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My teeth are yellow or dark and brushing does not remove it: what whitening options are there?｜證據鏈

km 編輯部2026-08-13About 22 min read
#證據鏈#牙醫KM#台灣#美白

本頁是〈My teeth are yellow or dark and brushing does not remove it: what whitening options are there?〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

My teeth are yellow or dark and brushing does not remove it: what whitening options are there?｜證據鏈

F-Units (fact ledger)

  • F1｜confidence: verified｜basis: internal_dataset｜period: 2025-03 to 2026-08 GSC｜geo: TW｜span: backlog #19「美白牙膏」「牙齒美白」「四環黴素」「牙齒黑黑的刷不掉」「牙齒美白方法」等 6 詞項合計曝光 164,023，跨 4 站｜caveat: impressions are asset-level, non-deduplicated figures; the listing follows queue-page #19 and must not be added to or reduced; do not output this unit when converting for publication (2026-08-05 decision: internal data must not enter the visible layer)
  • F2｜confidence: editorial structural summary (communication framework, not an external factual claim)｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 「四個問題」的拆解與「外因性／內因性判斷線索」對照，為本站依 F3 至 F32 文獻整理的溝通用架構｜caveat: not a clinical criterion or diagnostic tool; does not replace a dentist's examination
  • F3｜confidence: verified｜basis: peer_reviewed (PMID 30590875, Cochrane systematic review)｜period: searched to 2018-01-10, published 2018; update of the 2013 version｜geo: universal｜span: 「scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining)」「We included two studies with 1711 participants in the analyses」「routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up」｜caveat: population limited to adults without severe periodontitis who attend regularly; outcomes were periodontal health, not whitening degree; this card cites only the treatment-scope definition and periodontal outcomes
  • F4｜confidence: verified｜basis: peer_reviewed (PMID 35906494, systematic review and meta-analysis)｜period: searched to 2020-12, published 2022｜geo: universal｜span: 「The database search yielded 2164 results, 14 of which matched the eligibility criteria」「dental black stain is associated with lower dental caries experience in children with primary dentition」「it is questionable whether black stain has a protective effect against dental caries」「The meta-analysis showed that the likelihood of developing caries (Fixed effect model: OR [95% CI]: 0.67 [0.54; 0.82]; I2=37%; τ2=0.05), number of teeth affected (Random effects model: MD [95% CI]: -0.98 [-1.54; -0.42]; I2=79%; τ2 =0.44), and number of surfaces affected (Random-effects model: MD [95% CI]: -2.34 [-4.23; -0.44]; I2=85%; τ2 =2.93), were all lower in children with black stain.」｜caveat: limited to children with primary dentition and must not be extrapolated to adults; authors reserve the causal direction
  • F5｜confidence: verified｜basis: peer_reviewed (PMID 34041053, split-mouth randomised clinical trial)｜period: published 2021｜geo: universal｜span: 「This split-mouth randomized clinical trial was conducted on a total of 60 subjects」「Both the techniques (RCP and AP) demonstrated a significant reduction in plaque and stains within their respective groups, but revealed non-significant differences between the study groups」「Gingival trauma was found to be significantly higher in case of AP group」｜caveat: single-centre, small 60-subject trial, not a systematic review; glycine powder was the powder type used in that trial
  • F6｜confidence: verified｜basis: peer_reviewed (PMID 30562408, Cochrane systematic review)｜period: searched to 2018-06-12, published 2018; update of the 2006 version; PubMed recheck on 2026-08-06 found no update｜geo: universal｜span: 「We included 71 trials in the review with 26 studies (1398 participants) comparing a bleaching agent to placebo and 51 studies (2382 participants) comparing a bleaching agent to another bleaching agent」「Tooth sensitivity and oral irritation were the most common side effects which were more prevalent with higher concentrations of active agents though the effects were mild and transient」「Tooth whitening did not have any effect on oral health-related quality of life」「We found low to very low-certainty evidence over short time periods to support the effectiveness of home-based chemically-induced bleaching methods compared to placebo」｜caveat: low to very-low certainty; trials were mainly short term (2 weeks to 6 months); 67 of 71 had overall unclear risk of bias
  • F7｜confidence: verified｜basis: peer_reviewed (PMID 17054282, 2006 Cochrane systematic review, superseded by the 2018 version)｜period: searched to 2005-09, published 2006｜geo: universal｜span: 「Update in Cochrane Database Syst Rev. 2018 Dec 18;12:CD006202」｜caveat: used only to document version history (F6 is current); its content data are not the basis for this card
