Writing about what’s wrong with conventional treatments has never been a favorite for us.
As many of you who regularly read our articles know, we much prefer to discuss solutions to help each of us navigate the path to greater oral health.
So, it’s in this spirit to help you along your path to a happier, healthier mouth that we share our research on the various risks of conventional teeth whitening treatments.
This article follows on the heels of previous articles where we detail what we consider the first step to naturally whitening your teeth as well as lay a foundation of the various methods and strategies used to whiten teeth.
These previous articles really do set the stage for this continued discussion. While you can read this article first, you’ll get more out of it if you read the previous articles first.
The ‘official’ word on the risks of conventional tooth whitening treatments states that the two common complaints are increased tooth sensitivity and gum tissue irritation.
However, digging further into the research exposed that there are many other very real concerns about whitening treatments including:
- tooth surface roughening and softening
- increased potential for demineralization
- increased risk of tooth fracture
- degradation of dental restorations
- unacceptable color change of dental restorations
So, let’s make our way through understanding what’s really behind these complaints and risks to help you determine if conventional teeth whitening treatments can be part of your oral health plan.
(Quick note: While we researched many clinical studies for this article, the main resource we reference–and arguably the most respected compilation on this subject–is “Hydrogen Peroxide, in its free form or when released, in oral hygiene products and tooth whitening products” which was published by the European Union Scientific Committee on Consumer Products in 2007.)
How common are the complaints?
In a large survey of dentists, 91% of 8,143 dentists stated that they had used tooth bleaching in their practice. Here’s the tally of the side effects reported to these dentists. 62.2% noted tooth hypersensitivity, 45.9% reported soft tissue irritation, 2.1% noted systemic effects, and 18.8% reported no side effects. (1)
Increased tooth sensitivity
Hands down, the #1 complaint about bleaching treatments is increased sensitivity.
This makes total sense when we consider that teeth are porous and have tiny holes on their surface. Bleaching agents travel through these tiny holes and penetrate the tooth surface oxidizing any staining agents on their journey into the teeth. This is why bleaching chemicals work to whiten our teeth. They bleach these tiny pathways through our teeth.
In another study, volunteers used either home based or dentist delivered whitening techniques. Results showed that up to 70% of the volunteers experienced sensitivity and 13.8% of the participants actually withdrew from the study due to mouth pain. (2)
What the post whitening sensitivity is really saying…
The research shows that bleaching agents cause an inflammatory response in the deepest layers of our teeth (at the junction of the dentin and tooth pulp). This inflammation corresponds to the pain patients have from whitening treatments.(1)
Our concerns:
We believe that anything we use in the mouth should help us move in the direction toward optimal oral health. So, if some chemical causes a temporary inflammatory response inside the deepest layer of our teeth, this causes real concern for us.
Is it a huge deal? Maybe not. After all, within a week from bleaching, in almost all participants, hyper-sensitivity was gone. (However, in all fairness, we should also mention that for some people the increased tooth sensitivity is permanent.)
But does the research clearly show that bleaching agents cause a stress to the immune system? Yes.
It just seems to us that our immune systems can only take so many ‘whacks’ before they begin to show signs of wear and tear. Yeah, there’s a place to argue that we need some challenge/stress to get stronger and we agree with that. But is the risk of causing inflammation in the deepest layer of tissue of our teeth really worth it? That’s your call…
Gum tissue irritation
Teeth are one thing and gum tissue is a whole other subject…
Our gums like to be stimulated. They like to be massaged. They don’t like chemical warfare or being tortured by poorly fitting mouth trays. These bleaching agents are meant for the teeth (even more specifically, tooth enamel). When these strong bleaching agents sit on our gum tissue, they fry it.
Again, is it a permanent issue? No. Gum tissue can and will regenerate (think of how many times you’ve burned the roof of your mouth with hot pizza and the soft tissue sloughed off and recovered).
But again, why cause more stress to tissue that for most of us is challenged to begin with? Speaking of stressed tissue, if you tend to get canker sores, aggressive whitening strategies can make the situation much worse.
