The Effects of Teeth Whitening on the Oral Microbiome

Teeth whitening, or dental bleaching, is a popular cosmetic procedure aimed at lightening teeth colour. Despite its widespread use, the impact of these treatments on the oral microbiome remains underexplored. 

What We Know:

• Most in-office teeth whitening treatments rely on hydrogen peroxide (HP) or its precursor, carbamide peroxide (CP). As products containing > 0.1% peroxide are typically restricted to dentist-prescribed use, over-the-counter alternatives have emerged, including agents such as phthalimidoperoxycaproic acid, sodium chlorite and sodium bicarbonate. Additionally, natural enzymes like bromelain, papain and cysteine proteases have also been tested as whitening agents in vitro (Müller-Heupt et al., 2023).

• Peroxides, especially HP, are considered the gold standard for teeth whitening. They generate reactive free radicals that oxidise organic chromophores, like those from coffee, red wine or tea. This oxidation breaks down the chromophores into smaller molecules that absorb fewer wavelengths of visible light, making the teeth appear lighter (Müller-Heupt et al., 2023).

• Although peroxide-based treatments are safe and effective, they cause temporary tooth sensitivity in 43-80% of patients. This sensitivity is likely due to microscopic damage to the enamel, which allows oxygen radicals to reach the dental nerve, causing inflammation and temporary discomfort (Müller-Heupt et al., 2023).

Industry Impact and Potential:

• Some oral microbes, including viridans streptococci, exhibit resistance to peroxide. These bacteria can survive in HP environments and may even metabolise it. Salivary enzymes like lactoperoxidase further help reduce the toxicity of HP, protecting bacteria from its effects. While in vitro studies have shown that CP can inhibit certain bacteria, these findings have not been consistently observed in vivo. Overall, dental bleaching does not significantly disrupt the oral microbiome, as the overall population of microorganisms remains stable (Franz-Montan et al., 2009). 

• HP whitening agents can temporarily reduce Streptococcus mutans populations. However, these reductions are short-lived, with S. mutans levels returning to baseline within 30 days. In contrast, CP whitening shows no significant effect on S. mutans. The antimicrobial action of HP is localised to the treatment area and works by damaging bacterial DNA and disrupting metabolic processes. Whitening agents have minimal effects on areas like saliva and buccal mucosa due to limited gel contact and protective enzymes (Briso et al., 2018).

Our Solution:

Sequential specialises in microbiome analysis and product development across oral, skin, scalp and vulvar areas. By pioneering innovative solutions, we support and preserve the microbiome. With our expertise, we are equipped to collaborate with your company in developing teeth-whitening products that promote both a healthy oral microbiome and overall oral health.

References:

Briso, A., Silva, Ú., Souza, M., Rahal, V., Jardim Júnior, E.G. & Cintra, L. (2018) A clinical, randomized study on the influence of dental whitening on Streptococcus mutans population. Australian Dental Journal. 63 (1), 94–98. doi:10.1111/adj.12569.

Franz-Montan, M., Ramacciato, J.C., Rodrigues, J.A., Marchi, G.M., Rosalen, P.L. & Groppo, F.C. (2009) The effect of combined bleaching techniques on oral microbiota. Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research. 20 (3), 304–307. doi:10.4103/0970-9290.57367.

Müller-Heupt, L.K., Wiesmann-Imilowski, N., Kaya, S., Schumann, S., Steiger, M., Bjelopavlovic, M., Deschner, J., Al-Nawas, B. & Lehmann, K.M. (2023) Effectiveness and Safety of Over-the-Counter Tooth-Whitening Agents Compared to Hydrogen Peroxide In Vitro. International Journal of Molecular Sciences. 24 (3), 1956. doi:10.3390/ijms24031956.