Safety issues of tooth whitening using peroxide-based materials

Abstract

In-office tooth whitening using hydrogen peroxide (H₂O₂) has been practised in dentistry without significant safety concerns for more than a century. While few disputes exist regarding the efficacy of peroxide-based at-home whitening since its first introduction in 1989, its safety has been the cause of controversy and concern. This article reviews and discusses safety issues of tooth whitening using peroxide-based materials, including biological properties and toxicology of H₂O₂, use of chlorine dioxide, safety studies on tooth whitening, and clinical considerations of its use. Data accumulated during the last two decades demonstrate that, when used properly, peroxide-based tooth whitening is safe and effective. The most commonly seen side effects are tooth sensitivity and gingival irritation, which are usually mild to moderate and transient. So far there is no evidence of significant health risks associated with tooth whitening; however, potential adverse effects can occur with inappropriate application, abuse, or the use of inappropriate whitening products. With the knowledge on peroxide-based whitening materials and the recognition of potential adverse effects associated with the procedure, dental professionals are able to formulate an effective and safe tooth whitening regimen for individual patients to achieve maximal benefits while minimising potential risks.

Attitudes of Students of Different Schools of University of Zagreb on Tooth Bleaching

“…Mehanizam izbjeljivanja također nije jasan. Smatra se da je izbjeljivanje oksidacijska reakcija tijekom koje se peroksid metabolizira u vodu i slobodne radikale s pojedinačnim elektronom koji ulazi u reakciju s kromagenim faktorima te ih dekolorizira ili potpuno razgrađuje (13,14).…”

“…The mechanism of bleaching is also unclear. Bleaching is considered to be an oxidation reaction where hydrogen peroxide metabolizes into water and free radicals possess a single electron, which is thought to combine with the chromagens to decolorize or soubise them (13,14).…”

“…No clinical studies or case reports in the literature have documented macroscopically or clinically visible damage due to vital bleaching or clinically relevant tissue destruction (17). Tooth sensitivity can occur during or after the bleaching treatment (8,11,13) and it is considered a transient painful sensation which usually completely disappears in two to three days (13,14,27,28). Pain and sensitivity can be explained by the irritating effect of hydrogen peroxide on the pulp cells because the molecules of hydrogen peroxide can penetrate to the pulp through enamel and dentin.…”

“…Nadalje, Tanalp je sa suradnicima ustanovio da studenti ne vjeruju u uspjeh izbjeljivanja avitalnih, endodontski liječenih zuba (23). Do danas je proveden zavidan broj istraživanja o mehanizmu djelovanja pojedinih sredstava za izbjeljivanje zuba, o učinkovitosti samog tretmana i o neže-ljenim, štetnim učincima (10,13,14,17,25,26). Ako se slijede upute proizvođača i ako se obavlja pod stalnim stručnim nadzorom doktora dentalne medicine, izbjeljivanje zuba siguran je klinički postupak.…”

The Whitening Efficiency on Colored Teeth

“…The last step was to bleach the colored teeth using 14% hydrogen peroxide for 30 minutes. 5,6 After application of the whitening agent, the teeth gained a whiter shade, but they could not reach the initial one (Panels C, F, I, and L). The images show that the most spectacular changes occurred while using blueberry jam (Panels A, B, and C), Coca-Cola (Panels D, E, and F), red wine (Panels G, H, and I), and methylene blue-based oral antiseptic (Panels J, K, and L).…”