Clinical Oral Investigations

, Volume 21, Issue 9, pp 2811–2818 | Cite as

Effect of acidity of in-office bleaching gels on tooth sensitivity and whitening: a two-center double-blind randomized clinical trial

  • A. D. LoguercioEmail author
  • F. Servat
  • R. Stanislawczuk
  • A. Mena-Serrano
  • M. Rezende
  • M. V. Prieto
  • V. Cereño
  • M. F. Rojas
  • K. Ortega
  • E. Fernandez
  • A. Reis
Original Article



The study aimed to compare the tooth sensitivity (TS) and bleaching efficacy of two hydrogen peroxide gels with different pHs (acid pH [Pola Office, SDI] and the neutral pH [Pola Office+, SDI]) used for in-office bleaching.

Materials and methods

Fifty-four patients from Brazil and Chile, with right superior incisor darker than A2, were selected for this double-blind, split-mouth randomized trial. Teeth were bleached in two sessions, with 1-week interval. Each session had three applications of 8 min each, according to the manufacturer’s instructions. The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easy shade spectrophotometer) methods. Participants recorded TS with 0–10 visual analog scale. Color change in shade guide units (SGU) and ΔE was analyzed by Student’s t test (α = 0.05). The absolute risk and intensity of TS were evaluated by McNemar’s test and Wilcoxon-paired test, respectively (α = 0.05).


All groups achieved the same level of whitening after 30 days of clinical evaluation. The use of a neutral in-office bleaching gel significantly decreases the absolute risk of TS (28%, 95% CI 18–41) and intensity of TS when compared to the acid bleaching gel (absolute risk of 50%, 95% CI 37–63).


The use of a neutral in-office bleaching agent gel produced the same whitening degree than an acid bleaching gel but with reduced risk and intensity of tooth sensitivity.

Clinical significance

Clinicians should opt to use in-office bleaching with a neutral gel than an acid product because the former causes a significant lower risk and intensity of tooth sensitivity.


In-office bleaching Neutral gel Acidic gel Tooth sensitivity Whitening effectiveness 


Compliance with ethical standards

Conflict of interest

A. Loguercio declares that he has no conflict of interest, F. Servat declares that he has no conflict of interest, R. Stanislawczuk declares that he had no conflict of interest, A. Mena-Serrano declares that she has no conflict of interest, M. Rezende declares that she has no conflict of interest, M. V. Prieto declares that she has no conflict of interest, V. Cereño declares that she has no conflict of interest, M. F. Rojas declares that she has no conflict of interest, K. Ortega declares that she has no conflict of interest, E. Fernández declares that he has no conflict of interest, and A. Reis declares that she has no conflict of interest.


The work was partially supported by National Council for Scientific and Technological Development under grants 304105/2013-9 and 305588/2014-1.

Ethical approval

This clinical study was approved by the Ethics Committee of The Center of Higher Education of Campos Gerais (CESCAGE, protocol 390.941) and the University of Chile (protocol 2013/41) and was conducted according to the Consolidated Standards of Reporting Trials Statement and Helsinki Declaration of 1975 revised in 2000.

Informed consent

All persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.


