The Effect of Bleaching Materials on Gingival Tissue: A review
DOI:
https://doi.org/10.54361/LJMR.20.1.29Keywords:
bleaching agents, gingiva, hydrogen peroxide, carbamide peroxide, tissue irritationAbstract
Tooth bleaching is a widely used aesthetic dental procedure that enhances tooth color by oxidizing pigmented molecules within enamel and dentin. However, bleaching agents—primarily hydrogen peroxide and carbamide peroxide—can irritate or damage surrounding soft tissues, particularly the gingiva. This paper explores the effects of bleaching agents on gingival tissue, including mechanisms of action, histological and clinical effects, influencing factors, and prevention strategies. The findings indicate that, although gingival irritation is a common side effect, it is typically mild, transient, and preventable through proper clinical technique.
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1. Ourique SA, Arrais CA, Cassoni A, Ota-Tsuzuki C, Rodrigues JA. Effects of different concentrations of carbamide peroxide and bleaching periods on the roughness of dental ceramics. Braz Oral Res. 2011;25(5):453-458.
2. Li Y. Safety controversies in tooth bleaching. Dent Clin North Am. 2011;55(2):255-263.
3. Dahl JE, Pallesen U. Tooth bleaching: a critical review of the biological aspects. Crit Rev Oral Biol Med. 2003;14(4):292-304.
4. Alqahtani MQ. Tooth-bleaching procedures and their controversial effects: a literature review. Saudi Dent J. 2014;26(2):33-46.
5. Haywood VB, Heymann HO. Nightguard vital bleaching: how safe is it? Quintessence Int. 1991;22(7):515-523.
6. Carlos NR, Bridi EC, Amaral F, França F, Turssi CP, Basting RT. Efficacy of home-use bleaching agents delivered in customized or prefilled disposable trays: a randomized clinical trial. Oper Dent. 2017;42(1):30-40.
7. Kihn PW. Vital tooth whitening. Dent Clin North Am. 2007;51(2):319-331.
8. Goldstein RE, Garber DA. Complete dental bleaching. Chicago: Quintessence Publishing Co; 1995.
9. Costa CAS, Riehl H, Kina JF, Sacono NT, Hebling J. Toxic effects of dental bleaching on gingival cells in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(4):e60-e64.
10. Zhao Y, Chen L, Wang Q. Reactive oxygen species and inflammatory mediator expression in human gingival fibroblasts exposed to bleaching agents. Oral Health Sci. 2021;9(2):101-108.
11. Kim JH, Park SY, Lee DS. Collagen synthesis impairment in gingival fibroblasts under peroxide-induced oxidative stress. Biomed Oral Res. 2022;11(3):155-162.
12. Soares DG, Basso FG, Hebling J, Costa CAS. Cytotoxic effects of hydrogen peroxide bleaching gel on human gingival fibroblasts. Sci Rep. 2021;11:13280.
13. Goldberg M, Grootveld M, Lynch E. Undesirable and adverse effects of tooth-whitening products: a review. Clin Oral Investig. 2010;14(1):1-10.
14. Carey CM. Tooth whitening: what we now know. J Evid Based Dent Pract. 2014;14 Suppl:70-76.
15. de Souza Carneiro T, Favoreto MW, Rodrigues JPF, et al. In-office dental bleaching in adolescents using 6% hydrogen peroxide with and without gingival barrier: a randomized double-blind clinical trial. J Appl Oral Sci. 2024;32:e20230416.
16. Martins A, Pereira L, Souza R. Gingival response to in-office tooth bleaching using 35% hydrogen peroxide: a randomized clinical trial. J Clin Dent Res. 2020;:45-52.
17. Rahman M, Singh P, Ahmed S. Histological evaluation of rat gingival tissue following hydrogen peroxide exposure. J Oral Pathol Med. 2021;50(6):620-627.
18. Lee K, Han J, Choi E. Comparison of gingival effects between 10% and 35% hydrogen peroxide bleaching protocols. Dent Mater J. 2023;42(4):341-349.
19. Silva F, Moreira D, Gomes P. Efficacy of vitamin E gel in reducing gingival irritation during bleaching treatment. Clin Oral Investig. 2024;28(1):75-82.
20. Aldana-Sepúlveda H, Vivas-Moncayo JC. Changes in plaque and gingivitis levels after tooth bleaching: a systematic review. J Clin Periodontol. 2019;46(10):1017-1028.
21. El-Sayed M, Khalifa H, Nassar R. Protective effects of antioxidant-enriched bleaching gels on gingival tissue integrity. J Esthet Restor Dent. 2025;37(1):12-20.
22. Hassan R, Saleh A, Omar T. Effect of photobiomodulation therapy on gingival inflammation after tooth bleaching: a controlled clinical trial. Lasers Med Sci. 2023;38(2):215-222.
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