Use of Hydrogen Peroxide-Based Tooth Whitening Products and its Relationship to Oral Cancer

Use of Hydrogen Peroxide-Based Tooth Whitening Products and its Relationship to Oral Cancer
Issue online:
28 Jun 2006
To cite this article: ian c. munro, gary m. williams, harald o. heymann, robert kroes (2006)
Use of Hydrogen Peroxide-Based Tooth Whitening Products and its Relationship to Oral Cancer
Journal of Esthetic and Restorative Dentistry 18 (3), 119Ò125.
doi:10.1111/j.1708-8240.2006.00006.x
Blackwell Synergy

ian c. munro**Vice president, Cantox Health Sciences International, Suite 308, 2233 Argentia Road Mississauga, Ontario CanadaIC Munro, Cantox Health Sciences International, Suite 308, 2233 Argentia Road Mississauga, Ontario, Canada L5N 2X7; Tel.: 001Ò905-542-2900; Fax: 001Ò905-542-1011; e-mail: imunro@cantox.com, gary m. williams‹‹Professor of pathology, New York Medical College, Department of Pathology, Basic Science Building, Valhalla, NY, USA, harald o. heymann··Professor and graduate program director, University of North Carolina, Chapel Hill, NC, USA and robert kroes??Director of the Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80176, NI-3508 TD Utrecht, The Netherlands

IC Munro, Cantox Health Sciences International, Suite 308, 2233 Argentia Road Mississauga, Ontario, Canada L5N 2X7; Tel.: 001Ò905-542-2900; Fax: 001Ò905-542-1011; e-mail: imunro@cantox.com

ABSTRACT

Tooth whitening products containing hydrogen peroxide or carbamide peroxide were evaluated in this review for potential oral cancer risk from their use. Hydrogen peroxide is genotoxic in vitro, but not in vivo. Hydrogen peroxide was not considered to pose a genotoxic risk to humans. The animal toxicology data relevant to the assessment of the carcinogenicity of hydrogen peroxide do not indicate that it has significant carcinogenic activity at any site, including the oral cavity. Hydrogen peroxide was found to enhance the carcinogenic effects of potent DNA reactive carcinogens in experimental animals. However, these experimental conditions are artificial as they are related to high exposures and are of no relevance to potential human exposures to low quantities of hydrogen peroxide from the use of tooth whitening products. Clinical data on hydrogen peroxide-containing tooth whitening products show no evidence for the development of preneoplastic or neoplastic oral lesions. Exposures to hydrogen peroxide received by the oral cavity are exceedingly low, of short duration (30Ò60 minutes), and could not plausibly enhance any carcinogenic risk associated with exposure of the oral cavity to chemicals in cigarette smoke or to alcohol, both known risk factors for the development of oral cancer.

CLINICAL SIGNIFICANCE
Based on a comprehensive review of the available literature and research, the use of tooth whitening products containing hydrogen peroxide or carbamide peroxide does not appear to pose an increased risk of oral cancer in the general population, including those persons who are alcohol abusers and/or heavy cigarette smokers.

introduction

Tooth whitening products (eg, strips, gels, varnishes) that contain hydrogen peroxide, or carbamide peroxide, a product that degrades to form urea and hydrogen peroxide, have been in common use throughout North America, particularly over the past 15 years. During this time no significant health effects from the use of tooth whitening products have been noted. In Europe, by contrast, tooth whitening products containing hydrogen peroxide or carbamide peroxide are available to consumers only from a dental practitioner. Recently, the European UnionÌs Scientific Committee on Consumer Products1,2 raised concerns with respect to the potential of hydrogen peroxide, including hydrogen peroxide generated from carbamide peroxide, to convey an increased risk of oral cancer, especially in smokers and alcohol abusers. Given this opinion, a comprehensive review was undertaken of the available safety data on various tooth whitening products, and hydrogen peroxide in particular, to assess the carcinogenic risks posed to humans by hydrogen peroxide exposures from the use, both intended and exaggerated, of tooth whitening products.3 This article presents a summary of this review regarding the safety of tooth whitening products with respect to their potential carcinogenicity in humans.

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