EBP Presentation Revised

8/11/2019 EBP Presentation Revised

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Do over the counter tooth

lightening agents work, and if sowhich modality is the most

effective?

Type of Question:

Therapy/Intervention

Ideal Type of Research:

Meta-analysis of RCTs


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Finding The Best Research Cochrane and Medline searches using search terms such as:

Dent*, vital, bleaching, lightening

P (population)- stained teeth

I (intervention)- OTC Lightening Agents

C (Comparator)- No Lightening Agent

O (Outcome)- Change in Tooth Shade


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Finding The Best ResearchAdd pic of search strategy


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Our Research Paper


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Research Design Evaluate efficacy of over the counter (OTC) bleaching

products

Compare visual and computer aided shade measurements

after bleaching agents were applied

White Strips, Paint on Varnish, Custom Trays, Bite and Boil

trays, paint on varnish


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Research Methods 288 extracted human

incisors were stained withred wine and black tea

Teeth cleaned with

prophylaxis paste to

remove extrinsic staining

Teeth mounted in modelsand stored in artificial saliva

re-mineralising solution at

37 degrees


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Research Methods Teeth were randomly allocated to 8 study groups (n=36)

Paint on Varnish (6% CP) 1x/20min/day

Paint on Vanish (6% CP) 2x/20min/day

Paint on Varnish (6% CP) 2x/5min/day

Paint on Lacquer (5.9% HP) 2x/30min/day

Whitening Trays (10% CP) 1x/60min/day

Whitening Trays (2.5 % SC) 2x/10min/day

Whitening Strips (5.9% HP) 2x/30min/day

Control (WATER) 1x/60min/day


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Products

Viva Style- Paint On

6% Carbamide PeroxidePaint-On

Viva Style- Custom Trays

10% Carbamide Peroxide


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Products

Colgate Simply White

Paint On Application

5.9% Hydrogen Peroxide

Blend-A-Mend White Strips

Sold in Australia as Crest White Strips

5.9% Hydrogen Peroxide


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Products

Odol-med3 Beauty KurNot sold in Australia!

Bite-and-Boil Trays

2.5% Sodium Chlorite


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Research MethodsAfter bleaching agents were applied for specified time

frames, they were removed with a soft toothbrush under

running water for 3 minutes

Bleaching protocols were performed for a period of 14 days


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Research Methods Tooth colour was assessed at baseline (m0) before bleaching

started and 24hrs after the final bleaching procedure (m1) Single investigator blinded to type of bleaching agent

Visual assessment using shade guide

Computer assessment using spectrophotometer

Measured from middle of labial surface of each tooth

Environment was standardised as much as possible for all

readings

Changes in tooth colour were calculated between m0 and m1


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Results For both visual and computer-aided shade measurements no

significant difference in shade was detected at baseline (m0)

Significant differences in shade found between m0-m1 for all 8

groups in both visual and computer aided readings


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Results Whitening strips providedthe greatest change in tooth

shade

Trays with sodium chlorite

provided the least changein shade

No difference of shade with

frequency or duration of

paint on varnish

Evaluation methods did notmatch sufficiently closely


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Sources of Bias / Effects Conducted in Vitro.

Effect of saliva?

Patient comfort

Compliance

Only one product whereduration and frequencyaltered

Examiner fatigue

Teeth artificially stainedusing only 2 products

Teeth prophied prior toplacement of bleachingagent

Influence of ambientlightening during visual

examination

Agent may not be aseffective in vivo

Relationship may notextend to other products

Variation in measurementsfor controls

Other sources of stainingmay not be as receptive to

products

Patient may not removeextrinsic stains- yieldinglesser results


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Research Strengths Compared readily available over the counter products at

concentrations available

Objective and Subjective criteria

Blinding

Randomization

Large patient pool with respect to other studies High level of standardization- one researcher conducting all

measurements


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Research Weaknesses Only time and frequency modified on one product.

Only a small subset of products

Not all products available globally

Did not include whitening toothpastes, as these are also

available over the counter

No mention as of compliance, sensitivity, side effects orrebound

Study design in terms of long term outcome


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Level of Evidence Level 1b, Randomized control trial.

Examiner blinded.


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ConclusionsAll products reduced shade when compared to controls

Visual and computer shade matching provided different

results, but both showed improvement in shade in all

products

Sodium Chlorite agents produced least satisfying results


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Implications for Patient Do over the counter tooth lightening agents work, and if so

which modality is the most effective?

Over the counter tooth lightening agents (strips, gels, trays) will

likely reduce tooth shade

Whitening strips are the most effective at tooth lightening


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Unanswered Questions Is the reduction in tooth shade clinically relevant?

Will the patient be satisfied with the change in shade?

Are there any side effects associated with the over the

counter lightening agents?

Sensitivity?

How long does the lightening last for?

Is there any relapse?

Documents

EBP Presentation Revised