  • F8｜confidence: verified｜basis: peer_reviewed (PMID 40485133, systematic review and meta-analysis)｜period: published 2025; update of the 2016 version｜geo: universal｜span: 「This is an update of a systematic review first published in 2016, adding new evidence」「The intensity of tooth sensitivity was significantly lower for at-home bleaching (standardized mean difference [SMD] -0.78; 95% confidence interval [CI] -1.53 to -0.03; p=0.04)」「There was no significant difference in the risk of tooth sensitivity (relative risk [RR] 0.82; 95% CI 0.61 to 1.10; p=0.19) or bleaching efficacy in ΔSGU (SMD 0.04; 95% CI -0.17 to 0.25; p=0.68)」「the quality of the evidence was considered low」｜caveat: authors rate evidence quality low; ΔE and ΔSGU colour-difference measures are not consistent, so the card presents both without choosing one
  • F9｜confidence: verified｜basis: peer_reviewed (PMID 27045285, 2016 systematic review and meta-analysis, updated by F8)｜period: published 2016｜geo: universal｜span: 「In an overall comparison of at-home and in-office bleaching, no differences were detected, either regarding risk/intensity of tooth sensitivity or the effectiveness of the bleaching treatment」｜caveat: old-version conclusion, used only to explain the change before and after the update
  • F10｜confidence: verified｜basis: peer_reviewed (PMID 40460969, systematic review and Bayesian network meta-analysis)｜period: PROSPERO CRD42021265220, published 2025｜geo: universal｜span: 「81 studies were eligible and 53 included in the NMA. A high RoB was observed in most studies included」「Most at-home agents showed similar bleaching efficacy (ΔE, ΔSGU), except when the highest and lowest concentrations were compared one another with a low QoE」｜caveat: high risk of bias in most included studies and low evidence quality; concentrations are study parameters, not instructions for use
  • F11｜confidence: verified｜basis: peer_reviewed (PMID 40484311, systematic review and Bayesian network meta-analysis)｜period: PROSPERO CRD42021265220, published 2025｜geo: universal｜span: 「77 studies were included, and 50 of these were eligible for meta-analysis」「High at-home bleaching concentrations increase the risk and intensity of TS. On average, TS is mild for all bleaching agents and concentrations」｜caveat: low evidence quality and heterogeneous study protocols; TS means tooth sensitivity
  • F12｜confidence: verified｜basis: peer_reviewed (PMID 32396502, systematic review and meta-analysis)｜period: PROSPERO CRD42017064493, published 2020｜geo: universal｜span: 「A total of 649 patients were evaluated」「a lower concentration of hydrogen peroxide causes less tooth sensitivity and better effectiveness in objective color change (ΔE); however, there is no difference between them related to subjective color (ΔSGU)」｜caveat: 14 qualitative and 7 quantitative studies; high heterogeneity; objective and subjective colour-change conclusions differ
  • F13｜confidence: verified｜basis: peer_reviewed (PMID 40082147, narrative review)｜period: published 2025｜geo: universal｜span: 「This review consolidates current knowledge on dentist-supervised tooth bleaching for vital teeth」「Daily at-home bleaching with 10 % carbamide peroxide or lower-concentration hydrogen peroxide over three to four weeks is effective」｜caveat: narrative review, not meta-analysis; limited to dentist-supervised vital-tooth bleaching; concentration and duration are study parameters, not instructions for use
  • F14｜confidence: verified｜basis: peer_reviewed (PMID 26245272, systematic review and meta-analysis)｜period: searched to 2014-10, published 2016｜geo: universal｜span: 「Eight studies were included in the metanalysis」「The observed gingival irritation was higher when the 10 % CP gel was applied on tray (RR 0.43; 95 % CI [0.20-0.93]; Z = 2.14; p = 0.03)」「The quality of evidence generated was rated very low for all outcomes」｜caveat: all outcomes were rated very-low quality; comparison is over-the-counter strips versus tray-delivered 10% carbamide peroxide
  • F15｜confidence: verified｜basis: peer_reviewed (PMID 38582435, scoping review)｜period: searched to 2024-01, published 2024｜geo: universal｜span: 「A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28)」「Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies」「the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes」｜caveat: a scoping review does not pool effects; it maps the evidence only; 49 of 88 studies were in vitro
  • F16｜confidence: verified｜basis: peer_reviewed (PMID 30510576, systematic review)｜period: PROSPERO CRD42017065132, published 2018｜geo: universal｜span: 「Significant differences in tooth color change were found between the groups using whitening dentifrices and those using nonwhitening dentifrices」「the evidence from this systematic review suggests that bleaching dentifrices have potential in tooth whitening」｜caveat: 9 studies in qualitative analysis and no meta-analysis; authors say “have potential,” not certain effect
  • F17｜confidence: verified｜basis: peer_reviewed (PMID 36183933, systematic review of in-vitro studies)｜period: published 2023｜geo: universal｜span: 「Out of 208 articles, 11 met the inclusion criteria, the Risk of Bias of the selected studies was determined as medium-high」「Toothpastes based on activated charcoal possess a lower whitening effect than other alternatives and can be considered as less safe due to its high abrasive potential」｜caveat: included studies were mainly in vitro and ex-vivo teeth; risk of bias medium to high
