Cochrane · intervention · CD006202

Home‐based chemically‐induced whitening (bleaching) of teeth in adults

Eachempati, P, Kumbargere Nagraj, S, Kiran Kumar Krishanappa, S, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library

Oral HealthEsthetic dentistry2 versionsAMSTAR 2: not assessed
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
81
current version
GRADE rated
53
No studies
7
Included studies
71
as reported
No studies 7 · 8.6%Ungraded 21 · 25.9%Very low 50 · 61.7%Low 3 · 3.7%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

ElementPlanned (methods)Found (results)
PopulationHome‐based whitening involving adults who were 18 years old and above were included in our review regardless of gender, race, profession, geographical location or baseline tooth shade. We included participants with teeth stained because of tetracycline use and smokingSeventy studies were in the English language, one was in German. The countries of origin for the included studies were forty‐two from the USA, three trials were from Brazil, five from Germany, four from Italy, four from the UK, three from Spain, two from Switzerland, two from Hong Kong, one from China, two from Turkey, one from Japan, one from Canada, and one from Ireland. The minimum age included in a study was 18 years and the maximum age included in a study was 79 years. The minimum sample size was six and the maximum sample size was 117 with a median value of 58
InterventionAny intervention including home‐based chemically‐induced whitening with comparisons of different interventions; intervention versus placebo or no treatment; comparisons between different concentrations; comparisons between different time periods of applicationCP gel in tray (n=6); HP gel in tray (n=2); HP strips (n=10); CP paint‐on gel (n=1); HP paint‐on gel (n=2); SHMP chewing gum (n=3); STPP chewing gum (n=1); HP mouthwash (n=1); CP tray versus CP tray (n=18); CP tray versus HP tray (n=7); HP strips versus CP tray (n=10); HP strips versus HP tray (n=2); HP strips versus HP strips (n=2); HP strip versus HP mouthwash (n=1); CP paint‐on versus HP strip (n=2); HP paint‐on versus HP strip (n=2); SPC paint‐on versus HP strip (n=1); CP paint‐on versus CP paint‐on (n=2); CP paint‐on versus HP paint‐on (n=1); HP paint‐on versus HP paint‐on (n=1); SPC paint‐on versus CP paint‐on (n=1); SPC paint‐on versus HP paint‐on (n=1)
ComparisonPlacebo/No treatment/Other comparable productsPlacebo (n=26); No treatment (n=2)
OutcomesTooth whitening assessed by the dentist using any relevant tool; Tooth whitening reported by the patient using any relevant tool; Patient satisfaction or acceptability of the tooth whitening procedure; Adverse effects; Oral health‐related quality of lifeTooth whitening assessed by the dentist (n=69); Tooth whitening reported by the patient (n=11); Patient satisfaction or acceptability (n=8); Adverse effects (n=57); Oral health‐related quality of life (n=3)
Study designsRandomised controlled clinical trials comparing dentist‐dispensed or over‐the‐counter (OTC) tooth whitening products (with chemical, bleaching action) with placebo or other comparable productsNR
TimingOutcome data had to be presented for tooth whitening, irrespective of the application timeOutcome data had to be presented for tooth whitening, irrespective of the application time. Long‐term results were reported by some studies at 3 months and 6 months

Search date: 2018-06. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid

Questions and results

Show all 2 versions

10% CP gel in tray vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
7 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
2 weeks · dark baseline shade
MD 10 [9.44, 10.56]1 studyVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
6 months
RR 6.74 [3.15, 14.40]
107 per 1000 vs 722 per 1000
2 studies · 109 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Main adverse events reported in majority of trials were mild and transient tooth sensitivity and oral irritation which occurred more in the intervention group compared to placebo3 studiesUngraded
Tooth whitening - assessed by the dentist
2 weeks
MD 4.56 [1.52, 7.59]1 study · 21 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks
MD 4.70 [3.28, 6.12]1 study · 37 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks · light baseline shade
MD 4.50 [4.04, 4.96]1 studyVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks · medium-dark baseline shade
MD 9.30 [8.75, 9.85]1 studyVery low
Downgraded: risk of bias, imprecision

18% CP paint-on gel vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
3 weeks
MD 3.50 [3.12, 3.88]1 study · 77 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Not reportedNRNo studies

