Effectiveness and Adverse Effects of Over-the-Counter Whitening Products on Dental Tissues

Abstract

The role of bleaching agents (e.g., hydrogen peroxide) in tooth bleaching is quite well-described in a few literature studies and considered as the option choice for those desiring brighter teeth, but alternative methods have emerged to fulfill the desire of patients in a faster, easier, and cheaper way. In this context, whitening over-the-counter (OTC) products are available in several vehicles, such as toothpaste, rinses, gums, paint-on varnishes, and strips, but their effectiveness in terms of bleaching is questioned. This review aimed to describe their mode of action, whitening effectiveness, and harmful effects associated with the indiscriminate use of these products. Dentifrices usually present a combination of abrasives that can induce damage to the tooth surface without evidence of promoting real bleaching. The same was found for rinses, which might present a low pH, with an erosive potential. Charcoal has been included in the composition of these products to improve their whitening effect but there is no evidence supporting it. Regarding strips, they present hydrogen peroxide in a variety of concentrations and are the only OTC products able to promote bleaching. Despite the vehicle, an indication for the use of these products should be made after a careful individual diagnosis of the etiology of the dental staining, considering that most of them seem to be effective only in removing extrinsic stains or preventing their formation over enamel. Also, their indiscriminate use might induce damage and deleterious effects over tooth tissues or gingival tissues. The dentist should be aware of the composition and mode of action of each individual product as they change according to the composition and the vehicle used to recommend the best mode of usage. Still, there is no sound evidence that any of the described OTC products promote a better bleaching effect than the products indicated for a professional.

Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review

“…There are formulations specifically designed to have a whitening action, which includes chemicals such as peroxides, citrates, and pyrophosphates, as well as certain enzymes and surfactants. 21 , 22 The findings found in the studies showed that the toothpastes and mouthwashes with whitening action did not have a favorable effect on the outcomes evaluated and in some cases did not show differences with the control group or with regular toothpastes and mouthwashes.…”

Evaluating the efficiency of two different over-the-counter tooth whitening systems: a randomised controlled clinical trial

“…This might be attributed to the design of OTC-paint on gel products where there is no physical barrier to protect the active materials from oral environment and enhance the contact with the tooth surface [24]. In addition, the reduced CP concentration in these products decreases the whitening efficiency [25]. This may encourage patients to overuse these products to get the expected aesthetic outcome.…”

Effect of Bleachorexia on Teeth Shade

“…Once the stain etiology is identified, dentists shall propose an individualized treatment to each patient considering their wishes, expectations, dental condition, and oral health. 3 Usually, tooth bleaching is carried out in the office with more concentrated gels and reduced application time (in-office technique), or at home, under the dentist's supervision, with less concentrated gels and longer application time (athome technique). [4][5][6] Moreover, there is a niche in the oral care market comprising toothpastes, rinses, paint-on varnishes, gels, strips and flosses with bleaching or whitening properties, known as over-the-counter (OTC) products.…”