At the risk of freaking you out, there is substantial research that suggests that high concentrations of hydrogen peroxide (like those used in dental office applied bleaching) can increase risk of oral cancer. Much more on hydrogen peroxide and concentrations below.
Risk of losing enamel
Losing enamel is serious. According to the European Journal of Dentistry, “All bleaching treatments… promoted a significant reduction in the micro hardness values [of enamel]”. (4)
This study tested various strengths of bleaching treatments along with some that used special lights to accelerate the ‘in office’ bleaching treatment. The study found that there was up to an 8.5% loss of hardness of enamel 24 hours after bleaching. The amount of loss of enamel hardness directly related with the strength of the bleaching agent used.
In other words, the higher the concentration of bleaching agent, the higher the loss. There was an 8.5% loss when using 35% hydrogen peroxide + light compared to only a 1.3% loss when a 15% concentration and no light was used.
The good news is our bodies are always repairing the crazy damage done to them. That’s the case with this loss of enamel micro-hardness too. Within a week, the body has remineralized the loss and teeth are back to their ‘normal’ hardness.
But at what cost? What damage can be done while the enamel is in this ‘less that optimal’ state of hardness? Aren’t most of us trying to maintain decay free mouths without this insult to enamel hardness?
Permanent Enamel Loss – The Hidden Risk of Whitening
In this most recent section above, we discussed how enamel micro-hardness was reduced up to 8.5% 24 hours after a bleaching session and that enamel hardness was back to ‘pre-whitening’ levels after a week.
Several studies show a significant risk of permanent enamel loss due to abrasion of weakened enamel due to bleaching. One study states there is a “significant increase in enamel wear following treatment protocols”. And, this particular study used hydrogen and carbamide peroxide concentrations that are on the lower end of those used commercially. (1)
What all this means to us is that bleaching causes a temporary softness of tooth enamel and if we brush unconsciously, we run the very real risk of removing enamel.
This situation can become a vicious cycle because loss of enamel is one of the main reasons that our teeth discolor with age. So, we bleach more and lose more enamel which further causes discoloration, etc.
Risk of Tooth Fracture
(Special word of caution for anyone with gum recession…)
Up until now, we’ve been talking about the potential risks of bleaching agents mostly on tooth enamel. However, once a person has some gum recession, this means that they have exposed dentin (where the gum tissue has receded from).
And dentin isn’t as hard as enamel…
So, teeth with exposed dentin (like in the case of gum recession) are at an increased risk of fracturing. None of us want to experience a tooth breaking while we are chewing on it…
One study tested the relative strength of dentin after bleaching and found a significant reduction in fracture resistance.
In the closing statement of one study, the authors state, “caution should be considered when using bleach for prolonged treatment times in clinical cases where there is dentin exposure such as gingival recession.” (5)
Are Bleaching Treatments Really that Bad?
We have to state that many studies show little difference and insignificant risks from bleaching. However, we feel that some of this can be attributed to the fact of who is sponsoring the study and the resulting ‘spin’ how the study is created to produce the results that industry desires. Also, there are significant differences between how all these studies were set up, what parameters were used, etc which can cause two different studies to come up with very different conclusions.
That said, even the studies that ‘show no negative results’ state, “Numerous studies have indicated negligible changes in enamel surface texture associated with peroxide bleaching. When changes are observed, they are for the most part minor, involving the formation of shallow depressions or increased porosities. These are likely to be a side effect of the bleaching matrices.” (6)
Uh, I don’t know about you, but I don’t consider shallow depressions or increased porosity of my teeth negligible.
Special ‘Under the Bus’ Award for Chlorine Dioxide
According to Linda Greenwall, a dental specialist in the UK who literally wrote the book on tooth whitening, “these products are causing harm to teeth”.
Greenwald explains that the problem with chlorine dioxide is it’s very acidic (ph of 1-3!). So, when chlorine dioxide is used on the teeth for bleaching, the damage is compounded. “Placing this directly on teeth can result in permanent etching of tooth enamel.”
