Tooth discolouration and staining: a review of the literature

The effect of the combined use of silver diamine fluoride and potassium iodide in disrupting the plaque biofilm microbiome and alleviating tooth discoloration: A systematic review

Silver diamine fluoride (SDF) is used in minimally invasive dentistry for arresting dental caries. However, discoloration of teeth is a significant side effect that has limited the use of SDF. Hence, the application of potassium iodide (KI) following SDF has been proposed to ameliorate the staining. Although antimicrobial activity is one of the major mechanisms of the caries-arresting effect of SDF, the antimicrobial potency of SDF/KI combination is unclear. Thus, the primary objective of this systematic review was to appraise the studies on the antimicrobial efficacy of SDF/KI combination on cariogenic microbes. The secondary objective was to summarize the evidence on the potential of KI in reducing the discoloration associated with the application of SDF. Electronic databases of Medline via PubMed, Cochrane Library, Web of Science, and EBSCO host were searched for English language manuscripts from January 2005 to 15th November 2020. The reference lists of these manuscripts were manually searched for additional studies. Twelve studies were included in the final analysis, seven of which have investigated the antimicrobial efficacy of SDF/KI, and the rest have examined the anti-staining potential of KI. The exploratory findings from the reviewed articles revealed the promising antimicrobial potential of SDF/KI on cariogenic microbes associated with dentine caries. There is, however, contradictory evidence on the effect of SDF/KI on tooth color. The reviewed in-vitro studies indicated significant effectiveness of KI in preventing staining. A clinical trial on primary dentition showed 25% reduction in the incidence of staining by SDF after applying KI, while a clinical study on root caries in adults showed no significant effect. Within the methodological limitations of this review, we conclude that for arresting dental caries, SDF could be combined with KI, as there may be a lower likelihood of staining. Further, well-designed clinical trials on the antimicrobial and anti-staining effect of SDF/KI are needed to obtain more robust evidence.

Chromatic analysis of orthodontic resin bonding agents exposed to different antiseptic mouthrinses

Objective:

To assess the color of different orthodontic resin bonding agents exposed to three antiseptic mouthrinses for a prolonged time interval (10-year aging simulation).

Methods:

160 specimens were distributed into four groups, according to the orthodontic resin bond agent (Concise, Transbond XT, Transbond Plus Color Change, and Natural Ortho). Each group was exposed to different antiseptic mouthrinses: alcohol-based (Listerine®), alcohol-free (Oral-B®), chlorhexidine (Periogard®) and distilled water as the control. Specimens were submitted to two cycles of staining and artificial aging. Color was evaluated by means of a digital spectrophotometer at the beginning of the experiment and after every cycle. The system used to assess color changes was the CIE L*a*b*. Data was analyzed using the ANOVA and Tukey post-hoc test.

Results:

After simulation of 10 years of aging, Transbond XT and Natural Ortho composites presented no statistically significant differences in ∆E when exposed to different mouthrinses. The Concise composite specimens exposed to alcohol-free mouthrinse presented a significant difference when compared with specimens from the same group exposed to other antiseptic mouthrinses. Transbond Plus Color Change specimens exposed to chlorhexidine mouthrinse and to alcohol-containing mouthrinse presented a significant difference when compared with the specimens from the group exposed to water and alcohol-free antiseptic.

Conclusion:

All orthodontic resin bonding agents tested presented clinically perceptible color changes when exposed to at least one of the mouthrinses, except for the Natural Ortho composite. The Concise composite exposed to the alcohol-free solution was the resin that presented the highest color change values.

First insights into chlorhexidine retention in the oral cavity after application of different regimens

Objectives

This in situ study aimed to determine and compare the chlorhexidine (CHX) retention in the oral cavity after the application of different CHX pharmaceutical regimens.

Methods

Five volunteers used different CHX treatment regimens including mouth rinses, dental spray and toothpaste gel. After the application of the different CHX regimens, 2-μl samples were taken from saliva and buccal mucosa pellicle as well as the dental pellicle samples formed on standardized enamel surfaces. Sample collection was conducted at six time points within 12 h. Retention of CHX was measured using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry.

Results

CHX retention values in the oral mucosa pellicle were significantly higher than those in saliva. CHX remained in the mucosal pellicle at microgrammes per millilitre levels for 12 h after mouth rinsing, 10 h after spray application and 2 h after using the toothpaste. CHX was detected in the dental pellicle for at least 12 h after application of mouth rinsing and spray. Retention of CHX after mouth rinsing or spray application was significantly higher than the retention after using toothpaste.

Conclusions

Oral mucosa was the favourable site for CHX retention. Higher mouth rinse concentration and longer rinsing time produced a slight increase in CHX retention. CHX spray provided considerable retention values, whereas toothpaste gel delivered the lowest retention after application. MALDI-TOF was a sensitive method with excellent limits of quantification for CHX detection.

Reduction of extrinsic tooth stain by a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate: an 8-week randomised clinical trial

Objective

To assess the effects for controlling extrinsic tooth stain of a whitening toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate, in comparison with a negative control toothpaste.

Methods

A total of 86 adults who met with the inclusion and exclusion criteria were invited to take part in the study. They were distributed into test and control groups randomly. At baseline, 4 weeks and 8 weeks, the same examiner provided the clinical examinations, including evaluations of oral soft and hard tissues and measurements of tooth stain of the anterior teeth using the Lobene Stain Index. Adverse events and any changes in general health conditions of the patients were monitored.

Results

When the study was completed, comparisons between patients in test and control groups yielded statistically significant differences in Lobene stain adjusted mean area score [0.83 (0.05) vs. 1.13 (0.05)], Lobene stain adjusted mean intensity score [0.99 (0.06) vs. 1.32 (0.06)] and Lobene stain adjusted mean composite score [1.45 (0.13) vs. 2.50 (0.13)] (All, P < 0.001). Patients in the test group exhibited reductions of 26.55%, 25% and 42%, respectively in Lobene stain area, intensity and composite scores, relative to patients in the control group. Comparisons within groups showed that all three Lobene scores at 8 weeks in both groups were lower than those at baseline (All, P < 0.001).

Conclusion

This study demonstrates that 8-week use of a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate can effectively reduce extrinsic tooth stain.

Trial registration NCT04238429 (before enrollment of the first participant). Data register: March 4, 2018.

Optical detection of the potential for tooth discoloration from children's beverages by quantitative light-induced fluorescence technology

BACKGROUND

Some beverages are known to cause extrinsic staining on the tooth. This study investigated the degree of pigmentation caused by children's acidic beverages, and to confirm the possibility of the quantitative light-induced fluorescence (QLF) technology in assessing staining of the tooth.

METHODS

Bovine tooth specimens were subjected to an 8-day pH-cycling model, using six children's beverages (experimental groups) and a cola (control group), and a remineralizing solution. Before and after the pH-cycling, white-light and fluorescence images of the enamel surface were photographed with a QLF to evaluate color change (ΔE_after) and fluorescence loss (ΔF_after), respectively. Paired t-test was used to compare the tooth colors obtained before and after the pH-cycling. Spearman correlation analysis was performed to examine the correlation between the ΔE_after and ΔF_after values.

RESULTS

Median ΔE_after values of all the beverages ranged from 1.33 to 20.42, showing the greatest value in Koal-Koal Koala™ (KKK, p < 0.001). The ΔE_after was correlated with ΔF_after value negatively (ρ=-0.611, p < 0.001). The median ΔF_after varied by beverages (-38.86-0.00) and KKK caused the greatest value.

CONCLUSIONS

The cola and 6 children's beverages showed the possibility for discoloration on the tooth. The QLF technology may enable monitoring the discoloration induced on the tooth surface by acidic beverage.

