Whitening dentifrice and tooth surface discoloration-a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review was to assess the effect of a whitening dentifrice (WDF) relative to a regular dentifrice (RDF) on the reduction of natural extrinsic tooth surface discoloration (ETD). MATERIALS AND METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL and EBSCO-Dentistry and Oral Sciences databases were searched, up to April 2017. The inclusion criteria were as follows:(randomized)controlled clinical trials, healthy subjects ≥18 years of age, studies comparing WDF with RDF, a follow-up period of at least 6 weeks and studies scoring ETD as the stain area/extent, stain intensity or a composite score. Studies using an induced staining model were excluded. RESULTS: Independent screening of 851 unique papers resulted in 21 eligible publications, which included 32 comparisons. The descriptive analysis illustrated that the majority of comparisons showed a significant effect on ETD, in favour of WDF over RDF. The meta-analysis substantiated this observation and revealed that the difference of means (diffM) comparing WDF and RDF was a reduction for stain area of -0.44 [(95% CI: -0.55; -0.339) (P<.00001)] according to the original Lobene Stain Index; this result is in favour of the WDF. For the modified Lobene Stain Index, the diffM was -0.41 [(95% CI: -0.71; -0.10) (P=.009)]. For overall stain intensity, the diffM was -0.35 [(95% CI: -0.44; -0.25) (P<.00001)], and the composite score was -0.39 [(95% CI: -0.57; -0.21) (P<.0001)] and -0.54 [(95% CI: -0.66; -0.43) (P<.00001)]. Subgroup analysis differentiating between products that contained added chemical antidiscoloration agents showed a similar pattern. CONCLUSION: In this review, nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing ETD, irrespective of whether or not a chemical discoloration agent was added.

Plaque removal with triple-headed vs single-headed manual toothbrushes-a systematic review.

OBJECTIVE: The aim of this systematic review was to establish the effectiveness of brushing with a triple-headed manual toothbrush compared to a single-headed manual toothbrush on plaque removal. MATERIALS AND METHODS: The MEDLINE-PubMed and Cochrane-CENTRAL databases were searched. The inclusion criteria were clinical trials conducted with humans without fixed orthodontic appliances who were not dental care professionals. Papers that evaluated the effect of toothbrushing with a triple-headed manual toothbrush compared to a single-headed manual toothbrush on plaque removal were included. Data were extracted from the eligible studies, and a descriptive analysis was performed. RESULT: The search retrieved 15 eligible publications including 18 relevant comparisons. Heterogeneity was most obvious with respect to the person who performed the brushing, either the participants themselves or a caregiver responsible for daily oral hygiene. Additionally, participant characteristics such as age and individual disabilities varied. A lack of appropriate data and a variation in the indices used allowed only a descriptive analysis. Of the 14 comparisons with self-performed brushing by the participants, the majority showed no difference between triple-headed and single-headed toothbrushes, with a few favouring the triple-headed. In the comparisons in which a caregiver performed the brushing, three of the four showed that the triple-headed toothbrush performed significantly better on the reduction in plaque scores. CONCLUSION: From this review emerges the recommendation that the use of a triple-headed manual toothbrush instead of a single-headed manual toothbrush might be favorable with respect to plaque removal in case a care-dependent individual is brushed by a caregiver.