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Evaluation of the genotoxic potential of different delivery methods of at-home bleaching gels: a single-blind, randomized clinical trial

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Abstract

Objective

This single-blind, parallel, randomized clinical trial evaluated the genotoxic potential and effectiveness of 10% hydrogen peroxide (HP) in patients submitted to at-home bleaching.

Materials and methods

Sixty young volunteers with maxillary incisors equal to or darker than M1.5 were included in the study. Patients were submitted to bleaching for 14 days (30 min/day) with one of the three 10% HP treatments: the bleaching agent was delivered in a bleaching tray (White Class, FGM), whitening strips (White Strips, Oral-b), or in prefilled disposable trays (Opalescence Go, Ultradent). The color change was evaluated with the Vita Bleachedguide, and the micronucleus test of exfoliative oral mucosa was carried out, starting from a count of 1000 cells, at the baseline, immediately after and 30 days after the end of the treatment. The micronucleus data were evaluated with the Kruskal-Wallis and Wilcoxon tests and color change with the two-way ANOVA test and the Tukey test (α = 0.05).

Results

Significant whitening was observed for all groups after 14 days (p = 0.001) and was maintained after 30 days, with no difference between groups (p = 0.42). The micronucleus count did not indicate genotoxic potential in any of the groups studied (p = 0.32), irrespective of the time intervals (p = 0.62).

Conclusion

No genotoxic effects of 10% HP were observed in patients submitted to at-home bleaching systems (30 min/day for 14 days), even 30 days after the end of treatment.

Clinical significance

It is safe to use different systems to deliver 10% HP during at-home bleaching according to the manufacturers’ recommendations, with no risk of genotoxic effects applied.

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References

  1. Kihn PW (2007) Vital tooth whitening. Dent Clin N Am 51:319–331. https://doi.org/10.1016/j.cden.2006.12.001

    Article  PubMed  Google Scholar 

  2. Loguercio AD, Souza D, Floor AS Mesko M, Barbosa AN, Busato ALS (2002) Avaliação clínica da reabsorção radicular externa em dentes desvitalizados submetidos ao clareamento. Pesqui Odontol Bras 16:131–135. https://doi.org/10.1590/S1517-74912002000200007

    Article  PubMed  Google Scholar 

  3. Sulieman MA (2008) An overview of tooth-bleaching techniques: chemistry, safety and efficacy. Periodontol 48:148–169. https://doi.org/10.1111/j.1600-0757.2008.00258.x

    Article  Google Scholar 

  4. Matis BA, Wang Y, Eckert GJ, Cochran MA, Jiang T (2006) Extended bleaching of tetracycline-stained teeth: a 5-year study. Oper Dent 31:643–651. https://doi.org/10.2341/06-6

    Article  PubMed  Google Scholar 

  5. Boushell LW, Ritter AV, Garland GE, Tiwana KK, Smith LR, Broome A, Leonard RH (2012) Nightguard vital bleaching: side effects and patient satisfaction 10 to 17 years post-treatment. J Esthet Dent 24:211–219. https://doi.org/10.1111/j.1708-8240.2011.00479.x

    Article  Google Scholar 

  6. Loguercio AD, Martins LM, Silva LM, Reis A (2016) In-office whitening. In: Perdigão J (ed) Tooth whitening: an evidence-based perspective, 1st edn. Springer International Publishing, Switzerland, pp 145–167

    Chapter  Google Scholar 

  7. Alonso De La Peña V, Balboa Cabrita O (2006) Comparison of the clinical efficacy and safety of carbamide peroxide and hydrogen peroxide in at-home bleaching gels. Quintessence Int 37:41–46

    Google Scholar 

  8. Delgado E, Hernández-Cott PL, Stewart B, Collins M, De Vizio WP (2007) Tooth-whitening efficacy of custom tray-delivered 9% hydrogen peroxide and 20% carbamide peroxide during daytime use: a 14-day clinical trial. P R Health Sci J 26:367–372

    PubMed  Google Scholar 

  9. Ziebolz D, Helms K, Hannig C, Attin T (2007) Efficacy and oral side effects of two highly concentrated tray-based bleaching systems. Clin Oral Investig 11:267–275. https://doi.org/10.1007/s00784-007-0108-1

    Article  PubMed  Google Scholar 

  10. Naik S, Tredwin CJ, Scully C (2006) Hydrogen peroxide tooth-whitening (bleaching): review of safety in relation to possible carcinogenesis. Oral Oncol 42:668–674. https://doi.org/10.1016/j.oraloncology.2005.10.020

    Article  PubMed  Google Scholar 

  11. Dahl JE, Pallesen U (2003) Tooth bleaching, a critical review of the biological aspects. Crit Rev Oral Biol Med 14:292–304. https://doi.org/10.1177/154411130301400406

