Tooth bleaching - A critical review of the biological aspects
Tooth bleaching - A critical review of the biological aspects
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DOI：
10.1177/154411130301400406
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发表时间：
2003-07-01
期刊：
影响因子：
--
通讯作者：
Pallesen, U
中科院分区：
文献类型：
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作者：
Dahl, JE;Pallesen, U
目前的牙齿漂白技术是基于过氧化氢作为活性剂。它可以直接使用，也可以通过过硼酸钠或过氧化脲的化学反应产生。据报道，对于非活髓牙的冠内漂白，超过90%的即刻成功率，并且在1-8年的观察时间内，从10%到40%的最初成功治疗的牙齿需要再治疗。颈根吸收是内部漂白的一个可能后果，并且在用热催化程序治疗的牙齿中更常见。当使用外部牙齿漂白技术时，牙齿颜色的第一个主观变化可以在牙齿漂白2-4夜后观察到，并且超过90%的满意结果已经被报道。牙齿敏感是15%-78%的患者观察到的外部牙齿漂白的常见副作用，但缺乏解决其他不良反应风险的临床研究。直接接触过氧化氢诱导细菌和培养细胞的遗传毒性效应，而在代谢酶的存在下，该效应降低或消除。一些促进肿瘤的研究，包括仓鼠颊囊模型，表明过氧化氢可能起促进作用。多次暴露于过氧化氢导致小鼠和大鼠胃粘膜局部效应、摄食量减少、体重增加减少和血液化学变化。我们的风险评估显示，在某些临床情况下，外部牙齿漂白没有达到足够的安全水平，例如用35%过氧化脲漂白一个牙弓，每天使用几次22%过氧化脲，并用22%过氧化脲同时漂白两个牙弓。建议在进行外部漂白时避免使用浓度高于10%的过氧化脲。我们提倡在高道德标准和专业判断的基础上选择性地使用外部牙齿漂白。
Present tooth-bleaching techniques are based upon hydrogen peroxide as the active agent. It is applied directly, or produced in a chemical reaction from sodium perborate or carbamide peroxide. More than 90% immediate success has been reported for intracoronal bleaching of non-vital teeth, and in the period of 1-8 years' observation time, from 10 to 40% of the initially successfully treated teeth needed re-treatment. Cervical root resorption is a possible consequence of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic procedure. When the external tooth- bleaching technique is used, the first subjective change in tooth color may be observed after 2-4 nights of tooth bleaching, and more than 90% satisfactory results have been reported. Tooth sensitivity is a common side-effect of external tooth bleaching observed in 15%-78% of the patients, but clinical studies addressing the risk of other adverse effects are lacking. Direct contact with hydrogen peroxide induced genotoxic effects in bacteria and cultured cells, whereas the effect was reduced or abolished in the presence of metabolizing enzymes. Several tumor-promoting studies, including the hamster cheek pouch model, indicated that hydrogen peroxide might act as a promoter. Multiple exposures of hydrogen peroxide have resulted in localized effects on the gastric mucosa, decreased food consumption, reduced weight gain, and blood chemistry changes in mice and rats. Our risk assessment revealed that a sufficient safety level was not reached in certain clinical situations of external tooth bleaching, such as bleaching one tooth arch with 35% carbamide peroxide, using several applications per day of 22% carbamide peroxide, and bleaching both arches simultaneously with 22% carbamide peroxide. The recommendation is to avoid using concentrations higher than 10% carbamide peroxide when one performs external bleaching. We advocate a selective use of external tooth bleaching based on high ethical standards and professional judgment.