The Decisive Role of Laser Doppler Flowmetry for Pulp Preservation in Discolored Traumatized Teeth

Objective: It has been stated that blood pigments within discolored teeth may interfere with Laser Doppler Flowmetry (LDF) measurements. The aim of this study was to assess pulp vitality with LDF in a cohort of discolored traumatized teeth referred for endodontic treatment or where the referring dentist had doubts regarding maintained tooth vitality. Background: Discoloration of teeth is a common sequel of dental trauma. Still today, it is taken as an indicator for root canal treatment. Transient apical breakdown (TAB) is confused with apical periodontitis, although it is a sequel of dental trauma in young mature teeth and will result in revascularization and dissolution of the apical radiolucency. Methods: A total of 26 patients with 28 discolored teeth, belonging to a cohort of referred patients with traumatized teeth referred for root canal treatment and/or pulp vitality assessment were screened on color with photographs by three investigators, with traditional sensibility tests and with a Moor VMS II LDF meter. Results: The color of the intrinsically discolored teeth was grayish in 58% of teeth, blue 20%, pink/crimson 12%, and yellow 4%. Eighty-five percent were central maxillary incisors, 11% were mandibulary incisors. Thanks to LDF, 43% of the trauma cases in this small cohort with discoloration underwent root canal treatment instead of 70% with traditional sensibility tests as indicator. TAB was found in 11%. Conclusions: LDF was decisive in diagnosing vitality of discolored teeth and there was no negative impact of tooth discoloration on LDF measurements.

Primary Teeth Stains and Discoloration: A Review

The current review assesses the literature concerning the etiology of primary teeth staining and discoloration. The appearance of the dentition is of concern to many children and their caregivers seeking dental treatment as the color of the teeth is of aesthetic importance. The correct diagnosis of the cause of the discoloration is important as, invariably, it has a profound effect on treatment outcomes. It would seem reasonable, therefore, that dental practitioners understand the etiology of tooth discoloration to make a diagnosis and enable appropriate treatment to be conducted. Knowledge of the etiology of tooth staining is of importance to the dental practitioner to explain the patient the exact nature of the condition. In some instances, the mechanism of staining affects the outcome of the treatment and influences the options the dentist will be able to offer. Many of these contributing factors are preventable if parents are educated, managed by professional interventions, or provide a multidisciplinary approach. In this review, we highlight the importance of children smiles and the difference between primary and permanent teeth. We discuss the different types of primary teeth staining and discoloration and whether it is intrinsic or extrinsic, as well as the different impacts of some conditions on primary teeth compared with permanent teeth.

ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles

Background

Tooth whitening is one of the most requested dental treatments, but it still presents some side effects. Indeed, the bleaching agent can generate patients’ discomfort and dental hard tissue damages, not achieving an efficient and long-lasting treatment with optimum whitening effect. To overcome these limitations, the bleaching agents containing nano-hydroxyapatite can represent a reliable solution to avoid these detrimental effects.

Methods

In this study, human third molars were treated with commercial bleaching agents, containing nano-hydroxyapatite (nHA) and 6% (at-home treatment), 12% and 18% (in-office treatments) of hydrogen peroxide (HP), named respectively G1, G2 and G3. The results were evaluated descriptively and analytically using Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (ATR-FTIR), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray spectroscopy (EDS), comparing the treated groups with a commercial gel containing 10% carbamide peroxide (CONV) and with a non-treated control group (CTRL).

Results

ATR-FTIR analysis revealed a similar composition in carbonates and phosphates for CTRL, G1 and G2 groups, which showed no significant differences in their spectral profiles; an increased amount of organic matter was found in G3, while CONV displayed an intermediate behavior. SEM analysis did not highlight significant changes in the enamel microstructure of G1 and CONV when compared to CTRL; the pattern observed in G2 presented a slight increase of enamel irregularities, while G3 displayed a partial removal of the aprismatic layer and microporosities. No evident effects due to nHA were observed in the structure of the hydroxyapatite component of G1, G2 and CONV, if compared to CTRL, while G3 showed a slight loss of crystallinity. In all groups, EDS identified slight changes in the concentration of chemical elements O and Ca, while the Ca/P ratio was similar when compared to CTRL.

Conclusion

The obtained results suggest that the application of the tested commercial bleaching agents, with a concentration of HP up to 12%, does not alter the morphological and chemical composition of the enamel surface and maintains its crystallinity.

Effects of dental bleaching protocols with violet radiation on the color and chemical composition of stained bovine enamel

OBJECTIVES

To evaluate the bleaching efficacy of a violet radiation (VR) combined or not with bleaching gels on the color and mineral content of stained teeth.

MATERIAL AND METHODS

Enamel/dentin blocks were obtained and stained (n = 50) with coffee, red wine, tobacco smoke, or were left non-stained. The stained or not-stained blocks (n = 10) were distributed into five bleaching groups (n = 10): VR, CP (37 % carbamide peroxide), VR/CP, HP (35 % hydrogen peroxide), and VR/HP. Color (ΔE_00, ΔL, Δa, and Δb) and whiteness index (ΔWI_D) changes were evaluated after staining and after bleaching using a spectrophotometer. Calcium (Ca), phosphorous (P), and Ca/P contents (in wt%) were measured after bleaching using energy-dispersive X-ray spectroscopy (EDS). Data was statistically analyzed (α = 0.05) using two-way ANOVA and Tukey tests (ΔE_00, ΔWI_D, ΔL, Δb, wt%) or Kruskal-Wallis and Dunn tests (Δa).

RESULTS

VR alone caused higher colorimetric changes on coffee, tobacco and red wine-stained groups compared to non-stained enamel (p < 0.05). VR/CP exhibited higher colorimetric changes compared to CP in coffee and non-stained groups. The VR/CP, HP and VR/HP groups exhibited no change differences (p > 0.05). No differences were observed for the wt% of Ca, P and Ca/P between the groups.

CONCLUSIONS

The violet radiation was more effective in bleaching stained rather than non-stained teeth. VR combined with 37 % carbamide peroxide was as effective as the HP agent. Besides, no adverse effects could be observed in the enamel mineral content, regardless of the bleaching protocol tested, according to the EDS semi-quantitative analysis.

Impact of 0.1% octenidine mouthwash on plaque re-growth in healthy adults: a multi-center phase 3 randomized clinical trial

Objectives

To investigate plaque inhibition of 0.1% octenidine mouthwash (OCT) vs. placebo over 5 days in the absence of mechanical plaque control.

Materials and methods

For this randomized, placebo-controlled, double-blind, parallel group, multi-center phase 3 study, 201 healthy adults were recruited. After baseline recording of plaque index (PI) and gingival index (GI), collection of salivary samples, and dental prophylaxis, subjects were randomly assigned to OCT or placebo mouthwash in a 3:1 ratio. Rinsing was performed twice daily for 30 s. Colony forming units in saliva were determined before and after the first rinse. At day 5, PI, GI, and tooth discoloration index (DI) were assessed. Non-parametric van Elteren tests were applied with a significance level of p < 0.05.

Results

Treatment with OCT inhibited plaque formation more than treatment with placebo (PI: 0.36 vs. 1.29; p < 0.0001). OCT reduced GI (0.04 vs. placebo 0.00; p = 0.003) and salivary bacterial counts (2.73 vs. placebo 0.24 lgCFU/ml; p < 0.0001). Tooth discoloration was slightly higher under OCT (DI: 0.25 vs. placebo 0.00; p = 0.0011). Mild tongue staining and dysgeusia occurred.

Conclusions

OCT 0.1% mouthwash inhibits plaque formation over 5 days. It therefore can be recommended when regular oral hygiene is temporarily compromised.

