OxyFile #427

Hydrogen peroxide: a review of its use in dentistry.

Marshall MV; Cancro LP; Fischman SL

Dermigen, Smithville, TX, USA.

J Periodontol, 66: 9, 1995 Sep, 786-96


Several dentifrices that contain hydrogen peroxide are currently 
being marketed. The increased use of bleaching agents containing 
(or generating) H2O2 prompted this review of the safety of H2O2 
when used in oral hygiene. Daily exposure to the low levels of 
H2O2 present in dentifrices is much lower than that of bleaching 
agents that contain or produce high levels of H2O2 for an extended 
period of time. Hydrogen peroxide has been used in dentistry alone 
or in combination with salts for over 70 years. Studies in which 
3% H2O2 or less were used daily for up to 6 years showed 
occasional transitory irritant effects only in a small number of 
subjects with preexisting ulceration, or when high levels of salt 
solutions were concurrently administered. In contrast, bleaching 
agents that employ or generate high levels of H2O2 or organic 
peroxides can produce localized oral toxicity following sustained 
exposure if mishandled. Potential health concerns related to 
prolonged hydrogen peroxide use have been raised, based on animal 
studies. From a single study using the hamster cheek pouch model, 
30% H2O2 was referred to as a cocarcinogen in the oral mucosa. 
This (and later) studies have shown that at 3% or less, no 
cocarcinogenic activity or adverse effects were observed in the 
hamster cheek pouch following lengthy exposure to H2O2. In 
patients, prolonged use of hydrogen peroxide decreased plaque and 
gingivitis indices. However, therapeutic delivery of H2O2 to 
prevent periodontal disease required mechanical access to 
subgingival pockets. Furthermore, wound healing following gingival 
surgery was enhanced due to the antimicrobial effects of topically 
administered hydrogen peroxide. For most subjects, beneficial 
effects were seen with H2O2 levels above 1%.