  1. 1.
    Matis BA, Cochran MA, Eckert G (2009) Review of the effectiveness of various tooth whitening systems. Oper Dent 34:230–235. doi: 10.2341/08-74 CrossRefPubMedGoogle Scholar
  2. 2.
    Kwon SR, Wertz PW (2015) Review of the mechanism of tooth whitening. J Esthet Restor Dent 27:240–257. doi: 10.1111/jerd.12152 CrossRefPubMedGoogle Scholar
  3. 3.
    Tay LY, Kose C, Herrera DR, Reis A, Loguercio AD (2012) Long-term efficacy of in-office and at-home bleaching: a 2-year double-blind randomized clinical trial. Am J Dent 25:199–204PubMedGoogle Scholar
  4. 4.
    Giachetti L, Bertini F, Bambi C, Nieri M, Scaminaci Russo D (2010) A randomized clinical trial comparing at-home and in-office tooth whitening techniques: a nine-month follow-up. J Am Dent Assoc 141:1357–1364CrossRefPubMedGoogle Scholar
  5. 5.
    Auschill TM, Schneider-Del Savio T, Hellwig E, Arweiler NB (2012) Randomized clinical trial of the efficacy, tolerability, and long-term color stability of two bleaching techniques: 18-month follow-up. Quintessence Int 43:683–694PubMedGoogle Scholar
  6. 6.
    Ferrari M, Cagidiaco MC, Monticelli F, Kugel G, Barker ML, Gerlach RW (2007) Daytime use of a custom bleaching tray or whitening strips: initial and sustained color improvement. Am J Dent 20 Spec No A:19A–22APubMedGoogle Scholar
  7. 7.
    Majeed A, Grobler SR, Moola MH (2011) The pH of various tooth-whitening products on the South African market. South Afr Dent J 66:278–281Google Scholar
  8. 8.
    Price RB, Sedarous M, Hiltz GS (2000) The pH of tooth-whitening products. J Can Dent Assoc 66:421–426PubMedGoogle Scholar
  9. 9.
    Freire A, Archegas LR, de Souza EM, Vieira S (2009) Effect of storage temperature on pH of in-office and at-home dental bleaching agents. Acta Odontol Latinoam 22:27–31PubMedGoogle Scholar
  10. 10.
    Chen JH, Xu JW, Shing CX (1993) Decomposition rate of hydrogen peroxide bleaching agents under various chemical and physical conditions. J Prosth Dent 69:46–48CrossRefGoogle Scholar
  11. 11.
    Attin T, Schmidlin PR, Wegehaupt F, Wiegand A (2009) Influence of study design on the impact of bleaching agents on dental enamel microhardness: a review. Dent Mater 25:143–157. doi: 10.1016/ CrossRefPubMedGoogle Scholar
  12. 12.
    Sa Y, Sun L, Wang Z, Ma X, Liang S, Xing W, Jiang T, Wang Y (2013) Effects of two in-office bleaching agents with different pH on the structure of human enamel: an in situ and in vitro study. Oper Dent 38:100–110. doi: 10.2341/11-173-L CrossRefPubMedGoogle Scholar
  13. 13.
    Xu B, Li Q, Wang Y (2011) Effects of pH values of hydrogen peroxide bleaching agents on enamel surface properties. Oper Dent 36:554–562. doi: 10.2341/11-045-1 CrossRefPubMedGoogle Scholar
  14. 14.
    Azrak B, Callaway A, Kurth P, Willershausen B (2010) Influence of bleaching agents on surface roughness of sound or eroded dental enamel specimens. J Esthet Restor Dent 22:391–399. doi: 10.1111/j.1708-8240.2010.00372.x CrossRefPubMedGoogle Scholar
  15. 15.
    Jadad EBRM, Arana G, Palo RM, Gomes OMM, Arana-Gordillo LA (2014) In vitro evaluation of pH values of whitening agents in relationship to time. Revista APCD de Estética 2:520–526Google Scholar
  16. 16.
    Torres CR, Crastechini E, Feitosa FA, Pucci CR, Borges AB (2014) Influence of pH on the effectiveness of hydrogen peroxide whitening. Oper Dent 39:E261–E268. doi: 10.2341/13-214-L CrossRefPubMedGoogle Scholar
  17. 17.
    Frysh H, Bowles WH, Baker F, Rivera-Hidalgo F, Guillen G (1995) Effect of pH on hydrogen peroxide bleaching agents. J Esthet Dent 7:130–133CrossRefPubMedGoogle Scholar
  18. 18.
    Basting RT, Amaral FL, Franca FM, Florio FM (2012) 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. Oper Dent 37:464–473. doi: 10.2341/11-337-C CrossRefPubMedGoogle Scholar
  19. 19.
    Reis A, Kossatz S, Martins GC, Loguercio AD (2013) Efficacy of and effect on tooth sensitivity of in-office bleaching gel concentrations: a randomized clinical trial. Oper Dent 38:386–393. doi: 10.2341/12-140-C CrossRefPubMedGoogle Scholar
  20. 20.
    Kossatz S, Martins G, Loguercio AD, Reis A (2012) Tooth sensitivity and bleaching effectiveness associated with use of a calcium-containing in-office bleaching gel. J Am Dent Assoc 143:e81–e87CrossRefPubMedGoogle Scholar
  21. 21.
    Schulz KF, Altman DG, Moher D, Group C (2011) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 9:672–677. doi: 10.1016/j.ijsu.2011.09.004 CrossRefPubMedGoogle Scholar
