Bleaching agents containing a high concentration of H2O2 in the dental market lead to formation of reactive oxygen species, which have genotoxic effects. However, ozone bleaching, one of the most effective oxidants known, stimulates blood circulation and immune response and thus it has strong antimicrobial activity against viruses, bacteria, fungi, and protozoa. For these reasons, one of our hypothesis was ozone bleaching would reduce local and systemic DNA damage in the body. Hence, we aimed to determine the oxidative DNA damage biomarker levels in serum, saliva, and gingival crevicular fluid (GCF) by measuring 8-hydroxy-2′-deoxyguanosine (8-OHdG) after different bleaching methods.
Forty-eight volunteers who requested dental bleaching were divided into three treatment groups (n = 16). Group 1: ozone bleaching with the ozone-releasing machine; Group 2: chemical bleaching with 40% hydrogen peroxide (H2O2) gel; Group 3: 40% H2O2 gel activated with the diode laser. Initial and post-operative (immediately after bleaching and two weeks later) color measurements were performed with a spectrophotometer. The color changes were calculated with the CIEDE2000 (ΔE00) formula. 8-OHdG levels in serum, saliva, and GCF samples were determined with ELISA. All three treatments resulted in efficient and statistically similar bleaching. The 8-OHdG levels in the serum and saliva were not affected by all bleaching methods (p > 0.05), but a temporary increase was observed in the GCF for chemical and laser-assisted groups except the ozone group (p > 0.05). According to the findings, chemical and laser-assisted bleaching can affect DNA damage locally but not systemically. Bleaching with ozone may eliminate this local DNA damage.
JoinerA. The bleaching of teeth: a review of the literature. J Dent2006; 34: 412–419.
2.
KayaATürkünM. Reversal of dentin bonding to bleached teeth. Oper Dent2003; 28: 825–829.
3.
EimarHSicilianoRAbdallahMN, et al.Hydrogen peroxide whitens teeth by oxidizing the organic structure. J Dent2012; 40: e25–e33.
4.
Féliz-MatosLHernándezLMAbreuN.Dental bleaching techniques; hydrogen-carbamide peroxides and light sources for activation, an update. mini review article. Open Dent J2014; 8: 264–268.
5.
AttinTPaqueFAjamF, et al.Review of the current status of tooth whitening with the walking bleach technique. Int Endod J2003; 36: 313–329.
6.
BenettiARValeraMManciniM, et al.In vitro penetration of bleaching agents into the pulp chamber. Int Endod J2004; 37: 120–124.
7.
GurganSCakirFYYaziciE. Different light-activated in-office bleaching systems: a clinical evaluation. Lasers Med Sci2010; 25: 817–822.
8.
ZachLCohenG. Pulp response to externally applied heat. Oral Surg Oral Med Oral Pathol1965; 19: 515–530.
9.
ElsalawyRNHamzaHSYousryMM. The effectıveness of ozone gas as a bleachıng agent and ıts ınfluence on the enamel surface roughness. Egypt Dent J2005; 51: 1351–1364.
10.
MuñozNPVargasCRPérezMA, et al.Oxidative damage in substantia nigra and striatum of rats chronically exposed to ozone. J Chem Neuroanat2006; 31: 114–123.
11.
RibeiroAPDSaconoNTLessaFCR, et al.Cytotoxic effect of a 35% hydrogen peroxide bleaching gel on odontoblast-like MDPC-23 cells. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2009; 108: 458–464.
12.
MateosRBravoL. Chromatographic and electrophoretic methods for the analysis of biomarkers of oxidative damage to macromolecules (DNA, lipids, and proteins). J Sep Sc2007; 30: 175–191.
13.
WangJSchipperHMVellyAM, et al.Salivary biomarkers of oxidative stress: a critical review. Free Radic Biol Med2015; 85: 95–104.
14.
Lazalde-RamosBPZamora-PerezALSosa-MacíasM, et al.DNA and oxidative damages decrease after ingestion of folic acid in patients with type 2 diabetes. Arch Med Res2012; 43: 476–481.
15.
PerezAZGarcíaYORamosBL, et al.Increased micronuclei and nuclear abnormalities in buccal mucosa and oxidative damage in saliva from patients with chronic and aggressive periodontal diseases. J Periodontal Res2015; 50: 28–36.
16.
JohnstonWM. Color measurement in dentistry. J Dent2009; 37: e2–e6.
17.
LuoMRCuiGRiggB.The development of the CIE 2000 colour-difference formula: CIEDE2000. Color Res Appl2001; 26: 340–350.