  • F18｜confidence: verified｜basis: peer_reviewed (PMID 36303293, laboratory measurement study)｜period: published 2023｜geo: universal｜span: 「The RDA and REA values of the charcoal toothpastes have a broad range of 24-166 and 0-14, respectively」「the lack of fluoride compounds in many of the investigated charcoal toothpastes can have a less beneficial effect for the consumers」｜caveat: laboratory radioactivity measurement, not a clinical-outcomes study; authors also record no significant difference from existing commercial toothpastes
  • F19｜confidence: verified｜basis: peer_reviewed (PMID 24929591, evidence review)｜period: published 2014｜geo: universal｜span: 「New research has shown that there are other risks such as tooth surface roughening and softening, increased potential for demineralization, degradation of dental restorations, and unacceptable color change of dental restorations」｜caveat: review article, not meta-analysis; this card does not cite its broad safety or efficacy conclusion
  • F20｜confidence: verified｜basis: peer_reviewed (PMID 15451241, systematic review)｜period: published 2004｜geo: universal｜span: 「Existing literature reveals that bleaching therapies may have a negative effect on physical properties, marginal integrity, enamel and dentin bond strength, and color of restorative materials as investigated in numerous in vitro studies」「there are no reports in literature indicating that bleaching may exert a negative impact on existing restorations requiring renewal of the restorations under clinical conditions」｜caveat: 2004 review and material generations have since changed; evidence is chiefly in vitro; the card explicitly labels that property in its body
  • F21｜confidence: verified｜basis: peer_reviewed (PMID 28478214, randomised controlled trial)｜period: published 2017｜geo: universal｜span: 「Twelve and fourteen participants were allocated to the tray and the strip group respectively」「Over a three-month period, 6.0% hydrogen peroxide strip performed equally well as the 15% carbamide peroxide tray delivery system in TST」｜caveat: sample 26, 3-month follow-up; TST means tetracycline-stained teeth; methods state 6.5% and conclusion 6.0%, and the body uses the methods value while identifying the difference
  • F22｜confidence: verified｜basis: peer_reviewed (PMID 12859112, long-term follow-up survey)｜period: 90 months after treatment, published 2003｜geo: universal｜span: 「Fifteen of 21 participants enrolled in the study (71%) were contacted」「Nine participants (60%) reported no obvious shade change or only a slight darkening not noticed by others」「tetracycline-stained teeth can be whitened successfully using extended treatment time and that shade stability may last at least 90 months post treatment (range 84-100 mo)」｜caveat: retrospective survey, not a randomised trial; only 15 of 21 were contacted and 8 had clinical examination; 4 received bleaching again during follow-up
  • F23｜confidence: verified｜basis: peer_reviewed (PMID 30194793, systematic review)｜period: PROSPERO CRD42016053492, searched to 2016-12, published 2018｜geo: universal｜span: 「Six trials with a total of 348 patients」「Evidence of low quality indicated that microabrasion resulted in smaller esthetic improvement compared to bleaching (MD = -2.9; 95% CI = -3.4 to -2.5)」「all comparisons were supported from single trials and therefore caution is warranted」｜caveat: each comparison was supported by a single trial; mean age 17.7 years, a relatively young population
  • F24｜confidence: verified｜basis: peer_reviewed (PMID 41623091, systematic review and network meta-analysis)｜period: PROSPERO CRD420251234096, published 2026 (Epub 2026-02-02)｜geo: universal｜span: 「Seven controlled clinical studies (13 interventions; 555 participants) met eligibility criteria」「Multimodal protocols combining microabrasion with in-office bleaching achieved the highest esthetic performance across immediate, three-month, and 6-month evaluations」「Resin infiltration alone showed consistent, clinically meaningful effects」｜caveat: only 7 studies; results are SUCRA ranking probabilities, not individual effect; rankings do not fully agree with F23, so this card presents both without choosing one
  • F25｜confidence: verified｜basis: peer_reviewed (PMID 34762968, systematic review and meta-analysis)｜period: published 2022｜geo: universal｜span: 「Eight studies were included in the systematic review, 6 of which could be included in the meta-analyses」「Internal bleaching led to a significant change in tooth shade (ΔSGU: 6.27 [95% confidence interval, 5.36-7.17], ΔE: 12.83 [95% confidence interval, 9.46-16.20])」「The risk of bias of the included studies was classified as moderate to high」｜caveat: indication is limited to discoloured teeth after root-canal treatment; authors note lack of long-term recall data
