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PubMed2000

Effectiveness of dentist-prescribed, home-applied tooth whitening. A meta analysis.

INTRODUCTION: Common clinical experience suggests that tooth whitening agents are 100% effective. This study uses meta-analysis of data from published randomized controlled clinical trials to determine the efficacy of tooth whitening agents. METHODS: A MEDLINE search strategy was developed and implemented to systematically identify clinical trials on dentist-prescribed, home-applied tooth whitening agents, using 10% carbamide peroxide, published between 1989-1999. Inclusion criteria (e.g., in English, human clinical trials) and exclusion criteria (e.g., not placebo controlled) were established and clinical trials that met these criteria were critically appraised for validity and clinical applicability. Meta-analysis was then used to quantitatively integrate the findings. RESULTS: Seven studies were identified that met the inclusion and validity criteria. These studies indicated that: Whitening results in a significant mean change of 6 4 shade guide units (p < 0.01), while the placebo control group exhibited little change (0.7 0.6, p > 0.05). 93% of the bleached patients exhibited 2 shade guide unit change, while 20% of the placebo control group exhibited this change. The brand of bleaching agent had a significant effect on tooth whitening, but the daily application time and duration of treatment did not. Whitening is maintained for 6 months for 1/2 of the people treated. Neither gingival indices nor plaque indices were adversely or favorably affected by bleaching. CLINICAL APPLICABILITY: The data from the reviewed studies indicate that rather than being 100% effective, on average: 73% (93% for bleached group minus 20% placebo group) of people who whiten their teeth will exhibit a whitening that is 2 shade guide units greater than the placebo. 20% of the people who use dentist-prescribed, home-applied bleaching will achieve a mean whitening effect of 5 shade guide units. Re-treatment for 50% of people may be necessary to maintain this effect longer than 6 months. The methods used here are Internet applicable for other clinical topics.

Adult↗
PubMed1993

Toxicity of two carbamide peroxide products used in nightguard vital bleaching.

This study evaluated the effects of two generic classes of 10% carbamide-peroxide (CP) oxygenating agents (currently under clinical assessment for nightguard vital tooth bleaching) for lethality and genetic mutation after oral administration to mice, and for cellular cytotoxicity to mouse fibroblasts in vitro. The single dose LD50 values for a non-carbopol-containing CP (Gly-Oxide) and a carbopol-containing CP (Proxigel) in mice were found to be 143.8 mg/kg and 87.2 mg/kg, respectively. Genotoxicity, as measured by the Mouse Micronucleus test for mutagenicity, was negative for both 10% CP agents in comparison with positive and negative controls. Cytotoxicity as measured in the L929 fibroblast lysis assay resulted in 50% killing of L929 fibroblasts at 0.62 for the non-carbopol-containing CP and 1.88 mmol/L for the carbopol-containing CP. Both 10% CP agents were compared with seven widely-used dental products in the L929 fibroblast lysis assay and found to be no more toxic than these products.

Analysis of Variance↗
PubMedDate not supplied

The effect of different bleaching agents on the surface texture of restorative materials.

This blind in vitro study evaluated the effect of a home and an in-office bleaching agent on the surface texture of different tooth-colored restorative materials. Four composites (a hybrid, a flowable, a microhybrid and a nano-hybrid), an ormocer and a ceramic were used, and 2 bleaching agents were tested: 38% hydrogen peroxide and 15% carbamide peroxide. For 38% hydrogen peroxide, the surface morphology of the restorative materials was evaluated after the following time periods: before bleaching, after 15, 30 and 45 minutes of bleaching, 24 hours and 1 month after bleaching. For 15% carbamide peroxide, the time periods were: before bleaching, after 8 and 56 hours of bleaching and 24 hours and 1 month after bleaching. For the 4 composite materials and the ormocer, 2 samples groups were prepared; in 1 group, the specimens were polished and in the other, they stayed unpolished. For the ceramic group, polished samples were prepared. For every material, 3 samples per category and time period were prepared, respectively. Subsequently, the appropriate bleaching procedure was performed on samples of every group. Scanning electron micrographs were produced at 60x, 200x and 2000x magnifications of respective areas of the samples. The results showed that the effect of bleaching on the surface texture was material- and time-dependent. Within the limitations of this study, it was concluded that bleaching with 38% hydrogen peroxide and 15% carbamide peroxide did not cause major surface texture changes on the polished surfaces of the restorative materials.