5.3% HP strip vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
9 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
6 months
MD 1.21 [0.67, 1.75]1 study · 52 participantsVery low
Downgraded: risk of bias, imprecision
Oral health-related quality of life
No significant impact of tooth whitening on OHRQoL (Bruhn 2012; Wong 2004)2 studiesUngraded
Tooth whitening - assessed by the dentist
2 weeks
MD 2.24 [1.83, 2.66]4 studies · 195 participantsLow
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
6 weeks
MD 5.16 [4.21, 6.11]1 study · 35 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
3 weeks
MD 7.60 [6.18, 9.02]1 study · 28 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Mild and transient tooth sensitivity and oral irritation were the most common adverse events reported in most of the trials7 studiesUngraded
Tooth whitening - assessed by the dentist
6 weeks
MD 2.90 [1.73, 4.07]1 study · 37 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
15 days
MD 1.93 [1.34, 2.52]1 study · 40 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
day 8
MD 2.24 [1.72, 2.76]1 study · 36 participantsVery low
Downgraded: risk of bias, imprecision

CP paint-on gel vs CP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
3 questions
OutcomeEffectEvidenceStatus / GRADE
Adverse effects
Very mild tooth sensitivity in the 4x/day group; gingival and tooth sensitivity transient, none withdrew2 studiesUngraded
Tooth whitening - assessed by the dentist
2 weeks
MD -0.70 [-2.21, 0.81]1 study · 93 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
1 week
MD 1.39 [0.50, 2.28]1 study · 69 participantsVery low
Downgraded: risk of bias, imprecision

25% CP paint-on gel vs 8.75% HP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
MD -0.16 [-1.39, 1.07]1 study · 59 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Not reportedNRNo studies

19% SPC paint-on gel vs 8.7% HP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
MD -0.36 [-0.71, -0.01]1 study · 56 participantsUngraded
Adverse effects
Tooth sensitivity in one subject from both groups; one subject in 19% SPC reported oral sensitivity; all mild (Gerlach 2003)1 studyUngraded

6% HP strip vs 18% CP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
2 weeks
SMD 1.50 [1.06, 1.94]2 studies · 102 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Not reportedNRNo studies

9.5% adhesion HP strip vs 10% HP strip

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
3 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
day 9
MD -1.50 [-2.33, -0.67]1 study · 29 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
15 days
MD 0.68 [0.16, 1.20]1 study · 35 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Very thin gel had less tooth sensitivity than thicker gel despite higher HP; not significant2 studiesUngraded

14% HP strip vs 35% CP gel in tray

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
8 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
30 days
MD 0.58 [-0.61, 1.77]1 study · 24 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Results variable for tooth sensitivity and oral irritation, some favouring strip, some tray, some no difference7 studiesUngraded
Tooth whitening - assessed by the dentist
2 weeks
MD -0.42 [-0.92, 0.09]4 studies · 149 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
21 days
MD 2.10 [1.16, 3.04]1 study · 55 participantsLow
Downgraded: imprecision
Tooth whitening - assessed by the dentist
6 weeks
MD -0.30 [-0.95, 0.35]1 study · 36 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - reported by the patient
MD -0.41 [-2.05, 1.23]1 study · 43 participantsUngraded
Tooth whitening - assessed by the dentist
1 week
MD -0.71 [-1.35, -0.07]1 study · 32 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
3 months
MD 3.15 [-0.15, 6.45]1 study · 24 participantsVery low
Downgraded: risk of bias, imprecision

CP gel in tray vs CP gel in tray

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
8 questions
OutcomeEffectEvidenceStatus / GRADE
Adverse effects
Higher concentrations of CP in tray led to more tooth sensitivity and gingival irritation; symptoms mild and transient; CP with desensitiser showed significantly less sensitivity4 studiesUngraded
Tooth whitening - assessed by the dentist
2 weeks
RR 1.03 [0.90, 1.18]
912 per 1000 vs 937 per 1000
1 study · 66 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks
MD 2.22 [1.29, 3.15]1 study · 25 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - reported by the patient
3 weeks
MD 2.60 [2.57, 2.63]1 study · 20 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks
MD 0.41 [-2.17, 2.98]1 study · 21 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
6 months
MD 0.78 [0.37, 1.19]1 study · 27 participantsLow
Downgraded: imprecision
Tooth whitening - assessed by the dentist
2-year follow-up
MD 1.20 [-0.35, 2.75]1 study · 81 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks
SMD 0.32 [-0.20, 0.84]2 studies · 58 participantsVery low
Downgraded: risk of bias, imprecision