18.
ParavinaRDGhineaRHerreraLJ, et al.Color difference thresholds in dentistry. J Esthet Restor Dent2015; 27: S1–S9.
19.
PerchyonokVGroblerS. Tooth-bleaching: mechanism, biological aspects and antioxidants. Int J Dent Oral Health2015; 1: 1–7.
20.
SharmaASharmaS. Reactive oxygen species and antioxidants in periodontics: a review. Int J Clin Dent2011; 3: 44–47.
21.
CecariniVGeeJFiorettiE, et al.Protein oxidation and cellular homeostasis: emphasis on metabolism. Biochim Biophys Acta2007; 1773: 93–104.
22.
de Oliveira DuqueCCSoaresDGBassoFG, et al.Bleaching effectiveness, hydrogen peroxide diffusion, and cytotoxicity of a chemically activated bleaching gel. Clin Oral Investig2014; 18: 1631–1637.
23.
WalshLJ. Safety issues relating to the use of hydrogen peroxide in dentistry. Aust Dent J2000; 45: 257–269.
24.
GoldbergMGrootveldMLynchE. Undesirable and adverse effects of tooth-whitening products: a review. Clin Oral Investig2010; 14: 1–10.
25.
de Souza CostaCARiehlHKinaJF, et al.Human pulp responses to in-office tooth bleaching. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2010; 109: e59–e64.
26.
BhattacharyyaSDudejaPKTobacmanJK. Carrageenan-induced NFκB activation depends on distinct pathways mediated by reactive oxygen species and Hsp27 or by Bcl10. Biochim Biophys Acta2008; 1780: 973–982.
27.
YoshidaAOguraYSTakahashiSW, et al.Blue light irradiation-induced oxidative stress in vivo via ROS generation in rat gingival tissue. J Photochem Photobiol B2015; 151: 48–53.
28.
SunG. The role of lasers in cosmetic dentistry. Dent Clin North Am2000; 44: 831–850.
29.
PolydorouOManolakisAHellwigE, et al.Evaluation of the curing depth of two translucent composite materials using a halogen and two LED curing units. Clin Oral Investig2008; 12: 45–51.
30.
Mena-SerranoAGarciaELuque-MartinezI, et al.A single-blind randomized trial about the effect of hydrogen peroxide concentration on light-activated bleaching. Oper Dent2016; 41: 455–464.
31.
OntiverosJCParavinaRD. Color change of vital teeth exposed to bleaching performed with and without supplementary light. J Dent2009; 37: 840–847.
32.
HenryRBauchmoyerSMooreW, et al.The effect of light on tooth whitening: a split-mouth design. Int J Dent Hyg2013; 11: 151–154.
33.
GiudiceRLPantaleoGLizioA, et al.Clinical and spectrophotometric evaluation of LED and laser activated teeth bleaching. Open Dent J2016; 10: 242–250.
34.
DominguezAGarciaJACostelaA, et al.Influence of the light source and bleaching gel on the efficacy of the tooth whitening process. Photomed Laser Surg2011; 29: 53–59.
35.
GoldsteinRE. In-office bleaching: where we came from, where we are today. J Am Dent Assoc1997; 128: 11–15.
36.
NayansiJJaeJREunHC, et al.Generation and role of reactive oxygen and nitrogen species induced by plasma, lasers, chemical agents, and other systems in dentistry. Oxid Med Cell Longev2017; 2017: 7542540.
37.
KawamotoKTsujimotoY. Effects of the hydroxyl radical and hydrogen peroxide on tooth bleaching. J Endod2004; 30: 45–50.
38.
RezendeMDe GeusJLLoguercioAD, et al.Clinical evaluation of genotoxicity of in-office bleaching. Oper Dent2016; 41: 578–586.
39.
LuALLiXGuY, et al.Repair of oxidative DNA damage. Cell Biochem Biophys2001; 35: 141–170.
40.
WesselsMLeyhausenGVolkJ, et al.Oxidative stress is responsible for genotoxicity of camphorquinone in primary human gingival fibroblasts. Clin Oral Investig2014; 18: 1705–1710.
41.
ArikanSDurusoyCAkalinN, et al.Oxidant/antioxidant status in recurrent aphthous stomatitis. Oral Dis2009; 15: 512–515.
GomesDAPiresJRZuzaEP, et al.Myeloperoxidase as inflammatory marker of periodontal disease: experimental study in rats. Immunol Invest2009; 38: 117–122.
44.
