Patient Perceptions of the Results of Tooth Whitening Procedures

Objective: To evaluate the perceptions and satisfaction of patients of home-based and in-office tooth whitening procedures. Methods: 298 subjects were enrolled in 3 different studies, each with the objective to assess the efficacy of a light and peroxide whitening system compared to similar systems, a tray delivery system, or a whitening toothpaste. The study designs were randomized, double blind, four-factorial clinical trials. Two studies compared 4 distinct products, and the third study compared 15% peroxide gel + light (BriteSmile 2000 system), the light alone, 15% peroxide gel alone, and a placebo. The placebo group experienced a sham procedure with peroxide –free gel provided by the manufacturer and a simulated light treatment. Tooth shade changes were assessed by shade guide and chromameter, and a post-treatment survey collected subjective responses. Results: 62 – 69% of subjects treated with the BriteSmile peroxide gel + light system reported that the procedure “greatly” increased the whiteness of their teeth, as compared with 32%, 27%, and 23% with other in-office light + gel systems. 23% of the home-based tray and 0% of toothpaste patients perceived a great increase in whiteness. However, 55% of subjects in the 3rd study's placebo arm reported some increase in tooth whiteness, but their objectively measured mean tooth shade values did not change between baseline (6.47+ 0.44) and post-treatment (6.28+0.42). There was a wide range of post-treatment sensitivity reports from 62% for trays to 22% for one of the BriteSmile treatments. Conclusions: Patient perception of efficacy is extremely important in tooth whitening procedures and must be taken into account for treatment success. The strong placebo effect demonstrated in the 3rd study highlights the important role of expectation in a cosmetic procedure. Supported by The CAP Foundation and BriteSmile, Walnut Creek, CA.