Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : ZC05 - ZC09 Full Version

Comparison of Two Home-based Chemically-induced Teeth Whitening in Adults: A Randomised Clinical Trial

Published: May 1, 2022 | DOI:
José Sebastião Galvão Dos Santos, Kamilla Yolanda de Souzae Silva, Larissa Hellen de Paiva Felix, Marlon Ferreira Dias, Paulo Cardoso Lins Filho, Claudio Heliomar Vicente da Silva, Rena

1. Faculty, Department of Prosthesis and Oral Facial Surgery, Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil. 2. Faculty, Department of Prosthesis and Oral Facial Surgery, Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil. 3. Faculty, Department of Prosthesis and Oral Facial Surgery, Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil. 4. Student, Department of Dental Materials and Prosthodontics São Paulo State University (UNESP), School of Dentistry Araraquara, São Paulo, Brazil. 5. PhD Student, Department of Prosthesis and Oral Facial Surgery, Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil. 6. Professor, Department of Prosthesis and Oral Facial Surgery, Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil. 7. Professor, Department of Prosthesis and Oral Facial Surgery, Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil.

Correspondence Address :
Dr. Renata Pedrosa Guimarães,
AV. Ministro Marcos Freire, 4443, APT 303, Casa Caiada, Recife, Pernambuco, Brazil.


Introduction: Whitening strips are one of the Over The Counter (OTC) bleaching products which performed tooth whitening through an easy-to-use, low-cost product with good esthetic results.

Aim: To compare the bleaching efficacy, tooth sensitivity and gingival irritation, and of home-based chemically-induced teeth whitening treatment performed using either a conventional customised tray or strips as delivering systems for whitening agents.

Materials and Methods: This randomised clinical trial was conducted at Federal University of Pernambuco (UFPE), Brazil, from 15th May 2015 to 20th January 2018. Total 21 subjects, with maxillary incisor’s shade A3 or darker were selected for this study. Patients were randomly assigned into two groups, according to the bleaching technique used i.e, G1 (n=10) was carbamide peroxide 10% (Whiteness Perfect/FGM) delivered in a customised tray, G2 (n=10) was hydrogen peroxide 10% delivered in strips (3D White Whitestrips/OralB). Color changes were evaluated by an objective (Easyshade Spectrophotometer/VITA) method at baseline, middle of treatment period, end of treatment, 15 and 30 days after treatment end. Tooth sensitivity, gingival irritation and degree of satisfaction were also recorded. Fisher’s-exact test was used for categorical variables i.e, Kolmogorov-Smirnov Normality Test for quantitative variables and Mann-Whitney’s test for comparison between two groups.

Results: No significant difference was observed in occurrence of tooth sensitivity (p-value=0.635), gingival irritation (p-value=0.090) and treatment satisfaction (p-value=0.476) between groups. Increased whitening effectiveness was observed in both groups after 30 days of clinical evaluation, however with no significant difference between groups (p-value=0.139).

Conclusion: Both bleaching systems showed similar effectiveness and high degree of satisfaction. Low degree of tooth sensitivity and gingival irritation was observed with no difference between groups.


Clinical trial, Dentin sensitivity, Peroxides, Tooth bleaching, Tooth bleaching agents

In the past few decades, home-based bleaching products have been exponentially increasing (1). In view of this market need, some products, such as bleaching strips or prefilled disposable trays products for at-home bleaching were introduced on market (2).

Supervised dental bleaching is one of the most commonly used techniques to change tooth color alterations (3). The main advantages of this modality are related to the reduced chair time and lower prevalence of tooth sensitivity in relation to in-office bleaching, which use high concentrations of peroxides (4). This method t is also safe, conservative, economical and effective alternative, as long as supervised by a qualified professional (5). In relation to the concentration of peroxide used in this type of technique, usually, 10% Carbamide Peroxide (CP) is the most suitable bleaching agent recommended (6).

Whitening strips are one of the hydrogen peroxide- containing Over The Counter (OTC) bleaching products and were introduced in 2000 aiming to popularize tooth whitening through an easy-to-use, low-cost product with good esthetic results (7). These whitening strips adhere to surface of anterior teeth and release 5 to 14 % hydrogen peroxide during relatively short periods of time (5). However, a previous study showed ocurrence of deleterious effect on enamel surface caused by whitening strips when compared to supervised whitening (8). Strips adapts to the dental arches but they must be used under dentist’s supervision. They can cause discomfort to the patient as they do not provide adequate sealing (9).

