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18-12-2013 | Oral medicine | Article

Shades of gray in QoL measures after dental whitening


Free abstract

medwireNews: A complex picture has emerged of changes in oral-health-related quality of life (QoL) after at-home dental bleaching, with some measures improving and others deteriorating after the treatment, a Brazilian double-blind randomized clinical trial has shown.

Participants reported a significant reduction in measures such as problems with smiling or showing their teeth with embarrassment, but they also reported an increase in some negative impacts, including difficulty in cleaning teeth.

“Quality of life is complex and encompasses different domains,” point out lead researcher Flávio Demarco and co-workers from the Federal University of Pelotas. “Dentists must consider these aspects when performing aesthetics procedures.”

Ninety-two volunteers aged 18–30 years with a mean shade of C1 or darker for the six maxillary anterior teeth were recruited to the study. They were randomly assigned to receive 10% (n=46) or 16% (n=46) carbamide peroxide treatment.

Volunteers had good oral health and good general health, had not used tooth whiteners in the previous 3years, had no past or present hypersensitivity, and were not undergoing orthodontic treatment. The participants did not have tetracycline-stained teeth, and were not smokers, pregnant, or lactating.

There was no significant difference between gender, educational level, and profession between the two groups. Most participants were female, with a high educational level and relatively high socioeconomic status.

Participants received three bleaching gel tubes and were instructed to use the gel for 2 hours every night for 3 weeks. They also received toothbrushes and toothpastes without whitening agents in order to standardize their oral hygiene regimes.

To assess changes in oral QoL, participants were asked to complete the oral impact on daily performance questionnaire at the start and 1 week after completion of treatment.

No difference was found between the two groups in whitening effect or tooth sensitivity during or after treatment; consequently, QoL analyses for the two groups were merged.

The proportion of participants who reported difficulty with oral hygiene increased from 9.8% at baseline to 22.8% at the end of treatment. However, the proportion who reported problems with smiling decreased from 9.8% to 3.3%. Similarly, although a significantly higher number of participants reported pain after treatment than at baseline, there was also a significant decrease in individuals reporting that they were unhappy with their appearance.

More than 40% of volunteers reported some sensitivity after the 3-week treatment.

Although over 80% of the reported sensitivity was described as mild, “clinicians should be aware of this potential impact caused by tooth sensitivity and offer proper instructions to prevent it or treatment to reduce the impact,” Demarco and colleagues conclude in the Journal of Dentistry.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Afsaneh Gray, medwireNews Reporter