Title	Carbamide Peroxide Gel is as Effective as Hydrogen Peroxide Gel for Teeth Whitening
Clinical Question	In an adult patient with natural dentition, is carbamide peroxide gel as effective as hydrogen peroxide gel for teeth whitening?
Clinical Bottom Line	Hydrogen peroxide gel and carbamide peroxide gel both provide statistically significant whitening improvement after two weeks. Both gels are also equal in their effectiveness in bleaching teeth.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18246965 Delgado/2007 46 adults Randomized Controlled Trial Key results Both the carbamide peroxide and hydrogen peroxide treated groups showed statistically significant whitening improvement after 5, 7, and 14 days. After 5 days, 9% hydrogen peroxide was statistically more efficient in bleaching compared to carbamide peroxide. However, after 7 and 14 days, the groups had equal results. 14520776 Nathoo/2003 59 adults Randomized Control Trial Key results The patients in each group showed statistically significant (p < 0.05) shade lightening results at the two-week and three-week evaluations. At both evaluations, there was no statistically significant difference in the degree of whitening achieved between the groups.
Evidence Search	(("carbamide peroxide" [Supplementary Concept]) AND "Hydrogen Peroxide"[Mesh]) AND "Tooth Bleaching"[Mesh]
Comments on The Evidence	These two single randomized controlled trials show great validity with similar statistically significant results after two weeks. In both of the trials, the groups were similar at the start and were treated the same. In Delgado’s trial, all 46 adults had zero restorations on their maxillary anterior teeth. The patients were all given a baseline, 5-day, 7-day and 14-day shade by 1 of 2 examiners using the same Vita guide with color-corrected lighting. However, even though the 2 examiners were calibrated, there could still be some variation in their ability to accurately choose a shade. In Nathoo’s trial, the two treatment groups were balanced for baseline Vita shade guide scores, sex, and age. The subjects in each of the two groups were given the same toothbrush, non-whitening toothpaste and application instructions at the beginning of the trial. All the subjects had their tooth shade reevaluated with the Vita shade guide after 2 and 3 weeks of using their assigned product.
Applicability	Whitening agents have become very popular in today's society. Patients’ frequently turn to their dentist to help them choose the best product. The evidence presented in these articles suggests that dentists can be confident in prescribing either hydrogen peroxide gel or carbamide peroxide gel for effective whitening.
Specialty	(General Dentistry) (Restorative Dentistry) (Dental Hygiene)
Keywords	Carbamide peroxide gel, hydrogen peroxide gel, bleaching, tooth whitening
ID#	2226
Date of submission	04/26/2012
E-mail	fraserl@livemail.uthssa.edu
Author	Lindsey Fraser
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Mary Norma Partida, DDS, MPH
Faculty mentor e-mail	partidam@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) None available