GuptaG.Gingival crevicular fluid as a periodontal diagnostic indicator-II: inflammatory mediators, host-response modifiers and chair side diagnostic aids. J Med Life2013; 6: 7–13.
45.
ValavanidisAVlachogianniTFiotakisC. 8-hydroxy-2′-deoxyguanosine (8-OHdG): a critical biomarker of oxidative stress and carcinogenesis. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev2009; 27: 120–139.
46.
ÖnderCKurganŞAltıngözSM, et al.Impact of non-surgical periodontal therapy on saliva and serum levels of markers of oxidative stress. Clin Oral Investig2017; 21: 1961–1969.
47.
MuthurajMSAJanakiramSChithresanK, et al.Effect of scaling and root planing on levels of 8-hydroxydeoxyguanosine in gingival crevicular fluid of chronic periodontitis patients with and without type II diabetes mellitus. J Indian Soc Periodontol2017; 21: 201–206.
48.
MartinJHBishopJGGuenthermanRH, et al.Cellular response of gingival to prolonged application of dilute hydrogen peroxide. J Periodontol1968;39:208–210.
49.
LimaSNLRibeiroISGrisottoMA, et al.Evaluation of several clinical parameters after bleaching with hydrogen peroxide at different concentrations: a randomized clinical trial. J Dent2018; 68: 91–97.
50.
BocciVA. Scientific and medical aspects of ozone therapy. state of the art. Arch Med Res2006; 37: 425–435.
51.
Al-OmiriMKAbulRSHAlzareaBK, et al.Comparison of dental bleaching effects of ozone and hydrogen peroxide: an ex vivo study. Am J Dent2016; 29: 251–254.
52.
Al-OmiriMKRa’edSAlZareaBK, et al.Improved tooth bleaching combining ozone and hydrogen peroxide—a blinded study. J Dent2016; 46: 30–35.
53.
Al-OmiriMKAl NazehAAKielbassaAM, et al.Randomized controlled clinical trial on bleaching sensitivity and whitening efficacy of hydrogen peroxide versus combinations of hydrogen peroxide and ozone. Sci Rep2018; 8: 2407.
54.
ChavesRMEstrelaCCardosoPC, et al.Ozone gas effect on mineral content of dentin exposed to streptococcus mutans biofilm: an energy-dispersive X-ray evaluation. J Contemp Dent Pract2017; 18: 265–269.
55.
HosoyaNHondaKIinoF, et al.Changes in enamel surface roughness and adhesion of streptococcus mutans to enamel after vital bleaching. J Dent2003; 31: 543–548.
56.
ColaresVLPLimaSNLSousaNCF, et al.Hydrogen peroxide-based products alter inflammatory and tissue damage-related proteins in the gingival crevicular fluid of healthy volunteers: a randomized trial. Sci Rep2019; 9: 1–11.
57.
FiratEErcanEGurganS, et al.The effect of bleachıng systems on the gingiva and the levels of IL-1β and IL-10 in gingival crevicular fluid. Oper Dent2011; 36: 572–580.
58.
AkbariMNejatAHFarkhondehN, et al.Does at-home bleaching induce systemic oxidative stress in healthy subjects?Aust Dent J2017; 62: 58–64.
59.
AzumaKMoriTKawamotoK, et al.Anti-inflammatory effects of ozonated water in an experimental mouse model. Biomed Rep2014; 2: 671–674.
60.
ÇelikÇYüzügüllüBErkutS, et al.Effect of bleaching on staining susceptibility of resin composite restorative materials. J Esthet Restor Dent2009; 21: 407–414.
61.
LagoMMozzaquatroLRRodriguesC, et al.Influence of bleaching agents on color and translucency of aged resin composites. J Esthet Restor Dent2017; 29: 368–377.
62.
PruthiGJainVKandpalH, et al.Effect of bleaching on color change and surface topography of composite restorations. Int J Dent2010; 2010: 695748.
63.
PolydorouOWirschingMWokewitzM, et al.Three-month evaluation of vital tooth bleaching using light units—a randomized clinical study. Oper Dent2013; 38: 21–32.
64.
Aykut-YetkinerAErtuğrulFEdenE, et al.Color assessment after bleaching with hydrogen peroxide versus ozone: a randomized controlled clinical trial. Gen Dent2017; 65: e12–e17.
65.
SurmeliogluDTorunOY. Evaluation of effectiveness and postoperative sensitivity following ozone and laser activated bleaching methods. J Ataturk Univ Dent Faculty. 2019; 29: 416–423.
