title: Effects of hydrogen peroxide bleaching strips on tooth surface color, surface microhardness, surface and subsurface ultrastructure, and microchemical (Raman spectroscopic) composition.
abstract: OBJECTIVE
  This study examined the effects of hydrogen peroxide tooth bleaching strips on the surface hardness and morphology of enamel and the ultrastructure and chemical composition of enamel and dentin in vitro.
  
  
  METHODS
  Sound human molars were ground and polished to prepare a uniform substrate for bleaching treatments. A cycling treatment methodology was employed which alternated ex vivo human salivary exposures with bleaching treatments under conditions of controlled temperature and durations of treatment. Bleaching treatments included commercial Crest Whitestrips bleaching strips, which utilize hydrogen peroxide in a gel as the in situ bleaching source at 6.0 and 6.5% concentrations of H2O2. Control treatments included an untreated group. Crest Whitestrips bleaching included treatment exposures simulating 2x the recommended clinical exposures (28 hours bleaching). Surface color measurements were taken prior to and following bleaching to ensure tooth bleaching activity. The effects of bleach on physical properties of enamel were assessed with microhardness measures. Ultrastructural effects were classified by surface and subsurface confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) techniques. In addition, the effects of bleaching on tooth microchemical composition was studied in different tooth regions by coincident assessment of Raman spectroscopic signature.
  
  
  RESULTS
  Color assessments confirmed significant ex vivo tooth bleaching by Whitestrips. Surface microhardness and SEM measures revealed no deleterious effects on the enamel surfaces. CLSM micromorphological assessments supported the safety of hydrogen peroxide bleaching strips both on surface and subsurface enamel, DEJ, and dentin ultrastructure. Raman spectroscopy analysis demonstrated no obvious effects of bleaching treatments on the microchemical composition of enamel and dentin.
  
  
  CONCLUSIONS
  These results confirm that tooth bleaching with hydrogen peroxide whitening strips does not produce changes in surface/subsurface histomorphology or in surface microhardness and ultrastructure of treated teeth. In addition, for the first time, these results confirm the safety of hydrogen peroxide bleaching strips to tooth microchemical composition as measured by Raman spectroscopy.
authors.affiliation: Applied Structure and Microanalysis, Medical Faculty, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Duschner
authors.forename: Hermann
authors.initials: H
authors.lastname: Götz
authors.forename: Donald J
authors.initials: DJ
authors.lastname: White
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Kozak
authors.forename: James R
authors.initials: JR
authors.lastname: Zoladz
mesh_terms: D003743:Dental Enamel / Q000737:chemistry / Q000187:drug effects* / Q000648:ultrastructure; D003804:Dentin / Q000737:chemistry / Q000187:drug effects / Q000648:ultrastructure; D006244:Hardness / Q000187:drug effects; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology* / Q000627:therapeutic use; D016877:Oxidants / Q000494:pharmacology* / Q000627:therapeutic use; D013059:Spectrum Analysis, Raman; D014073:Tooth Bleaching / Q000379:methods*; D014075:Tooth Discoloration / Q000188:drug therapy
chemical_list: C488279:Crest whitestrips; D016877:Oxidants; D006861:Hydrogen Peroxide