A review of the effect of vital teeth bleaching on the mechanical properties of tooth enamel.

Tooth whitening is considered the easiest and most cost-effective procedure for treating tooth discoloration. Contemporary bleaching agents contain hydrogen peroxide as the active ingredient. It is either applied directly or produced from its precursor, carbamide peroxide. A review of the published literature was undertaken to investigate the potential adverse effects of whitening products on dental enamel, with a focus on its mechanical properties and the influence of various parameters on study outcomes. There appear to be considerable differences in opinion as to whether changes in mechanical properties occur as a result of tooth whitening. However, the mechanical property findings of those studies appear to be related to the load applied during the indentation tests. Most studies which used loads higher than 500mN to determine enamel hardness showed no effect of bleaching, whereas those using lower loads were able to detect hardness reduction in the surface layer of enamel. In conclusion, bleaching reduces the hardness of the enamel surface of enamel, and that is more readily detected with instrumented low load testing systems. This hardness reduction may arise due to degradation or denaturation of enamel matrix proteins by the peroxide oxidation.

Effect of tooth bleaching agents on protein content and mechanical properties of dental enamel.

This study investigated the effect of two bleaching agents, 16% carbamide peroxide (CP) and 35% hydrogen peroxide (HP), on the mechanical properties and protein content of human enamel from freshly extracted teeth. The protein components of control and treated enamel were extracted and examined on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Marked reduction of the protein matrix and random fragmentation of the enamel proteins after bleaching treatments was found. The mechanical properties were analyzed with Vickers indentations to characterize fracture toughness, and nanoindentation to establish enamel hardness, elastic modulus and creep deformation. Results indicate that the hardness and elastic modulus of enamel were significantly reduced after treatment with CP and HP. After bleaching, the creep deformation at maximum load increased and the recovery upon unloading reduced. Crack lengths of CP and HP treated enamel were increased, while fracture toughness decreased. Additionally, the microstructures of fractured and indented samples were examined with field emission gun scanning electron microscopy (FEG-SEM) showing distinct differences in the fracture surface morphology between pre- and post-bleached enamel. In conclusion, tooth bleaching agents can produce detrimental effects on the mechanical properties of enamel, possibly as a consequence of damaging or denaturing of its protein components.