Tooth Whitening in Children and Adolescents: A Literature Review

Dan Boboia
Article Review 10/2/09

Title: Tooth Whitening in Children and Adolescents: A Literature Review
Author: Lee et al.
Pediatric Dentistry: 27:5, 2005
Major Topic / Purpose: To summarize the findings of a lit. review on the use of peroxide-based tooth whitening agents in children and adolescents
Primary Teeth Whitening:
· Rarely done in children younger then 6
· In a 2004 study 32% of 2,495 children were dissatisfied with their tooth color. No evidence / studies state that bleaching is unsafe to use in children.
· Studies do of course indicate that dose, frequency, and duration of bleaching play a vital role in the safety of this material. Peroxide overuse could certainly have harmful effects in both adult and pediatric patient groups.
· All recommendations for whitening safety on pediatric patients are based off adult studies.
· Most safety data comes from short-term clinical observations.
· Increased sensitivity would be expected due to primary tooth characteristics (thinner enamel / large pulp chambers). This however was not consistent with the limited data available.

Whitening Safety Considerations:
· One study showed that dentin demineralization can occur from bleaching products; however the remineralizing effect of saliva reversed this process. Another study did not demonstrate this demineralizing effect.
· Another study stated that “overoxidation” and tooth structure break down could occur
· With low doses, proper exposure frequency, and short duration, tooth bleaching may not damage the enamel surface of the primary, mixed, or permanent dentition in children.

Carcinogenicity:
· Inadequate evidence regarding the carcinogenicity of hydrogen peroxide in humans
· Existing evidence does not support the concern of carcinogenicity of hydrogen peroxide

Suggested Approaches to Pediatric Whitening:
· Study shows younger children more critical of anterior tooth shade the older children
· So far there is no commonly accepted approach for whitening
· Due to compliance issue, at-home whitening discouraged until patient is 15 y/o
· Lower concentrations with higher frequency advised
· Custom trays with 10% carbamide peroxide is advised for adolescents who use at-home system

Considerations to take into account before bleaching:
1. dry mouth
2. resp. disorders
3. asthma mouth breathing
4. unrestored tooth decay
5. exposed root surfaces
6. broken teeth
7. grinding
8. poor OH

Reminders for Parents:
· Sensitivity is likely, especially if high concentration bleach is used
· Realistic whitening expectations
· A “slowing-down effect” occurs with higher frequency in any patient population
· Whitening tooth pastes can be used to maintain effects
· Do not use high concentration as effects on pulp have not been well determined
· Fluoride treatment after whitening can be use to promote remineralization


Assessment:
Great review. Great reference article for discussions with parents asking for this.