Download - EBP Presentation Revised
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8/11/2019 EBP Presentation Revised
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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?