Efficacy and Adverse Effects of Whitening Dentifrices Compared With Other Products: A Systematic Review and Meta-analysis

Abstract

SUMMARY Whitening dentifrices (WDs) are widespread and accessible worldwide, claiming to whiten teeth. Therefore, this systematic review aimed to assess the extrinsic stain removal (ESR), the whitening potential, and the adverse effects of WDs. Randomized controlled trials comparing WDs with regular dentifrices (RDs) and other home-based whitening products were searched at NCBI-PubMed, Cochrane-CENTRAL, EBSCO-Host, and clinicaltrials.gov. The studies were screened and had data extracted by two independent researchers. Eligible studies presented outcomes of ESR, color change, and adverse effects, with no restriction of publication date. Data were meta-analyzed using RevMan 5.3, and the level of evidence was rated according to GRADE criteria. Eleven studies (n=1962) assessed reduction of stain area and intensity through Lobene Stain index, with a mean difference (MD) of −0.33 ([−0.41;−0.25]; p=0.00001) and −0.34 ([−0.44;−0.25]; p=0.00001), respectively. When the modified Lobene Stain index was used (six studies; n=2576), MD was −0.42 ([−0.58;−0.25]; p=0.00001) and −0.30 ([−0.39;−0.21]; p=0.00001), respectively. Mean color change through shade guide tabs (three studies; n=1322) was −1.80 ([−2.33;−1.26]; p=0.00001). All differences were in favor of the WDs, which also produced a risk of adverse effects (RR=1.74; [1.20, 2.52]; p=0.003; four studies; n=1322). The comparison of WDs with paint-on gel (two studies; n=58) yielded similar efficacy and adverse effects (p>0.05), whereas the comparison of WDs with white strips (two studies; n=87) yielded higher efficacy of the latter (p=0.00001) and similar adverse effects (p=0.52). The quality of evidence varied from low to moderate. WDs are more effective in reducing extrinsic stain and producing a whitening-like effect in teeth than RDs, although they also produce more adverse effects. Whitening efficacy of WDs is similar to paint-on gel and lower than white strips. Higher-quality evidence demands larger, well-conducted, independent studies.

Effects of activated charcoal powder combined with toothpastes on enamel color change and surface properties

“…Meta-analysis evaluations pointed out that the majority of whitening toothpastes evaluated exhibited a beneficial effect on extrinsic discoloration removal in comparison to regular toothpaste. 5,9 In the current study, WT resulted in color change significantly higher than CONT. Nonetheless, the combination of charcoal powder eliminated this difference.…”

“…Intake of staining such as tea, coffee, red wine, or smoking habits are involved in extrinsic discoloration 4 . Therefore, recent researches have investigated the impact of toothpastes on changing tooth color 5,6 …”

“…Even though evidence lacks to indicate if there is a most effective type of toothpaste to change the color of teeth, a systematic review demonstrated reduction of extrinsic pigmentation for all whitening products tested 9 . A more recent systematic review and meta‐analysis pointed out that whitening toothpastes produces a more effective whitening effect compared to the regular ones 5 . Nevertheless, an increase in surface roughness (Ra) has already been detected in vitro in enamel submitted to brushing with whitening toothpastes, regardless of the combination of the whitening toothpastes with peroxide‐based gels 10 .…”

“…4 Therefore, recent researches have investigated the impact of toothpastes on changing tooth color. 5,6 Although several types of whitening toothpastes with different mechanism of actions are available, it is known that the abrasivity of a toothpaste itself could remove extrinsic staining. 7 Other than that, titanium dioxide or blue covarine can be added to the products, depositing a thin layer of these pigments.…”

“…9 A more recent systematic review and metaanalysis pointed out that whitening toothpastes produces a more effective whitening effect compared to the regular ones. 5 Nevertheless, an increase in surface roughness (Ra) has already been detected in vitro in enamel submitted to brushing with whitening toothpastes, regardless of the combination of the whitening toothpastes with peroxide-based gels. 10 Thus, caution should be taken when combining both methods clinically.…”