Clinical relevance

When individual plaque control is compromised, rinsing with octenidine mouthwash is recommended to maintain healthy oral conditions while side effects are limited.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-03781-3.

Oral care product formulations, properties and challenges

This review explores the physical, chemical and structural properties of key components of oral care products, whilst looking at the challenges which need to be overcome to continue to improve the efficacy of oral care, and improve dental health. Oral care has been an essential part of all populations and cultures around the world for thousands of years. To maintain good oral health, dental plaque causing bacteria and malodour must be controlled whilst also strengthening and protecting the teeth to prevent dental caries. Advanced modern formulations need to provide controlled and extended release of ingredients vital for dental health. With modern day products such as toothpastes and mouthwashes, it has never been easier to maintain good oral hygiene and health, yet the incidence of dental caries is still on the rise. The complex formulations of modern toothpastes and mouthwashes makes them one of the most sophisticated pharmaceutical products on the market today. The demands of the consumer coupled with the complexity of the oral cavity make it one of the most challenging development processes.

Targeted nanomedicines for the treatment of bone disease and regeneration

Targeted delivery by either passive or active targeting of therapeutics to the bone is an attractive treatment for various bone related diseases such as osteoporosis, osteosarcoma, multiple myeloma, and metastatic bone tumors. Engineering novel drug delivery carriers can increase therapeutic efficacy and minimize the risk of side effects. Developmnet of nanocarrier delivery systems is an interesting field of ongoing studies with opportunities to provide more effective therapies. In addition, preclinical nanomedicine research can open new opportunities for preclinical bone-targeted drug delivery; nevertheless, further research is needed to progress these therapies towards clinical applications. In the present review, the latest advancements in targeting moieties and nanocarrier drug delivery systems for the treatment of bone diseases are summarized. We also review the regeneration capability and effective delivery of nanomedicines for orthopedic applications.

In vitro antibacterial activity and durability of a nano-curcumin-containing pulp capping agent combined with antimicrobial photodynamic therapy

BACKGROUND

Considering the antibacterial properties of nano-curcumin (nCur) reinforced with antimicrobial photodynamic therapy (aPDT), this study aimed to assess the antibacterial activity and durability of Activa BioActive Base/Liner (ABBL) containing nCur (nCur-ABBL) as a pulp capping agent against Streptococcus mutans, the most common cause of secondary caries.

MATERIALS AND METHODS

In this in vitro experimental study, ABBL discs containing 0.5 %, 1%, 2%, and 5% (w/w) concentrations of nCur were fabricated. After aPDT using light emitting diode (LED) at 435 ± 20 nm wavelength for 5 min, the discs were undergone aging in artificial saliva for 90 days. The antibacterial activity of the discs against S. mutans was evaluated by the disc agar diffusion test, and the number of bacterial colonies present in the biofilm formed on the disc surfaces was counted after 0, 15, 30, and 60 days of aging.

RESULTS

The maximum growth inhibition zone was noted around the 5% nCur-ABBL discs. Increasing the concentration of nCur from 0.5 % to 5% combined with aPDT significantly decreased the number of S. mutans colonies in the biofilm over time (P < 0.05). nCur-ABBL discs containing 2% and 5% nCur had no difference in antibacterial activity at any time point up to 60 days (P > 0.05).

CONCLUSION

According to our data, 5% nCur-ABBL revealed the largest growth inhibition zone in S. mutans culture. Moreover, 5% nCur can serve as an excellent ABBL additive in aPDT producer against S. mutans biofilms up to 60 days of aging period.

Conservative esthetic management of post orthodontic treatment discolored tooth with calcified canal: a case report

A case of pulp canal obliteration (PCO) two years after the completion of orthodontic treatment is presented. Post orthodontic treatment PCO is a rare finding. A 23 years old female presented with the discoloration of clinical crown of maxillary right central incisor. Radiographic examination revealed the calcified canal and diffused periapical radiolucency. Vitality tests were negative. A decision was made to do root canal treatment followed by the walking bleaching. After the successful completion of the root canal treatment the internal bleaching was performed. The discolored tooth showed significant improvement in color. Internal bleaching is a viable conservative treatment for improving esthetics in single non vital discolored tooth.

Effectiveness of a Novel Dentifrice Containing Stabilized Chlorine Dioxide, Sarkosyl, and Sodium Fluoride

This in vitro study evaluated the effectiveness of a novel dentifrice containing stabilized chlorine dioxide, sodium lauroyl sarcosinate (sarkosyl), and sodium fluoride in enhancing enamel fluoride uptake, remineralization, pellicle cleaning and inhibiting biofilm regrowth. Remineralization was measured by fluoride uptake and surface microhardness assessment tests. Artificial stains were removed and scored based on pellicle cleaning ratio. Biofilm regrowth was measured by counting colonies on the agar plates. All studies were conducted using bovine teeth specimens. The efficacy of Toothpaste C (CloSYS anticavity toothpaste) was compared with United States Pharmacopoeia Reference Dentifrice, Toothpaste B (discontinued CloSYS anticavity toothpaste formulation) and leading commercial toothpastes. The enamel fluoride uptake and remineralization by Toothpaste C was 96.1% to 303.3% and 38.0% to 102.4% higher than the tested toothpastes, respectively. The mean pellicle cleaning ratio of Toothpaste C was similar to American Dental Association Reference Material. Toothpaste C had a significant reduction in regrowth of the oral polymicrobial biofilm compared to the control. All tested toothpastes contained 0.24% sodium fluoride. Toothpaste C exhibited significantly superior performance towards fluoride uptake and remineralization compared to the tested toothpastes. Therefore, toothpaste ingredients other than sodium fluoride accounted for the enhanced fluoride uptake and remineralization.

Prevalence and public knowledge regarding tooth bleaching in Saudi Arabia

Background:

Nowadays, cosmetic dentistry has become one of the most important sections of dentistry because patients care about the appearance of their smile with their general health. Hence, the present study was conducted to find the prevalence of public knowledge regarding tooth bleaching in Saudi Arabia.

Methods:

A cross sectional study with cluster sampling method was carried out in the central, northern, southern, eastern, and western regions of the Kingdom of Saudi Arabia. A modified close ended questionnaire in Arabic/English language was distributed among randomly selected shopping malls and social media (WhatsApp and Twitter) via link in Google Sheet. The survey questionnaires were distributed systematically to individuals entering the malls. The survey items were divided into two sections that included sociodemographic data and knowledge subscales. Regression analysis was done to measure the factors influencing the overall impression of bleaching/tooth whitening.

Results:

The sample comprised a total of 2543 respondents, of whom there were 1190 males (46.8%) and 1353 females (53.2%). When the population was asked the perceived or actual complication of bleaching, it was observed that the majority of those surveyed felt that there was either a real or perceived threat of tooth sensitivity followed by burning of the gums.

Conclusion:

Most of the participants heard about tooth bleaching via advertisements, and most of them have used home bleaching more than professional bleaching. Respondents with frequent dental visits had higher levels of knowledge on tooth bleaching compared to respondents with a lack of dental visits.

In-office bleaching with low/medium vs. high concentrate hydrogen peroxide: A systematic review and meta-analysis

OBJECTIVE

To answer the following research question: "Dolow/medium hydrogen peroxide (HP) concentrations used for in-office bleaching in patients with permanent dentition have similar color change and bleaching sensitivity (BS) to high HP concentrations?"

DATA

Randomized controlled trials that compared low/medium vs. high concentrate HP were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change (ΔE*ab, ΔSGU/SGU), risk, and intensity of BS, using the random-effects model. Heterogeneity was assessed with the Cochrane Q test, I² statistics, and prediction interval. The GRADE assessed the certainty of the evidence.

SOURCES

Search was performed in PubMed, Cochrane Library, BBO, LILACS, Scopus, Web of Science and grey literature on 15th September 2018 (updated on 13th May 2020).

