Sensitivity and Structural Alterations Due to Hydrogen Peroxide Bleaching: A Systematic In Vivo and In Vitro Review
DOI:
https://doi.org/10.29166/od.v28iEsp.9918Keywords:
Tooth Bleaching, Hydrogen Peroxide, Tooth SensitivityAbstract
Dental bleaching with high-concentration agents is widely used to improve dental aesthetics; however, some studies report adverse effects, such as transient tooth sensitivity and possible structural changes in dental tissues. The objective of this systematic review was to evaluate scientific evidence on the effects of hydrogen peroxide bleaching on tooth sensitivity and on the structure of enamel and dentin. A search was conducted in PubMed, Scopus, and the Cochrane Library, including in vivo and in vitro studies published in English and Spanish between 2010 and 2025. The selected studies evaluated the use of hydrogen peroxide at concentrations of 35%, 38%, and 40% for in-office dental bleaching. Thirty-six in vivo studies analyzing tooth sensitivity associated with the procedure were included; all reported its presence, although 20 specifically described its intensity or duration. In addition, 24 in vitro studies focused on structural alterations in enamel and dentin were analyzed, mainly microhardness, surface roughness, morphological changes, and dentin permeability. Overall, the evidence indicates that dental bleaching with high concentrations of hydrogen peroxide may be associated with transient tooth sensitivity and structural changes in dental tissues. However, methodological heterogeneity among the studies limits the possibility of drawing definitive conclusions regarding the magnitude and clinical relevance of these effects and requires cautious interpretation of the findings.
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