Niederman R, Tantraphol M C, Slinin P, Hayes C, Conway S
Office of Evidence-Based Dentistry, Harvard School of Dental Medicine and Forsyth Institute, Boston, MA 02115, USA.
J Contemp Dent Pract. 2000 Nov 15;1(4):20-36.
Common clinical experience suggests that tooth whitening agents are 100% effective. This study uses meta-analysis of data from published randomized controlled clinical trials to determine the efficacy of tooth whitening agents.
A MEDLINE search strategy was developed and implemented to systematically identify clinical trials on dentist-prescribed, home-applied tooth whitening agents, using 10% carbamide peroxide, published between 1989-1999. Inclusion criteria (e.g., in English, human clinical trials) and exclusion criteria (e.g., not placebo controlled) were established and clinical trials that met these criteria were critically appraised for validity and clinical applicability. Meta-analysis was then used to quantitatively integrate the findings.
Seven studies were identified that met the inclusion and validity criteria. These studies indicated that: Whitening results in a significant mean change of 6 4 shade guide units (p < 0.01), while the placebo control group exhibited little change (0.7 0.6, p > 0.05). 93% of the bleached patients exhibited 2 shade guide unit change, while 20% of the placebo control group exhibited this change. The brand of bleaching agent had a significant effect on tooth whitening, but the daily application time and duration of treatment did not. Whitening is maintained for 6 months for 1/2 of the people treated. Neither gingival indices nor plaque indices were adversely or favorably affected by bleaching. CLINICAL APPLICABILITY: The data from the reviewed studies indicate that rather than being 100% effective, on average: 73% (93% for bleached group minus 20% placebo group) of people who whiten their teeth will exhibit a whitening that is 2 shade guide units greater than the placebo. 20% of the people who use dentist-prescribed, home-applied bleaching will achieve a mean whitening effect of 5 shade guide units. Re-treatment for 50% of people may be necessary to maintain this effect longer than 6 months. The methods used here are Internet applicable for other clinical topics.
临床经验表明牙齿美白剂的效果是100%有效的。本研究采用对已发表的随机对照临床试验数据进行荟萃分析的方法，以确定牙齿美白剂的疗效。
制定并实施了MEDLINE检索策略，以系统识别1989年至1999年间发表的关于牙医处方、家庭使用的含10%过氧化脲的牙齿美白剂的临床试验。确定了纳入标准（如英文、人体临床试验）和排除标准（如非安慰剂对照），并对符合这些标准的临床试验的有效性和临床适用性进行了严格评估。然后使用荟萃分析对研究结果进行定量整合。
确定了7项符合纳入和有效性标准的研究。这些研究表明：美白导致平均色阶显著变化6.4个色阶单位（p<0.01），而安慰剂对照组变化很小（0.7±0.6，p>0.05）。93%的漂白患者色阶变化2个色阶单位，而安慰剂对照组有20%的患者有此变化。漂白剂品牌对牙齿美白有显著影响，但每日使用时间和治疗持续时间没有影响。接受治疗的人中，有一半的人美白效果可维持6个月。漂白对牙龈指数和菌斑指数均无不良或有益影响。
综述研究的数据表明，牙齿美白剂并非100%有效，平均而言：美白牙齿的人中有73%（美白组的93%减去安慰剂组的20%）的美白效果比安慰剂组高出2个色阶单位。20%使用牙医处方、家庭使用漂白剂的人平均美白效果可达5个色阶单位。50%的人可能需要再次治疗才能使这种效果维持超过6个月。这里使用的方法适用于互联网上的其他临床主题。