Carbamide Peroxide↗
PubMed2004

Effect of light energy on peroxide tooth bleaching.

BACKGROUND: Light-activated bleaching is a method of tooth whitening. The authors conducted a study to compare the whitening effects and tooth temperature changes induced by various combinations of peroxide bleaches and light sources. METHODS: The authors randomly assigned 250 extracted human teeth halves into experimental groups (n = 10). A placebo gel (control), a 35 percent hydrogen peroxide or a 10 percent carbamide peroxide bleach was placed on the tooth surface and was irradiated with no light (control); a halogen curing light; an infrared, or IR, light; an argon laser; or a carbon dioxide, or CO2, laser. Color changes were evaluated immediately, one day and one week after treatment using a value-oriented shade guide and an electronic dental color analyzer. The outer enamel and inner dentin surface temperatures were monitored before and immediately after each 30-second application of light using a thermocouple thermometer. RESULTS: Color and temperature changes were significantly affected by an interaction of the bleach and light variables. The application of lights significantly improved the whitening efficacy of some bleach materials, but it caused significant temperature increases in the outer and inner tooth surfaces. The IR and CO2 laser lights caused the highest tooth temperature increases. CONCLUSIONS: Dentists performing an in-office bleaching technique with the use of an additional light source to accelerate tooth whitening should consider the specific bleaching agent being used, as well as the potential risks of heating teeth. CLINICAL IMPLICATIONS: A specific combination of bleach and light that demonstrates good color change and little temperature rise should be selected for in-office tooth bleaching.

Argon↗
PubMed2006

External bleaching therapy with activation by heat, light or laser--a systematic review.

OBJECTIVE: External bleaching procedures utilizing highly concentrated 30-35% hydrogen peroxide solutions or hydrogen peroxide releasing agents can be used for tooth whitening. To enhance or accelerate the whitening process, heat-activation of the bleaching agent by light, heat or laser is described in the literature. The aim of the present review article was to summarize and discuss the available information concerning the efficacy, effects and side effects of activated bleaching procedures. SOURCES: Information from all original scientific full papers or reviews listed in PubMed or ISI Web of Science (search term: (bleaching OR brightening OR whitening OR colour) AND (light OR laser OR heat OR activation)) were included in the review. DATA: Existing literature reveals that activation of bleaching agents by heat, light or laser may have an adverse effect on pulpal tissue due to an increase of intra-pulpal temperature exceeding the critical value of 5.5 degrees C. Available studies do not allow for a final judgment whether tooth whitening can either be increased or accelerated by additional activation. CONCLUSION: Therefore, application of activated bleaching procedures should be critically assessed considering the physical, physiological and patho-physiological implications.

Humans↗
PubMed2006

Spectrophotometric and visual evaluation of vital tooth bleaching employing different carbamide peroxide concentrations.

OBJECTIVE: The aim of the present study was to assess the hypothesis that the efficiency of vital tooth bleaching depends on the concentration of carbamide peroxide agents. METHODS: The front teeth of 30 subjects were bleached at home with 10%, 17% or 0% (control) carbamide peroxide for 1 week in a double-blind study design. Tooth shades were determined in the LCH color space employing a visual shade matching system and a spectrophotometer. Differences in lightness (Deltal), chroma (Deltac) and hue (Deltah) were measured to assess the treatment process. After 2 weeks of no treatment, tooth shades were evaluated again to assess stability of the resultant shade. RESULTS: First-time changes of shade values could be observed after 3 days in the 17% group and after 7 days in the 10% group. After 1 week, in both the 17% group (Deltal: 2.80, Deltac: -3.33, Deltah: 0.60) and the 10% group (Deltal: 2.61, Deltac: -2.54, Deltah: 0.09), values for lightness and chroma were significantly different from the control (Deltal: 0.13, Deltac: 0.14, Deltah: 0.21, p<0.05) with no difference between the test groups (p>0.05). Two weeks after treatment, a rebound of shade values could be observed in the test groups (p<0.05). SIGNIFICANCE: The study indicates that higher concentration bleaching agents might whiten teeth faster with major changes in lightness and chroma. However, by bleaching daily for 1 week, similar effects can be achieved with both a high and a low concentration agent. After treatment, a regression of the resultant shade has to be expected.