Even with the diversity of whitening techniques available, there is still a lack of clinical studies that provide scientific support for these OTC products (1),(10). Therefore, the aim of this clinical investigation was to compare the effects of whitening techniques using carbamide peroxide or hydrogen peroxide dispensed in customized trays or strips on color change, tooth sensitivity, gingival irritation, and treatment acceptance. The null hypothesis tested was that there would be no difference in terms of tooth sensitivity, gingival irritation, and bleaching efficacy among the whitening strips in comparison to 10% carbamide peroxide in customized trays.

Material and Methods

This randomised clinical trial was conducted at Federal University of Pernambuco (UFPE), Brazil, from 15th May 2015 to 20th January 2018. The study was in full accordance with ethical principles, including the Declaration of Helsinki, as revised in 2002, and was approved by the Research Ethical Committee of Universidade Federal de Pernambuco, School of Dentistry, Recife, Pernambuco, Brazil (No. 29049814.5), prior to the start of the study. This article was also prepared using the protocol established by the Consolidated Standards of Reporting Trials statement (Table/Fig 1).

This study was a single-blind, parallel randomized clinical open trial in which the evaluator was blinded to the group assignment.

Inclusion criteria: Patients with minimum age of 18 years, presence of all permanent anterior teeth, vitalized, without restorations involving the vestibular faces, and with maxillary incisor's shade A3 or darker on the VITA scale (VITA shade, VITA Zahnfabrik, Bad Säckingen, Germany) and with good oral health were inlcuded in the study.

Exclusion criteria: Patients with tooth sensitivity, cervical injuries or fractures, smokers, pregnant women and lactating women, children and adolescents (upto 18 years), previous history of cancerous lesions, caries and periodontal disease, prostheses and/or previous restorations were excluded from the study.

Based on pre-established criteria described above, a total of 21 patients (convenience sample), of both sexes, were selected for the study.


The patients fit to participate were assigned by simple randomization into two groups according to the bleaching treatment. For this step, opaque, sealed, and consecutively numbered envelopes containing the identification of the groups were prepared by a third person not involved in the research protocol. These envelopes were opened immediately before the beginning of the bleaching procedure.

• Group G1 (n=10)- Patient underwent tooth whitening treatment with 10% Carbamide Peroxide (CP) (Whiteness Perfect 10- FGM, Joinvile, SC, Brasil) delivered in a customized tray.
• Group G2 (n=11)-Patient underwent tooth whitening treatment with 10% hydrogen peroxide delivered in strips (White Strips, Oral-B, São Paulo, SP, Brazil).

Group 1: For G1, custom-fitted trays were fabricated. Alginate impressions (Jeltrate/Dentsply, São Paulo, SP, Brasil) were made of both dental arches. After this step, disinfection was perfomed and these impressions were filled with dental stone (Diamante/IGE, Araripina, PE, Brazil). To fabricate the customized trays, a soft vinyl material (Whiteness Placas para Moldeiras/FGM) was submitted in a vacuum forming machine (Plastivasc P7/Bioartl, São Carlos, SP, Brazil) (2).

Instructions were given to the participants regarding placement of the gel in the disposable tray. All participants checked the adaptation of the bleaching tray before starting the clinical study, and It was also instructed to follow the recommendations to use the bleaching agent for 8 hours, during sleep, once a day for 15 days (2).

Group 2: For G2 members were given instructions on how to apply the bleaching strips and how to use them, according to the guidelines described by the manufacturer. The usage time was 30 minutes, twice a day for 7 days. All patients received verbal instructions about oral hygiene, encouraging participants to brush their teeth regularly with fluoridated toothpastes without whitening components.

For the color evaluation with the Vita Easyshade Spectrophotometer (Vita Zahnfabrik), an impression of the maxillary arch was taken with Alginate (Jeltrate/Dentsply). The impression served as a standard color measurement guide for the spectrophotometer. For each tooth to be evaluated, a window whose diameter corresponds to the diameter of the Spectrophotometer tip was created on the buccal surface of the molded silicone guide (Table/Fig 2). This way, the measurement was always taken at the same location, after tooth prophylaxis with pumice and water. The shade of the middle third of the upper anterior elements (11 and 21) was taken as reference, according to the CIELab space of the Commission Internationale de l'Eclairage. The color variation was expressed as a continuous variable (ΔE). The arithmetic mean between the values of L* (black-white), a* (red-green) and b* (yellow-blue) of these two teeth was considered (1),(11).

