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Effectiveness and Adverse Effects of Over-the-Counter Tooth Bleaching Products
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To map and summarize the current scientific evidence concerning the active ingredients, effectiveness, and adverse effects of over-the-counter (OTC) bleaching products.
DATA AND SOURCE
This study was conducted according to the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform.
STUDY SELECTION
Database searches were conducted in PubMed/MEDLINE, Embase, and Scopus up to January 2024. All in vitro, in situ, and clinical studies evaluating the effectiveness and adverse effects of OTC bleaching products were included. A descriptive analysis of the included studies was performed.
RESULTS
A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28). The main OTC bleaching products identified were whitening or stain-removing toothpastes (n = 42), followed by whitening strips (n = 39). Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies. The main adverse effects associated with OTC bleaching agents were tooth sensitivity and gingival irritation.
CONCLUSION
A wide variety of OTC bleaching products is available for consumer self-administered use. Clinical studies have mainly confirmed the bleaching effectiveness of whitening strips, while the validation for toothpastes, mouth rinses and whitening trays has mainly relied on in vitro studies. Nevertheless, the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes.
CLINICAL SIGNIFICANCE
Some over-the-counter bleaching products may have whitening properties supported by clinical studies, particularly those containing hydrogen or carbamide peroxide. Nonetheless, clinicians must be aware of the potential risks associated with excessive self-administration of these products, which may result in adverse effects.
Additional Info
Disclosure statements are available on the authors' profiles:
Over-the-counter products in tooth bleaching: A scoping review
J Dent 2024 Apr 04;145(xx)104989, LMM Barbosa, MBG Amâncio Filha, JVC Leite, JVDN Santos, JM De Medeiros, ILM De Oliveira, OE Pecho, SS Meireles, RBW LimaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Tooth bleaching is widely available and used worldwide. Bleaching can be performed by a dental professional in-office, at home under professional guidance, or without professional supervision when a consumer uses over-the-counter (OTC) products. OTC products are convenient and inexpensive for consumers and are increasingly popular. OTC products include prefabricated trays, whitening strips, paint-on applications, toothpastes, and mouth rinses. The purpose of this scoping review was to evaluate the existing literature on the active ingredients, effectiveness, and adverse effects of OTC bleaching products. This scoping review considered published and unpublished studies, searched the Gray Literature and Google Scholar, and included observational, in vivo, and in vitro studies. Of the 483 articles identified, 88 studies were included for qualitative analysis. The results indicated that more research had been performed on whitening toothpastes and whitening strips than on mouth rinses or paint-on systems. The results showed that OTC tooth bleaching products are effective in tooth whitening. The most common side effects of OTC products were tooth sensitivity, gingival irritation, and surface alterations of the tooth enamel such as increased roughness and mineral loss. Most of these changes are transient and reversible.
In stain-removing toothpastes, the active ingredient is often 2.2% hydrogen peroxide, with hydrated silica or calcium carbonate frequently added as an abrasive. Most of the whitening effects of stain-removing toothpastes are attributed to the removal of extrinsic stains and not from hydrogen peroxide. Many whitening or stain-removing types of toothpaste have a relative dentin abrasion value of more than 120 and should be used with a softer toothbrush to avoid tooth abrasion. Prefabricated bleaching trays generally contain 9% to 10% hydrogen peroxide, resulting in more gingival irritation than that induced by the more tightly adapted custom trays fabricated by a professional. In tooth whitening strips, the most common concentration of hydrogen peroxide used is 10%. The authors concluded that OTC bleaching is generally safe but tooth sensitivity, gingival irritation, and enamel surface changes owing to demineralization or abrasion can occur.
Additional considerations when patients use OTC bleaching materials include occasional uneven bleaching and increased time with less dramatic changes compared with in-office bleaching. The most common complaint by patients following bleaching is the lingering sensitivity to hot and cold fluids and gingival irritation. Bleaching can damage veneers or other dental work performed on teeth. OTC bleaching materials are generally safe, but professionals should guide patients to use OTC products with caution, starting slowly, monitoring for abrasion, and stopping if sensitivity develops.