  • F26｜confidence: verified｜basis: peer_reviewed (PMID 32170243, clinical review)｜period: published 2020｜geo: universal｜span: 「A commonly cited risk associated with it is external cervical resorption (ECR), which is a potentially significant complication that could result in loss of the tooth」「Other restorative options for discoloured teeth, such as veneers or crowns, involve the irreversible removal of tooth tissue」｜caveat: narrative review, no incidence figure; this card cites no incidence of external cervical resorption
  • F27｜confidence: verified｜basis: peer_reviewed (PMID 39523553, systematic review and meta-analysis)｜period: searched to 2024-02-19, published 2025｜geo: universal｜span: 「Twenty-nine studies were included. Meta-analysis revealed a pooled survival-rate of 96.13% for feldspathic, 93.70% for LRGC and 96.81% for LDS at 10.4 years」「Feldspathic: 41.48%/19.64%/6.51%; LRGC: 29.87%/17.89%/4.4%; LDS: 6.1%/1.9%/0.45% at 10.4 years」「No long-term data was available for zirconia」「Zirconia showed a 100% survival-rate with no complications at 2.6 years.」｜caveat: survival is population-level, not an individual expectation; scope limited to ceramic veneers on anterior teeth and premolars; zirconia has only short-term data, so this card does not cite a zirconia figure
  • F28｜confidence: verified｜basis: peer_reviewed (PMID 23846062, safety review)｜period: published 2013｜geo: universal｜span: 「The most commonly seen side effects are tooth sensitivity and gingival irritation, which are usually mild to moderate and transient」「potential adverse effects can occur with inappropriate application, abuse, or the use of inappropriate whitening products」｜caveat: narrative review; the card deliberately cites only the two statements on adverse effects and inappropriate use, not its broad safety conclusion
  • F29｜confidence: verified｜basis: peer_reviewed (PMID 25913140, systematic review and meta-analysis)｜period: searched to 2014-04, published 2015; not the only current evidence and must be read with F40 and F41｜geo: universal｜span: 「Potassium nitrate and sodium fluoride reduce tooth sensitivity while no consistent conclusion of tooth colour change was found」｜caveat: population-level effect of agent ingredients, not a medication instruction; after the 2015 search, 2020 and 2021 analyses qualified this conclusion (F40, F41), so this card presents all three without choosing one
  • F40｜confidence: verified｜basis: peer_reviewed (PMID 34075489, systematic review and meta-analysis)｜period: published 2021｜geo: universal｜span: 「After the database screening, 24 articles remained」「A significant 12% lower risk for the groups where desensitizing agents were applied (p = 0.02), with a risk ratio of 0.88 (95% CI 0.78 to 0.98)」「the clinical significance of this reduction is subtle and clinically questionable. Color change is not affected by the use of agents」｜caveat: PICO is limited to topical potassium-nitrate desensitiser before bleaching; authors themselves question clinical importance; the card must not present this as an effective treatment recommendation
  • F41｜confidence: verified｜basis: peer_reviewed (PMID 31765021, systematic review and meta-analysis)｜period: published 2020 (Epub 2019-12-21)｜geo: universal｜span: 「Six studies were included in the systematic review and most of them had unclear risk of bias for the key domains, and of these only five were included in the meta-analysis」「The addition of potassium nitrate to carbamide peroxide gel did not reduce the risk and intensity of tooth sensitivity during at-home bleaching」｜caveat: PICO is limited to potassium nitrate added to carbamide-peroxide gel, differing from the timing of topical application in F40; most included studies had unclear risk of bias
  • F30｜confidence: verified｜basis: peer_reviewed (PMID 20709137, double-blind randomised clinical trial)｜period: 2-year follow-up, published 2010｜geo: universal｜span: 「Eighty-one (88%) of the original 92 subjects enrolled in the study were recalled at 2-year follow-up」「At 2-year post-bleaching, tooth shade remained lighter than at baseline for both CP concentrations tested」「more than 66% of the participants from each group reported a tooth shade relapse from mild to moderate (p=0.6)」｜caveat: single-centre study; shade relapse was self-reported; the card does not turn this into a maintenance-duration promise
  • F31｜confidence: verified｜basis: peer_reviewed (PMID 35986934, randomised controlled trial)｜period: published 2022｜geo: universal｜span: 「45 subjects undergoing home bleaching with 16% carbamide peroxide (CP) were randomly separated into three groups」「No statistically significant differences in ΔE, ΔL, Δa, and Δb were found between the groups」｜caveat: single small trial (45 people), 30-day follow-up; insufficient to overturn individual dietary advice, and used here only to explain evidence strength