“Damaging effect of chlorine dioxide whitening treatment on teeth: etching of teeth, loss of tooth luster, teeth appearing more discolored, teeth absorbing more stains than before (due to loss of protective enamel), teeth feeling rough, increased sensitivity (sometimes permanent).” (7)
With all this said, how can OraWellness suggest using hydrogen peroxide?
First off, it’s super important that we clarify that we ONLY endorse the use of hydrogen peroxide in the mouth at a maximum concentration of 1.5%. As many of you Healthy Mouth System users know, we commonly teach to start with a 1.0% hydrogen peroxide solution.
You see, concentration does make a HUGE difference.
It’s important for us to grasp that some of the cells that make up our immune systems create hydrogen peroxide to use to defend us from ‘thug bugs’. So, it’s not that hydrogen peroxide is bad or good. The concentration plays a big role whether anything is health giving or destroying.
For example, we all know that drinking water is good for us. But you can drink too much water and actually drink yourself to death. It’s called dilutional hyponatremia. Strange but true.
To support this statement, let’s reflect on this study on the ability of hydrogen peroxide to penetrate tooth tissue and reach the tooth pulp… Peroxide was detected in the pulp cavity as early as 15 minutes following exposure of enamel to 10 or 30% hydrogen peroxide, and the amounts detected showed a significant dose relationship. (8)
Long-Term Implications of Whitening Treatments
Let’s close by keeping in mind that our teeth are meant to last a lifetime provided we care for them well. One last study concluded that, “the results indicated a need to warn patients of the potential for enamel alteration and its detrimental effect on tooth structure even if the long-term consequences have yet to be conclusively determined.” (9)
“So is bleaching safe or not?”
We have attempted to present the research here so you can make an educated choice whether conventional whitening treatments are safe for you or not. This is a value judgment mostly based on how deeply you want to whiten your teeth compared to the risks as you understand them now.
If you choose to bleach…
Learning from this research into the studies on teeth whitening, there are things we can do to help mitigate the potential risks of bleaching. Here are some quick ‘takeaway’ gems.
- Use LOW concentrations. Don’t be sold on the safety of high concentrations of bleaching agents. While there are plenty of studies that ‘prove’ their safety, there are many other studies that suggest a more conservative approach is wise. Think marathon, not sprint.
- Brush consciously after bleaching. Yes, you want to keep your white smile white, but just be really conscious about how you brush because there is a very real risk of brushing your enamel off. Also, be cautious using pastes or powders that are ‘whitening’ as they very well may be more abrasive which could make the enamel erosion even more extreme.
- Choose carbamide peroxide (low concentration). Studies show that carbamide peroxide penetrates the teeth less which feels better to us regarding the impact on tooth pulp. This suggests that carbamide peroxide causes less inflammation to the tooth pulp and is therefore less irritating.
Our final word on the risks…
Similar to our stance on the use of fluoride in the mouth, if these conventional whitening treatments were the only way to have a naturally whiter smile, we would have to take a closer look regarding whether they were ‘worth the risk’ to us. Thankfully, there are strategies that we all can apply to help us have a whiter smile that don’t compromise the health of our teeth and gums.
We will share our findings of strategies how to have a naturally whiter smile without compromising your tooth enamel in upcoming articles.
Now it’s your turn…
Have you tried conventional teeth whitening methods (at home or dental office applied)? If so, what was your experience? Did you experience any of the risks above?
Please share so we can all continue to learn from one another.
