Vital tooth bleaching: Biologic adverse effects-A review

Depending on etiology, the esthetic treatment of dyschromia may involve vital tooth- bleaching techniques. Hydrogen peroxide is the active molecule used for such procedures; however, its action mechanism is not clearly understood. Moreover, a variety of contradictory studies make difficult the evaluation of the safety of bleaching techniques. The purpose of this article is therefore to review the available literature (1) to describe the physicochemical properties of hydrogen peroxide and (2) to assess the safety of its use as a vital tooth-bleaching agent. Indeed, based on hydrogen peroxide's capacity to generate free radicals that diffuse throughout the dental hard tissues, concerns have been addressed regarding the adverse effects that bleaching products can induce on the enamel and dentin structures, pulp, and bonding to a composite resin system. Moreover, during self-application of home bleaching products, hydrogen peroxide is released into the oral cavity and ingested. Some questions have therefore arisen concerning its toxicity and its possible carcinogenicity. Keywords: adverse effects, bleaching, cancer, carbamide peroxide, enamel, hydrogen peroxide, tooth, toxicity