To determine the effectiveness of toothpastes containing abrasives,chemical,oxidizing or multiple whitening agents in the improvement of tooth-discoloration/removal/prevention of stains;to examine any adverse effects.
Methods:
The Cochrane OHG Trials Register,CENTRAL, MEDLINE, EMBASE, and reference lists were searched for relevant studies; selected authors and manufacturers were contacted.
Randomized/quasi-randomized trials, comparing whitening toothpastes with placebo/standard non-whitening toothpastes, in adults (over 18), and measuring change in tooth color/ removal/prevention of stains for at least 4 weeks were included. Study selection, data extraction and quality assessment were conducted independently by two reviewers. Random effects meta-analyses were performed where data could be pooled;the main effect measure was the mean difference in change from baseline stain/shade rank scores.
Results:
1213 reports were identified,78 obtained; 22 trials included, 17 with results for meta-analysis.The overall pooled estimates of 8 trials (4 trials containing abrasives, 3 with multiple ingredients, 1 with oxidizing agents) for stain composite scores and 10 (4 with abrasives, 5 with chemical and 1 with multiple ingredients) for area and intensity scores, produced weighted mean differences (WMD) of -0.16 (95% CI, -0.26 to -0.07, p=0.0009), -0.34 (95% CI, -0.47 to -0.2, p<0.0001), and -0.32 (95% CI,-0.48 to -0.15, p=0.0002) respectively, all favoring whitening toothpastes. 1 trial with multiple ingredients for shade rank score also favored whitening toothpaste (4.64 (95% CI,4.11 to 5.17, p<0.0001). Only 1 trial with multiple ingredients for stain score by color matching favored non-whitening toothpaste (0.15 (95% CI, 0.03 to 0.27, p=0.01). All trials analyzed assessed removal/prevention of extrinsic stains,except one (shade rank trial) which assessed internalized stains.
Conclusions:
There is evidence showing that whitening toothpastes are effective in removal/prevention of extrinsic stains; evidence for removal of internalized stains is weak. No evidence is available for intrinsic stains. Adverse effects information was scarce.