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Title Teeth Whitening Does Not Increase Susceptibility to Dental caries
Clinical Question Is a patient with a history of teeth whitening more susceptible to caries than a patient with no history?
Clinical Bottom Line History of teeth bleaching does not influence an individual’s susceptibility to dental caries.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17694204Alves/2007Ninety human enamel slabsIn vitro randomized trial
Key resultsTeeth bleached with in-home products (with 10% carbamide peroxide or 16% hydrogen peroxide) developed less severe caries (scores 0-1, no caries to very early caries), while those bleached with professional in-office products (with 37% carbamide peroxide or 35% hydrogen peroxide) or unbleached developed moderately to severe caries (scores 2-3). In-home bleaching products decreased caries susceptibility.
#2) 15853114Al-Qunaian/2005Forty-eight sections of human teethIn vitro randomized trial
Key resultsBleaching did not affect caries susceptibility. There was no significant difference in depth (µm±SD) of caries lesion developed on teeth bleached vs unbleached with 10% carbamide peroxide (37.1±5.6 vs 39.9±7.6), 35% hydrogen peroxide (40.4±5.4 vs 48.3±10.2) or 20% carbamide peroxide (30.1±9.2 vs 42.2±9.3). The 3 products did not significantly differ in caries assessment parameters except in total lesion area that is significantly higher in 10% (8603.4±1727.5) than in 20% (6060.8±2438.8) CP.
Evidence Search ("Tooth Bleaching"[Mesh]) AND "Dental Caries Susceptibility"[Mesh]
Comments on
The Evidence
The Alves article used two different products for both at-home (10% and 16% carbamide peroxide) and in-office (37% carbamide peroxide and 35% hydrogen peroxide) bleaching and used two control groups. In the Al-Qunaian article, one group that was treated with 20% carbamide peroxide with fluoride showed decreased caries susceptibility. However, the other two groups treated with 10% carbamide peroxide and 35% hydrogen peroxide showed no significant influence on caries susceptibility. The reduced susceptibility observed with 20% carbamide peroxide with fluoride may have been induced by fluoride, a known caries inhibiting agent. It is important to mention that the evidences presented in this review are in vitro studies that ignore the subjects’ habits and practices. Patients interested in whitening their teeth are very enthusiastic and meticulous with brushing their teeth, and thus maintaining excellent oral hygiene that is known to prevent caries formation.
Applicability With the evolution of esthetic dentistry, improvement of the appearance of discolored teeth using tooth-whitening products is now an important treatment modality in dentistry, amidst the uncertainty regarding its influence on caries susceptibility of the bleached teeth. However, this review indicated that tooth whitening does not influence the patients’ risk of developing dental caries.
Specialty/Discipline (Public Health) (General Dentistry) (Basic Science)
Keywords Teeth whitening, Teeth bleaching, Dental caries, caries susceptibility
ID# 2187
Date of submission: 04/09/2012spacer
E-mail thusu@livemail.uthscsa.edu
Author Akshay Thusu
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor/Co-author e-mail amaechi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Joshua Mijares, Olivia Britton (San Antonio, TX) on 12/01/2017
A PubMed search was conducted in November 2017, and no new research is available over this topic. However, one study by Zheng in 2014 examined the effects of bleaching on the growth of S. mutans (PMID #24535343). The whitening agent inhibited "the growth of Streptococcus mutans biofilm for about 3 weeks; but after 3 weeks, it seems that the bleached surface will increase the growth of biofilm." The next step would be an in vivo study to address issues such as human habits that influence the formation of caries.

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