STUDY SELECTION

25 studies remained. Five were at low RoB; thirteen were at unclear RoB, and seven were at high RoB. The risk of having BS was, on average, 33 % lower (RR = 0.67; 95 % CI 0.51 to 0.86) for low/medium concentrate HP than high HP. No significant difference in color change was detected among groups, except from the subgroup low vs. high HP for the immediate color change, but this difference is not clinically relevant. The certainty of evidence for color change was low and very low, and moderate for the BS.

CONCLUSIONS

Low and medium hydrogen peroxide concentrate products for in-office bleaching have lower risk and intensity of bleaching sensitivity than the high concentrate hydrogen peroxide group, with no difference in color change efficacy.

CLINICAL SIGNIFICANCE

The use of low concentrate hydrogen peroxide products may produce the same color change efficacy with the bonus of having lower risk and intensity of bleaching sensitivity. However, the ideal concentration at which this occurs is yet unknown and deserves further investigations. No funding. PROSPERO CRD42018108266.

Bleaching Stained Arrested Caries Lesions: In vivo Clinical Study

Objective  Conservative approaches to esthetically treat stained arrested caries lesions (s-ACLs) have not been explored in clinical studies. This study aims to investigate the efficacy of in-office dental bleaching agent, as a conservative approach, to esthetically treat s-ACLs.

Materials and Methods  Twelve patients ( n = 46) presented with s-ACLs were treated with 40% hydrogen peroxide (in-office bleaching protocol; 20 minutes × 3). Color values were measured using a spectrophotometer (CIE L*a*b*), aided with digital photography to assess visual color change clinically. Measurements were taken for each specimen at baseline and immediately after bleaching.

Statistical Analysis  The color change calculated before and after bleaching for each dental substrate was analyzed using paired t -test (α = 0.05).

Results  The bleached s-ACLs had a significant increase in L * values ( p < 0.001), and a significant decrease in both a * ( p = 0.001) and b * ( p = 0.007) values, indicating lighter color improvement (bleaching efficacy). The baseline mean of L *, a *, and b * values were 61.5, 2, and 15.4, respectively, and after bleaching were 67.7, 1.4, and 13.3, respectively, with a mean increase in ∆ E of >7.9, which resulted in a visible clinical stain improvement as orange/light brown stains were removed completely, while gray/black stains improved to a lesser extent.

Conclusion  Significant color improvement was observed when the in-office bleaching protocol (40% hydrogen peroxide) was used in orange/brown s-ACLs. However, it showed lesser improvement in gray/black s-ACLs.

Oral health-related quality of life among pediatric liver transplant candidates

To assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of pediatric liver transplant candidates. This cross-sectional study included 60 children aged 13 to 48 months who were liver transplant candidates that attended the AC Camargo Cancer Center, São Paulo, Brazil. On the day of oral examinations, the children's mothers were invited to answer two questionnaires; one related to children's OHRQoL using the B-ECOHIS and another related to socioeconomic/demographic characteristics. Thereafter, a single, adequately trained dentist carried out children's oral examinations for gingival inflammation (Silness-Löe index), dental plaque (Green-Vermillion Simplified index), dental caries (dmft index), developmental defects of enamel (DDE index), tooth discoloration, oral mucosal/lip alterations. The data collected also included socioeconomic/demographic characteristics and liver disease. The adjusted Poisson regression model was used to associate children's socioeconomic/demographic characteristics and clinical conditions to the outcome. The adjusted regression model showed that children with untreated caries lesions (RR = 3.35, p < 0.0001) and tooth discoloration (RR = 1.74, p = 0.04) had poorer total B-ECOHIS scores. Dental discoloration and untreated caries lesions had a negative impact on the OHRQoL in pediatric liver transplant candidates.

Analysis of chemical deposits on tooth enamel exposed to total particulate matter from cigarette smoke and tobacco heating system 2.2 aerosol by novel GC-MS deconvolution procedures

Tobacco smoking contributes to tooth discoloration. Pigmented compounds in the smoke generated by combustion of tobacco can cause discoloration of dental hard tissues. However, aerosols from heated tobacco products cause less discoloration than cigarette smoke (CS) in vitro. The objective of the present study was to optimize a method for extracting the colored chemical compounds deposited on tooth enamel following exposure to total particulate matter (TPM) from CS or a heated tobacco product (Tobacco Heating System [THS] 2.2), analyze the extracts by gas chromatography coupled to time-of-flight mass spectrometry, and identify the key chemicals associated with tooth discoloration. Sixty bovine enamel blocks were exposed for 2 weeks to TPM from CS or THS 2.2 aerosol or to artificial saliva as a control. Brushing without toothpaste and color measurements were performed each week. Noticeable discoloration of enamel was observed following exposure to CS TPM. The discoloration following exposure to THS 2.2 aerosol TPM or artificial saliva was not distinguishable to the eye (ΔE < 3.3). Carbon disulfide was used to extract surface-deposited chemicals. Untargeted analyses were followed by partial least squares correlation against discoloration scores (R2 = 0.96). Eleven compounds had variable importance in projection scores greater than 2. Discriminant autocorrelation matrix calculation of their mass spectral information identified eight of the eleven compounds as terpenoids. None of the compounds were related to nicotine. Several of these compounds were also detected in THS 2.2 aerosol TPM-exposed enamel, but at lower levels, in line with our findings showing less discoloration. Compared with CS TPM exposure, THS 2.2 aerosol TPM exposure resulted in lower deposition of color-related compounds on enamel surface, consistent with minimal discoloration of dental enamel.

Potential Advantages of Peroxoborates and Their Ester Adducts Over Hydrogen Peroxide as Therapeutic Agents in Oral Healthcare Products: Chemical/Biochemical Reactivity Considerations In Vitro, Ex Vivo And In Vivo

Peroxides present in oral healthcare products generally exert favourable protective activities against the development and progression of tooth decay, plaque, gingivitis, and halitosis, etc. However, despite the high level of research focus on hydrogen and carbamide peroxides as therapeutically active (and tooth-whitening) agents, to date the use of alternative chemical forms of peroxides such as peroxoborates for these purposes has received only scant attention. Intriguingly, peroxoborate and its esters with polyols, such as glycerol, have a very diverse chemistry/biochemistry in aqueous solution, for which there is an increasing amount of evidence that it remains distinctive from that of hydrogen peroxide; such properties include self-associative and hydrolytic equilibria, and their abilities to participate in electrophile- or nucleophile-scavenging, metal ion-complexing, redox and free radical reactions, for example. Therefore, the purpose of this detailed commentary is to evaluate both differences and similarities between the molecular/biomolecular reactivities of peroxoborate species and hydrogen peroxide in vitro, ex-vivo and in vivo. It encompasses brief sectional accounts regarding the molecular heterogeneity of peroxoborates, the release of bioactive agents therefrom, and their oxidative attack on oral cavity biomolecules (the nucleophilic or electrophilic character of these oxidations are discussed). Further areas explored are the abilities of borates and peroxoborates to enhance the solubility of iron ions in aqueous solution, their involvements in free radical biochemistry (particularly the complexation of oxygen radical-promoting transition metal ions by, and antioxidant properties of, peroxoborate-polyol ester adducts), and the specific inhibition of protease enzymes. Further aspects focus on the tooth-whitening, oral malodor neutralizing, and potential mutagenic and genotoxic properties of peroxoborates, along with possible mechanisms for these processes. The abilities of peroxoborates, and peroxides in general, to modulate the activities of inflammatory mediators and vitamins, antioxidant or otherwise, are also explored.

