Title Whitening Strips are Better Than Toothpastes for Reducing Yellowness, But The Results Might Not be Clinically Significant
Clinical Question In all age groups is there a significant difference in the effectiveness of whitening strips vs whitening toothpastes?
Clinical Bottom Line 14% hydrogen peroxide strips are more effective than whitening toothpastes for reducing yellowness, but might not achieve the 4-unit reduction of color determined to be clinically significant.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19838560Demarco/2009Literature review
Key resultsThis review of the literature summarized outcomes for studies with whitening toothpastes, rinses, dental floss and toothbrushes, chewing gum, paint-on gels, trays with light activated gels, and whitening strips. In one study, toothpaste groups did not show color improvement in 14 days vs baseline. Hydrogen peroxide strips with higher concentration (14%) demonstrated improved whitening over 6% strips. Most whitening products do not achieve the clinically significant reduction in yellowness of 4 units.
19681257Yudhira/200746 adultsRandomized Controlled Trial
Key resultsThree groups were followed for 12 weeks: 6% hydrogen peroxide strips and toothpaste; placebo strips and a NaF whitening toothpaste; and placebo strips and a MFP whitening toothpaste. There was no significant difference between the toothpaste groups (p> 0.18). Between group comparisons showed significant reductions in yellowness and redness (p<0.0001). Tooth sensitivity and oral irritation were reported as side effects.
14515596Gerlach/2003348 adults, 60 teenagers; age range 12-72 yrs Integrated review of 7 Randomized Controlled Trial
Key results212 subjects used 14% hydrogen peroxide strips, 152 used one of the bleaching controls, and 60 used placebo strips. Research was conducted at 7 different clinical settings. In a 2-6 week, 14% hydrogen peroxide usage period, 83% exhibited a 2-unit or greater reduction in yellowness index, and 60% with a 3-unit or greater reduction. Relative to placebo, the 14% strip group demonstrated a significant reduction in yellowness index (p<0.0001). Relative to positive controls that included other commercial bleaching agents, the 14% strip group demonstrated significant reduction of yellowness index (p<0.05). Tooth sensitivity was reported by 43% of strip users and oral irritation was reported by 23%.
Evidence Search Whitening, whitening toothpaste, whitening strips, English language, 10 years
Comments on
The Evidence
The authors of 14515596 are employed by the manufacturer of the materials evaluated. Two authors of 19681257 are employed by the manufacturer. The mediocre quality and lack of consistency of study design made it difficult to compare studies to make definitive conclusions. The two articles by authors associated with the manufacturer showed a subtle bias in the reporting of data in that positive results were emphasized. There was insufficient discussion of the clinical relevance of the outcomes.
Applicability The information might be useful to clinicians for advising patients on reducing yellowness of anterior teeth using procedures to be done by the patient at home.
Specialty (General Dentistry) (Restorative Dentistry) (Dental Hygiene)
Keywords Whitening toothpaste and strips, whitening dentrifrice
ID# 2494
Date of submission 08/01/2013
E-mail Platta@ohsu.edu
Author Jacqueline Platta
Co-author(s) Conor Scanlon
Co-author(s) e-mail scanlonc71@gmail.com
Faculty mentor Ronald Sakaguchi, DDS, MS, PHD, MBA and Eli Schwarz, DDS, MPH, PhD
Faculty mentor e-mail sakaguch@ohsu.edu; schwarz@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
None available