Comparative Tooth Sensitivity and Oral Irritation of Three Bleaching Systems

Tooth sensitivity and oral irritation represent the most common adverse events associated with peroxide vital tooth bleaching. While there are many comparative efficacy reports, few clinical trials have statistically compared the relative tolerability of the various marketed bleaching systems. Objective: The purpose of this study was to compare tooth sensitivity and oral irritation of 3 home bleaching systems in a randomized 2-week clinical trial. Materials and Methods: Seventy-three adults were randomized to 10% or 20% carbamide peroxide (CP) gel used overnight in a custom tray, or 6.0% hydrogen peroxide (HP) whitening strips used 30 minutes twice daily. Interviews were conducted to assess tooth sensitivity and oral irritation. Bleaching Tolerability Severity-Days (BTSD) was calculated from onset, severity and duration data, and treatments were compared using ANOVA. Results: Forty subjects (55% of the treated subjects) reported either tooth sensitivity or oral irritation sometime during treatment. BTSD means (SD) were 0.59 (0.80) and 1.29 (1.06) for the 10% and 20% CP tray systems, respectively. With a BTSD mean (SD) of 0.17 (0.38), the whitening strips were directionally (p = 0.07) or significantly (p < 0.0001) better tolerated than the 10% and 20% CP tray systems, respectively. The 10% CP tray system was significantly better tolerated (p = 0.003) than the 20% CP tray system. No subjects discontinued treatment early because of tooth sensitivity or oral irritation. Conclusion: The 6.0% HP whitening strips exhibited less tooth sensitivity and oral irritation than either the 10% or 20% CP tray system, and significantly lower BTSD relative to the 20% CP tray system. Supported by The Procter & Gamble. E-mail: rittera@dentistry.unc.edu