Toepassing van 35% waterstofperoxide in de tandheelkunde is niet zonder gevaar

Bleeksystemen bevatten waterstofperoxide en moeten om die reden uitsluitend door tandartsen worden toegepast. Daar is men het in de professie zo langzamerhand wel over eens. Een onderzoek toont aan dat gebruik van bleeksystemen met 35% waterstofperoxide de harde en zachte dentineweefsel dramatisch verandert.

Hydrogen peroxide is an oxidative agent commonly used for dental bleaching procedures. The structural and biochemical responses of enamel, dentin, and pulp tissues to the in vivo bleaching of human (n = 20) premolars were investigated in this study. Atomic force microscopy (AFM) was used to observe enamel nanostructure. The chemical composition of enamel and dentin was analyzed by infrared spectroscopy (FTIR). The enzymatic activities of dental cathepsin B and matrix metalloproteinases (MMPs) were monitored with fluorogenic substrates. The amount of collagen in dentin was measured by emission of collagen autofluorescence with confocal fluorescence microscopy. The presence of Reactive Oxygen Species (ROS) in the pulp was evaluated with a fluorogenic 2',7'-dichlorodihydrofluorescein diacetate (DCFDA) probe. Vital bleaching of teeth significantly altered all tested parameters: AFM images revealed a corrosion of surface enamel nanostructure; FTIR analysis showed a loss of carbonate and proteins from enamel and dentin, along with an increase in the proteolytic activity of cathepsin-B and MMPs; and there was a reduction in the autofluorescence of collagen and an increase in both cathepsin-B activity and ROS in pulp tissues. Together, these results indicate that 35% hydrogen peroxide used in clinical bleaching protocols dramatically alters the structural and biochemical properties of dental hard and soft pulp tissue.

Bron
Sato C, Rodrigues FA, Garcia DM, et al. Tooth bleaching increases dentinal protease activity. J Dent Res 2013; 92: 187-192. doi: 10.1177/0022034512470831. Epub 2012 Dec 14