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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 53-55

Adverse effects of tooth bleaching: A review


Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication29-Aug-2019

Correspondence Address:
Dr. Fatima L AlOtaibi
Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, An Namuthajiya Campus, Riyadh 11681
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_22_19

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  Abstract 

Current bleaching methods mainly use hydrogen peroxide as the active agents. Tooth whitening is achieved either by in-office bleaching technique or self-applied or home bleach method. This review focused mainly on the adverse outcomes of tooth bleaching such as cervical root resorption, crown fracture, tooth sensitivity, mucosal reaction, and enamel surface alterations produced during the treatment and the management of vital and non-vital teeth-bleaching procedures. Cervical root resorption is one of the unwanted effects observed with the internal bleaching, especially seen with thermo-catalytic procedures. There is a possibility of crown fracture after intracoronal bleaching most likely due to the extensive removal of the intracoronal dentin. One of the common side effects of external tooth bleaching is the tooth sensitivity that ranged between 15% and 65%. Another important adverse effect of high concentration of hydrogen peroxide bleaching is the mucosal irritation ranged between 30% and 35%. Morphologic changes of enamel were also observed with the use of higher concentration of bleaching agents. In view of this review, it is highly desirable to take all the necessary precautions and considerations while performing tooth-bleaching treatment.

Keywords: Bleaching, cervical root resorption, crown fracture, enamel alteration, sensitivity


How to cite this article:
AlOtaibi FL. Adverse effects of tooth bleaching: A review. Int J Oral Care Res 2019;7:53-5

How to cite this URL:
AlOtaibi FL. Adverse effects of tooth bleaching: A review. Int J Oral Care Res [serial online] 2019 [cited 2019 Sep 21];7:53-5. Available from: http://www.ijocr.org/text.asp?2019/7/2/53/260727




  Introduction Top


The most commonly observed staining of vital teeth is the result of highly colored drink or food. Tobacco produces a yellowish brown to black discoloration, usually in the cervical portion of the teeth and mainly on the lingual surfaces. Chewing tobacco frequently penetrates the enamel to produce an even darker stain, and marijuana may produce sharply delineated rings around the cervical portion of the teeth next to the gingival margins. Coffee and tea can cause severe, tenacious brown to black discolorations. Those stains, such as the ones caused by brightly colored foods, are the most difficult to remove from pits, fissures, grooves, or enamel defects.[1],[2],[3],[4] “Bleaching” or “teeth whitening” is the most conservative dental treatment for discolored teeth compared to the other teeth-whitening procedures such as resin-bonded composites, porcelain veneers, and crowns. Methods of tooth whitening have existed for more than 100 years. During the last decade, increased attention to techniques of bleaching has raised safety concerns. Review found 246 citations by cross-referencing hydrogen peroxide with toxicity. There are safety concerns associated with the potential biological effects of free radicals, specifically free radicals of oxygen that are by-products or intermediates of hydrogen peroxide metabolism.[2] Contemporary bleaching systems involve the use of hydrogen peroxide or carbamide peroxide, which can be applied externally, in a procedure known as vital bleaching, or internally, in the pulp chamber, in a procedure that can be used only for non-vital teeth. Both techniques are intended to bleach the chromogens “pigments” in the dentin. Mechanism involved in tooth bleaching is based on the diffusion of hydrogen peroxide through dentinal tubules and the oxidation of pigments. During the bleaching procedure, neither the patient nor the dentist can exactly control the amount of lightening. This technique runs the risk of both over- and under-bleaching. There is a possibility of soft tissue damage due to the caustic nature of the high concentrations of peroxide. There is a greater risk of postoperative sensitivity.[2] Tooth sensitivity was considered as an important side effect of tooth-bleaching agents. Comparative studies have pointed out higher incidence of tooth sensitivity ranging from 67% to 78% after the use of in-office power bleaching method compared with the home vital bleaching method, using 10% carbamide peroxide (15%–65%).[5] There are several reviews that reported on adverse and undesirable effects of bleaching on local hard and soft tissues. Newer bleaching agents with the different activation methods have been incorporated to reduce these untoward effects of bleaching. This study outlines the untoward effects reported by bleaching products introduced within the field of dental bleaching. Hence, the purpose of this narrative review was to report the cervical root resorption, crown fracture, tooth sensitivity, mucosal reaction and enamel surface alterations produced during the treatment, and the management of vital and non-vital teeth-bleaching procedures.