The readings were taken 5 times for each patient in both groups:

• At baseline (before the beginning of the study),
• After 1 week for G1 and after 4 days for G2 (middle of treatment of each group),
• After 15 days of the beginning of treatment for G1 and 7 days after the beginning of treatment for G2 (end of treatment of each group), and
• 15 days and 30 days after the end of treatment for both groups.

To determine color differences at different times of treatment, ΔE was calculated using the formula: ΔE * = [ΔL * 2 + Δa * 2 + Δb * 2] 1/2, where ΔL * = L0-L1; Δa = a0-a1; Δb = b0-b1. ΔE were checked at four different times: ΔE1 = shade registered in the middle of the treatment compared to the initial shade; ΔE2: shade at the end of the treatment compared to the initial shade; ΔE3: shade after 15 days compared to the shade at the end of the treatment; ΔE4: shade after 30 days compared to the shade at the end of the treatment (1).

Gingival irritation

The gingival irritation was also recorded during the period of bleaching treatments by filling out a form with a dichotomous scale in which patients recorded whether they experienced gingival alterations due to peroxide contact. The patients have answered the form any time during treatment, and the data were collectted at evaluation appoitments. In this same form, patients were also asked about the occurrence of tooth sensitivity during and immediately after the use of whitening products.

Sensitivity: This sensitivity was measured using a Visual Analogue Scale (VAS). This scale is a 10 cm horizontal line with scores of 0 and 10 at their ends, in which 0 means no sensitivity and 10 means severe tooth sensitivity. If the participant scored 0 (no sensitivity) after the bleaching session, this participant was considered to be insensitive to the bleaching protocol. In all other circumstances, scored > 0 in VAS, the participants were considered to have bleaching-induced tooth sensitivity (12).

Degree of satisfaction

At the end of the treatment, the patients were evaluated for their degree of satisfaction with the technique and with the results obtained, by filling in a specific form (1).

Statitical Analysis

Data were submitted to statistical analysis, all tests were applied considering an error of 5% and the confidence interval of 95% and the analyzes were carried out using Statistical Package for the Social Sciences (SPSS) software version 23.0 (SPSS Inc. Chicago, IL, USA). Numerical variables were represented by measures of central tendency and measures of dispersion; to verify the existence of an association, Fisher’s-exact test was used for categorical variables; the Kolmogorov-Smirnov normality test for quantitative variables and Mann-Whitney’s test for comparison between 2 groups. The p-value<0.05 was considered as statistically significant.


The sample was composed by 61.9% (n=13) male with an average age of 24.22 years, ranging from 19 to 37 years old.

The color change at ΔE1 was grater for G1 (p-value<0.05). However, the comparison between the mean values of ΔE2 obtained between the initial and final evaluations of treatment (11.06 for G1 and 8.47 for G2), using the Mann-Whitney’s test showed no statistically significant difference (p-value=0.139) (Table/Fig 3).

Only 28.6% (n=6) of the sample showed sensitivity during treatment, gingival reaction was observed in 19.0% (n=4) of the patients and satisfaction with the treatment result obtained was 90.5% (n=19). No statistical significance was obtained for comparisons among groups for these variables (Table/Fig 4).


Tooth whitening is an esthetic procedure widely performed in dental clinic, this technique is able to reverse the darkened color of tooth and enhance patient’s self-esteem (13). There are several modalities of tooth whitening: in-office technique which use high concentrate gels of hydrogen peroxide associated or without LED (14), supervised whitening that use gel with low concentrations of hydrogen peroxide or domestic whitening strategies, called Over The Counter (OTC) products, which are available to public without dental supervison (5).

In this present study, bleaching strips (OCT) were evaluated in comparision to a supervisioned dental bleaching (10% carbamide peroxide). Although the use of bleaching strips offers advantages, such as shorter application time and ease of use compared to other systems, there is still a lack of clinical evidence regarding the safety of these products (1),(9). Thus, the safety of these whitening agents remains controversial, and may have potentially deleterious effects on health (8).