  • F32｜confidence: verified｜basis: peer_reviewed (PMID 36512116, systematic review)｜period: published 2023｜geo: universal｜span: 「Five studies were selected for qualitative analysis」「GRADE performed only for color change results and showed a low certainty of evidence」「Limited evidence suggests that effectiveness of TW between smokers and non-smokers is similar. The tooth sensitivity also does not seem to be influenced by smoking」｜caveat: only 5 studies, with heterogeneous data unsuitable for meta-analysis; 1 had serious and 1 critical risk of bias
  • F33｜confidence: verified (2026-08-06, loaded in ego-browser and checked verbatim)｜basis: law｜period: current text｜geo: TW｜span: Article 3(1) of Taiwan's Cosmetic Hygiene and Safety Act: “Cosmetics” means preparations applied to the external human body, teeth, or oral mucosa for moisturizing hair or skin, stimulating smell, improving body odour, modifying appearance, or cleansing the body; preparations classified as drugs under other laws are excluded.｜caveat: legal text, not legal advice; classification of an individual product remains for the competent authority and this card makes no individual-product classification
  • F34｜confidence: verified (2026-08-06, loaded in ego-browser and checked verbatim)｜basis: law｜period: current text｜geo: TW｜span: Article 10 of Taiwan's Cosmetic Hygiene and Safety Act: cosmetic labeling, promotion, and advertising must not be false or exaggerated; cosmetics must not be labeled, promoted, or advertised as having medical efficacy.｜caveat: legal-text citation, not legal advice; standards for false or exaggerated claims and medical efficacy are set by the central competent authority under paragraph 4 of the same article
  • F35｜confidence: verified (2026-08-06, loaded in ego-browser and checked verbatim; same anchor as F25 in card #34)｜basis: law｜period: current text｜geo: TW｜span: Article 51 of Taiwan's National Health Insurance Act: items outside insurance coverage include, among others, drug-dependence treatment, cosmetic surgery, non-traumatic therapeutic orthodontics, preventive surgery, assisted reproductive technology, sex reassignment surgery, and dentures, artificial eyes, glasses, hearing aids, wheelchairs, crutches, and other devices not of active therapeutic character.｜caveat: individual coverage is determined under current National Health Insurance Administration notices and indications; this card makes no coverage determination and asserts no procedure is or is not within those items
  • F36｜confidence: verified (2026-08-06, loaded in ego-browser and checked verbatim)｜basis: law｜period: current text｜geo: TW｜span: Article 81 of Taiwan's Medical Care Act: when treating a patient, a medical care institution shall inform the patient or the patient's legal representative, spouse, relatives, or relevant persons of the condition, treatment direction, procedure, medication, prognosis, and possible adverse reactions.｜caveat: legal-text citation, not legal advice
  • F37｜confidence: verified (2026-08-06, loaded in ego-browser and checked verbatim)｜basis: law｜period: current text｜geo: TW｜span: Article 87 of Taiwan's Medical Care Act: advertising whose content implies or insinuates medical services is deemed medical advertising; publication of new medical knowledge or research reports, patient health education, and academic publications that do not solicit medical business are not deemed medical advertising.｜caveat: used to identify this card's health-education position; legal-text citation, not legal advice
  • F38｜confidence: verified (2026-08-06, ego-browser loaded HTTP 200 and the providing-agency field was checked verbatim)｜basis: official_statement｜period: dataset status (metadata updated 2026-07-13)｜geo: TW｜span: Government Open Data Platform dataset “Taipei City Medical Fee Standards,” providing agency: Taipei City Department of Health｜caveat: one-municipality example; pages for other municipalities must be individually verified before scale-up; the dataset is not an individual institution's actual charge, which remains subject to its written itemisation　[On the official page the label appears in Chinese only: 「臺北市醫療收費標準」]
  • F39｜confidence: editorial structural summary (evidence-gap statement, not an external factual claim)｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: This search did not obtain direct clinical evidence on: ① outcomes of bleaching with untreated caries, periodontal disease, tooth cracks, or exposed dentine present; ② bleaching during pregnancy and breastfeeding; ③ long-term outcomes of bleaching in minors; ④ relative bleaching effectiveness across different causes of discoloration｜caveat: “evidence not obtained” does not mean risk or ineffectiveness has been proven; the card therefore gives no self-judged contraindication list and instead lists items to be assessed by a dentist before care

Sources

Access date for all sources: 2026-08-06. PubMed records were retrieved using E-utilities efetch for verbatim abstract comparison and each record page was tested at HTTP 200; Taiwan statutes and the official dataset were loaded in ego-browser and checked verbatim.