Flash tooth whitening: A friendly formulation based on a nanoencapsulated reductant

Tooth whitening materials have not undergone relevant advances in the last years. Current materials base their action on the oxidant activity of peroxides, which present the disadvantage of requiring long application times, along with unpleasant side effects of dental hypersensitivity (e.g. sharp pain). In this work, a novel tooth whitening formulation based on the encapsulation of a reducing agent (sodium metabisulfite) in liposomes is developed. An experimental design was applied to optimize the formulation in terms of whitening action and safety, using bovine teeth as in vitro model. Results were obtained by colorimetry, profilometry and nanoindentation techniques. The comparison with standard whitening treatments showed a similar whitening action of the optimized formulation but in remarkable shorter application times. Moreover, teeth roughness values obtained with the presented formulation conformed with ISO 28399. As mechanism of action, results obtained from fluorescent confocal microscopy showed the liposomal formulation to form a layer surrounding the enamel surface, enhancing the treatment efficacy in terms of diffusion of the protected reductant towards the enamel. The better efficiency of this formulation encourages its use as an alternative to current oxidative treatments.

Parathyroidectomy Resolves Tooth Discoloration: A New Presenting Sign of Hyperparathyroidism?

Introduction

We report the resolution of tooth discoloration following parathyroidectomy in an otherwise asymptomatic woman with primary hyperparathyroidism-associated hypercalcemia. Case Report. A 59-year-old Caucasian woman, diagnosed with primary hyperparathyroidism in 2011, nonsmoker with excellent overall oral health. She complained of tooth discoloration starting in 2013. Pigmentation was particularly evident in the necks of the lower central and lateral incisors (Vita Classical score C2). No bleaching was undertaken. Parathyroidectomy was performed five years after primary hyperparathyroidism diagnosis. Six months later, a reduction in pigmentation was strikingly evident, with incisors scoring A1 and A2. The improvement persisted over time. Tooth value also increased compared to baseline.

Conclusions

This is, to our knowledge, the first report that parathyroidectomy might resolve dental discoloration. This outcome deserves investigation in a meaningful sample size and may eventually prompt the inclusion of dental issues among the consequences of primary hyperparathyroidism.

AMELX Gene Association with Dental Caries in Iranian Adults

Dental decay is a disease that is greatly affected by environmental components, but recently there have been an increasing number of documents supporting a genetic factor in the development of caries. The purpose of this study was to examine the association between dental caries and single-nucleotide polymorphisms in the AMELX gene. This research was carried out on 360 individuals of both sexes, who were referred to the dental school at the Shiraz University of Medical Sciences. In this research, individuals aged 20–65 years were divided into two groups: controls (decayed, missed, or filled teeth (DMFT) ≤ 5; n = 180) and cases (DMFT ≥ 14; n = 180). The tetra-primer ARMS-PCR technique was performed for genotyping the DNA extracted from blood cells. Analysis of the AMELX rs946252 polymorphism showed that the T allele of rs946252 was a significant protective factor against dental caries in Iranian adults (T vs. C: OR = 0.70, 95% CI: 0.49–0.98, P = 0.04). We demonstrated the significant differences in the genotype frequencies under two genetic models: overdominant (TC vs. TT + CC: OR 0.35, 95% CI 0.19–0.64, P = 0.0006) and recessive (CC vs. TC + TT: OR 2.57, 95% CI 1.39–4.76, P = 0.002). Our results show that the SNPs of the AMELX gene may be related with susceptibility to dental caries in Iranian adults.

Bleaching of severely darkened nonvital tooth case report-48 months clinical control

OBJECTIVE

To record in detail, the long-term success of a bleaching treatment employing hydrogen peroxide in a severely darkened tooth.

CLINICAL CONSIDERATIONS

Tooth discoloration is an important aesthetic complain of patients. Because it is a relatively common condition, different materials and techniques capable of restoring the tooth color in a minimally invasive, conservative, and longstanding manner were developed. In this case, it was used the association between mediate (walking bleach) and immediate (internal/external) bleaching techniques using hydrogen peroxide as the main agent.

CONCLUSION

The association of techniques was a conservative therapeutic solution to restore the natural color of the right upper central incisor, which was darkened after an endodontic treatment performed more than twenty years ago. The bleaching protocol used presented no risk to the patient, such as cervical resorption and the color was stable over a 48 months period, showing the success of the protocol proposed for this case.

CLINICAL SIGNIFICANCE

There is a possibility to severely darkened teeth receive an adequate bleaching treatment protocol, which can successfully restore the aesthetics and natural color in a conservative and long lasting way.

Influence of Tooth Pigmentation on H2O2 Diffusion and Its Cytotoxicity After In-office Tooth Bleaching

Clinical Relevance

Pigments in tooth structures affect the diffusion of H2O2 through enamel and dentin. The bleaching methodology can be impacted.

SUMMARY

Objective: The aim of this study was to evaluate the influence of the presence of pigments in tooth structures on the trans-enamel and trans-dentin diffusion of hydrogen peroxide (H2O2) and its cytotoxicity after carrying out an in-office bleaching therapy.

Methods and Materials: A bleaching gel with 35% H2O2 was applied for 45 minutes (three times for 15 minutes) on enamel and dentin discs (n=6), either previously submitted to the intrinsic pigmentation protocol with a concentrated solution of black tea, or not, defining the following groups: G1, unbleached untreated discs (control 1); G2, unbleached pigmented discs (control 2); G3, bleached untreated discs; G4, bleached pigmented discs. The discs were adapted to artificial pulp chambers, which were placed in wells of 24-well plates containing 1 mL culture medium (Dulbecco’s modified Eagle’s medium [DMEM]). After applying the bleaching gel on enamel, the extracts (DMEM + components of bleaching gel that diffused through the discs) were collected and then applied on the cultured MDPC-23 odontoblast-like cells. Cell viability (methyl tetrazolium assay and Live & Dead, Calcein AM, and ethidium homodimer-1 [EthD-1] probes), the amount of H2O2 that diffused through enamel and dentin (leuco-crystal violet product), and the H2O2-mediated oxidative cell stress (SOx) and components of degradation were assessed (analysis of variance/Tukey; α=0.05).

Results: There was no significant difference between the groups G1 and G2 for all the parameters tested (p&gt;0.05). Reduction in the trans-enamel and trans-dentin diffusion of H2O2 occurred for G4 in comparison with G3. Significantly lower cell viability associated with greater oxidative stress was observed for G3 (p&lt;0.05). Therefore, in-office tooth bleaching therapy performed in pigmented samples caused lower cytotoxic effects compared with untreated samples submitted to the same esthetic procedure (p&lt;0.05).

Conclusion: According to the methodology used in this investigation, the authors concluded that the presence of pigments in hard tooth structures decreases the trans-enamel and trans-dentin diffusion of H2O2 and the toxicity to pulp cells of an in-office bleaching gel with 35% H2O2.

Low-Cost Hyperspectral Imaging System: Design and Testing for Laboratory-Based Environmental Applications

The recent surge in the development of low-cost, miniaturised technologies provides a significant opportunity to develop miniaturised hyperspectral imagers at a fraction of the cost of currently available commercial set-ups. This article introduces a low-cost laboratory-based hyperspectral imager developed using commercially available components. The imager is capable of quantitative and qualitative hyperspectral measurements, and it was tested in a variety of laboratory-based environmental applications where it demonstrated its ability to collect data that correlates well with existing datasets. In its current format, the imager is an accurate laboratory measurement tool, with significant potential for ongoing future developments. It represents an initial development in accessible hyperspectral technologies, providing a robust basis for future improvements.

Green Pigmentation of Teeth Caused by Neonatal Cholestatic Jaundice and Sepsis: A Case Report

Aim

The aim of this article is to report a case of green discoloration of primary teeth associated with neonatal cholestatic jaundice and sepsis in a 2-year-old girl.

