Objective: This randomized double-blind clinical trial compared tooth sensitivity (TS), bleaching efficacy, and cytokine levels after applying in-office bleaching treatments containing 15% and 35% hydrogen peroxide (HP15% and HP35%, respectively).
Methods: Twenty-five volunteers were randomly assigned to receive HP15% or HP35% treatment. The bleaching agent was applied in three 15-min applications per session. Two bleaching sessions were separated by a 1-week interval. The participants scored TS using a visual analog scale and numerical rating scale. Bleaching efficacy was determined by subjective and objective methods. Gingival crevicular fluid was collected from three jaws sites per patient for the analysis of fluid volume. Flow cytometry was used to analyze gingival crevicular fluid levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-10, tumor necrosis factor, and interferon-gamma. All measurements were obtained before and after bleaching. All data were statistically analyzed (α=0.05).
Results: The absolute risk and intensity of TS was higher for HP35% than for HP15% (p>0.002). One month post-bleaching, HP35% produced more bleaching than HP15% (p=0.02). However patient perception (p=0.06) and patient satisfaction (p=0.53) with regard to bleaching were not significantly different. No significant differences existed in the gingival fluid volume (p>0.38) or in any cytokine level (p>0.05) for either HP concentration.
Conclusion: Treatment: with HP35% is more effective than HP15%, but generates a greater risk and intensity of TS. No inflammatory changes occurred despite the difference in the HP concentrations.
Clinical significance: Hydrogen peroxide at a lower concentration (e.g., 15%) should be considered a good treatment alternative for in-office bleaching because the higher concentration for in-office bleaching generates a greater risk and intensity of TS for patients.
Keywords: Cytokine; Gingival crevicular fluid; Hydrogen peroxide; In-office bleaching; Tooth sensitivity; Whitening.
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