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  2. Hasson H, et al. Home-based chemically-induced whitening of teeth in adults. Cochrane Database Syst Rev. 2006 (updated by the 2018 version). PMID 17054282
  3. de Geus JL, et al. At-home vs In-office Bleaching: An Updated Systematic Review and Meta-analysis. Oper Dent. 2025. PMID 40485133
  4. de Geus JL, et al. At-home vs In-office Bleaching: A Systematic Review and Meta-analysis. Oper Dent. 2016 (updated by the 2025 version). PMID 27045285
  5. Terra RMO, et al. Effect of at-home agents and concentrations on bleaching efficacy: A systematic review and network meta-analysis. J Dent. 2025. PMID 40460969
  6. Terra RMO, et al. Effect of at-home bleaching agents and concentrations on tooth sensitivity: A systematic review and network meta-analysis. J Dent. 2025. PMID 40484311
  7. Pontes M, et al. Effect of Bleaching Gel Concentration on Tooth Color and Sensitivity: A Systematic Review and Meta-analysis. Oper Dent. 2020. PMID 32396502
  8. Serraglio CR, et al. Efficacy and safety of over-the-counter whitening strips as compared to home-whitening with 10% carbamide peroxide gel. Clin Oral Investig. 2016. PMID 26245272
  9. Barbosa LMM, et al. Over-the-counter products in tooth bleaching: A scoping review. J Dent. 2024. PMID 38582435
  10. Casado BGS, et al. Efficacy of Dental Bleaching with Whitening Dentifrices: A Systematic Review. Int J Dent. 2018. PMID 30510576
  11. Tomás DBM, et al. Effectiveness and abrasiveness of activated charcoal as a whitening agent: A systematic review of in vitro studies. Ann Anat. 2023. PMID 36183933
  12. Zoller MJ, et al. Relative dentin and enamel abrasivity of charcoal toothpastes. Int J Dent Hyg. 2023. PMID 36303293
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  15. Botelho MG, et al. A randomized controlled trial of home bleaching of tetracycline-stained teeth. J Dent. 2017. PMID 28478214
  16. Leonard RH Jr, et al. Nightguard vital bleaching of tetracycline-stained teeth: 90 months post treatment. J Esthet Restor Dent. 2003. PMID 12859112
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  18. Chaple Gil AM, et al. Minimally Invasive Treatments for Dental Fluorosis: A Network Meta-Analysis of Esthetic Masking Efficacy. J Esthet Restor Dent. 2026. PMID 41623091
  19. Frank AC, et al. Comparison of the Bleaching Efficacy of Different Agents Used for Internal Bleaching: A Systematic Review and Meta-Analysis. J Endod. 2022. PMID 34762968
  20. Newton R, Hayes J. The association of external cervical resorption with modern internal bleaching protocols. Br Dent J. 2020. PMID 32170243
  21. Klein P, et al. Survival and Complication Rates of Feldspathic, Leucite-Reinforced, Lithium Disilicate and Zirconia Ceramic Laminate Veneers. J Esthet Restor Dent. 2025. PMID 39523553
  22. Li Y, Greenwall L. Safety issues of tooth whitening using peroxide-based materials. Br Dent J. 2013. PMID 23846062
  23. Wang Y, et al. Evaluation of the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment. J Dent. 2015. PMID 25913140
  24. Kury M, et al. Clinical decision-making in tooth bleaching based on current evidence: A narrative review. Dent Mater. 2025. PMID 40082147
  25. Meireles SS, et al. A double-blind randomized clinical trial of two carbamide peroxide tooth bleaching agents: 2-year follow-up. J Dent. 2010. PMID 20709137
  26. Souza JM, et al. Influence of diet and red wine exposure on the velocity of at home bleaching: A randomized controlled clinical trial. Am J Dent. 2022. PMID 35986934
  27. Takeuchi EV, et al. Influence of smoking on the effectiveness of tooth whitening: a systematic review. Clin Oral Investig. 2023. PMID 36512116
  28. Mousa HRF, et al. The association between black stain and lower risk of dental caries in children: a systematic review and meta-analysis. J Egypt Public Health Assoc. 2022. PMID 35906494
  29. Lamont T, et al. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. 2018. PMID 30590875