    Article  PubMed  Google Scholar 

  12. Goldberg M, Grootveld M, Lynch E (2010) Undesirable and adverse effects of tooth-whitening products: a review. Clin Oral Investig 14:1–10. https://doi.org/10.1007/s00784-009-0302-4

    Article  PubMed  Google Scholar 

  13. Ribeiro DA, Marques ME, Salvadori DM (2005) Assessment of genetic damage induced by dental bleaching agents on mouse lymphoma cells by single cell gel (comet) assay. J Oral Rehabil 32:766–771. https://doi.org/10.1111/j.1365-2842.2005.01500.x

    Article  PubMed  Google Scholar 

  14. Klaric E, Par M, Profeta I, Kopjar N, Rozgaj R, Kasuba V, Zeljezic D, Tarle Z ((2013)) Genotoxic effect of two bleaching agentes on oral mucosa. Cancer Genomics Proteomics 10:209–216

  15. de Geus JL, Bersezio C, Urrutia J, Yamada T, Fernández E, Loguercio AD, Reis A, Kossatz S (2015) Effectiveness and tooth sensitivity with at-home bleaching in smokers: a multicenter clinical trial. J Am Dent Assoc 52:1–8. https://doi.org/10.1016/j.adaj.2014.12.014

    Article  Google Scholar 

  16. de Geus JL, Rezende M, Margraf LS, Bortoluzzi MC, Fernandez E, Loguercio AD, Reis A, Kossatz S (2015) Evaluation of genotoxicity and efficacy of at-home bleaching in smokers: a single-blind controlled clinical trial. Oper Dent 40:E47–E55. https://doi.org/10.2341/14-121-C

    Article  PubMed  Google Scholar 

  17. Almeida AF, Torre Edo N, Selayaran Modos S, Leite FR, Demarco FF, Loguercio AD, Etges A (2015) Genotoxic potential of 10% and 16% carbamide peroxide in dental bleaching. Braz Oral Res 29:1–7. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0021

    Article  Google Scholar 

  18. da Costa Filho LC, da Costa CC, Soria ML, Taga R (2002) Effect of home bleaching and smoking on marginal gingival epithelium proliferation: a histologic study in women. J Oral Pathol Med 31:473–480. https://doi.org/10.1034/j.1600-0714.2002.00110.x

    Article  PubMed  Google Scholar 

  19. Matis BA, Gaiao U, Blackman D, Schultz FA, Eckert GJ (1999) In vivo degradation of bleaching gel used in whitening teeth. J Am Dent Assoc 130:227–235. https://doi.org/10.14219/jada.archive.1999.0172

    Article  PubMed  Google Scholar 

  20. Matis BA (2000) Degradation of gel in tray whitening. Compend Contin Educ Dent Suppl 28:S28 S31-5 28

    Google Scholar 

  21. Al-Qunaian TA, Matis BA, Cochran MA (2003) In vivo kinetics of bleaching gel with three-percent hydrogen peroxide within the first hour. Oper Dent 28:236–241

    PubMed  Google Scholar 

  22. Alonso De La Pena V, Rodriguez Carreira A, Corral Aneiros R, Lopez Raton M, Guitian Rivera F (2013) A study of in vivo degradation of two vital home bleaching gels. Dent Mater J 32:654–658. https://doi.org/10.4012/dmj.2012-317

    Article  PubMed  Google Scholar 

  23. Schmid W (1975) The micronucleus test. Mutat Res 31:9–15. https://doi.org/10.1016/0165-1161(75)90058-8

    Article  PubMed  Google Scholar 

  24. Belien JA, Copper MP, Braakhuis BJ, Snow GB, Baak JP (1995) Standardization of counting micronuclei: definition of a protocol to measure genotoxic damage in human exfoliated cells. Carcinogenesis 16:2395–2400. https://doi.org/10.1093/carcin/16.10.2395

    Article  PubMed  Google Scholar 

  25. Mateuca R, Lombaert N, Aka PV, Decordier I, Kirsch-Volders M (2006) Chromosomal changes: induction, detection methods and applicability in human biomonitoring. Biochimie 88:1515–1531. https://doi.org/10.1016/j.biochi.2006.07.004

    Article  PubMed  Google Scholar 

  26. Bansal H, Sandhu VS, Bhandari R, Sharma D (2012) Evaluation of micronuclei in tobacco users: a study in Punjabi population. Contemp Clin Dent 3:184–187. https://doi.org/10.4103/0976-237X.96825

    Article  PubMed  PubMed Central  Google Scholar 

  27. Naderi NJ, Farhadi S, Sarshar S (2012) Micronucleus assay of buccal mucosa cells in smokers with the history of smoking less and more than 10 years. Indian J Pathol Microbiol 55:433–438. https://doi.org/10.4103/0377-4929.107774