Carbamide Peroxide↗
PubMed1997

Acute illness and recovery in adult female rats following ingestion of a tooth whitener containing 6% hydrogen peroxide.

PURPOSE: To determine whether ingestion of a tooth whitener containing 6% hydrogen peroxide as bleaching agent affected the gastric mucosa of adult, female laboratory rats. MATERIALS AND METHODS: Thirty-six fasting rats were intubated with a single bolus (5 g/kg body weight) of the tooth whitener Natural White which contains 6% hydrogen peroxide. Thirty-two control rats received deionized water. Rats were necropsied 15 minutes, 2 hours, 1 and 2 weeks after whitener ingestion. The gastric mucosa was examined histologically and blood hematocrit, glucose, BUN, and bilirubin measured. RESULTS: Six of the 36 rats died within 2 hours of receiving whitener. Within 15 minutes of whitener ingestion, stomachs were grossly bloated with gas. Histological observation showed that gastric mucosal cells were vacuolated and gastric glands dilated. After 2 hours, gastric epithelial and glandular cells had sloughed off into the gastric lumen. Mean blood glucose and hematocrit were significantly (P < 0.05) elevated (233 +/- 41 mg/ml and 50.5 +/- 0.9%) over mean control values (129 +/- 8 mg/ml and 42.8 +/- 2.4%). Within 1 week, the stomachs of experimental rats were no longer bloated, the gastric mucosa appeared normal histologically, but mean blood hematocrit was significantly (P < 0.05) decreased (38.0 +/- 1.5%) from mean control value (43.3 +/- 0.5%). There were no significant differences in mean blood values 2 weeks after whitener ingestion.

Acute Disease↗
PubMed1997

In vitro adherence of bacteria to bleached or unbleached enamel surfaces.

The purpose of this in vitro study was to evaluate the effects of three 10% carbamide peroxide bleaching agents on adherence of bacteria to tooth enamel surface. Enamel specimens were subjected to one of three carbamide peroxide solutions for 8 h per day for 30 days. Control specimens were kept in saline solution. Profilometer evaluation of surface roughness was performed on all specimens. The adherence of Streptococcus mutans was determined bacteriologically. There was no significant difference in surface roughness between the untreated and treated enamel specimens but a statistically significant difference was found in the adherence of S. mutans to bleached and unbleached enamel specimens. Specimens treated with Opalescence showed the highest adherence.

Analysis of Variance↗
PubMed2005

Extrinsic whitening effects of sodium hexametaphosphate--a review including a dentifrice with stabilized stannous fluoride.

The number of tooth whitening products available to patients has grown dramatically during recent years. While peroxide is the primary agent found in products that bleach and remove intrinsic sources of discoloration, various ingredients are incorporated in formulations to remove and inhibit extrinsic sources of tooth discoloration, ie, tooth stain. Recently, an advanced antitartar ingredient with extrinsic-stain-inhibiting benefits was introduced: sodium hexametaphosphate. This long-chain condensed phosphate, also known as polypyrophosphate, chemically removes existing stains and provides long-lasting inhibition of new-stain chromogen adsorption. Sodium hexametaphosphate was originally introduced in a sodium fluoride dentifrice formulation and was later marketed in a chewing gum delivery system. Recently, sodium hexametaphosphate was launched in another dentifrice formulation containing stabilized stannous fluoride (Crest Pro-Health). This article reviews published clinical and laboratory data demonstrating sodium hexametaphosphate's extrinsic whitening benefits in all three formulations.

