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Assessment of color changes and adverse effects of over-the-counter bleaching protocols: a systematic review and network meta-analysis

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Abstract

Objectives

To assess color change efficacy and the adverse effects of varied over-the-counter (OTC) bleaching protocols.

Methodology

The study included randomized clinical trials evaluating color changes from OTC bleaching agents. Nine databases were searched, including the partial capture of the grey literature. The RoB2 tool analyzed the individual risk of bias in the studies. Frequentist network meta-analyses compared treatments through common comparators (∆Eab* and ∆SGU color changes, and tooth sensitivity), integrating direct and indirect estimates and using the mean and risk differences as effect measures with respective 95% confidence intervals. The GRADE approach assessed the certainty of the evidence.

Results

Overall, 37 remaining studies constituted the qualitative analysis, and ten composed the meta-analyses. The total sample included 1,932 individuals. ∆Eab* was significantly higher in groups 6% hydrogen peroxide (HP) strips (≥ 14 h). ∆SGU was significantly higher in groups at-home 10% carbamide peroxide (CP) (≥ 14 h), followed by 6% HP strips (≥ 14 h) and 3% HP strips (≥ 14 h). At-home 10% CP (7-13 h) and placebo showed lower risks of tooth sensitivity without significant differences between these treatments.

Conclusion

Considering the low level of evidence, OTC products presented satisfactory short-term effects on tooth bleaching compared to the placebo, with little to no impact on dentin hypersensitivity and gingival irritation.

Clinical Relevance.

OTC products are proving to be practical alternatives for tooth whitening. However, patients should be advised about the possible risks of carrying out such procedures without professional supervision.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was partially funded by the Coordination for the Improvement of Higher Education Personnel—Brazil (CAPES) – Finance Code 001. We also appreciate the support of CNPq (National Counsel of Technological and Scientific Development—Brazil) and the Minas Gerais Research Foundation—Brazil (FAPEMIG).

Author information

Authors and Affiliations

  1. School of Dentistry, University Center—UNIFAE, São João da Boa Vista, SP, Brazil

    Murilo Navarro de Oliveira

  2. Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Murilo Navarro de Oliveira, Maria Tereza Campos Vidigal & Caio Luiz Lins-Candeiro

  3. Division of Endodontics, Department of Restorative Dentistry, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil

    Walbert Vieira

  4. Department of Stomatology, Postgraduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil

    Leandro Machado Oliveira

  5. Duke-NUS Medical School, Oral Health Academic Programme, Singapore, Singapore

    Gustavo G. Nascimento

  6. Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore

    Gustavo G. Nascimento

  7. Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Gisele Rodrigues da Silva

  8. Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil

    Luiz Renato Paranhos

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  1. Murilo Navarro de Oliveira
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Contributions

MNO: Conception and design, analysis and interpretation of data, drafting the manuscript, final approval.

MTCV: Conception and design, analysis and interpretation of data, drafting the manuscript, final approval.

WAV: Analysis and interpretation of data, drafting the manuscript, final approval.

CLLC: Analysis and interpretation of data, drafting the manuscript, final approval.

LMO: Analysis and interpretation of data, drafting the manuscript, final approval.

GGN: Interpretation of data, drafting the manuscript (review), final approval.

GRS: Interpretation of data, drafting the manuscript (review), final approval.

LRP: Drafting the manuscript (review), final approval.

Corresponding author

Correspondence to Luiz Renato Paranhos.

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de Oliveira, M.N., Vidigal, M.T.C., Vieira, W. et al. Assessment of color changes and adverse effects of over-the-counter bleaching protocols: a systematic review and network meta-analysis. Clin Oral Invest 28, 189 (2024). https://doi.org/10.1007/s00784-024-05595-5

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