Adjunct Professor, Molecular Pathology Area, School of Dentistry, Universidad de la República (UDELAR), Montevideo, Uruguay; Post-dotoral Fellowship, Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
PhD student, Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
J Prosthet Dent. 2024 Mar;131(3):375-383. doi: 10.1016/j.prosdent.2022.02.001. Epub 2022 Mar 10.
Little is known about the extent to which hydrogen peroxide as used for tooth bleaching could be carcinogenic to the oral mucosa.
The purpose of this systematic review and meta-analysis was to evaluate whether hydrogen peroxide as used for tooth bleaching has carcinogenic effects on the oral mucosa.
PubMed, Web of Science, Scopus, and Embase electronic databases were searched. Studies evaluating different outcomes potentially related to the carcinogenic effects of hydrogen peroxide for tooth bleaching on the oral mucosa were included. Risk of bias was assessed by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Risk Of Bias in Non-randomized Studies of Interventions (ROBINS-I), or Risk of Bias 2 (RoB 2) tools. The strength of the evidence was assessed by using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. The quantitative analysis was performed with means, standard deviations, and 95% confidence intervals (CIs). Heterogeneity was analyzed by using I-squared statistics.
Thirteen articles comprising 5 animal and 8 clinical studies met the inclusion criteria. Three of the 5 animal studies associated the bleaching agents with a carcinogen and demonstrated an enhancement of the carcinogenic effect, but probably with the bleaching agent acting only as a promoter. Five clinical studies concluded that the bleaching agents did not cause mutagenic stress on the oral mucosa by using the micronucleus test. The meta-analysis demonstrated that the frequency of micronuclei did not differ significantly between baseline and 30 days after bleaching (mean difference: 0.48; 95% CI, -1.49, 2.46; P=.63).
This systematic review indicated that hydrogen peroxide does not appear to have carcinogenic effects on the oral mucosa.
对于用于牙齿漂白的过氧化氢在多大程度上可能对口腔粘膜具有致癌性，知之甚少。
本系统评价和荟萃分析的目的是评估用于牙齿漂白的过氧化氢是否对口腔粘膜具有致癌作用。
检索了 PubMed、Web of Science、Scopus 和 Embase 电子数据库。纳入了评估与用于牙齿漂白的过氧化氢的致癌作用相关的不同结果的研究。通过系统评价实验室动物实验中心（SYRCLE）、非随机干预研究的偏倚风险（ROBINS-I）或偏倚风险 2（RoB 2）工具评估偏倚风险。使用推荐评估、开发和评估（GRADE）协议评估证据的强度。使用平均值、标准差和 95%置信区间（CI）进行定量分析。通过 I 平方统计分析异质性。
符合纳入标准的有 13 篇文章，包括 5 篇动物研究和 8 篇临床研究。5 项动物研究中的 3 项将漂白剂与致癌剂相关联，并证明了致癌作用的增强，但可能仅因漂白剂充当促进剂。5 项临床研究得出结论，漂白剂通过微核试验未对口腔粘膜造成致突变应激。荟萃分析表明，漂白后 30 天内微核的频率没有显著差异（平均差异：0.48；95%CI，-1.49，2.46；P=.63）。
本系统评价表明，过氧化氢似乎对口腔粘膜没有致癌作用。