  22. 22.
    Rezende M, Loguercio AD, Reis A, Kossatz S (2013) Clinical effects of exposure to coffee during at-home vital bleaching. Oper Dent 38:E229–E236. doi: 10.2341/12-188-C CrossRefPubMedGoogle Scholar
  23. 23.
    Bonafe E, Loguercio AD, Reis A, Kossatz S (2014) Effectiveness of a desensitizing agent before in-office tooth bleaching in restored teeth. Clin Oral Investig 18:839–845. doi: 10.1007/s00784-013-1055-7 CrossRefPubMedGoogle Scholar
  24. 24.
    Bonafe E, Bacovis CL, Iensen S, Loguercio AD, Reis A, Kossatz S (2013) Tooth sensitivity and efficacy of in-office bleaching in restored teeth. J Dent 41:363–369. doi: 10.1016/j.jdent.2013.01.007 CrossRefPubMedGoogle Scholar
  25. 25.
    de Geus JL, Bersezio C, Urrutia J, Yamada T, Fernandez E, Loguercio AD, Reis A, Kossatz S (2015a) Effectiveness of and tooth sensitivity with at-home bleaching in smokers: a multicenter clinical trial. J Am Dent Assoc 146:233–240. doi: 10.1016/j.adaj.2014.12.014 CrossRefPubMedGoogle Scholar
  26. 26.
    de Geus JL, Rezende M, Margraf LS, Bortoluzzi MC, Fernandez E, Loguercio AD, Reis A, Kossatz S (2015b) Evaluation of genotoxicity and efficacy of at-home bleaching in smokers: a single-blind controlled clinical trial. Oper Dent 40:E47–E55. doi: 10.2341/14-121-C CrossRefPubMedGoogle Scholar
  27. 27.
    Rezende M, Ferri L, Kossatz S, Loguercio AD, Reis A (2016a) Combined bleaching technique using low and high hydrogen peroxide in-office bleaching gel. Oper Dent 41:388–396. doi: 10.2341/15-266-C CrossRefPubMedGoogle Scholar
  28. 28.
    Rezende M, Loguercio AD, Kossatz S, Reis A (2016b) Predictive factors on the efficacy and risk/intensity of tooth sensitivity of dental bleaching: a multi regression and logistic analysis. J Dent 45:1–6. doi: 10.1016/j.jdent.2015.11.003 CrossRefPubMedGoogle Scholar
  29. 29.
    Ontiveros JC, Eldiwany MS, Paravina R (2012) Clinical effectiveness and sensitivity with overnight use of 22% carbamide peroxide gel. J Dent 40(Suppl 2):e17–e24. doi: 10.1016/j.jdent.2012.08.009 CrossRefPubMedGoogle Scholar
  30. 30.
    Kossatz S, Dalanhol AP, Cunha T, Loguercio A, Reis A (2011) Effect of light activation on tooth sensitivity after in-office bleaching. Oper Dent 36:251–257. doi: 10.2341/10-289-C CrossRefPubMedGoogle Scholar
  31. 31.
    Bernardon JK, Sartori N, Ballarin A, Perdigao J, Lopes GC, Baratieri LN (2010) Clinical performance of vital bleaching techniques. Oper Dent 35:3–10. doi: 10.2341/09-008CR CrossRefPubMedGoogle Scholar
  32. 32.
    Kose C, Calixto AL, Bauer J, Reis A, Loguercio AD (2016) Comparison of the effects of in-office bleaching times on whitening and tooth sensitivity: a single blind, randomized clinical trial. Oper Dent 41:138–145. doi: 10.2341/15-085-C CrossRefPubMedGoogle Scholar
  33. 33.
    Abdel-Halim ES, Al-Deyab SS (2013) One-step bleaching process for cotton fabrics using activated hydrogen peroxide. Carbohydr Polym 92:1844–1849. doi: 10.1016/j.carbpol.2012.11.045 CrossRefPubMedGoogle Scholar
  34. 34.
    Mena-Serrano AP, Parreiras SO, do Nascimento EM, Borges CP, Berger SB, Loguercio AD, Reis A (2015) Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber. Oper Dent 40:E76–E82. doi: 10.2341/13-352-L CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • A. D. Loguercio
    • 1
    • 2
    Email author
  • F. Servat
    • 3
  • R. Stanislawczuk
    • 3
  • A. Mena-Serrano
    • 4
  • M. Rezende
    • 1
  • M. V. Prieto
    • 5
  • V. Cereño
    • 5
  • M. F. Rojas
    • 5
  • K. Ortega
    • 5
  • E. Fernandez
    • 5
    • 6
  • A. Reis
    • 1
  1. 1.School of Dentistry, Department of Restorative DentistryState University of Ponta GrossaPonta GrossaBrazil
  2. 2.Department of Restorative Dentistry, School of Dentistry, Faculdade de OdontologiaUniversidade Estadual de Ponta GrossaSão PauloBrazil
  3. 3.School of Dentistry, Department of Restorative Dentistry, Center of Higher Education of Campos GeraisPonta GrossaBrazil
  4. 4.School of Dentistry, Department of Restorative DentistryUniversidad de las AmericasQuitoEcuador
  5. 5.Department of Restorative Dentistry, School of Dentistry, School of Dentistry of SantiagoUniversidad de ChileSantiagoChile
  6. 6.Instituto de Ciencias Biomédicas, Universidad Autónoma de ChileSantiagoChile

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