title: Soft-tissue alterations following exposure to tooth-whitening agents.
abstract: BACKGROUND
  Tooth-whitening agents are widely used, either as self-application products or under the supervision of a dentist. These products may be associated with transient gross morphologic changes in oral soft tissues. However, their potential effects on human keratinocytes and fibroblasts in a stratified squamous epithelium have yet to be elucidated.
  
  
  METHODS
  In this study, three-dimensional human tissue equivalents are exposed to varying concentrations of tooth-whitening agents for increasing time periods. Tissue alterations are investigated in terms of morphology, proliferation, apoptosis, and protein expression.
  
  
  RESULTS
  All whitening agents tested altered tissue morphology, induced proliferation of basal keratinocytes, and caused apoptosis of cells in all epithelial strata. In addition, whitening agents induced alterations in the expression of cytokines that are linked to inflammation.
  
  
  CONCLUSIONS
  These results suggest that whitening agents may induce similar changes in vivo and that these products should be used for limited periods of time or under the supervision of a dental professional.
authors.affiliation: Department of Oral and Maxillofacial Pathology, Division of Cancer Biology and Tissue Engineering, Tufts University School of Dental Medicine, Boston, MA, USA.
authors.forename: Rebekah N
authors.initials: RN
authors.lastname: Lucier
authors.forename: Olivier
authors.initials: O
authors.lastname: Etienne
authors.forename: Susana
authors.initials: S
authors.lastname: Ferreira
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Garlick
authors.forename: Gerard
authors.initials: G
authors.lastname: Kugel
authors.forename: Christophe
authors.initials: C
authors.lastname: Egles
mesh_terms: D017209:Apoptosis / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D002478:Cells, Cultured; D004847:Epithelial Cells / Q000166:cytology / Q000187:drug effects*; D005347:Fibroblasts / Q000187:drug effects; D006801:Humans; D006861:Hydrogen Peroxide / Q000633:toxicity*; D007378:Interleukins / Q000096:biosynthesis; D015603:Keratinocytes / Q000187:drug effects*; D009061:Mouth Mucosa / Q000166:cytology / Q000187:drug effects*; D000075023:S100 Calcium Binding Protein A7; D009418:S100 Proteins / Q000096:biosynthesis; D058205:Tooth Bleaching Agents / Q000633:toxicity*
chemical_list: D007378:Interleukins; D000075023:S100 Calcium Binding Protein A7; D009418:S100 Proteins; C089242:S100A7 protein, human; D058205:Tooth Bleaching Agents; D006861:Hydrogen Peroxide