Inside Dentistry
April 2006
Volume 2, Issue 3

Effectiveness and safety of tooth bleaching in teenagers

Howard E. Strassler, DMD

Donly KJ, Kennedy P, Segura A, Gerlach RW. Pediatr Dent. 2005 Jul-Aug;27(4): 298-302.


PURPOSE: The purpose of this study was to compare the efficacy and safety outcomes of a currently marketed, peroxide-containing, tray-based, tooth-whitening system to a peroxide-containing, “trayless” tooth-whitening system. METHODS: Fifty-seven subjects, 12 to 17 years of age, participated in this study and were divided into 2 balanced groups. Twelve subjects received custom trays with 10% carbamide peroxide gel that they were instructed to wear overnight. Forty-five subjects received 10% hydrogen peroxide polyethylene strips to wear for 30 minutes twice a day. Teeth were bleached for 2 weeks. Digital image analysis measured color in B, L, and A color spaces, where B indicated yellowness, L indicated lightness, and A indicated redness. Oral examinations and interviews were used to ascertain any adverse events that may have occurred during treatment. RESULTS: Fifty-one patients completed this study. Both whitening systems yielded significant (P < .001) color improvement, as evidenced by decreased yellowness, increased lightness, and decreased redness. Groups did not differ significantly(P > .39) regarding color improvement for B, L, or A on either the maxillary or mandibular teeth. Twelve subjects (27%) in the polyethylene strip group reported adverse events compared with 5 subjects (42%) in the tray-delivered group. Minor and transient tooth sensitivity and oral irritation were the most common adverse events. CONCLUSIONS: Both the daytime strip and overnight tray groups significantly (P < .0001) whitened teeth; there were no significant differences between the 2 groups in any of the color parameters; both whitening systems were well tolerated, and most adverse events were mild in severity.


Who doesn’t want whiter teeth? Our children exist in a world of peer pressure and are bombarded by a “look good, be accepted” philosophy. Although we all hope our children are being raised to feel good about themselves and to make good choices, peer pressure as well as dissatisfaction with their smiles may cause adolescents to desire tooth whitening. Teenagers often whiten their teeth without the knowledge of their parents and dental professionals. Over-the-counter whitening systems, especially bleaching strip technology, are readily available to adolescent patients. One concern has been that self treatment with whitening by adolescents has not been evaluated in clinical studies. Although there have been case reports of vital bleaching cases, studies assessing the safety and effectiveness of peroxide whitening in an adolescent population have been very limited.

This study provides the practitioner with important information. The study evaluated 2 different at-home tooth whitening systems over 4 weeks with adolescents aged 12 to 17 years. One group used a 10% hydrogen peroxide strip system (Crest Whitestrips® Premium, Procter & Gamble, Cincinnati, OH) and the second group used a 10% carbamide peroxide tray system (Opalescence® Overnight, Ultradent Products, Inc, South Jordan, UT). Exclusion was based on existing tooth shade before being accepted into the study. All of the participants accepted into the study had a Vita A-2 shade or darker. This exclusion criteria is comparable to many adult studies that require an A-3.5 shade or darker. A darker tooth shade at the initiation of a study creates successful data for tooth whitening using both shade change evaluation criteria and digital image analysis. Also, adolescents with a past history of whitening or a history of dentin hypersensitivity were excluded.

The findings indicated that these 2 bleaching systems were effective at whitening adolescents’ teeth with no difference in whitening between the two systems. The data presented parallels what has been reported previously using an adult population with both whitening regimens. The study did not break out the data for tooth sensitivity and oral irritation, but reported overall data of 27% for the strips and 42% for the tray group. No products were given to subjects to manage sensitivity and no subjects dropped out of the study because of reactions. The authors reported that although there were reports of oral irritation and tooth sensitivity, these adverse effects were mild.

Should children whiten their teeth? Within our practices, we can feel comfortable making recommendations for tooth whitening with either a strip or tray system for teenagers who have concerns about the appearance of their smiles.

About the Author

Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore, Maryland

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