Helpful, Related Resources:
The First Step How to Whiten Your Teeth Naturally [article]
Teeth Whitening – Methods and Differences [article]
Sources:
1. http://ec.europa.eu/health/ph_risk/committees/04_sccp/docs/sccp_o_122.pdf
2. http://www.ncbi.nlm.nih.gov/pubmed/22616927
3. http://www.ncbi.nlm.nih.gov/pubmed/1402591
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319295/table/T2/
5. http://www.ncbi.nlm.nih.gov/pubmed/17374116?dopt=Abstract
6. http://www.ncbi.nlm.nih.gov/pubmed/1432795
7. http://www.academia.edu/5820972/The_dangers_of_chlorine_dioxide_tooth_bleaching
8. http://www.ncbi.nlm.nih.gov/pubmed/3481804
9 http://www.ncbi.nlm.nih.gov/pubmed/9667168
Hi there,
I can see that there are no recent comments,
But I will try submit one anyway,
I had an in office whitening precedure 2 years ago, the dentists used 12% peroxide along with the blue led light, at the end of that I could see the difference from my original shade, I didn’t have any stains at all, just wanted a more white shade, it wasn’t yellow either when I came.. but I guess I wanted it to be whiter,
But n any case the whiter shade lasted barely a week, I came back to the same dentist, and he performed the whole precedure again.
Like the previous time it again lasted barely a week, after that I didn’t have sensitive gums so much, but the teeth lost their smooth texture and sine, this fortunately recovers after couple of months, but my over all feeling is that the shade of my teeth became more yellow from the shade I had prior to all of this.
Is there anything you recommend I do now, two years later? I think my dentin later was affected and possibly absorbed some color while the pours were open during and after the 2 in office whitening sessions, so now it is basically done, since I am not going to do any more bleaching on my teeth, I wonder if I should just stop trying anything else, I now use carbon toothpaste though. Thanks so much for your help.
Ella.
I have used bleaching trays from time to time. Now that I am 50, I am experiencing really bad issues with my teeth fracturing and coming out or having to be extracted. It is very disturbing emotionally. I believe it is partially due to the OCCASIONAL bleaching I have done at home with peroxide gels that I bought from my dentist. I always used the higher percentage. I had 2 teeth break and come out in one week shortly after bleaching. My problem is not gum disease. It is weak enamel (prior to bleaching). Please be careful and maybe use the lower concentration. Tooth loss is hard on your self esteem and implants or bridges are expensive!! (and I have great dental insurance)
I so wish I read this article 2 weeks ago – before I decided to “treat” myself to a whitening treatment at my dentist’s office. My teeth are more stained and unattractive now than before I had the treatment done. My teeth also feel rough. After reading your article, I now understand that some of my enamel has been eroded away (which is EXACTLY what it felt like but my dentist said the whitening procedures she performed could not wear away the enamel).
Is there anything I can do to reverse the damage that has been done? My dentist says that I need to continue with home whitening treatments by using the kit she sent me home with, but I am not going anywhere near this kind of thing ever again (continuing with a process that damaged my teeth in the first place is nuts!).
Any advice would be greatly appreciated.
Thank you so much for your enlightening article.
Louise,
Thank you for the informative article. Yes, I’ve tried teeth whitening products. But, I can’t say I used them long enough to encounter any of the symptoms you list above.
I probably had a little tooth sensitivity right after I applied the strips I was using. But, I can’t say it lasted very long.
But, you list of risks does make me think twice about continuing to use products like this.
Regards,
Jagger
Nice article! many thanks for sharing your knowledge with us, I hope you continue sharing your knowledge with everyone about teeth whitening.
Thank you for stopping by to share your kind words of support with us Paula.
Knowing that people like you appreciate our work and are ‘out there’ reading and benefiting from it really helps us keep doing what we do.
Aloha!
As a Biological Independent Registered Dental Hygienist, I have been on a journey to make oral therapy treatments as chemical free as possible….no fluoride, all natural polishing paste, natural toothpastes, rinses and yes, Healthy Mouth Oral Blend essential oils are part of my repertoire.
Whitening has been a tx option that I have struggled with over the years. My journey has been as such: I used to offer take home syringes with custom fit trays; I got out of this after trying it myself. There was no way of avoiding swallowing this and getting directly into your system. Up until recently, I have only offered H202 for in-office treatments. This way I have been able to control the placement of the agent, avoiding the soft tissues. But even in this controlled environment, I have been questioning as it doesn’t fit with my desire to go as chemical free as possible. So as of late, I offer my clients activated charcoal.
