Whitening toothpastes: a review of the literature

Objectives: To review and summarise the whitening agents contained within tooth whitening toothpaste formulations, their mode of action in tooth whitening, and the in vitro and clinical methods used to evaluate and demonstrate their efficacy.

Methods: Original scientific full papers or reviews listed in ISI Web of Science and Medline were included in this review using the search terms white*, toothpaste and dentifrice.

Conclusions: Due to the reported consumer and patient dissatisfaction with their perceived tooth color, toothpaste manufacturers have responded by developing a vast array of contemporary whitening toothpastes. One of the key functional ingredients in whitening toothpastes is the abrasive system. In general, these have been designed to give effective removal of extrinsic stains and help prevent tooth stains from reforming without undue abrasivity towards the dental hard tissues. Whitening toothpastes may contain additional agents that augment the abrasive cleaning by aiding the removal and/or prevention of extrinsic stains, for examples, peroxide, enzymes, citrate, pyrophosphate and hexametaphosphate, or optical agents such as blue covarine which can improve tooth whiteness following tooth brushing. In vitro methods used to evaluate tooth whitening efficacy typically determine the ability of a toothpaste formulation to remove/prevent model extrinsic stains on substrates such as enamel or hydroxyapatite or changes in the intrinsic color of tooth specimens. Clinical protocols for evaluating the efficacy of whitening toothpastes typically determine either stain removal or prevention, where changes in natural stain or chlorhexidine/tea induced stain are measured typically over 2-6 weeks. In some clinical studies the overall tooth color change was measured using techniques such as Vita shade guides, colorimeters and image analysis of digital photographs of teeth.