  Literature Search Strategy Top


A comprehensive literature search in electronic databases of Scopus, PubMed, Medline, Web of Science, Saudi Digital Library, and Google Scholar databases was performed by using important terms. The key words used were “adverse effects of tooth bleaching,” “adverse reaction of tooth bleaching,” “adverse effects of vital bleaching,” “adverse effects of non-vital bleaching,” “undesirable effects of tooth bleaching,” and “biological effects of dental bleaching.” Adverse effects of cervical root resorption, crown fracture, tooth sensitivity, alteration in enamel surface, and mucosal irritations were reported after carefully analyzing the reported literature.


  Cervical Root Resorption Top


Of the 58 bleached teeth, four teeth with intracoronal bleaching (30% hydrogen peroxide) showed external root resorption. In other study, sodium perborate was used as an intracanal bleaching agent that did not reveal any external root resorption. It has been reported that high concentration of hydrogen peroxide in the presence of heat was found to increase the cervical root resorption. The exact mechanism of cervical root resorption is not clear; however, it was postulated that bleaching agent escapes through dental tubules to reach periodontal tissues and initiates inflammatory process.[6] Care must be taken while using thermo-catalytic bleaching on defective dentinal areas due to the risk of cervical perforation.


  Crown Fracture Top


There is a possibility of crown fracture after intracoronal bleaching, most likely due to the extensive removal of the intracoronal dentin. In addition, use of 30% hydrogen peroxide for the purpose of bleaching in intracoronal area could decrease the microhardness of dentin and enamel and deteriorate the mechanical properties of the dentin.[7] Chauhan et al. reported that the intracoronal bleaching significantly affected the shear bond strength of ceramic brackets after 1 month of bleaching, and perborates affected strength more adversely compared to the hydrogen peroxide and carbamide peroxide bleaching agent. Care must be taken while using thermo-catalytic bleaching on defective dentinal areas because of the risk of cervical perforation.[8]


  Tooth Sensitivity Top


One of the common side effects of external tooth bleaching is the tooth sensitivity. Albanai et al. reported the incidences of dentin sensitivity ranging from 15% to 65% by using 10% carbamide peroxide.[9] Incidence of tooth sensitivity increased in in-office bleach with hydrogen peroxide and heat application. It is common to have tooth sensitivity for 4 days after tooth bleaching, and it ceases at the end of the treatment. However, persistence of tooth sensitivity up to 39 days was also reported within the literature. The exact mechanism concerned with tooth sensitivity is not clearly established; however, in vitro experiments have suggested that peroxide penetrated enamel and dentin and entered the pulp chamber.[10]


  Effect of Bleaching Agent on Mucosal Tissues Top


It has been shown that a high concentration of hydrogen peroxide in the range of 30%–35% is destructive to mucus membrane and may lead to burns and bleaching of the gums. Most of the findings from animal studies have revealed that exposure of the gingiva to 1% hydrogen peroxide for approximately 6–48h damaged the epithelium and caused acute inflammation of subepithelial connective tissue. Various studies reported the effect of tooth-bleaching agent on changes in soft tissue morphology, proliferation of basal keratinocytes, apoptosis of cells in all epithelial strata, and alterations in the expression of cytokines associated with the inflammation.[11] Hence, it is always recommended to use the tray that will prevent gingival exposure by exclusively contacting the teeth.