    Article  PubMed  Google Scholar 

  28. Cardoso PC, Reis A, Loguercio A, Vieira LC, Baratieri LN (2010) Clinical effectiveness and tooth sensitivity associated with different bleaching times for a 10 percent carbamide peroxide gel. J Am Dent Assoc 141:1213–1220. https://doi.org/10.14219/jada.archive.2010.0048

    Article  PubMed  Google Scholar 

  29. Holland N, Bolognesi C, Kirsch-Volders M, Bonassi S, Zeiger E, Knasmueller S, Fenech M (2008) The micronucleus assay in human buccal cells as a tool for biomonitoring DNA damage: the HUMN project perspective on current status and knowledge gaps. Mutat Res 659:93–108. https://doi.org/10.1016/j.mrrev.2008.03.007

    Article  PubMed  Google Scholar 

  30. Tolbert PE, Shy CM, Allen JW (1992) Micronuclei and other nuclear anomalies in bucal smears: methods development. Mutat Res 271:69–77. https://doi.org/10.1016/0165-1161(92)90033-I

    Article  PubMed  Google Scholar 

  31. American Dental Association, Council on Scientific Affairs (2006) Guidelines for the acceptance of over-the-counter home-use tooth bleaching American Dental Association 1-14. www.ada.org/files/guide_overcounter_bleach.pdf. www.ada.org/files/guide_overcounter_bleach.pdf

  32. Rezende M, Bonafe E, Vochikovski L, Farago PV, Loguercio AD, Reis A, Kossatz S (2016) Pre- and postoperative dexamethasone does not reduce bleaching-induced tooth sensitivity: a randomized, triple-masked clinical trial. J Am Dent Assoc 147:41–49. https://doi.org/10.1016/j.adaj.2015.07.003

    Article  PubMed  Google Scholar 

  33. Carlos NR, Bridi EC, Amaral F, França F, Turssi CP, Basting RT (2016) Efficacy of home-use bleaching agents delivered in customized or prefilled disposable trays: a randomized clinical trial. Oper Dent 42:30–40. https://doi.org/10.2341/15-315-C

    Article  PubMed  Google Scholar 

  34. da Costa JB, McPharlin R, Hilton T, Ferracane JI, Wang M (2012) Comparison of two at-home whitening products of similar peroxide concentration and different delivery methods. Oper Dent 37:333–339. https://doi.org/10.2341/11-053-C

    Article  PubMed  Google Scholar 

  35. Oliveira GM, Miguez PA, Oliveira GB, Swift EJ Jr, Farrell S, Anastasia MK, Conde E, Walter R (2013) Safety and efficacy of a high-adhesion whitening strip under extended wear regimen. J Dent 41(Suppl 3):e46–e52. https://doi.org/10.1016/j.jdent.2012.11.019

    Article  PubMed  Google Scholar 

  36. Pinto MM, Gonçalves ML, Mota AC, Deana AM, Olivan SR, Bortoletto C, Godoy CH, Vergilio KL, Altavista OM, Motta LJ, Bussadori SK (2017) Controlled clinical trial addressing teeth whitening with hydrogen peroxide in adolescents: a 12-month follow-up. Clinics (Sao Paulo) 72:161–170. https://doi.org/10.6061/clinics/2017(03)06

    Article  Google Scholar 

  37. Lee SS, Zhang W, Lee DH, Li Y (2005) Tooth whitening in children and adolescents: a literature review. Pediatr Dent 27:362–368

    PubMed  Google Scholar 

  38. (2016) Policy on the use of dental bleaching for child and adolescent patients. Pediatr Dent 38:81–83

  39. Rossini G, Parrini S, Castroflorio T, Fortini A, Deregibus A, Debernardi CL (2016) Children’s perceptions of smile esthetics and their influence on social judgment. Angle Orthod 86:1050–1055. https://doi.org/10.2319/102715-722

    Article  PubMed  Google Scholar 

  40. Donly KJ, Henson T, Jamison D, Gerlach RW (2006) Clinical trial evaluating two peroxide whitening strips used by teenagers. Gen Dent 54:110–112

    PubMed  Google Scholar 

  41. Donly KJ, Segura A, Sasa I, Perez E, Anastasia MK, Farrell S (2010) A controlled clinical trial to evaluate the safety and whitening efficacy of a 9.5% hydrogen peroxide high-adhesion whitening strip in a teen population. Am J Dent 23:292–296

    PubMed  Google Scholar 

  42. Bloching M, Hofmann A, Lautenschlager C, Berghaus A, Grummt T (2000) Exfoliative cytology of normal buccal mucosa to predict the relative risk of cancer in the upper aero digestive tract using the MN-assay. Oral Oncol 36:550–555. https://doi.org/10.1016/S1368-8375(00)00051-8

