compare results of in-office whitening to an at-home system; however, the study also evaluated the longevity of both techniques up to nine months post-bleaching. Giachetti et al. note that although there are factors that can affect the degree of bleaching efficacy, the clinical bottom line remains true. The findings support those discussed in the CAT: at-home tooth bleaching can produce sustainable whitening.