Tooth Whiteners Containing Hydrogen Peroxide
A summary of the "Opinion on Hydrogen Peroxide in Tooth Whitening Products" produced in 2005 by the European Commission Scientific Committee on Consumer Products (SCCP). GreenFacts was contracted to prepare this summary by the Directorate General for Health and Consumer Protection of the European Commission, which authorised its publication.
Context - To date, millions of tooth whitening kits have been sold across the world to consumers seeking to brighten their smiles.
Tooth whitening products can be applied using paint-on gels, strips, or mouthguards, either at the dentist’s office or at home. The whitening ingredient in these products is hydrogen peroxide. In general, the more hydrogen peroxide and the longer the treatment time, the greater the whitening power.
Are tooth whiteners with up to 6% hydrogen peroxide safe? Should they be freely available to consumers?
An assessment by the European Commission Scientific Committee on Consumer Products (SCCP)
Questions on Tooth Whiteners
1. Hydrogen Peroxyde
1. What is hydrogen peroxide and what is it used for?
2. What health effects of hydrogen peroxide have been observed?
3. Tooth Whitening
3. How is hydrogen peroxide used to whiten teeth?
4. How much hydrogen peroxide is one exposed to during tooth whitening treatment?
5. Can dental products containing hydrogen peroxide harm teeth?
6. What should be considered before a tooth whitening treatment?
7. What comments were expressed on the findings of this assessment?
8. Conclusion – Are tooth whitening products containing up to 6% hydrogen peroxide safe and should they be freely and directly available to consumers?
1. What is hydrogen peroxide and what is it used for?
Hydrogen peroxide is used as bleaching agent in tooth whiteners and in some toothpastes
Hydrogen peroxide is used as bleaching agent in tooth whiteners and in some toothpastes
Source:
Micro Application
Hydrogen peroxide is a highly reactive chemical containing hydrogen and oxygen. It is used mainly in the production of other chemicals and to bleach paper and textiles. Moreover, contact lenses can be disinfected with highly diluted hydrogen peroxide.
Carbamide peroxide is a chemical that is made of hydrogen peroxide and urea.
Both hydrogen peroxide and carbamide peroxide are used in cosmetics, mainly as bleaches in dental products such as toothpastes and tooth whiteners, but also in some hair products. They are also used in some medicines as disinfecting agents, for instance in products to treat mouth sores and in ear drops, as well as in mouth rinses.
In the European Union, cosmetics are regulated by the Cosmetics Directive
2. What health effects of hydrogen peroxide have been observed?
The use of contact lens solutions containing some hydrogen peroxide can irritate the eyes
The use of contact lens solutions containing some hydrogen peroxide can irritate the eyes
Source: Wikipedia
2.1 Swallowing a large dose of hydrogen peroxide can be lethal. More on the Europa website...
2.2 Highly diluted hydrogen peroxide solutions are non-irritant or mildly irritant. However, animal tests have shown that, when exceeding certain concentrations, hydrogen peroxide can cause irritation of eyes, skin, and the inside of mouth, stomach, and intestine. The use of eye drops and contact lens solutions containing some hydrogen peroxide can irritate the eyes. More on the Europa website...
2.3 Mouth rinses that contain small amounts of hydrogen peroxide and are used once or twice per day do not seem to harm the inside of the mouth, even in the long term. On the contrary, they can improve gum health. However, rinses that contain larger amounts of hydrogen peroxide or that are used more frequently can cause mouth irritation. More on the Europa website...
2.4 Hydrogen peroxide can act as a weak cancer promoter, meaning it can slightly stimulate the growth or multiplication of cancer cells. There is not enough data to evaluate potential effects of hydrogen peroxide on reproduction and development. More on the Europa website...
2.5 People with certain genetic disorders are more vulnerable to hydrogen peroxide because their bodies cannot break it down effectively. More on the Europa website...
3. How is hydrogen peroxide used to whiten teeth?
Tooth whiteners can be applied to teeth using custom made mouthguards
Tooth whiteners can be applied to teeth using custom made mouthguards
Source: GreenFacts
Tooth whitening products can be applied at home in three different ways: using strips that are stuck onto teeth, custom made mouthguards that maintain the whitening product on the teeth, or gels that are painted directly on the teeth.
Tooth whiteners use hydrogen peroxide or carbamide peroxide as the whitening agent. Peroxide acts by passing into the tooth and reacting with the molecules that cause stains or discoloration. In general, the more peroxide, the greater the whitening power.
Depending on their peroxide content, tooth whitening kits are either freely sold over the counter for home use, dispensed by dentists for home use, or exclusively applied by dentists in their offices. In the European Union, oral hygiene products may only be sold freely to consumers if they contain no more than 0.1% hydrogen peroxide whereas in the USA, whitening products are sold at higher concentrations.