  Effect of Bleaching Agents on Enamel Surface Top


Many studies have reported morphologic changes of enamel after bleaching with various agents. When enamel surface is exposed to the bleaching agent, it showed some morphologic changes compared to untreated control surfaces. Cavalli et al.[10] reported that 35% carbamide peroxide produced the roughest enamel surfaces. Different concentrations of carbamide peroxide produced similar staining means and enamel surface morphological alterations.[12] Türkun et al.[11] showed that 10% carbamide peroxide bleaching materials caused alterations in enamel surface morphology immediately after bleaching, these alterations were dependent on brand and application time. Moreover, these enamel alterations reversed to normal within 3 months.[13] Hence, all the precautions should be taken while planning dental bleaching to avoid further risk of discoloration.


  Conclusion Top


In view of this review, it is highly desirable to take all the necessary precautions and considerations while performing tooth-bleaching treatment. It is concerned with various adverse reactions of cervical root resorption, crown fracture, tooth sensitivity, mucosal reaction, and enamel surface alterations. Hence, regular updated knowledge of the bleaching products and techniques is vital to avoid adverse outcomes of teeth-bleaching treatment. Hence, it is necessary for the professionals to inform about the possible adverse reactions of tooth bleaching to the patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Eriksen HM, Nordbø H. Extrinsic discoloration of teeth. J Clin Periodontol 1978;5:229-36.  Back to cited text no. 1
    
2.
Goldstein GR, Kiremidjian-Schumacher L. Bleaching: Is it safe and effective? J Prosthet Dent 1993;69:325-8.  Back to cited text no. 2
    
3.
Hattab FN, Qudeimat MA, al-Rimawi HS. Dental discoloration: An overview. J Esthet Dent 1999;11:291-310.  Back to cited text no. 3
    
4.
Watts A, Addy M. Tooth discolouration and staining: A review of the literature. Br Dent J 2001;190:309-16.  Back to cited text no. 4
    
5.
Nathanson D, Parra C. Bleaching vital teeth: A review and clinical study. Compend Newtown Pa 1987;8:490-2, 494, 496-7.  Back to cited text no. 5
    
6.
Velloso GR, de Freitas MM, Alves A, Silva A, Barboza E, Moraschini V. Multiple external cervical root resorptions after home whitening treatment: A case report. Aust Dent J 2017;62:528-33.  Back to cited text no. 6
    
7.
Chng HK, Palamara JE, Messer HH. Effect of hydrogen peroxide and sodium perborate on biomechanical properties of human dentin. J Endod 2002;28:62-7.  Back to cited text no. 7
    
8.
Chauhan V, Kumar P, Sharma P, Shetty D. Effect of different intracoronal bleaching methods on shear bond strength of ceramic brackets bonded to bleached enamel: An in-vitro study. J Orthod Sci 2017;6:86-90.  Back to cited text no. 8
    
9.
Albanai SR, Gillam DG, Taylor PD.An overview on the effects of 10% and 15% Carbamide Peroxide and its relationship to dentine sensitivity. Eur J Prosthodont Restor Dent 2015;23:50-5.  Back to cited text no. 9
    
10.
Thitinanthapan W, Satamanont P, Vongsavan N. In vitro penetration of the pulp chamber by three brands of carbamide peroxide. J Esthet Dent 1999;11:259-64.  Back to cited text no. 10
    
11.
Alqahtani MQ. Tooth-bleaching procedures and their controversial effects: A literature review. Saudi Dent J 2014;26:33-46.  Back to cited text no. 11
    
12.
Cavalli V, Arrais CA, Giannini M, Ambrosano GM. High-concentrated carbamide peroxide bleaching agents effects on enamel surface. J Oral Rehabil 2004;31:155-9.  Back to cited text no. 12
    
13.
Türkun M, Sevgican F, Pehlivan Y, Aktener BO. Effects of 10% carbamide peroxide on the enamel surface morphology: A scanning electron microscopy study. J Esthet Restor Dent 2002;14: 238-44.  Back to cited text no. 13
    




 

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  In this article
   Abstract
  Introduction
   Literature Searc...
   Cervical Root Re...
  Crown Fracture
  Tooth Sensitivity
   Effect of Bleach...
   Effect of Bleach...
  Conclusion
   References

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