teeth whiteners / teeth bleaching / side effects and safety

Are teeth whiteners (10% carbamide peroxide) used with tray-based teeth whitening products safe? The first article to appear in a dental journal documenting an at-home tray-based teeth whitening (teeth bleaching) system using 10% carbamide peroxide as the whitener was published in 1989, although the technique itself can be traced back to the 1960's. During the years following this article tray-based teeth whitening technique has gained wide acceptance by the dental community. The overwhelming majority of dentists in this country do offer this procedure to their patients. The research data that has been accumulated since 1989 has supported and continues to support this method's effectiveness and safety.

What side effects can be expected when using 10% carbamide peroxide teeth whiteners? Side effects can and do occur when using a 10% carbamide peroxide whitener in conjunction with an at-home tray-based teeth whitening system. The two most common side effects are the creation (or increase) of tooth thermal sensitivity (hot and cold sensitivity in a person's teeth), and irritation of a person's gums. Other, less frequently encountered, side effects that have been reported by patients are: sore throat, tooth pain, tingling of the tissues, and headaches.

While the side effects a person encounters can be significant enough that the bleaching process must be discontinued, they are usually found to be minor. One study asked participants to rate the discomfort associated with their side effects on a scale from 0 to 10, 10 being the most painful. Most respondents rated their side effects as a 1 or 2. In all cases, if you do notice any side effects during the bleaching process, you should report them to your dentist. When just minor side effects have presented themselves a dentist will often recommend that the person just reduce the total number of hours their bleaching trays are worn each day, or recommend that the bleaching process only be performed on alternating days. Because both of these methods reduce a person's exposure to the carbamide peroxide teeth whitener, the side effects they have noticed will usually subside. In more severe cases a dentist may feel that palliative treatments, usually quite simple in nature, are indicated or else that the teeth whitening process should be stopped altogether.

At Home Teeth Whitening: Page 1 What is "at home" teeth whitening? Are all teeth whiteners about the same? Page 2 When will teeth whitening work? How long do at home teeth whiteners take? Page 3 When won't teeth whiteners work? Page 4 What are the steps of the teeth whitening process? How long does teeth whitening last? Page 5 What are the side effects of teeth whiteners? Are teeth whiteners safe? Page 6 How much do at home teeth whiteners cost? Page 7 Questions to ask about teeth whiteners.

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A) Tooth thermal sensitivity (sensitivity to hot and cold). The teeth of people performing at-home teeth bleaching treatments can develop a sensitivity to hot and cold temperature variations. Easily half of all patients who bleach their teeth do notice at least some transient thermal sensitivity. While there is no way to predict specifically who will develop this problem there are some general indicators. Those persons who prior to bleaching already notice sensitivity to hot and cold, and also those persons who have found that they experience increased thermal sensitivity after getting their teeth cleaned are both more likely to complain about tooth thermal sensitivity while bleaching their teeth than others. Any problems with thermal sensitivity should be reported to your dentist. Usually a dentist can help you control the degree to which you do experience thermal sensitivity by either making suggestions about reducing the amount of time that you wear your bleaching trays or else by recommending some simple palliative measures such as fluoride or potassium nitrate treatments. Both fluoride and potassium nitrate are both common ingredients found in those over-the-counter toothpastes formulated to help desensitize "sensitive teeth".

B) Gingival ("gum") irritation. During the teeth whitening process a person's gums can become irritated from their contact with the teeth whitener. It is generally thought that the potential of developing gum irriation is related to the concentration of the peroxide found in the whitening gel. This is one reason why the use of a 10% carbamide peroxide whitener is typically considered to be more prudent than the use of a more concentrated one.

To minimize or remedy the problem of gum irritation a dentist will usually trim a person's bleaching trays in a scalloped fashion so they cover a maximum of each tooth being bleached, but rest just short of touching the gums. Additionally as a general rule, so to help reduce gum irritation, when bleaching trays are initially inserted a person should wipe away the excess whitening gel that escapes from the tray onto their gums with their finger or a toothbrush.

What are the safety concerns associated with the use of 10% carbamide peroxide teeth whiteners? As mentioned in our section titled "About at home teeth whitening products: Know what you are buying." , all references to teeth whiteners, bleaches, bleaching agents, bleaching gels, etc... on these pages refers to "10% carbamide peroxide" products. These products contain carbamide peroxide as their active ingredient and as non-active ingredients compounds such as glycerin and flavorings. With the continued accumulation of data by dentists over the last 10 years, most of the safety concerns with teeth whiteners containing 10% carbamide peroxide have diminished (when these products are used as instructed). Adverse effects associated with tray teeth bleaching technique may develop when it is used inappropriately. Inappropriate usage of the method includes "over use" of the technique and also utilizing it with inappropriate teeth whiteners.

Will 10% carbamide peroxide teeth whiteners cause cancer? Concerns have been postulated that teeth whiteners can possibly cause cancer in the soft tissues of the mouth. These concerns are related to the fact that the peroxide contained in teeth whiteners can produce molecules called "free radicals". Free radicals are capable of causing cellular damage. The proper use of dentist monitored at home teeth whiteners containing 10% carbamide peroxide have not been shown to produce a carcinogenic risk. The concentration of hydrogen peroxide created by these whiteners is low, on the order of 3.5%. Studies of hydrogen peroxide at about this same concentration (actually 3.0%) have not shown a carcinogenic risk. The actual contact of teeth whitener to a person's soft tissues ("gums") in dentist made bleaching trays is minimal. One of the human body's major defenses against the adverse affects of peroxides is a compound found in saliva. This compound has been calculated to effectively neutralize about 30mg of peroxide in one minute. The typical single application of carbamide peroxide tooth whitener is only 3.52 mg. Calculations have been made and on average, the daily total peroxide a person is exposed to from bleaching their teeth is less than .1% of the daily production of peroxide by their liver.

Will 10% carbamide peroxide teeth whiteners damage tooth enamel? Studies involving 10% carbamide peroxide whiteners have found minimal or no effect on the microhardness or mineral content of tooth enamel surfaces. Scanning electron microscope studies of the enamel of teeth that have been bleached have typically not shown any damage either. In relative terms, studies have shown that exposure to soft drinks and fruit juices cause comparable or greater alteration of tooth enamel than tooth whiteners.

Will peroxide-based teeth whiteners damage my existing dental restorations? Teeth can be whitened with the at home bleaching method utilizing a 10% carbamide peroxide whitener with little concern about significant damage to a person's existing fillings. Over ten years of clinical use of these products has not revealed any obvious problems or concerns. Some studies have suggested that some degree of interaction or change might occur with white dental fillings, amalgam dental fillings, and some types of dental cements. However the clinical significance of these effects is still considered to be inconclusive. Your dentist can address any specific concerns you may have during your pre-whitening dental examination. The main difficulty encountered with existing dental work is that it does not lighten during the at home teeth whitening process (the color of porcelain veneers may be affected). This means that pre-existing dental work will usually have to be replaced so to match a person's new, post bleaching, tooth shade.