Cariostatic Agents↗
PubMed1999

Bleaching agents.

Explore the source record for details and available documents.

Dental Enamel↗
PubMed2004

Effect of home bleaching agents on the microhardness of human enamel and dentin.

In this study, the effects of home bleaching agents that contains carbamide peroxide (in different concentrations such as 10 and 15%) on the surface hardness of human enamel and dentine were evaluated. The buccal surfaces of 90 recently extracted human mandibular anterior teeth were used. The specimens in the dentine group were ground to expose of dentine surface. Then, samples in both enamel and dentine group were randomly divided into six main groups with 15 in each group. In the group 1 and 4, 15% carbamide peroxide was applied to the enamel and dentine surfaces and then the teeth were left in an incubator at 37 degrees C and 100% humidity for 4 h first, then left 28 h after repeating the same procedures seven times. The teeth were treated with 10% carbamide peroxide in groups 2 and 5 and distilled water in groups 3 and 6 (control groups), using the same procedures. Vicker's microhardness of enamel and dentine were assessed on each tooth before and after each treatment period (4 and 28 h). The hardness of control group specimens was also obtained after 4 h in distilled water and then after 28 h. For statistical analysis one-way ANOVA and post-hoc Tukey tests were used. For both 10 and 15%, there were no statistically significant differences between the untreated control specimens and the specimens treated with the bleaching materials for enamel and dentine at any given measurement time (P > 0.05). Nevertheless, in vivo use of bleaching agents on tooth hard tissues requires further analysis.

Carbamide Peroxide↗
PubMed2002

Real-time monitoring of stain formation and removal on calcium hydroxyapatite surfaces using quartz crystal sensor technology.

Stain formation, stain inhibition and stain removal may be monitored in real-time using a novel method employing a quartz crystal resonance sensor (QCR), based upon quartz crystal microbalance (QCM) technologies. Crystalline hydroxyapatite (HA) surfaces were prepared on phosphate-terminated, polymer-modified gold surfaces of quartz crystal transducers. The resulting sensors were placed in a specially constructed flow cell, and the interaction of adsorbates from the tea stain solution monitored as a function of time. The ability of sodium tripolyphosphate (STP) to remove extrinsic stain and also to inhibit its formation was examined. The adsorption of material from the staining solution passed over the sensor was clearly observable, and once bound, the crystal based real-time data suggest that tea adsorbates were not removed in the absence of an active under conditions of continuous flow. STP was shown to rapidly remove existing stain, and exhibited a clear inhibitory action on stain formation irrespective of whether the HA had been previously exposed to tea chromogens. The continuous data generated by the QCR technique were in good agreement with the results obtained using a discontinuous spectrophotometric method. The presently described quartz crystal model for extrinsic dental stain should provide a valuable tool to aid understanding of the interactions of staining agents with a crystalline HA surface as a model tooth surface, and to evaluate the efficacy and mode of action of STP and putative stain removal agents.

Coloring Agents↗
PubMed1996

Surface morphology changes in human enamel, dentin and cementum following bleaching: a scanning electron microscopy study.

Extracted human premolars were cut, cleaned and divided into 6 experimental groups. Each group was treated with one of the following bleaching materials: 30% hydrogen peroxide, 10% carbamide peroxide, sodium perborate, Nu-Smile, Opalescence and DentlBright. Morphological changes in tooth surface occurred following treatment with most bleaching agents. Hydrogen peroxide and DentlBright were associated with surface changes in all dental tissues. Hydrogen peroxide, DentlBright, Nu-Smile and Opalescence were mainly associated with surface changes in the cementum, which exhibited more changes than the other tissues.

Borates↗
PubMed2002

Tooth whitening today.

