Int J Dent Hygiene. 2017;1–12. wileyonlinelibrary.com/journal/idh | 1 © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted: 21 April 2017 DOI: 10.1111/idh.12289 REVIEW ARTICLE Whitening dentifrice and tooth surface discoloration —a systematic review and meta-analysis GD Soeteman 1 | C Valkenburg 2 | GA Van der Weijden 3 | C Van Loveren 4 | EWP Bakker 5 | DE Slot 3 1 School for Dental Hygiene, University of Applied Sciences Utrecht, Utrecht, The Netherlands 2 Dentist, Hoevelaken, The Netherlands 3 Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 4 Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 5 Division of Clinical Methods and Public Health, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands Correspondence DE Slot, Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands. Email: d.slot@acta.nl Funding information DUO Teachers Scholarship, Grant/Award Number: Personal for GD Soeteman Abstract 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 ex- trinsic 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 compos- ite score. Studies using an induced staining model were excluded. Results: Independent screening of 851 unique papers resulted in 21 eligible publica- tions, which included 32 comparisons. The descriptive analysis illustrated that the ma- jority 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 antidiscol- oration 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. KEYWORDS dentifrice, systematic review, tooth surface discoloration, toothpaste 1 | INTRODUCTION Adequate oral hygiene is essential for maintaining oral health. 1 It is widely accepted that plaque forms, and will remain on tooth surfaces, in the absence of mechanical forces. This microbiological biofilm is the principal aetiological factor associated with dental decay and peri- odontal disease. Daily oral hygiene routines support the maintenance of healthy marginal periodontal tissues and dental hard tissues. This maintenance contributes to a general feeling of well-being. 2 There is good evidence to support recommending toothbrushing twice a day