Background

Systemic changes can lead to dental alterations of the teeth. One of the disorders is elevated serum bilirubin levels that can cause pigmentation of teeth. Green pigmentation of teeth is uncommon, but when it occurs, is a cause of concern for parents and the child, as he may also loose self-confidence.

Case description

The parents reported to the clinic with the child whose chief complaint was green pigmented teeth. Her medical records revealed she was preterm and was diagnosed with neonatal cholestatic jaundice which lead to hyperbilirubinemia and sepsis. On review at 36 months of age, all her deciduous teeth were completely erupted and a striking demarcation was visible between the green incisal edges and the normally colored cervical one-thirds of all primary teeth. Treatment alternatives were suggested and the child was kept on regular follow-ups.

Conclusion

So, one should be aware of such condition and seek medical practitioner or reports to confirm the diagnosis. If such a condition exists, esthetic treatment can be achieved with the newer techniques in cosmetic dentistry.

Clinical significance

Green pigmentation has very limited causes. The time of illness coincides with the stage of tooth formation. Proper medical history is important to evaluate the extent of pigmentation and probable involvement of the permanent teeth.

How to cite this article

Lamba G, Nagpal DI, Korishettar R. Green Pigmentation of Teeth Caused by Neonatal Cholestatic Jaundice and Sepsis: A Case Report. Int J Clin Pediatr Dent 2019;12(6):566–568.

Effect of phytosphingosine on staining resistance and microhardness of tooth enamel

OBJECTIVE

To evaluate the protective effect of phytosphingosine (PHS) against staining on dental enamel.

MATERIALS AND METHODS

Ninety-six specimens of bovine teeth (6 mm × 6 mm × 2 mm) were cut, and initial color (Easyshade, VITA), microhardness (HMV-2, Shimadzu) and fluorescence (Matlabs software, Matworks) measurements were performed. Specimens were separated into four groups according to the treatments: Distilled water (control); Human saliva (HS); PHS; PHS + HS. Specimens (n = 6) were submitted to staining procedures: Distilled water (immersion for 30 days-control); Coffee (15 minutes, twice a day/for 15 days); Black tea (as described for Coffee) and cigarette smoke (20 cigarettes/sample). Final measurements were performed, and data were analyzed (Color-CIEDE2000, fluorescence-2-way ANOVA, Tukey, and microhardness-Kruskal-Wallis Dunn, P < .05).

RESULTS

Coffee caused the highest color change (ΔE₀₀ ), followed by black tea, regardless of the treatment employed. Distilled water and cigarette smoke produced similar color changes (P > .05) for the groups control (water = 1.0 + - 0.5/ cigarette = 2.3 0.3) and PHS (water = 0.8 0.4/ cigarette = 2.3 0.4). PHS + HS demonstrated intermediate means than PHS and HS when stained with coffee and tea. After treatments, the least fluorescence alterations occurred for the groups treated with distilled water and cigarette, regardless of the treatment, with no difference (P > .05) between them. There was a significant difference (P < .05) on microhardness between all the groups, as PHS + HS > PHS > HS > Distilled water.

CONCLUSIONS

It was concluded that PHS treatment did not protect the staining of the enamel by coffee and tea, but increased the microhardness, both in the presence and absence of a salivary pellicle.

PRACTICAL IMPLICATIONS

Phytoshingosine is a novel agent and considered a promising component for anti-biofilm and anti-erosion properties by the formation of a diffusion barrier on the dental enamel. In line, PHS might be considered for anti-staining purposes.

Effect of antiseptic gels in the microbiologic colonization of the suture threads after oral surgery

Three different bioadhesive gels were evaluated in a double-blind randomized clinical trial in which microbial growth in the suture thread was assessed following post-surgical application of the aforementioned gels. Also assessed in this trial were, the intensity of post-surgical pain as well as the degree of healing of the patients’ surgical wounds. A total of 21 patients (with 42 wisdom teeth) participated in this trial. Chlorhexidine gel, chlorhexidine-chitosan gel, and hyaluronic acid gel were evaluated, with a neutral water-based gel serving as the control agent. The aerobic and facultative anaerobic bacterial recovery on blood agar was lower in the placebo group than in the experimental groups. The most significant difference (p = 0.04) was observed in the chlorhexidine-chitosan group. in which the growth of Blood Agar and Mitis Salivarius Agar was significantly higher than in the placebo group. The intensity of post-surgical pain was very similar among all the groups. Significantly better healing rates were observed in the patients treated with chlorhexidine-chitosan gel when compared with those who used the placebo gel (p = 0.03), and in particular when compared with those patients who used hyaluronic acid gel (p = 0.01). Through our microbiological analyses, we were able to conclude that none of the bioadhesive gels tested resulted in beneficial reductions in the bacterial/fungal populations. However, the healing rates of patients who were treated with chlorhexidine-chitosan were better than those of the patients who used either the placebo gel or the hyaluronic acid gel.

Effect of mouthwashes on the discoloration of bracket-bonded tooth surfaces: an in vitro study

OBJECTIVES

This in vitro study aimed to investigate the color changes of the bracket-bonded tooth surfaces after the use of 4 different mouthwashes.

MATERIALS AND METHODS

A total of 100 human premolar teeth were randomly divided into 10 equal groups. Color values (L*a*b*) of the buccal surfaces of each tooth were assessed using a digital spectrophotometer. Then the brackets were bonded. The groups were put either in sterile saline (4 test+1 control) or artificial saliva (4 test+1 control) solutions, and test groups were immersed in their mouthwashes (Colgate Plax, Listerine Cool Mint, Klorhex, and Tantum Verde) for 1 min each in the morning/evening to simulate the mouth washing for 21 days after the bonding. After the debonding and finishing procedures, final color measurements were performed. Color changes (∆E) were calculated.

RESULTS

All of the parameters showed statistically significant differences among the groups. The least noticeable color changes were detected in the control groups. The most noticeable color change (ΔE) was observed in the Tantum Verde + artificial saliva group, followed by Tantum Verde + sterile saline and Klorhex + artificial saliva groups, all of which were significantly higher than the control groups.

CONCLUSION

The use of mouthwashes during orthodontic treatment may cause noticeable changes in tooth color. Listerine Cool Mint may be the choice of mouthwash with its less discoloring effects. Artificial saliva should be preferred in similar in vitro studies to reflect the oral environment better.

CLINICAL RELEVANCE

Mouthwash use during orthodontic treatment may result in different levels of enamel discoloration.

Effect of in-office bleaching gels with calcium or fluoride on color, roughness, and enamel microhardness

Background

Commercial bleaching gels with remineralizing agents were developed to reduce the adverse effects of dental bleaching. The present study evaluated the effects on teeth of in-office bleaching gels containing 35-40% hydrogen peroxide (HP) with Calcium (Ca) or Fluoride (F).

Material and Methods

Bovine enamel/dentin blocks (4x4x2.5 mm) were randomly divided into the following groups (n=12): no treatment (control); 35% HP (Whiteness HP, FGM); 35% HP with Ca (Whiteness HP Blue, FGM); 40% HP with F (Opalescence Boost, Ultradent). The specimens were analyzed for color (ΔL*, Δa*, Δb*, and ΔE), roughness (Ra), and Knoop microhardness (KHN). The color and KHN data were submitted to ANOVA and Tukey’s test, while Ra values were analyzed using mixed models for repeated measures and Tukey-Kramer’s test (α=0.05).

Results

The bleached groups did not exhibit statistical differences among them for color. For roughness, 35% HP provided a slight increase of Ra, which was statistically different from the control. For microhardness, 35% HP and 40% HP with F presented KHN values that were statistically lower from the control, while the 35% HP with Ca did not statistically differ from the control.