In Europe, hydrogen peroxide solutions containing 5 to 20% hydrogen peroxide must be labelled harmful due to eye and skin irritation.
The length of treatment depends on the level of discoloration and the whitening product used. It ranges from short interventions in the dental office to applications at home lasting minutes/hours per day and repeated over a number of days.
Some toothpastes also contain small amounts of hydrogen peroxide.
4. How much hydrogen peroxide is an individual exposed to during tooth whitening treatment?
Concentration of hydrogen peroxide on the gums falls rapidly during treatment
Concentration of hydrogen peroxide on the gums falls rapidly during treatment
Source: GreenFacts
How much hydrogen peroxide is released into the saliva during tooth whitening treatments depends mostly on the amount of hydrogen peroxide in the product being used and the product type and only partly on the amount of saliva produced.
During a tooth whitening treatment procedure, the concentration of hydrogen peroxide on the gums and in the saliva falls rapidly because hydrogen peroxide is broken down quickly.
It is estimated that up to 25% of the hydrogen peroxide applied by tooth whitening products is swallowed.
5. Can dental products containing hydrogen peroxide harm teeth?
5.1 Toothpastes containing small amounts of hydrogen peroxide do not have more side effects than normal toothpastes.
For whitening products containing larger amounts of hydrogen peroxide, the two most common side effects are mouth irritation and increased tooth sensitivity to temperature changes. Both these effects are temporary.
More on the Europa website...
According to most studies, tooth whitening does not harm the enamel
According to most studies, tooth whitening does not harm the enamel
Source: Wikipedia
5.2 Hydrogen peroxide passes easily through the tooth enamel. According to most existing studies, bleaching does not harm the enamel. However, a few investigations have reported that bleaching can harm the surface of the teeth, making the enamel more porous and leading to dents, scratches, and loss of minerals. More on the Europa website...
5.3 After crossing the enamel, hydrogen peroxide passes into dentin and pulp. In some cases, whiteners cause minor inflammations of the pulp. However, generally tooth whitening does not seem to harm dental pulp of healthy teeth, possibly because the levels of hydrogen peroxide are too low to cause damage. More on the Europa website...
5.4 Tooth whitening does not usually change the colour of fillings and other restorative materials. It does not affect porcelain, other ceramics, or dental gold. However, it can slightly affect restorations made with composite materials, cements and dental amalgams. More on the Europa website...
6. What should be considered before a tooth whitening treatment?
Before engaging in tooth whitening treatment, a dentist should be consulted
Before engaging in tooth whitening treatment, a dentist should be consulted Source:
Micro Application
Above 0.1% hydrogen peroxide, tooth bleaching is not just a simple cosmetic procedure. It is important that the dentists diagnose the cause of the staining, predict whether the stains can be removed or not, check whether patients have any other oral health problems, and counsel patients about the best way of dealing with this esthetical problem.
As already mentioned above, common undesirable side effects of tooth whitening treatment are increased tooth sensitivity and mouth irritation. Such effects usually disappear within a few days. The surface of fillings and other restorations can be affected.
Hydrogen peroxide can act as a weak cancer promoter, meaning it can slightly stimulate the growth or multiplication of cancer cells. Tobacco use, alcohol abuse, and specific genetic predispositions increase the risk of oral cancer. Hydrogen peroxide may therefore further increase this risk, especially when the treatment is repeated. This may be of concern as smokers are likely candidates for tooth whitening. The risk of harmful effects may be greater for people who have pre-existing oral diseases.
7. What comments were expressed on the findings of this assessment?
Interested parties were invited to comment on the findings of this assessment by the European Commission Scientific Committee on Consumer Products (SCCP). Most of the comments concerned the availability of tooth whitening products and their possible harmful health effects.
About half the comments, essentially from consumer organizations and individuals from the health sector, supported the notion that tooth whitening products should only be used after consultation with a dentist.
The cosmetic industry and its organizations asserted that the products are safe and should therefore be freely available in the European Union.
8. Conclusion – Are tooth whitening products containing up to 6% hydrogen peroxide safe and should they be freely and directly available to consumers?
To conclude, the SCCP (Scientific Committee on Consumer Products) of the European Commission expressed the following opinions:
* The use of tooth whiteners containing up to 0.1% hydrogen peroxide is safe.
* Conditional to approval by a dentist, proper use of tooth whiteners containing between 0.1 and 6.0 % hydrogen peroxide is also considered safe. However, they are not considered safe to be sold over the counter and used freely, because potential harmful effects in the mouth have not yet been sufficiently studied and because the specific situation of each individual should be taken into account prior to treatment.
By Directorate General for Health and Consumer Protection of the European Commission (Text copyright ©)
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