Title

Comparing The Application Method Of Different Peroxide-Containing Tooth Whitening Systems

Clinical Question

In patients with discolored teeth, does undergoing at-home tooth whitening with bleaching trays, compared to using over-the-counter bleaching systems, experience a more esthetic result?

Clinical Bottom Line

The findings in these short term studies are significant as the custom tray group experienced on average greater color improvement compared to either the paint-on gel or activated peroxide whitening dentifrice, differing significantly (p< 0.01) from either of the barrier-free systems. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
15794456	Gerlach/2004	43 adults	Randomized Controlled Trial
Key results	The custom tray group experienced a significantly better color improvement (p< 0.01)compared to either the paint-on gel or activated peroxide whitening dentifrice that did not experience a significantly different color change (p< 0.10). Tooth sensitivity and oral irritation were the most common side effects in the tray and dentifrice groups, but there were no side effects in the paint-on group.
17054282	Hasson/2006	25 articles	Systematic Review
Key results	“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)” quoted from Weyant Results.

Evidence Search

PubMed: "Tooth Bleaching"[Mesh] AND "Tooth Discoloration"[Mesh] AND "Dentifrices"[Mesh] AND "Esthetics, Dental"[Mesh]

Comments on
The Evidence

Studies used in the systematic review used short term follow-up periods and were supported by manufacturers of the products tested. Independent long term studies are needed to clarify the long term effectiveness of these procedures.

Applicability

Using a barrier-based tray system for tooth whitening provides superior tooth color enhancement compared to other barrier-free over-the-counter whitening systems.

Specialty

(General Dentistry) (Restorative Dentistry)

Keywords

whitening, bleaching, sensitivity, esthetic, time

ID#

474

Date of submission

01/13/2010

E-mail

cooperrb@uthscsa.edu

Author

Amber Todora

Co-author(s)

R. Bryn Cooper

Co-author(s) e-mail

Faculty mentor

Kevin M. Gureckis, DMD

Faculty mentor e-mail

gureckis@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?)

None available

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

by Emily Moers (San Antonio, TX) on 04/24/2012
After a similar evidence search, a more recent article in the American Journal of Dentistry, 2007, reiterated the above key findings. PMID: 17993029 randomized control trial or 87 adults found 6% hydrogen peroxide whitening strips significantly whitened teeth compared to whitening gel and placebo.