Conclusions

The presence of Ca or F in bleaching gels did not interfere with bleaching efficacy. However, only the enamel exposed to the bleaching gel containing Ca obtained microhardness values similar to unbleached enamel.

Key words:Hydrogen peroxide, tooth bleaching, tooth bleaching agents, laboratory research.

The Contribution of Photodynamic Inactivation vs. Corsodyl Mouthwash to the Control of Streptococcus mutans Biofilms

This work compared the inhibition effect of the commercially available mouthwash Corsodyl, containing 0.1% chlorhexidine digluconate, and photodynamic inactivation (PDI) employing methylene blue (MB) with irradiation from a red laser on 24-h biofilms formed by Streptococcus mutans strains on hydroxyapatite surfaces. The cytotoxicity of Corsodyl and MB was evaluated by Galleria mellonella surviving assay. The viability of biofilm cells after exposure to mouthwash and PDI was determined by counting colony-forming units. The inhibitory effect of antimicrobial agents was confirmed by confocal scanning laser microscopy. MB did not exhibit a cytotoxic effect on larval survival. Non-diluted Corsodyl slightly decreased the survival of larvae. Using our PDI parameters achieved better inhibition than with non-PDI, proving a significant effect on the eradication of S. mutans biofilms and therefore could be an appropriate supplement for the eradication of dental caries.

Whitening Dentifrices Effect on Enamel with Orthodontic Braces after Simulated Brushing

Objective  This study aimed to evaluate in vitro the effects of whitening dentifrices on enamel color, the shear bond strength of orthodontic brackets and adhesive remnant index (ARI).

Materials and Methods  Eighty bovine teeth with brackets were randomly divided into four groups ( n = 20): control group (GC)–water, test group 1 (GT1)–Colgate Total 12, test group 2 (GT2)–Curaprox Black Is White, and group test 3 (GT3)–Luminous White. All groups were submitted to brushing, simulating 12 months. The specimens were exposed to spectrophotometer color evaluation and to a shear strength test in a universal test machine using a 300 kN load with a crosshead speed of 0.5 mm/min. The ARI was evaluated with a stereoscopic magnifying glass.

Statistical Analysis  Nonparametric Kruskal–Wallis and Dunn’s tests were used for the color analysis, and Friedman and Nemenyi tests were used to compare the times in the variable. To compare the shear force between the groups, the data were evaluated by one-way analysis of variance and Tukey’s test, and ARI was analyzed using Fisher’s exact test, always with a significance level of 5%.

Results  In the color analysis, GT3 presented the greatest progression in whitening effect. GT1 had greater shear strength than GT3 did ( p ≤ 0.05). For ARI, the score 1 was predominant in the GC and GT1. The GT2 and GT3 groups had scores of 3.

Conclusion  The whitening dentifrices promoted significant color change over the 12-month brushing time and may have interfered in the resistance to shear bond strength and ARI.

The ability of dual whitening anti-caries mouthrinses to remove extrinsic staining and enhance caries lesion remineralization - An in vitro study

OBJECTIVES

This laboratory study investigated the ability of dual whitening anti-caries mouthrinses to remove extrinsic staining from artificially stained caries lesions and to enhance their remineralization and fluoridation.

MATERIALS AND METHODS

Early caries lesions were created in bovine enamel specimens. The lesions were artificially stained and pH cycled for 10 days with the daily cycling regimen consisting of twice daily 60s-treatments with one of 11 mouthrinses, a 4-h demineralization period and artificial saliva treatments in between. Mouthrinses were eight commercially available products, all containing 100ppm fluoride but utilizing hydrogen peroxide, pyro-, tri- or hexametaphosphate salts and/or sodium bicarbonate. The three control mouthrinses were 100ppm fluoride, 30 % hydrogen peroxide and deionized water. Enamel color changes (ΔE) were determined spectrophotometrically. Vickers surface microhardness (VHN) was used to determine lesion remineralization. Enamel fluoride content (EFC) was determined using the microbiopsy technique. Data were analyzed using ANOVA.

RESULTS

ΔE was significantly different among groups (p=0.0045). Thirty percent hydrogen peroxide was superior to all other mouthrinses, while there were no differences between commercial mouthrinses and deionized water. There were small, directional but non-significant differences between commercial mouthrinses with those containing hydrogen peroxide providing better whitening. There were no significant differences between mouthrinses in their ability to remineralize caries lesions (p=0.2898). EFC differed among groups (p<0.0001), with the two mouthrinses containing pyrophosphate salts having lower EFC than all but the deionized water group.

CONCLUSIONS

Artificially stained caries lesions show reduced susceptibility to fluoride remineralization and whitening effects of commercial whitening and anti-caries mouthrinses.

CLINICAL RELEVANCE

Artificially stained caries lesions appear to require stronger than over-the-counter interventions to successfully whiten and remineralizing them.

Effect of pigmenting agents on tooth enamel staining during immediate tooth whitening: an in vitro study

Abstract Introduction Considering the increased search for esthetic procedures, questions emerge about the maintenance and regression of color, especially regarding the need to restrict dark foods during bleaching procedures or their influence on the stability and effectiveness of the treatment. Objective To assess the influence of staining agents on tooth enamel during immediate bleaching treatment with 35% hydrogen peroxide. Material and method Sixty bovine teeth were divided into six groups (G) (n=10): G1: distilled water (control); G2: coffee; G3: cola soft drink; G4: wine; G5: mate tea; and G6: industrialized açaí. The samples were subjected to immediate bleaching using 35% hydrogen peroxide for 21 days (three applications of 15 minutes per session, every seven days) and pigment immersion between each session for 15 minutes. The color was assessed before starting bleaching and after 21 days, using a spectrophotometer. The data obtained were subjected to one-way ANOVA and heteroscedasticity analysis by the Welch and Brown-Forsythe tests. The Tamhane test was used for group comparison. Result The color change was visible to the naked eye, considering the mean ΔE in all groups tested was higher than 3.7. However, there was no statistical difference between the control group and the groups assessed. Conclusion The contact of staining agents on bovine tooth enamel did not affect the final result of the immediate tooth bleaching.

Comparing dental plaque microbiome diversity of extrinsic black stain in the primary dentition using Illumina MiSeq sequencing technique

Background

Extrinsic black stain (EBS) is characterized by discrete dark dots or lines on the tooth surface. The relationship between EBS and oral microbiota in children remains elusive. The aim of this study was to compare dental plaque microbiome in EBS children with that in EBS-free children in the primary dentition.

Methods

The Illumina MiSeq sequencing technique was utilized in the cross-sectional pilot study to investigate the diversity and composition of the supragingival plaque microbiota from 10 EBS-positive and 10 EBS-free children. The results were analysed with nonparametric Mann-Whitney U test, Pearson Chi-Square test, Fisher’s Exact test and one-way ANOVA tests.

Results

We identified 13 different phyla, 22 classes, 33 orders, 54 families, 105 genera, and 227 species from a total of 52,646 high-quality sequences. Between two groups, no statistical differences were observed in the estimators of community richness and diversity at 97% similarity, as well as in the Unweighted Unifrac principal co-ordinates analysis (PCoA). At the species level, higher level of relative abundance of Actinomyces naeslundii and lower level of relative abundance of a species belonging to Candidate_division_TM7 was observed in dental plaque of EBS-positive subjects, compared to dental plaque of EBS-free subjects (P < 0.05). This indicated that some species might be involved in the EBS process.

Conclusion

Changes in dental plaque microbiota is possibly relevant to the process of EBS in the primary dentition.

Tooth color and whitening - digital technologies

OBJECTIVES

To review the key concepts of color in the dental domain with specific reference to the use of digital technology to measure color and color appearance.