My question is would using ‘food grade’ H202 at your recommended 1.5% be oK as an option? My understanding is that food grade is much safer than regular. I recognize that people with mercury fillings cannot use this product. Thoughts?
Aloha Nicole,
As always, we so appreciate your experienced eye coming by to offer your viewpoint!
Thank you for asking us. Yeah, we do think that 1.5% food grade h2o2 is an option provided that someone does want to bleach. You are right that studies do show that peroxide does leach mercury from amalgams in small quantities. (exactly what is an acceptably small quantity of mercury?!?) But then again, amalgams off gas mercury 24/7 anyway so I don’t consider having amalgams a reason to not use peroxide as such concentrations.
It seems to us that you are very much heading in the right direction Nicole. We’re actually flattered that you stopped by to ask us! After all, you have the ‘in the trenches’ experience! 🙂
Thanks again for finding our work engaging enough for you to want to offer your experience to our community!
Aloha
Hi Will & Susan
Brilliant article again! I have tried many shop bought whitening kits, but none worked.
My teeth were badly discoloured by the mouth wash ‘Corsedyl. I now used 6% peroxide, twice per week, just wipe it on & then rinse & brush, seems to be working, but not sure how good/bad this is for my teeth (?)
With Thanks
Diane x
Thank you for the excellent article. My thought about the bleaching has always been that it damages your teeth and gum. Your article has confirmed it. Repeated use of bleaching agent over years would certainly can increase the risk of serious issues like oral cancer. I can see why all the dentist I saw had normal coloured teeth rather than pearly white teeth. They certainly should know what bleaching does to their teeth from their own observation. Your article should be read by everyone considering bleaching his teeth.
Thank you for the kind words of support Iona!
so if you’ll have an implant and then decide to do whitening or add veneers….it’s not possible to have all teeth the same colour?
I agree with Greg~ Great information ! I have seen tv personalities as well as the general public with “glowing” teeth and it is so obvious they have whitened their teeth. It is scary to me to think what they will have (or not have) when they are
older. (not to mention the 20’s, 30’s that feel compelled to whiten already) Thank you for all the research you do for us!
Truly, thank you for stopping by to read our research and comment. We literally do it for you. After all, we can only read our own articles so many times before they get really boring! 🙂
Thank you and Aloha!
In the article above you mentioned using a 1.0% hydrogen peroxide solution. To use this as a rinse, what would be the h.p. to water ratio?
Aloha Louise,
Thank you for stopping by to ask.
It depends on the concentration of hydrogen peroxide you purchase. Common in the US is 3%, however you can get various concentrations up to 35%, so dilution is really, really important!
We recommend food grade peroxide for oral use if a person chooses that they are going to use peroxide in their oral hygiene. Then just read the label carefully. It’s probably 3%. So, 1/3 peroxide and 2/3 water will give you a 1% solution.
I hope that helps!
This is an excellent article with excellent references. You are to be commended on your research. It should be required reading for all who want to have “whiter” teeth.
Aloha Dr D!
One of our favorite experts stops by to commend us!?! Thank you so much!
While it’s always great to get ‘kudos’ from our readers, getting such a glowing comment from someone who has as much experience in the field as you do is truly a feather in our caps.
Thank you and Aloha!
Thanks for the great info! What are your thoughts on using activated charcoal for tooth whitening?
Aloha Sarah,
Thank you for stopping to by ask.
We are almost to the article where we will share our thoughts on various natural whitening methods. Activated charcoal is on that list. 🙂
Stay tuned…
This is a truly outstanding article that should be read by people of all ages. Gradual discoloration of teeth is a natural occurrence. You cannot achieve the teeth color that you once had at 21 years of age. Your body ages and so do your teeth. If you have any implants, crowns or other cosmetic work done on your teeth, the bleaching will not match the dental work – now what do you do?
This information should be posted to Facebook for all to see BEFORE they destroy their teeth and suffer like never before………….
Thank you Greg for your kind words of support.
We are honored that you read our work as part of your journey to optimal oral health.
Thank you and Aloha!