Safety issues relating to the use of hydrogen peroxide in dentistry

Abstract

Hydrogen peroxide is used widely in professionally and self-administered products. Hydrogen peroxide is a highly reactive substance which can damage oral soft tissues and hard tissues when present in high concentrations and with exposures of prolonged duration. This report provides an overview of health issues relating to the use of hydrogen peroxide, with an emphasis on safety with prolonged exposure to low concentrations of peroxide products. There is good evidence for the safety of hydrogen peroxide when used at low concentrations on a daily basis over extended periods of time, in self-administered oral health care products such as dentifrices and mouthrinses. These low concentrations neither damage oral hard or soft tissues, nor do they pose a significant risk of adverse long-term effects. Caution should be exercised with the increasingly higher concentration peroxide products used for 'walking' or 'power' bleaching due to the possibility of chemical irritation of oral soft tissues with injudicious use. The volumes of material and application times should be controlled carefully. Thorough education of patients is particularly important with self-applied gels because of the lack of professional supervision with such products. Such education is part of the duty of care of the dentist who supplies bleaching gels for at-home use.

Effects of Low Magnetic Irradiation on Morphology and Ultrastructure of Parotid Glands in Rats and Amelioration by Vitamin E

“…Also, free oxygen radicals that produced after exposure to MFs acting as oxidizing agents and able to increase cellular damage [28] and cause decomposition of membranes with leakage of damaging lysosomal hydrolytic enzymes [29]. Similar apoptotic changes were detected in liver cells after exposure to EMFs and explained by decreased tissue concentration of glutathione enzyme [30].…”

Hydrogen peroxide tooth-whitening (bleaching) products: Review of adverse effects and safety issues

“…16 When 1.5% H 2 O 2 was used as a rinse for 18 months in orthodontic patients, no patients developed mucosal irritation. 84 Similar results were noted in other studies, some even using combinations of hydrogen peroxide/povidone iodine or hydrogen peroxide/sodium chloride/sodium bicarbonate and iodine.…”

“…16 In human tissue, intrinsic sources of H 2 O 2 are organelles (especially mitochondria), salivary cells, microorganisms and the lungs. 17 Hydrogen peroxide production can be followed by the liberation of highly reactive oxygen species in the body via enzymatic and spontaneous redox reactions that often involve interaction with transitional metals such as iron or copper.…”

“…19 Hydrogen peroxide toxicity Thirty per cent H 2 O 2 can cause severe irritation or burns on contact with skin or eyes. 16 Following inadvertent irrigation of H 2 O 2 into the periodontal ligament during root canal treatment, contact of the H 2 O 2 with blood and tissue proteins produces effervescence, liberating oxygen and causing tissue emphysema. 20 Following application of 30% H 2 O 2 at 15 minute intervals (four applications) to the tip of rat tongue, oedema was followed by intraepithelial and some subepithelial vesiculation, changes preventable by prior administration of catalase.…”

Synergistic Effect of Thermal Energy on Bactericidal Action of Photolysis of H 2 O 2 in Relation to Acceleration of Hydroxyl Radical Generation

“…The other is the concentration of H 2 O 2 . A high concentration of H 2 O 2 , however, might cause adverse effects when the disinfection technique is applied in the oral cavity (3,16,23). Hence, a low concentration of H 2 O 2 is preferable from a clinical point of view regarding safety issues.…”