Tooth Whitening Strips and Dental Safety
When used properly according to manufacturer instructions, tooth whitening strips are safe and effective for patients with no significant medical or dental history, with the most common side effects being mild to moderate tooth sensitivity and gingival irritation that are transient in nature. 1
Evidence-Based Safety Profile
The accumulated data over two decades demonstrates that peroxide-based tooth whitening, including strips, is safe when used appropriately. 1 The most frequently observed adverse effects include:
- Tooth sensitivity occurs in 15-78% of patients undergoing external tooth bleaching, but this is typically mild to moderate and temporary 1, 2
- Gingival irritation is the other primary side effect, also usually mild and self-limiting 1, 3
- No evidence of significant health risks has been documented when products are used as directed 1
Clinical Efficacy Data
Whitening strips containing 6% hydrogen peroxide demonstrate superior efficacy compared to other over-the-counter products. In a randomized clinical trial, 14-day use of 6% hydrogen peroxide whitening strips resulted in a significant 2-unit improvement in tooth color (delta b*) compared to both 18% carbamide peroxide paint-on gel and whitening dentifrice (P < 0.0001). 4 All products in this study were well tolerated with no subjects discontinuing due to adverse events. 4
Critical Safety Considerations and Pitfalls
The key to safety is proper application. Potential adverse effects occur primarily with inappropriate application, abuse, or use of inappropriate whitening products. 1 Specific concerns include:
- Avoid gingival contact: Direct contact with hydrogen peroxide can induce genotoxic effects in epithelial cells, though this effect is reduced in the presence of metabolizing enzymes 2
- Contraindications: Patients with damaged or diseased soft tissues should avoid hydrogen peroxide-containing products 2
- Professional oversight matters: Bleaching requires proper examination, diagnosis, and treatment planning that can only be performed appropriately by dental professionals to maximize efficacy and minimize risks 3
Comparison to Professional Supervision
While over-the-counter strips show similar aesthetic results and side effects compared to professionally supervised 10% carbamide peroxide tray bleaching, concerns exist regarding potential abusive use, especially in young patients, without professional guidance. 5 The lack of independent clinical trials for many OTC products (most studies are manufacturer-supported) and short-term evaluation periods represent limitations in the evidence base. 5
Practical Recommendations
For a patient with no significant medical or dental history:
- Whitening strips are appropriate when used strictly according to manufacturer instructions 1, 4
- Expect transient sensitivity in up to 78% of cases, which resolves after discontinuation 1, 2
- Minimize gingival exposure by careful application technique 2
- Dental professional involvement is recommended to ensure proper patient selection and monitoring, even for OTC products 3