Title Lower Concentration H2O2 Tooth Whitening Products Do Not Significantly Reduce Post-treatment Dentinal Hypersensitivity and Provide Clinically Similar Color Change Compared to Higher Concentration Products
Clinical Question In patients 18 years of age and older, would using lower concentration hydrogen peroxide tooth whitening products reduce post-treatment hypersensitivity and cause similar color change as higher concentration products?
Clinical Bottom Line The use of lower concentrations of H2O2 whitening products by young adults will not result in a statistically significant decrease of post-treatment dentinal hypersensitivity. Tooth color change will be similar to higher concentration products. These results are supported by a randomized clinical trial of 88 subjects, which found mean dentinal hypersensitivity was consistent at different time intervals with the use of different concentrations of H2O2 tooth whitening products. Another clinical trial confirmed these results along with the fact that different concentration of hydrogen peroxide resulted in similar whitening ability.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
23724543Martin/201388 subjects divided into 3 groups: 15% H2O2 + TiO2 + light, 35% H2O2 + light, 35% H2O2Randomized Controlled Trial
Key resultsNo significant difference in hypersensitivity was found between the 3 groups at the 3 time intervals. A P value of 0.104 immediately after treatment, P value of 0.598 7 days post-treatment, and a P value of 0.489 30 days post-treatment indicated no significant differences between the mean values of hypersensitivity change.
22536662Ward/201215 subjects all underwent three 20 minute procedures with 15% H2O2 on teeth #6-8 and 25% H2O2 on teeth 9-11Split-Mouth Clinical Trial
Key resultsUsing a VITA Classical shade guide to compare changes in color, the study found significant color change post-treatment using either 15% or 25% H2O2 (p<0.01). But, there was no significant difference between 15% and 25% H2O2 immediately post-treatment (p=0.15) and 1 week post-treatment (p=0.54). Mean dentinal hypersensitivity scores showed no significant differences and in fact were identical. Mean hypersensitivity scores on the day of treatment for both 15% and 25% H2O2 were 2.4 and 24 hours post-treatment were 1.33 using a scale from 0-10 (0 referring to no sensitivity and 10 referring to maximum sensitivity).
Evidence Search ("hypersensitivity"[MeSH Terms] OR "hypersensitivity"[All Fields]) AND H2O2[All Fields] AND ("tooth"[MeSH Terms] OR "tooth"[All Fields] OR "teeth"[All Fields])
Comments on
The Evidence
Validity: In Martin 2013 the completion rate for the study was low, as only 42 of the 88 subjects completed the entire study. In Ward 2012, it is unclear whether all 12 subjects completed treatment but a clear comparison between two concentrations of one product can be made in this study because of the method in which the study was conducted. Each side of the maxillary arch received a different level of hydrogen peroxide concentration product and results could be compared in the same patient side by side. This was not a blinded study so the doctor was aware of the different percentages of H2O2 in each treatment and different doctors may have a different interpretation of color change when referring to the shade guide. Perspective: It is difficult to truly interpret a patient’s hypersensitivity because each patient has a different threshold of pain.
Applicability It is surprising that there is a statistically insignificant difference in hypersensitivity and whitening ability of two whitening products with different concentrations of the active ingredient H2O2. Based on the evidence in the research and due to the fact that the two products are similar in price, it seems that either option would be viable for an adult patient. Treatment plans should be tailored to each patient based on their comfort level; however, further research is necessary.
Specialty (General Dentistry) (Restorative Dentistry) (Dental Hygiene)
Keywords Dentinal hypersensitivity, tooth whitening, hydrogen peroxide (H2O2)
ID# 2618
Date of submission 03/23/2014
E-mail houari@livemail.uthscsa.edu
Author Ibrahim Houari
Co-author(s) e-mail
Faculty mentor Archie Jones, DDS, MBA
Faculty mentor e-mail JonesA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available