The difference in treatment duration between the tested groups in this study (15 days for G1 and 7 days for G2) is justified by the need to conduct the protocol as recommended by the manufacturers.

In the present study, the strips showed a satisfactory bleaching effect. This finding can be explained due to the concentration of HP present in the product (10%), which is associated with good whitening results (2),(8),(15). Few studies in the literature have evaluated the real efficacy of these products and their main effects on dental structure and tissues of the oral cavity (1),(2),(9),(10),(15),[16[,(17),(18),(19). The results of the present clinical investigation point to a whitening effect in both groups with no difference significance. This finding does not corroborate with a previous clinical study which patients submited to different tooth whitening strategies obtained difference significance on whitening efficacy using the whitening strips and 10% of carbamide peroxide (1). However, a systematic review where the effectiveness and safety of the bleaching treatment with 10% CP and whitening strips were evaluated revealed same whitening efficacy between these groups through analysis of eight previous studies (20). Data from previously published studies have been compared with the present study in (Table/Fig 5) (1),(2),(8),(9),(15),(18).

The evaluation of the durability of the whitening effect, revealed similar results for both techniques, with slight color reversal in the first 15 days. This data may correlate to the presence of dyes on patient’s diets, however, previous findings suggest that there is no influence of diet on the whitening effect (13). This finding is more probably correlated to tooth dehydration immediately after whitening, which can influence tooth color due to demineralization caused by the low pH of some whitening products (21). Although it is considered a conservative treatment, tooth whitening may cause adverse effects after the procedure, such as transient dental sensitivity, which can be uncomfortable or imperceptible depending on the individual (22). This consequence can be associated with toxic components released by bleaching agents which are able to diffuse in the enamel and dentin causing damage to the dental pulp (23).

Among the 21 participants, six had transient dental sensitivity, four of them in the whitening strips group (G2). However, there was no significant difference between the groups, corroborating the results of a previous investigation where no significant difference was found regarding dental sensitivity between participants who used 10% hydrogen peroxide gel and whitening strips (9).

Considering the occurrence of gingival irritation, there was no significant difference between the groups analyzed in the present study. Among the patients evaluated during treatment, only 19% (n=4) had gingival irritation, annd all belonged to strips group (G2). However, similar studies (7),(20), demonstrated a higher frequency of gingival irritation in supervised whitening using trays, proposing as a cause the lower amount of gel in the whitening strips, since in the trays the excess of whitening gel can overflow and increase the contact with gingival tissue, causing gum damage.

The use of bleaching strips with 10% hydrogen peroxide cause a discrete cell viability reduction and slight alterations in odontoblast-like cells morphology (17). However, in addition to negative consequences documented in the present study due to exposure to bleaching agents, some researchers (16),(24) reported genotoxic effects of the whitening gel on the gingival epithelial, which is directed related to deoxyribonucleic acid damage (16). This reaffirms the need for qualified professional supervision, regardless of the chosen bleaching agent or delivery system.

Despite the existence of some transient side effects such as dental sensitivity and gingival irritation observed in the present study, the bleaching products used were equally effective in obtaining a satisfactory esthetic result. However, it is necessary to perform tooth whitening safely, employing scientific based evidence practices in order to obtain satisfactory and long-lasting whitening results, avoiding potential side effects.


Inspite of the interesting results found in the present study, the sample size was a limitation given the exclusion of a large number of patients due to the inclusion criteria necessary to carry out the research. Thus, future studies with a larger sample size are necessary in order to discuss the risks of uncontrolled use of over the counter bleaching agents without professional supervision.


Both bleaching systems showed similar effectiveness and high degree of satisfaction. Low degree of tooth sensitivity and gingival irritation was observed with no difference between groups. However, further studies are necessary in order to follow-up the durability of the whitening result achieved by OTC products and its safety due to the use of these products does not require a professional monitoring.


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DOI and Others

DOI: 10.7860/JCDR/2022/53020.16351

Date of Submission: Oct 27, 2021
Date of Peer Review: Dec 07, 2021
Date of Acceptance: Feb 10, 2022
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Oct 29, 2021
• Manual Googling: Feb 09, 2022
• iThenticate Software: Apr 27, 2022 (25%)

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