Clinical Comparative Study of the Effectiveness of and Tooth Sensitivity to 10% and 20% Carbamide Peroxide Home-use and 35% and 38% Hydrogen Peroxide In-office Bleaching Materials Containing Desensitizing Agents

Abstract

The aim of this study was to compare the effectiveness of and tooth sensitivity to 10% and 20% carbamide peroxide (CP) home-use bleaching agents and 35% and 38% hydrogen peroxide (HP) in-office bleaching agents, all of which contain desensitizing agents, in a clinical trial. Four agents were evaluated: 10% CP and 20% CP (Opalescence PF 10% and Opalescence PF 20%, Ultradent, both with 0.5% potassium nitrate and 0.11% fluoride ions), 38% HP (Opalescence Boost PF, Ultradent, with 3% potassium nitrate and 1.1% fluoride ions), and 35% HP (Pola Office, SDI, with potassium nitrate). The initial screening procedure included 100 volunteers, aged 18 to 42, with no previous sensitivity or bleaching treatment and with any tooth shade. Volunteers were randomly assigned among the technique/bleaching agent groups. A run-in period was performed 1 week before the beginning of the bleaching treatment. For the home-use bleaching technique, each volunteer was instructed to dispense gel (10% CP or 20% CP) into the trays and then insert them into his or her mouth for at least two hours per night for three weeks. For the in-office bleaching technique, the bleaching agents (38% HP or 35% HP) were prepared and used following the manufacturer's instructions, with three applications performed in each session. Three sessions were carried out with an interval of seven days between each session. The participants were evaluated before, at one week, two weeks, and three weeks after the beginning of the bleaching treatment, and again one and two weeks after the bleaching treatment ended. A shade guide (Vita Classical, Vita) was used by a blinded examiner to perform shade evaluations before bleaching and two weeks after the end of bleaching. At the time of the shade evaluations, tooth sensitivity was also recorded by asking the volunteers to classify the sensitivity during bleaching treatment as absent, mild, moderate, or severe. The present study found that 13.8% of the volunteers withdrew from the study due to tooth sensitivity, and 43.2% of the participants experienced some type of sensitivity during bleaching treatment. The χ(2) test showed that there was a significant prevalence of tooth sensitivity during bleaching treatment using the home-use 20% CP agent, with 71.4% of volunteers reporting any level of tooth sensitivity (p=0.0032). A low prevalence of tooth sensitivity was observed for volunteers who used the in-office 38% HP agent (15.0%). The Wilcoxon test (p<0.05) showed that all of the bleaching treatments were effective in bleaching teeth and that there were no differences between the final color shade results among the treatments (Kruskal-Wallis, p<0.05). This study showed that 43.2% of all the volunteers experienced mild or moderate tooth sensitivity during the treatment with bleaching agents. A higher prevalence of tooth sensitivity was observed for 71.4% of the volunteers who used the 20% CP home-use bleaching agent, which may be ascribed to the peroxide concentration and/or the time/length the agent was in contact with the denta...

In-office bleaching effects on the pulp flow and tooth sensitivity – case series

“…21 Additionally, it may also reduce the pulp-reparative capacity 22 and induce pulp inflammation, which may be responsible for the TS experienced by the patients during in-office bleaching. 1 All three participants from this study experienced moderate to considerable TS that decreased to a mild level one week after bleaching. The literature usually reports that TS normally persists for up to four days after bleaching, 2 but durations of up to 39 days have been reported.…”

“…The patients are instructed to wear the bleaching tray daily, for periods ranging from 1 to 8 h from 2 to 6 weeks. 1 In spite of the safety and effectiveness of this technique to whiten teeth, some patients do not want to use the trays even for shorter periods of time. In this clinical scenario, in-office bleaching using higher concentrations Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.…”

“…4,5 Even though professional-assisted dental bleaching is considered a safe procedure, tooth sensitivity (TS) is a remarkably common side effect reported by patients. 1,3,4 More than 70% of patients who undergo in-office bleaching complain of TS, 6 which leads some patients to forego treatment. 7 The uncomfortable and painful bleaching-induced TS is likely the result of pulp insult by the rapid diffusion of HP molecules.…”

Comparison of efficacy and outcome satisfaction between in-office and home teeth bleaching in Chinese patients

“…This finding is consistent with that documented by Zeknois et al, who reported that HB produced significantly lighter teeth than in-office bleaching during all active treatment periods and follow-up visits (10). However, most other bleaching studies conducted in Caucasian populations have reported both HB and OB to be equally effective (9,(13)(14)(15)(16)(17)(18)(19). The disparity in findings may be attributed to differences in bleaching agent concentrations, total treatment time, and racial variance of human teeth (20)(21)(22)(23).…”

“…Most clinical trials on dental bleaching have been conducted on Caucasian populations (9,(13)(14)(15)(16)(17)(18)(19). However, racial differences in tooth anatomy, dimensions, and translucency may influence the outcomes of dental bleaching (20)(21)(22)(23).…”