# Impact of Exposure to Commonly Used Carbamide Peroxide on Dental Pulp Stem Cells
## 4 Discussion  
DPSCs represent a small fraction of the resident cells in the dental pulp that remain quiescent under normal conditions. Upon injury or infection, these cells can rapidly activate and migrate to areas with damaged pulp [13]. Through their ability to differentiate into odontoblasts, DPSCs play a critical role in the formation of reparative dentin and are also key regulators of the pulpal immune response [14]. This study aimed to test the null hypothesis that the bleaching agent does not influence diffusion and does not have biological effects on DPSCs. Carbamide peroxide (CP) is a bleaching agent commonly used in dentistry for vital at-home tooth whitening. CP is a combination of hydrogen peroxide and urea. When applied to teeth, it breaks down into hydrogen peroxide (H\({}_{2}\)O\({}_{2}\)) and urea. The H\({}_{2}\)O\({}_{2}\) dissociates into water and highly reactive oxygen species, including free radicals such as  
Figure 7: Effect of the bleaching agent on cytokine release. The cytokine content was assessed by ELISA in the supernatant of an in vitro culture of DPSCs stimulated for 6, 12, and 24 h with various concentrations of the bleaching agent. Over time, after incubation with different concentrations of the bleaching agent, the production of IL-6 (**A**) and IL-8 (**B**) increased in a dose-dependent manner (***\(p\leq 0.0001\)). Each graph illustrates one representative experiment out of three independent experiments. hydroxyl radicals (OH-), and could reach the pulp chamber, mostly by diffusion through den amelogenesis imperfecta [24], fluorosis [25], and other enamel defects. Tooth whitening should not be used during mixed dentition. Therefore, it is crucial to approach the whitening of teeth in young people with an individualized, conservative strategy that focuses first and foremost on the health and safety of the teeth. One of the strengths of our study was that it investigated cellular recovery and the host immune response after exposure to H2O2-derived free radicals, as this provided important insights into the mechanisms underlying the pulp response to oxidative stress. On a concentration basis, CP appears to be immunogenic. Accordingly, this report indicates that CP is a virulence factor and that DPSCs are able to sense H2O2-derived free radicals and induce the secretion of IL-6 and IL-8. Furthermore, we could explore the multifaceted interplay between oxidative stress, inflammation, and regenerative capacity in the context of DPSCs. By examining these interrelated processes, we will aim to identify and characterize potential targets for modulation and gain valuable insight into the modulation of DPSCs' behavior in the presence of carbamide peroxide. This holistic approach is expected to contribute to a more comprehensive understanding of the molecular dynamics involved and to foster progress in the development of therapeutic strategies that harness the regenerative potential of DPSCs. The adhesion of the DPSCs to the collagen matrix was affected by the concentration of the bleaching agent; as the concentration of the bleaching agent increased, the adhesion of the DPSCs to the collagen matrix decreased. The findings of our study help us to understand how DPSCs behave after indirect/direct contact with carbamide peroxide as a tooth-bleaching agent and may serve as a catalyst for the development of novel strategies to enhance the regenerative properties of DPSCs despite an inflammatory environment. The translation of research findings into clinical applications is essential for the advancement of tooth-bleaching techniques. This process should integrate the regenerative potential of pulp cells, especially DPSCs, into improved bleaching protocols. Researchers must focus on practical implementation in dental clinics to improve both treatment outcomes and the patient experience. The goal is to develop methods that not only effectively whiten teeth but also promote dental tissue health.