Cytotoxicity of Bleaching Products: A Systematic Review

Abstract

The high demand for aesthetic treatments among the population has resulted in a wide array of bleaching products available on the market. It is imperative to investigate the potential adverse effects these products may have on dental health. The objective of this systematic review is to assess, based on available experimental in vitro studies in the scientific literature, whether bleaching products exhibit cytotoxic properties against pulp stem cells and fibroblasts. A comprehensive literature search was conducted across the Medline, Scopus, and Lilacs databases using the search formula ((Tooth whitening) OR (bleaching agent)) AND cytotoxicity AND ((stem cell*) OR fibroblast). Following the application of inclusion and exclusion criteria, 14 articles were deemed suitable for full analysis. The most utilized assay in the evaluated studies was the MTT cell viability assay. Fibroblasts emerged as the most scrutinized cell type due to the potential adverse effects of bleaching, such as invasive cervical resorption, which primarily affects the periodontal ligament where fibroblasts are located. It was observed that as the concentration of hydrogen peroxide increases, so does the cytotoxicity of the product. Additionally, other factors such as application time, activation methods, and the type of peroxide used also play a significant role. Bleaching products have been shown to exert cytotoxic effects on fibroblasts. Further exploration of the impact of bleaching agents on dental pulp stem cells is warranted to better understand their implications for these cells.