Tooth whitening in children and adolescents: a literature review

The purpose of this paper was to summarize the findings of a literature review on the use of peroxide-based tooth-whitening agents in children and adolescents. Safety considerations, including localized adverse effects and toxicological concerns, are described. Oral findings include: (1) 1 in every 2 to 3 patients may experience tooth sensitivity and/or gingival irritation after bleaching treatment, which may be more traumatic an experience for children than adults; (2) depending on dose, duration, frequency, and route, studies indicate excessive exposure to peroxide can be potentially harmful; (3) degree of potential toxicity and harmful outcomes increases in those who overuse whiteners--a concern in teenagers; (4) careful case selection using stringent criteria is suggested for primary teeth whitening; (5) whitening in healthy adolescents is a case-by-case determination that must include the weighing of risks (oral health and age) vs benefits (improved esthetic perception). It is hoped that the present review will lead to a better understanding of the health implications of tooth whitening in children and adolescents, and offer guidance for treatment that provides satisfactory outcomes externally (enamel and gingiva) and internally (endodontic tissues and systemic health).