  30. Kaur A, et al. Efficacy evaluation of rubber cup and air polishing techniques using glycine in plaque and stain removal — A clinical trial. J Family Med Prim Care. 2021. PMID 34041053
  31. Martini EC, et al. Topical application of a desensitizing agent containing potassium nitrate before dental bleaching: a systematic review and meta-analysis. Clin Oral Investig. 2021. PMID 34075489
  32. Costacurta AO, et al. Does the addition of potassium nitrate to carbamide peroxide gel reduce sensitivity during at-home bleaching? Aust Dent J. 2020. PMID 31765021
  33. Cosmetic Hygiene and Safety Act, Article 3 (Taiwan Laws & Regulations Database)
  34. Cosmetic Hygiene and Safety Act, Article 10 (Taiwan Laws & Regulations Database)
  35. National Health Insurance Act, Article 51 (Taiwan Laws & Regulations Database)
  36. Taiwan Medical Care Act, Article 81 (official English translation, Taiwan Laws & Regulations Database)
  37. Taiwan Medical Care Act, Article 87 (official English translation, Taiwan Laws & Regulations Database)
  38. Government Open Data Platform: Taipei City Medical Fee Standards (providing agency: Taipei City Department of Health)
  39. Internal data: `analysis/reports/km-dental-backlog.md` #19 appendix (term × site × impression ledger is auditable)
  40. Editorial framework: this site's four-question breakdown and the extrinsic/intrinsic-discoloration clue comparison (no external source; identified as structural summary)
  41. Editorial framework: evidence-gap statement for this card (no external source; identified as structural summary)

Internal citation chain

  • A dark spot that will not brush off may be caries: Does every cavity need a filling? How is a filling done? (KM-DENTAL-12)
  • How to choose oral-cleaning products and read their claims: How do I choose mouthrinse? Which one for periodontal disease? (KM-DENTAL-06)
  • How to read a quote and verify fee channels: How much is a fixed dental prosthesis? (KM-DENTAL-03)
Publication-gate reminder: this card is a draft. It must not enter km_entries until the zh-Hans, en, and ja versions are all produced. Until the competent authority gives an interpretation on classification of individual products in F33 and F34, the body must retain its “statutory quotation + no individual-product classification” position and must not be rewritten as a conclusion on any specific product's legality.

FAQ

Does whitening toothpaste really work?
**It addresses surface stain, and evidence for these products is mostly in-vitro.** A systematic review of 9 randomised clinical trials did find a difference in colour change between whitening and non-whitening toothpaste, but used the reserved wording “have potential” [F16]. The 2024 scoping review says toothpaste, mouthrinse, and over-the-counter trays are mainly supported by in-vitro studies, whereas strips have the principal clinical support [F15]. Charcoal toothpastes also raise abrasive concerns [F17][F18]. Under Article 10 of Taiwan's Cosmetic Hygiene and Safety Act, such products may not be labeled, promoted, or advertised as having medical efficacy [F34].
ホワイトニング歯磨剤は本当に効く？ — **対象は表面着色であり、これらの製品のエビデンスは主に in vitro です。** 9 件のランダム化臨床試験のシステマティックレビューは、ホワイトニング歯磨剤と非ホワイトニング歯磨剤の色変化に差を見つけましたが、「可能性がある」という留保付きの表現を使いました [F16]。2024 年のスコーピングレビューは、歯磨剤、洗口液、市販トレーは主に in vitro で支持され、ストリップには主な臨床的支持があるとしています [F15]。木炭歯磨剤には磨耗への懸念もあります [F17][F18]。台湾《化粧品衛生安全管理法》第 10 条により、このような製品は医療効能を表示、宣伝、広告することはできません [F34]。
Does whitening toothpaste really work? — **It addresses surface stain, and evidence for these products is mostly in-vitro.** A systematic review of 9 randomised clinical trials did find a difference in colour change between whitening and non-whitening toothpaste, but used the reserved wording “have potential” [F16]. The 2024 scoping review says toothpaste, mouthrinse, and over-the-counter trays are mainly supported by in-vitro studies, whereas strips have the principal clinical support [F15]. Charcoal toothpastes also raise abrasive concerns [F17][F18]. Under Article 10 of Taiwan's Cosmetic Hygiene and Safety Act, such products may not be labeled, promoted, or advertised as having medical efficacy [F34].
