Objective: This research was conducted to systematically evaluate the effectiveness and safety of adolescent tooth whitening. Methods: A meta-analysis was conducted using an inclusive dataset from 5 randomized clinical trials having common entrance criteria and methods. Each study compared 2 peroxide-based tooth whitening systems used for a 1-2 month period. A total of 5 whitening products were tested: 4 different whitening strips (The Procter & Gamble Company) at hydrogen peroxide concentrations ranging from 5-14% used twice daily for 30 minutes, and one 10% carbamide peroxide tray (Ultradent, Inc) used overnight. Effectiveness was measured objectively as L*a*b* color change using digital image analysis, while safety was assessed from interview and oral examination. Color change was investigated using a general linear mixed model, adjusting for baseline color as a fixed covariate and study as a random effect. Results: The pooled sample included 358 adolescents who used the peroxide-containing strip or tray products. At end-of-treatment, 99% of subjects exhibited 2-parameter color improvement (decreased yellowness and increased lightness). All groups had significant (p < 0.0001) color improvement at end-of-treatment, with adjusted mean (SE) Db* (yellowness) ranging from –2.8 (0.37) for the 5% strip up to –3.8 (0.39) for the 14% strip. Results were generally similar for DL* (lightness). Groups differed significantly (p < 0.01) for Db*, favoring the 14% hydrogen peroxide daytime strip and the 10% carbamide peroxide overnight tray. Minor and transient tooth sensitivity and oral irritation were the most common adverse events, and these did not contribute to appreciable for-cause dropout. Conclusion: This meta-analysis demonstrated that daytime use of 5-14% hydrogen peroxide whitening strips or overnight use of one 10% carbamide peroxide tray system provided significant color improvement in adolescents without serious adverse events.

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