BACKGROUND: Methods to improve the esthetics of the dentition by tooth whitening are of interest to dentists, their patients and the public. In the past 20 years, research on bleaching and other methods of removing tooth discolorations has dramatically increased. Dentist-supervised and over-the-counter products now are available to solve a variety of tooth discoloration problems without restorative intervention. The indications for appropriate use of tooth-whitening methods and products are dependent on correct diagnosis of the discoloration. OVERVIEW: Tooth-whitening methods include the use of peroxide bleaching agents to remove internal discolorations or abrasive products to remove external stains. Peroxide bleaching procedures are completed by the dentist in single or multiple appointments, or by the patient over a period of weeks to months using custom trays loaded with a bleaching agent. Both methods are safe and effective when supervised by the dentist. Microabrasion is indicated for the removal of isolated discolorations that often are associated with fluorosis. Whitening toothpastes remove surface stains only through the polishing effect of the abrasives they contain. CONCLUSIONS AND PRACTICE IMPLICATIONS: Tooth whitening is a form of dental treatment and should be completed as part of a comprehensive treatment plan developed by a dentist after an oral examination. When used appropriately, tooth-whitening methods are safe and effective.

Dental Devices, Home Care↗
PubMed1996

Clinical efficacy of a degradable film-forming product containing carbamide peroxide to reduce tooth discolouration.

The methods used to lighten tooth discolouration while conserving the tooth structure have attracted much attention in a society which places a high value on esthetics. The purpose of this article is to present a home bleaching agent that uses a film-forming preparation containing carbamide peroxide (CP) which, while degrading, serves as a slow release delivery system of the bleaching agent. The efficacy of the preparation containing 3% CP and 10% CP on reduction of tooth discolouration is evaluated by a Chromameter in a double-blind placebo-controlled study. The effect of the tested bleaching agent on the gingival status, plaque accumulation and pulp sensitivity is also assessed.

Adolescent↗
PubMed1996

Effects of hydrogen peroxide-containing bleaching agents on the morphology of human enamel.

The effects of four bleaching agents (Opalescence, HiLite, 30% hydrogen peroxide, and 30% hydrogen peroxide mixed with sodium perborate) and 37% phosphoric acid on the external surface of human enamel were examined with the scanning electron microscope. The materials were applied to the enamel surfaces of 60 specimens obtained from 10 teeth. Each test agent was applied to one specimen from each tooth. One specimen of each tooth was left untreated. Comparison to the untreated control surfaces revealed that enamel exposed to the bleaching agents underwent slight morphologic surface alterations. The enamel surfaces treated with phosphoric acid, in contrast, showed severe morphologic alterations.

Dental Enamel↗
PubMed2002

Sensitivity and tooth whitening agents.

PURPOSE: Three commercially available dentist-prescribed home-applied bleaching systems were evaluated to identify the incidence of sensitivity and to compare the efficacy of whitening the maxillary anterior teeth of 18 patients. METHODS: NiteWhite Excel 2Z (Discus Dental), fx (Challenge Products), and Rembrandt Xtra-Comfort (DenMat Corp.) were randomly assigned to six patients each. The fx product was used as a control since it was not advertised as a zero sensitivity product. The manufacturers' instructions for tray fabrication and use were followed while the patients bleached for 2 weeks. The patients kept a diary and were recalled at 1 week, 2 weeks, and 4 weeks. The shade change and the presence or absence of any sensitivity were evaluated at each recall. RESULTS: NiteWhite Excel 2Z was used for 83 days of treatment with the following percentage of positive sensitivity reported: 0% hot and cold, 2.4% throat sensitivity, 2.4% tongue sensitivity, and 25.3% gingival sensitivity. Rembrandt Xtra-Comfort was used for 84 days with 0% hot and cold, 0% throat, 11.9% tongue, and 27.4% gingival sensitivity reported. The fx product was used for 83 days and resulted in 14.5% hot and cold, 3.6% throat, 1.2% tongue, and 16.9% gingival sensitivity. All products lightened the teeth an average of eight shade tabs on the Vita guide. There was a statistically significant difference between the groups when comparing the presence of sensitivity (chi-squared test, p < .001) but not when comparing the shade tab change. CLINICAL SIGNIFICANCE: Of the products tested, all produced similar change in shade tab value, none were sensitivity free, but NiteWhite Excel 2Z and Rembrandt Xtra-Comfort did not produce thermal sensitivity.

Carbamide Peroxide↗