My teeth are dark and nothing brushes it off. Is it caries?
**It may be surface black stain, or caries or a filling-margin change; examination is needed to distinguish them.** Surface staining is among the local irritational factors removed by professional cleaning [F3]. A meta-analysis reports lower odds of caries in children with primary dentition and black stain (odds ratio 0.67) [F4], but its authors remain reserved about whether the stain is protective [F4]. This cannot be turned into “black needs no examination”: a dentist should identify the source of dark material that will not brush off.
歯が黒くて歯磨きで何も取れない。う蝕ですか？ — **表面のブラックステインの場合も、う蝕または詰め物の辺縁変化の場合もあり、区別には診察が必要です。** 表面着色は、専門的清掃で除去される局所刺激因子の一つです [F3]。メタ解析は、乳歯列でブラックステインのある小児でう蝕のオッズが低いと報告しています（オッズ比 0.67）[F4]。ただし著者らは、ブラックステインに予防効果があるかについて慎重です [F4]。これは「黒いものは診察不要」にはできません。歯磨きで取れない暗色物の原因を歯科医師が確認すべきです。
My teeth are dark and nothing brushes it off. Is it caries? — **It may be surface black stain, or caries or a filling-margin change; examination is needed to distinguish them.** Surface staining is among the local irritational factors removed by professional cleaning [F3]. A meta-analysis reports lower odds of caries in children with primary dentition and black stain (odds ratio 0.67) [F4], but its authors remain reserved about whether the stain is protective [F4]. This cannot be turned into “black needs no examination”: a dentist should identify the source of dark material that will not brush off.
Can tetracycline staining be treated?
**This path exists in the literature, but it needs extended treatment and rests on small studies.** The trial of 12 tray and 14 strip participants found comparable three-month performance for 15% carbamide peroxide trays and 6.5% hydrogen peroxide strips [F21]. A long-term follow-up says tetracycline-stained teeth can be bleached with extended treatment time and that stability may last at least 90 months; 60% of respondents reported no obvious shade change [F22]. Both studies are small (26 people and 15 respondents); the long-term study is retrospective, and 4 respondents received further bleaching [F22]. Those figures **cannot predict your own result or duration**. A dentist must assess feasibility and expected improvement for your staining pattern.
テトラサイクリン着色は処置できますか？ — **この経路は文献にありますが、処置期間の延長が必要で、小規模研究に基づきます。** トレー群 12 名、ストリップ群 14 名の試験は、15% 過酸化尿素トレーと 6.5% 過酸化水素ストリップで三か月の成績が同等でした [F21]。長期追跡は、テトラサイクリン着色歯を処置期間の延長で漂白でき、安定性が少なくとも 90 か月あり得ると述べ、回答者の 60% は明らかな色調変化なしと報告しました [F22]。両研究は小規模（26 名と 15 名の回答者）で、長期研究は後ろ向き、4 名の回答者は追加漂白を受けました [F22]。これらの数値は**あなた自身の結果や持続期間を予測できません**。あなたの着色パターンでの実現性と期待できる改善は、歯科医師が評価する必要があります。
Can tetracycline staining be treated? — **This path exists in the literature, but it needs extended treatment and rests on small studies.** The trial of 12 tray and 14 strip participants found comparable three-month performance for 15% carbamide peroxide trays and 6.5% hydrogen peroxide strips [F21]. A long-term follow-up says tetracycline-stained teeth can be bleached with extended treatment time and that stability may last at least 90 months; 60% of respondents reported no obvious shade change [F22]. Both studies are small (26 people and 15 respondents); the long-term study is retrospective, and 4 respondents received further bleaching [F22]. Those figures **cannot predict your own result or duration**. A dentist must assess feasibility and expected improvement for your staining pattern.

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km 編輯部・《My teeth are yellow or dark and brushing does not remove it: what whitening options are there?｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/reports/dental-teeth-whitening-evidence

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更新 2026-08-13T14:17:38.501Z · server-rendered · four-language · IDAEO 知識庫