The power of hydrogen peroxide: Finding long-term whitening solutions for your patients

Ever since I returned to work after the shutdown, I’ve become very curious about the power of hydrogen peroxide. Using this product has become a mainstay of my daily patient care routine as I give each of my patients a prerinse that contains this mysterious and powerful solution. As the bubbles form in a patient’s mouth, I am comforted by the fact that this common chemical has so many wide-ranging and beneficial applications in the dental arena. This step seems to reassure patients about the safety of their dental appointments, and oftentimes I hear about how they use this product in their mouths regularly at home.

One of the applications of hydrogen peroxide that is well-known is whitening. Patients seem to be interested in whitening now more than ever. When all dental care was put on hold during the shutdown, I think it helped patients realize how important access to dental care is. When my office finally reopened, my patients were anxious to get their desired dental care completed as soon as possible.

When it comes to recommending whitening solutions, one of the first questions I ask is, “Do you know what is causing the staining on your teeth?” As we all know, some types of tooth discolorations are more permanent than others. But one question that we may overlook is: How can we help our patients maintain the bright smiles that they achieve with whitening long term? Hydrogen peroxide may be a great whitening solution, and I believe that using it safely is key to maintaining results.

The details on hydrogen peroxide

As dental professionals, we know that hydrogen peroxide is used in whitening products. But beyond that, things can get a little bit cloudy. When talking to patients it helps to have a thorough understanding of the chemicals that are used in dental products. Hydrogen peroxide is a liquid that is closely related in composition to water, except that it has an extra oxygen molecule. Its chemical formula is H₂O₂, and normally it is found in dilute solutions.¹ Although hydrogen peroxide appears colorless in most commercial products, it is actually pale blue in its concentrated form.¹ It is a component of a wide variety of commercial products, ranging from hair bleach, laundry stain removers, and bath cleaners to dental products such as whitening gels, toothpastes, and mouthrinses.² 

The mechanism of action for teeth whitening with hydrogen peroxide gel is commonly believed to be the oxidation of organic pigments that are found in the teeth. The exact chemical process is still not completely understood.³ Carbamide peroxide is another common bleaching product that releases hydrogen peroxide when placed on the teeth. Its concentration is typically stronger, with a 10% formula yielding 3.5% hydrogen peroxide.⁴ 

Dental products that contain hydrogen peroxide for whi- tening have many benefits that go beyond tooth color, and this is something that I like to emphasize with patients. Hydrogen peroxide is effective against a wide variety of viruses, bacteria, fungi, and spores that are found in the mouth. In laboratory studies, just a .5% solution of accelerated hydrogen peroxide solution was found to be effective against bacteria and viruses in one minute. I have found that these numerous benefits encourage my patients to use products that contain hydrogen peroxide at a low concentration on a long-term basis to ensure their dental health.⁵ 

The problem with short-term whitening products

The most impressive aspect of using high concentrations of hydrogen peroxide—or its precursor, carbamide peroxide—in whitening products is that they work quickly and they are highly effective.⁶ That is why we recommend them. Yet a common threat to maintaining these beautiful results is patients’ dietary habits. Typically, people expose their teeth to a variety of stain-causing agents, such as coffee, tea, red wine, cola, blueberries, and more on a regular basis. Stain from smoking is yet another point of frustration for nearly all dental professionals.

Let’s start by taking a look at coffee consumption. According to the National Coffee Association, 64% of Americans drank coffee on a daily basis in 2019.⁷ The average coffee drinker in the United States drinks 2.7 cups each day. Also, as people age, they are more likely to consume coffee regularly.⁷ This makes the battle against stain more challenging as it is highly unlikely that people are going to forgo their daily caffeine boost in order to keep their teeth pearly white.

I am one of those people who expose their teeth to staining on an almost daily basis, although it is not from coffee. I love black tea, and I drink it nearly every day. During the summer I eat all kinds of berries. Although I absolutely want to have the whitest teeth I possibly can, there is no way that I’m going to change my dietary habits in order to achieve that goal. So, that leaves whitening products to pick up where I leave off. That is how I address my patients. I don’t expect them to change their habits. I expect dental products to pick up the slack.

The consistent results from a low dose of hydrogen peroxide 

When it comes to whitening, everyone wants their bright smile to last a long time. I tell my patients that one of the easiest ways to incorporate whitening solutions is to use a whitening toothpaste containing hydrogen peroxide on a regular basis. Surprisingly, whitening toothpastes account for the biggest market share when it comes to all of the products available in the tooth whitening industry.⁸ The huge demand is due mainly to this product’s affordable price and quick results. Ease of purchase is also a factor. 

To summarize, when it comes to recommending whitening products, it is important to take advantage of the benefits of hydrogen peroxide. Higher strength whitening products and the quick and dramatic results in patients’ smiles will encourage them to use those, but low-strength products help keep patients satisfied in the long run. Working with both products in combination guarantees winning results. 

References

1. Hydrogen peroxide. PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/Hydrogen-peroxide
2. Hydrogen peroxide. ChemicalSafetyFacts. https://www.chemicalsafetyfacts.org/hydrogen-peroxide/
3. Fiorillo L, Laino L, De Stefano R, et al. Dental whitening gels: strengths and weaknesses of an increasingly used method. 2019;5(3):35. doi:-10.3390/gels5030035
4. Tooth whitening/bleaching: treatment considerations for dentists and their patients. American Dental Association. September 2009. https://www.ada.org/~/media/ADA/About%20the%20ADA/Files/ada_house_of_delegates_whitening_report.ashx
5. Chemical disinfectants. Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html
6. Carey CM. Tooth whitening: what we know now. J Evid Based Dent Pract. 2014;6:70-76. https://doi.org/10.1016/j.jebdp.2014.02.006
7. Coffee statistics in the USA. MyFriendsCoffee. July 9, 2020. https://myfriendscoffee.com/usa-coffee-statistics/
8. Teeth whitening market: growth, trends, and forecasts (2020-2025). Mordor Intelligence. https://www.mordorintelligence.com/industry-reports/teeth-whitening-market

Amber Metro-Sanchez, BA, RDH, practices dental hygiene with Chris Bible, DDS, at Comfort Dental in Fort Wayne, Indiana. She also works as a professional educator on behalf of Waterpik. Metro-Sanchez was a member of the 2015 Colgate Oral Health Advisory Board. She is also a contributing author for the Colgate Professional and Colgate Oral Care Center webpages. Reach her at [email protected].