Peroxide interactions with hard tissues: effects on surface hardness and surface/subsurface ultrastructural properties.

Laboratory studies were performed to assess the impact of peroxide bleaching on enamel surface and subsurface physical and ultrastructural properties. Human enamel blocks were prepared, polished, and measured for native color. Cyclic bleaching treatments were carried out with soaks in whole stimulated saliva interspersed with bleaching treatments using bulk bleaching gels from commercial bleaching systems including Opalescence (20% and 10% carbamide peroxide systems) and Crest Whitestrips, a hydrogen peroxide gel formula, at doses of 5.3% and 6.5% hydrogen peroxide. Treatments ranged from conditions of normal use (14 hours as recommended for Crest Whitestrips) to excessive bleaching (70 hours). Controls included nontreated as well as treatments with placebo (not containing peroxide) gels. Surface hardness and confocal laser scanning microscopy (CLSM) techniques were used to characterize the effects of bleaching on the physical properties and ultrastructure of the teeth. Tooth color measurements revealed dose-response bleaching in vitro with the increases in L* and decreases in b* normally expected with effective bleaching. Placebo control treatments did not bleach. Surface hardness measurements showed no decreases associated with tooth bleaching. CLSM measurements also showed no effects from tooth bleaches on the surface or subsurface prism architecture of enamel. This was opposed to significant changes seen with even moderate levels of demineralization associated with the caries process. These studies support: (1) the safety of Crest Whitestrips formulas for enamel surfaces and tooth subsurfaces; and (2) the generic safety of peroxide bleaching of hard tissues associated with conditions of both recommended use and overuse.