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Title Vital Tooth Bleaching Is Considered Safe for Pediatric Patients
Clinical Question In pediatric dental patients, does vital tooth bleaching result in an increase in adverse outcomes?
Clinical Bottom Line In pediatric patients beginning at the age of 11 years, vital tooth bleaching is considered safe but is recommended to be completed under a dentist's oversight. Dentists should limit full arch bleaching until after complete exfoliation of primary dentition.
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) 11913290Donly/2002106 volunteers aged 11-18Randomized Controlled Trial
Key resultsTooth whitening in patients aged 11-18 can be accomplished safely using hydrogen peroxide bleaching strips or overnight carbamide peroxide tray systems.
#2) 16317969Donly/200557 subjects aged 12-18Randomized Controlled Trial
Key resultsBoth whitening systems used were well tolerated and only mild sensitivity noted in patients aged 12-18. "Twelve subjects (27%) in the polyethylene strip group reported adverse events compared to 5 subjects (42%) in the tray-delivered group. Minor and transient tooth sensitivity and oral irritation were the most common adverse events."
#3) 20456515Kina/201024 extracted premolarsRandomized Controlled Trial/Laboratory study
Key resultsTwelve pairs of premolar teeth from 12- to 18-year-old patients were randomly assigned to: bleaching gel + halogen light; bleaching gel; no treatment (control). The teeth were extracted 2-15 days after bleaching and examined histologically. "Professionally applied vital tooth bleaching with a 38% H2O2 gel with or without activation by a halogen light source did not cause damage to the pulp tissue of sound human premolar teeth."
#4) 11913290AAPD/2014N/AClinical Guideline
Key resultsThe AAPD's Policy on the Use of Dental Bleaching for Child and Adolescent Patients states that patients should consult with their dentist prior to any bleaching treatment and should discourage full arch cosmetic bleaching in the mixed dentition.
Evidence Search tooth bleaching and pediatric patients
Comments on
The Evidence
Validity: The controlled clinical trials showed that sensitivity and adverse effects do occur. However, only in the Kina/2010 article were the investigators or data collectors blinded and a negative (placebo) control included. Given the limited scope and the design of the studies they are at a high risk for bias. The AAPD policy statement included a search of all clinical trials within the preceding 10 years regarding patients aged birth to 18 years. Perspective: Although the indications for vital tooth bleaching in pediatric patients may seem limited to developmental issues associated with tooth color, as society changes, cosmetic desires of patients also change. These articles address the possibility for safely and effectively treating pediatric patients with several different bleaching systems when indicated solely for cosmetic desires in pediatric patients. Bleaching has been shown to cause reversible tooth sensitivity and tissue irritation. Given the lack of studies and the AAPD recommendations, it is recommended to limit vital tooth bleaching to permanent dentition only.
Applicability The evidence presented applies to healthy pediatric patients treated in-office with hydrogen peroxide and carbamide peroxide tooth bleaching systems. Patients and parents should be made aware that all bleaching systems may cause post-operative sensitivity. These results may vary depending on the bleaching system selected, concentration of bleaching, and duration of treatment.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Tooth bleaching, Pediatric Dentistry
ID# 3324
Date of submission: 09/18/2018spacer
Co-author(s) e-mail
Faculty mentor/Co-author DR. KEVIN DONLY
Faculty mentor/Co-author e-mail donly@uthscsa.edu
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