20% CP gel in tray vs 7.5% HP gel in tray

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
7 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
12 days
MD -0.99 [-2.32, 0.34]1 study · 56 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks
MD -0.58 [-8.01, 6.85]1 study · 37 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks · dark baseline shade
MD -4.30 [-5.02, -3.58]1 studyVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks
MD -1 [-2.86, 0.86]1 study · 48 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
No difference between HP and CP in tray groups in tooth sensitivity and oral irritation3 studiesUngraded
Tooth whitening - assessed by the dentist
12 weeks
MD -0.25 [-0.40, -0.10]1 study · 24 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
2 weeks · medium-dark and light baseline shade
MD -2.22 [-2.63, -1.81]2 studiesVery low
Downgraded: risk of bias, imprecision

HP gel in tray vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Adverse effects
Not reportedNRNo studies
Tooth whitening - assessed by the dentist
14 days
MD 3.08 [2.28, 3.88]1 study · 49 participantsVery low
Downgraded: risk of bias, imprecision

HP paint-on gel vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Adverse effects
HP group had more gum irritation (reddening) than placebo though mild; one case of tooth sensitivity (Collins 2004a)1 studyUngraded
Tooth whitening - assessed by the dentist
2 weeks
SMD 0.67 [0.19, 1.14]2 studies · 148 participantsVery low
Downgraded: risk of bias, imprecision

5.6% SHMP chewing gum vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
4 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
3 days
MD 2.60 [1.45, 3.75]1 study · 20 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Not reportedNRNo studies
Tooth whitening - assessed by the dentist
2 days
MD 0.89 [0.77, 1.01]1 study · 37 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
12 weeks
MD -0.14 [-0.38, 0.10]1 study · 108 participantsVery low
Downgraded: risk of bias, imprecision

1% STPP chewing gum vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
6 weeks
MD 0.18 [0.10, 0.26]1 study · 108 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Not reportedNRNo studies

HP mouthwash vs Placebo

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Adverse effects
Not reportedNRNo studies
Tooth whitening - assessed by the dentist
6 months
OR 10.89 [5.08, 23.35]
0 per 1000 vs 0 per 1000
1 study · 78 participantsVery low
Downgraded: risk of bias, imprecision

5.3% HP strip vs 5% HP gel in tray

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
4 questions
OutcomeEffectEvidenceStatus / GRADE
Patient comfort / acceptability
MD 1.27 [0.13, 2.41]1 study · 28 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Tooth sensitivity and oral irritation mild and transient and did not differ between groups2 studiesUngraded
Tooth whitening - assessed by the dentist
22 days
MD -1.40 [-2.35, -0.45]1 study · 29 participantsVery low
Downgraded: risk of bias, imprecision
Tooth whitening - assessed by the dentist
18 months
MD 0.06 [-2.24, 2.36]1 study · 28 participantsVery low
Downgraded: risk of bias, imprecision

10% HP strip vs 2% HP mouthwash/rinse

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
7 days
MD -1.10 [-1.49, -0.71]1 study · 28 participantsUngraded
Adverse effects
Tooth sensitivity and oral irritation more common in strip group; all mild (Gerlach 2005)1 studyUngraded

5.9% HP strip vs 5.9% HP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
4 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - reported by the patient
MD -0.25 [-1.88, 1.38]1 study · 40 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Adverse events mild; slightly higher tooth hypersensitivity and gingival irritation in strip group but no evidence of a difference2 studiesUngraded
Tooth whitening - assessed by the dentist
MD 1.28 [0.77, 1.79]1 study · 33 participantsUngraded
Tooth whitening - assessed by the dentist
MD 2.70 [2.08, 3.32]1 study · 40 participantsVery low
Downgraded: risk of bias, imprecision

6% HP strip vs 19% SPC paint-on film

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
MD 0.93 [0.59, 1.27]1 study · 47 participantsUngraded
Adverse effects
Tooth sensitivity and oral irritation most common adverse events with strip use; symptomatic only (Bizhang 2007)1 studyUngraded

6% HP paint-on gel + KF vs 6% HP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Tooth whitening - assessed by the dentist
MD -0.10 [-0.56, 0.36]1 study · 67 participantsVery low
Downgraded: risk of bias, imprecision
Adverse effects
Tooth sensitivity in both groups with no evidence of a difference (Ziebolz 2008)1 studyUngraded

SPC paint-on gel vs CP paint-on gel

Population: Adults (>=18 years) undergoing home-based bleaching (including tetracycline- and smoking-stained teeth, any baseline shade)
2 questions
OutcomeEffectEvidenceStatus / GRADE
Adverse effects
One subject in 19% SPC group reported oral sensitivity; all adverse events mild (Barlow 2003)1 studyUngraded
Tooth whitening - assessed by the dentist
14 days
MD -0.58 [-0.95, -0.21]1 study · 38 participantsVery low
Downgraded: risk of bias, imprecision