Dahl J E, Pallesen U
NIOM-Scandinavian Institute of Dental Materials, Kirkeveien 71B, PO Box 70, N-1305 Haslum, Norway.
Crit Rev Oral Biol Med. 2003;14(4):292-304. doi: 10.1177/154411130301400406.
Present tooth-bleaching techniques are based upon hydrogen peroxide as the active agent. It is applied directly, or produced in a chemical reaction from sodium perborate or carbamide peroxide. More than 90% immediate success has been reported for intracoronal bleaching of non-vital teeth, and in the period of 1-8 years' observation time, from 10 to 40% of the initially successfully treated teeth needed re-treatment. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. When the external tooth-bleaching technique is used, the first subjective change in tooth color may be observed after 2-4 nights of tooth bleaching, and more than 90% satisfactory results have been reported. Tooth sensitivity is a common side-effect of external tooth bleaching observed in 15%-78% of the patients, but clinical studies addressing the risk of other adverse effects are lacking. Direct contact with hydrogen peroxide induced genotoxic effects in bacteria and cultured cells, whereas the effect was reduced or abolished in the presence of metabolizing enzymes. Several tumor-promoting studies, including the hamster cheek pouch model, indicated that hydrogen peroxide might act as a promoter. Multiple exposures of hydrogen peroxide have resulted in localized effects on the gastric mucosa, decreased food consumption, reduced weight gain, and blood chemistry changes in mice and rats. Our risk assessment revealed that a sufficient safety level was not reached in certain clinical situations of external tooth bleaching, such as bleaching one tooth arch with 35% carbamide peroxide, using several applications per day of 22% carbamide peroxide, and bleaching both arches simultaneously with 22% carbamide peroxide. The recommendation is to avoid using concentrations higher than 10% carbamide peroxide when one performs external bleaching. We advocate a selective use of external tooth bleaching based on high ethical standards and professional judgment.
目前的牙齿美白技术是以过氧化氢作为活性剂。它可直接应用，或由过硼酸钠或过氧化脲通过化学反应产生。据报道，非活髓牙的冠内美白即刻成功率超过90%，在1至8年的观察期内，最初成功治疗的牙齿中有10%至40%需要再次治疗。颈段牙根吸收是内漂白可能的后果，在采用热催化法治疗的牙齿中更常观察到。使用外漂白技术时，牙齿漂白2至4个晚上后可能会观察到牙齿颜色的首个主观变化，据报道，满意度超过90%。牙齿敏感是外漂白常见的副作用，在15%至78%的患者中出现，但缺乏针对其他不良反应风险的临床研究。过氧化氢与细菌和培养细胞直接接触会诱导遗传毒性效应，而在有代谢酶存在的情况下，这种效应会减弱或消除。包括仓鼠颊囊模型在内的多项肿瘤促进研究表明，过氧化氢可能起促进剂的作用。多次接触过氧化氢已导致对小鼠和大鼠胃黏膜的局部影响、食物摄入量减少、体重增加减缓以及血液生化改变。我们的风险评估显示，在某些外漂白临床情况下未达到足够的安全水平，例如用35%的过氧化脲漂白一个牙弓、每天多次使用22%的过氧化脲以及用22%的过氧化脲同时漂白两个牙弓。建议在进行外漂白时避免使用浓度高于10%的过氧化脲。我们主张基于高道德标准和专业判断选择性地使用外漂白。
