General Dentistry

Bleaching

ADA Statement on the Safety and Effectiveness of Tooth Whitening Products

For more than a decade, the ADA Council on Scientific Affairs has monitored the development and the increasing numbers of whitening oral hygiene products. As the market for these products grew, the Association recognized a need for uniform definitions when discussing whiteners.

For example, "whitening" is any process that will make teeth appear whiter. This can be achieved in two ways. A product can bleach the tooth, which means that it actually changes the natural tooth color. Bleaching products contain peroxide(s) that help remove deep (intrinsic) and surface (extrinsic) stains. By contrast, non-bleaching whitening products contain agents that work by physical or chemical action to help remove surface stains only.  

Whitening products may be administered or dispensed by dentists or purchased over-the-counter (OTC) and can be categorized into two major groups:  

• Peroxide-containing whiteners or bleaching agents; and
• Whitening toothpastes (dentifrices).

Peroxide-containing whiteners or bleaching agents

Dentist-dispensed and OTC home-use products All of the products in this category that bear the ADA Seal of Acceptance contain 10 percent carbamide peroxide; however, participation in the program is not limited to products of this concentration. There are many whitening options currently available to consumers both from the dentist as well as from retail outlets. The ADA recommends that if you choose to use a bleaching product you should only do so after consultation with a dentist.  

In a water-based solution, carbamide peroxide breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active bleaching agent. Other ingredients of peroxide-containing tooth whiteners may include glycerin, carbopol, sodium hydroxide and flavoring agents.  

Accumulated clinical data on neutral pH 10 percent carbamide peroxide continue to support both the safety and effectiveness of this kind of tooth-whitening agent. The most commonly observed side effects to hydrogen or carbamide peroxide are tooth sensitivity and occasional irritation of the soft tissues in the mouth (oral mucosa), particularly the gums. Tooth sensitivity often occurs during early stages of bleaching treatment. Tissue irritation, in most cases, results from an ill-fitting tray rather than the tooth-bleaching agents. Both of these conditions usually are temporary and stop after the treatment.

Professionally applied bleach whiteners   
There are many professionally applied tooth whitening bleach products. These products use hydrogen peroxide in concentrations ranging from 15 percent to 35 percent and are sometimes used together with a light or laser, which reportedly accelerates the whitening process. Prior to application of professional products, gum tissues are isolated either with a rubber dam or a protective gel. Whereas home-use products are intended for use over a two-to-four week period, the professional procedure is usually completed in about one hour. Currently, all of the professionally applied whiteners that have the ADA Seal contain 35 percent hydrogen peroxide, although this concentration is not a requirement of the program.

As with the 10 percent home-use carbamide peroxide bleach products, the most commonly observed side effects of professionally applied hydrogen peroxide products are temporary tooth sensitivity and occasional irritation of oral tissues. On rare occasions, irreversible tooth damage has been reported.

The ADA advises patients to consult with their dentists to determine the most appropriate treatment. This is especially important for patients with many fillings, crowns, and extremely dark stains. A thorough oral examination, performed by a licensed dentist, is essential to determine if bleaching is an appropriate course of treatment. The dentist then supervises the use of bleaching agents within the context of a comprehensive, appropriately sequenced treatment plan.

Whitening toothpastes
Whitening toothpastes (dentifrices) in the ADA Seal of Acceptance program contain polishing or chemical agents to improve tooth appearance by removing surface stains through gentle polishing, chemical chelation, or some other non-bleaching action. Several whitening toothpastes that are available OTC have received the ADA Seal of Acceptance.