White diet is not necessary during dental bleaching treatment: A systematic review and network meta-analysis of clinical studies

Objectives

This systematic review with network meta-analysis (NMA) answered whether a white diet is necessary during dental bleaching and if there was any coloring food impacting more significantly the bleaching potential.

Data sources

The review followed the PRISMA Extension Statement for NMA. Six electronic databases and gray literature were searched until April 2024.

Study selection

The eligibility criteria considered clinical trials comparing the bleaching efficacy in participants that followed a white diet (control) and those who had either a supplemented intake of pigments or an unrestricted diet. Risk of bias was assessed using RoB2 (randomized clinical trials/RCT) and ROBINS-I (non-randomized clinical trials/NRCT), and the quality of evidence was checked using GRADE. Color change data were compared using both standard pairwise meta-analysis (SPMA) and Bayesian NMA.

Results

From 1051 records, seven studies were included in the review (four RCT, three NRCT). All studies were classified as having low risk of bias. Regarding NMA, the control group achieved similar color change than the other groups that received pigment supplementation with grape juice, coffee, tea, wine, cola, or an unrestricted diet (p>0.05). The GRADE analysis revealed a moderate quality of evidence.

Conclusions

The consumption of soft cola, coffee, black tea, grape juice, and red wine, as well as the consumption of a totally unrestricted diet, do not have a significant influence on the effectiveness of bleaching as compared to a white diet regimen.

Clinical significance

The accumulated evidence suggests that restricting the intake of dietary pigments during dental bleaching is not essential.