    Article  PubMed  Google Scholar 

  43. Bortoluzzi MC, Campagnoli EB, Milan JR, Reinheimer A, Masson M, Capella DL (2014) Frequency of micronucleus in oral epithelial cells after exposure to mate-tea in healthy humans. Med Oral Patol Oral Cir Bucal 19:e345–e349. https://doi.org/10.4317/medoral.19570

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bolognesi C, Bonassi S, Knasmueller S, Fenech M, Bruzzone M, Lando C, Ceppi M (2015) Clinical application of micronucleus test in exfoliated buccal cells: a systematic review and metanalysis. Mutat Res 766:20–31. https://doi.org/10.1016/j.mrrev.2015.07.002

    Article  Google Scholar 

  45. Nersesyan AK, Kundi M, Atefie K, Schulte-Hermann R, Knasmüller S (2006) Effect of staining procedures on the results of micronucleus assays with exfoliated oral mucosa cells. Cancer Epidemiol Biomark Prev 15:1835–1840. https://doi.org/10.1158/1055-9965.EPI-06-0248

    Article  Google Scholar 

  46. Pinto D, Ceballos JM, García G, Guzmán P, Del Razo LM, Vera E, Gómez H, García A, Gonsebatt ME (2000) Increased cytogenetic damage in outdoor painters. Mutat Res 467:105–111. https://doi.org/10.1016/S1383-5718(00)00024-3

    Article  PubMed  Google Scholar 

  47. Wu PA, Loh CH, Hsieh LL, Liu TY, Chen CJ, Liou SH (2004) Clastogenic effect for cigarette smoking but not areca quid chewing as measured by micronuclei in exfoliated buccal mucosal cells. Mutat Res 562:27–38. https://doi.org/10.1016/j.mrgentox.2004.05.004

    Article  PubMed  Google Scholar 

  48. Heuser VD, Andrade VM, Peres A, Gomes de Macedo Braga LM, Bogo Chies JA (2008) Influence of age and sex on the spontaneous DNA damage detected by micronucleus test and comet assay in mice peripheral blood cells. Cell Biol Int 32:1223–1229. https://doi.org/10.1016/j.cellbi.2008.07.005

    Article  PubMed  Google Scholar 

  49. Lucier RN, Etienne O, Ferreira S, Garlick JA, Kugel G, Egles C (2013) Soft-tissue alterations following exposure to tooth-whitening agents. J Periodontol 84:513–519. https://doi.org/10.1902/jop.2012.100383

    Article  PubMed  Google Scholar 

  50. Tredwin CJ, Naik S, Lewis NJ, Scully C (2006) Hydrogen peroxide tooth-whitening (bleaching) products: review of adverse effects and safety issues. Br Dent J 200:371–376. https://doi.org/10.1038/sj.bdj.4813423

    Article  PubMed  Google Scholar 

  51. Cordeiro D, Toda C, Hanan S, Arnhold LP, Reis A, Loguercio AD, Bandeira MFCL (2018) Clinical evaluation of different delivery methods of at-home bleaching with 10% hydrogen peroxide. Oper Dent

  52. Haywood VB, Heymann HO (1989) Nightguard vital bleaching. Quintessence Int 20:173–176

    PubMed  Google Scholar 

  53. Dahl JE, Becher R (1995) Acute toxicity of carbamide peroxide and a commercially available tooth bleaching agent in rats. J Dent Res 74:710–714. https://doi.org/10.1177/00220345950740021401

    Article  PubMed  Google Scholar 

  54. Li Y (1996) Biological properties of peroxide-containing tooth whiteners. Food Chem Toxicol 34:887–904. https://doi.org/10.1016/S0278-6915(96)00044-0

    Article  PubMed  Google Scholar 

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Funding

This study was partially supported by the National Council for Scientific and Technological Development (CNPq) under grants 305588/2014-1 as well as Federal University of Amazonas (Edital 019/2013—FAPEAM) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES).

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Correspondence to Alessandro D. Loguercio.

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The authors declare that they have no conflict of interest.

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All the procedures were performed in accordance with the ethical standards of the Research Ethics Committee involving humans of the Federal University of Amazonas and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethics standards.

Informed consent

All the participants of the research and those responsible for the minor patients signed informed consent forms, and the participants aged 15–18 signed a term of assent.

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Monteiro, M.J.F., Lindoso, J.B.C., de Oliveira Conde, N.C. et al. Evaluation of the genotoxic potential of different delivery methods of at-home bleaching gels: a single-blind, randomized clinical trial. Clin Oral Invest 23, 2199–2206 (2019). https://doi.org/10.1007/s00784-018-2659-8

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  • DOI: https://doi.org/10.1007/s00784-018-2659-8

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