Tooth Whitening in Children and Adolescents: A Literature Review

Meghan Sullivan Walsh February 23, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Tooth Whitening in Children and Adolescents: A Literature Review

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Tooth Whitening in Children and Adolescents: A Literature Review

Authors: Sean S. Lee, DDS; Wu, Zhang, MD; D. Harvey Lee, DDS, MPH; Yiming Li, DDS, MSD, PhD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 27:5, 2005, pages 362-368

Major Topic: To summarize the findings of the use of peroxide based tooth whitening agents in children and adolescents.

Overview of Method of Research: Literature review on child and adolescent tooth whitening, its side effects, usage trends, safety concerns and carcinogenesis. Recommendations for whitening usage is also mentioned.

Findings:

Parents and children are reporting that their tooth discoloration is “bringing negative attention.” In a 2004 study, 32% of children and 19% of these children’s parents were dissatisfied with their tooth color while only 9% of dentists felt these subjects had an unsatisfactory color. In one study, many children, some as young as ten, reported wearing tooth whitening strips on their way to school in the morning. A survey of American schools are reporting that 92% teach night guard bleaching.

Primary teeth whitening - Very few studies have been performed on whitening safety for children, particularly primary teeth, mostly due to ethical reasons. While the ADA has approved many teeth whiteners there is no specific indication or description of the use of these materials for children. It is unclear if the thinner enamel and dentin as well as the larger pulps will be effected more or less negatively. Children’s teeth are easier to bleach due to enamel permeability however the pulps may receive more exposure to peroxide.

Effects on micro hardness: In vitro studies are showing that dentin may become demineralized and a decrease in micro hardness. However other investigations are showing no significant difference between teeth exposed to bleaching and those with no exposure.

Carconogenicity: There is inadequate evidence regarding the carcinogenicity of hydrogen peroxide in humans.

Suggested approaches for pediatric tooth whitening:

Tooth bleaching should be done only with strict supervision of the dentist and parents. Due to compliance issues, younger children should not use at home bleaching. At home whitening treatments should be delayed to patients until the age of 14 or 15. A signed document and informed consent for treatment should be considered. The patient’s health history, risks and benefits should be discussed and carefully evaluated. A lower concentration of peroxide or carbamide peroxide should be used with a custom fabricated tray. Parents should be reminded of the intense sensitivity which can occur in the first 24 hours. Considering fluoride treatments after bleaching should also be discussed.

Key Points: Summary: The authors state that there are no indications for primary teeth whitening. The AAPD encourages the judicious use of bleaching in adolescent patients and discourages full-arch cosmetic bleaching for patients with mixed dentition. The authors also discussed having the FDA ban selling OTC bleaching products to minors. Adolescents are showing signs of misuse and overuse of these products and there are no extended use studies of these products on children.

Assessment of the Article: Just the title alone of this article made me upset. I feel we should really take a closer look at our children and adolescents as well as their parents who are requesting bleaching products. I have a big concern with the influence our society and parents are imposing on children to look a certain way in order to feel adequate. Tooth whitening has a role in our profession and can make a huge impact on a someone’s self esteem and our treatment. However it upsets me that even our pediatric and young adolescent patients are already feeling this pressure to look a certain way in order to feel accepted.