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Peroxide Use in Dentistry? Is It Safe for My Family?

Periodically, patients will ask if it’s safe to rinse daily with undiluted hydrogen peroxide. This is usually because they’ve heard that it can be beneficial for oral care in some way or another. Examples include using hydrogen peroxide as an alternative to toothpaste if they’ve run out.  There are also other patients who, at the mention of rinsing with peroxide, envision a thick, black coating on the tongue indicative of excessive use of peroxide for oral hygiene.

Although local 60540 dentists don’t recommend using undiluted hydrogen peroxide for oral care, they have been using peroxide safely with their patients since it first appeared in 1913 as a treatment for pyorrhea, or gum disease. Today, however, dentists use peroxides in a controlled manner to treat other oral health issues as well.

Peroxides for Dentistry

The two most common peroxides in use in dentistry today are hydrogen peroxide and carbamide peroxide (aka urea hydrogen peroxide).

With hydrogen peroxide, knowing its grade and concentration is quite important for its safe and effective use for oral health. The grade indicates what additives and stabilizers it contains and determines where it can be sold. The concentration represents the peroxide’s percentage and strength. For instance, the common household peroxide in the brown bottle has a 3% concentration. Parts per million (ppm) is another way to state the concentration of hydrogen peroxide.

Carbamide peroxide incorporates hydrogen peroxide in a ratio of 3:1. This means that if a product has 30% carbamide peroxide, it has around 10% hydrogen peroxide.

Whitening with Peroxides

The most common use of both hydrogen peroxide and carbamide peroxide in dental offices is for teeth whitening. This is because they oxidize stains on teeth, which involves removing electrons holding atoms together to force stain molecules to break apart. Each works equally well for whitening teeth, but with different treatment durations.

Hydrogen peroxide breaks down more quickly than carbamide peroxide and provides its whitening effects within 30 to 60 minutes. In contrast, carbamide peroxide releases around 50% of its effects in the first two hours and continues to whiten for up to six more hours. Research has shown that rinsing with a mouthwash with a 1.5% to 2% concentration of hydrogen peroxide for 12 weeks provides a level of whitening similar to the level attained in 2 weeks of using a 10% carbamide peroxide gel.

In-office, or “power”, bleach treatments or customized, take-home bleaching trays have also proven effective as safe options for whitening teeth. These treatments use light or heat to accelerate the breakdown of hydrogen peroxide for releasing oxygen. However, close monitoring by a dental professional is a must for this type of whitening treatment. In addition, custom-fitted whitening trays that don’t fit properly can cause inflammation and gum bleeding.

Peroxide Mouthwash

According to the American Dental Association (ADA), there are two types of mouthwash: cosmetic based and therapeutic based. Therapeutic mouthwash contains active ingredients like cetylpyridinium chloride or peroxide for removing plaque and preventing tooth decay, as well as for treating gingivitis (gum disease). On the other hand, cosmetic mouth rinses simply control bad breath without any other chemical applications.

While over-the-counter (OTC) mouthwash products typically contain 1.5% to 3% hydrogen peroxide, the recommended at-home dilution is ½ water, ½ hydrogen peroxide. The advised rinsing time/frequency is one minute up to four times per day. Increasing rinsing time and/or frequency can result in chemical burns to the soft tissues in the mouth.

One study investigated the effect of hydrogen peroxide mouthwash in conjunction with chlorhexidine for removing plaque and stains. Chlorhexidine gluconate is an antimicrobial mouth rinse that reduces germs in the mouth and is used to treat some forms of gingivitis. Over a 21-day period, participants who rinsed with a combination of these two ingredients showed significantly less plaque formation and stain intensity. The study concluded that hydrogen peroxide is effective as an adjunct treatment to treatment with chlorhexidine for whitening teeth..

Peroxide and Baking Soda

Oral hygiene products commonly contain both baking soda and hydrogen peroxide, with the percentage of peroxide typically falling between 1.5% and 3%. Baking soda accelerates decomposition and oxidation to allow hydrogen peroxide to penetrate cell membranes and produce an antimicrobial effect. Studies have shown that increasing the level of baking soda in oral care products makes it possible to use less peroxide to achieve the same effects.

Peroxide for Gum Disease

The Food and Drug Administration (FDA) approves the use of hydrogen peroxide for the treatment of gum disease. The peroxide breaks easily through the slime barrier that protects harmful bacteria and breaks down bacterial cell walls. It also releases oxygen, creating an unfit environment for bacteria to thrive.

Carbamide peroxide has also proven effective for removing plaque and treating gingivitis. Because it increases plaque and salivary pH, carbamide peroxide reduces damaging bacteria in the mouth. This makes it highly effective in treating patients with compromised oral health, including the elderly and those with special needs or who’ve undergone cancer treatment.

Safety Considerations

Black hairy tongue (BHT) is a benign condition in which elongated papillae form on the tongue and create a carpet-like appearance. Despite the name, BHT can also present as brown, green, blue, yellow or colorless. Undiluted rinsing with hydrogen peroxide and/or overuse of mouthwash containing sodium peroxide or hydrogen peroxide can result in BHT. Conversely, rinsing with a diluted solution of peroxide/water or baking soda/water is effective for treating BHT.

Moreover, prolonged use of high concentrations of 30% hydrogen peroxide can break down, or demineralize, enamel and dentin. This allows for both softened enamel and the growth of opportunistic, harmful bacteria. These conditions can occur at 12 hours and 30 hours after use, respectively.

Ultimately, there is strong evidence that the daily use of hydrogen peroxide is safe at low concentrations and over long periods. However, use in high concentrations for prolonged periods can cause damage to both hard and soft tissues in the mouth. The recommendation from Comfort Care Family Dentistry P.C. is a 3% hydrogen peroxide solution to avoid adverse effects.