MATERIALS AND METHODS

The literature on color assessment in dentistry is considered and methods for assessing whiteness, yellowness and color appearance are collated and described.

RESULTS AND CONCLUSION

A variety of methods for assessing color have been shown to exist and be viable including digital imaging. Equations to predict whiteness are identified; there is evidence that they are effective but further evaluation may be needed.

Effect of application of desensitizers before bleaching on change of tooth shade

The aim of this in vitro study was to evaluate the effects of desensitizer pre-treatment on in-office bleaching using an artificial discoloration tooth model. The stained specimens were divided into four groups (n=10); without application (Control group), Shield Force plus (SF group), UltraEz (UE group) and Teeth Mate AP paste (TM group) applied before bleaching. Each group was bleached by an in-office bleaching agent. The CIE L*a*b* values were measured by a colorimeter before and after ten consecutive bleaching treatments and the color difference (∆E) was calculated. There was no statistical difference among ∆E values of Control, UE, and TM groups (p>0.05). There was a significant difference between SF and Control groups (p<0.001). It was concluded that application of TM and UE did not affect the change of tooth shade while SF application impeded the bleaching effect.

Shade changing effectiveness of plasdone and blue covarine-based whitening toothpaste on teeth stained with chlorhexidine and black tea

Objective

This study evaluated the effectiveness of toothbrushing with whitening toothpaste in altering the shade of stained human enamel.

Materials and Methods

Thirty fragments of human enamel, stained with chlorhexidine/black tea underwent 1000 and 5000 brushing cycles (BC) with (n = 10): PLS (Gel Dental Day, Bitufo), Close Up White Now, Unilever (COVB) and regular (Gel Dental Night, Bitufo) toothpaste. Images were taken before staining (baseline), after staining (STN) and following 1000 and 5000 BC and were analyzed using the CIELAB parameters (ΔE, Δb and ΔL).

Statistical Analysis Used

Data were submitted to two-way ANOVA (α = 0.05).

Results

ΔE was higher from STN to baseline; 1000 BC to STN and 5000 BC to STN (P < 0.001). Significant differences in Δb values were found from 1000 BC to STN and 5000 BC to STN. For COVB, greater ΔL was observed from 1000 BC to STN, what differed statistically from the regular toothpaste (P < 0.05). There was no difference between toothpaste when ΔL was calculated from 5000 CB to STN.

Conclusions

Toothpaste containing COVB or PLS in association with 5000 BCs showed similar effectiveness in changing enamel shade; but after the first 1000 toothbrushing cycles, the use of COVB toothpaste promoted higher lightness in stained enamel.

Clinical comparison of the stain removal efficacy of two air polishing powders

Objectives:

Air polishing with sodium bicarbonate powders with a grain size of 40 μm is recommended for patient comfort. However, the efficacy of small grain size on stain removal has not been adequately studied. This study aimed to compare the stain removal efficacy of sodium bicarbonate powders with grain sizes of 65 and 40 μm and to evaluate patient acceptance and operator opinion after using both air polishing powders.

Materials and Methods:

A double-blind, randomized, split-mouth study was conducted with 35 participants with moderate to heavy dental staining on both sides of the upper teeth. Removal of dental stains on the index teeth was performed using sodium bicarbonate powders with a grain size of either 65 or 40 μm. The time taken to completely remove all dental stains was recorded. After treatment, a questionnaire was used to evaluate patient acceptance and the operator's opinion.

Results:

The average time for the removal of all stains by powder was 4.5 ± 3.6 min with a grain size of 65 μm and 4.4 ± 3.8 min with a grain size of 40 μm. The difference in the average time between the two groups was not significant (P = 0.461). The operator's opinions of the two powders were identical, and patient acceptance did not differ significantly between the two types of powders.

Conclusions:

The 40 μm sodium bicarbonate powder removed dental stains as efficiently as the 65-μm powder. Powder handling and patient acceptance were comparable between grain sizes of 65 and 40 μm.

Enhanced teeth whitening by nanofluidic transport of hydrogen peroxide into enamel with electrokinetic flows

Tooth whitening, a routine procedure in dentistry, is one of the examples of medical procedures that are limited by the challenge of delivering molecules into various types of nanoporous tissues. Current bleaching methods rely on simple diffusion of peroxides into enamel nano channels, therefore requires sufficient contact time with peroxides. In-office treatments often involve enamel etching or light activation which often results in patient sensitivity and potential soft tissue damage.

OBJECTIVE

To demonstrate a robust method to transport hydrogen peroxide to greater depths into enamel nanopores through nanofluidic flows driven by electrokinetics, with the intention to increase efficacy while reducing treatment time.

METHODS

Freshly extracted human teeth were subjected to electrokinetic flow treatment with hydrogen peroxide under different electric fields with varying operation times. Pre- and post-operative shade matching was done using a photospectrometer.

RESULTS

It is demonstrated that the operation time for the same concentration of hydrogen peroxide can be shortened by 10 times. The proposed method showed significant improvements in whitening effects over control groups and thus offers promising clinically-viable chairside applications with efficacy.

SIGNIFICANCE

The demonstrated nanofluidic transport of hydrogen peroxide into enamel has a potential to be applied for enhancing tooth whitening, compared to simple diffusion, without heating the hard dental tissues.

Efficacy of Three Toothpastes in Iron Stain Removal from Primary Teeth

Aim

This study aimed to assess the iron stain removal efficacy of three toothpastes in extracted primary teeth.

Materials and methods

In this in vitro study, 60 extracted sound primary teeth were selected, decoronated at the cementoenamel junction, and their pulp chambers were filled with a composite. The teeth were then immersed in ferrous sulfate solution and brushed 3,000 times in an automatic tooth-brushing machine using Colgate, whitening Crest, and conventional Crest dentifrices. Stain removal was done in four groups using a prophylaxis paste. Digital images were obtained from the teeth before and after brushing with dentifrices and the changes in color parameters were measured using Photoshop and iColor software programs. Changes in color parameters were statistically analyzed using one-way ANOVA while multiple comparisons were done by Tukey's test.

Results

The greatest change in chroma was observed in the prophylaxis group and then in the whitening Crest, Colgate, and conventional Crest (mean values of −65.2, −31.07, −21.27, and −0.73, respectively). Prophylaxis completely removed the stains. The greatest reduction in value occurred in conventional Crest, Colgate, and whitening Crest (−18.07, −12.23, and −0.4, respectively). In the L*a*b* system, the least reductions were noted in the whitening Crest, Colgate, and conventional Crest (mean values of −1.96, −3.92, and −3.37, respectively). Prophylaxis significantly improved tooth brightness (a mean increase of 4.26).

Conclusion

None of the toothpastes in this study were capable of effectively removing iron stains. Crest whitening toothpaste was slightly effective in this regard.

Clinical significance

Iron drops are routinely prescribed for children younger than 2 years of age to prevent iron deficiency and iron deficiency anemia. However, iron stains on teeth are a common concern for many parents. Finding toothpastes with greater efficacy for iron stain removal can help in this respect.

How to cite this article

Heidari A, Shahrabi M, et al. Efficacy of Three Toothpastes in Iron Stain Removal from Primary Teeth. Int J Clin Pediatr Dent 2019;12(1):10–14.

Toothpaste Composition Effect on Enamel Chromatic and Morphological Characteristics: In Vitro Analysis

The aim of this in vitro study was to assess the effect of toothpastes, with different compositions, on optical and morphological features of sound and demineralized enamel. We selected twenty-five teeth, recently extracted for orthodontic purposes, for this in vitro study. The teeth were caries free, without stains, fissures, filling or hypoplasia observed at inspection under standard conditions. Teeth were brushed (for 2–3 min, twice a day, for 21 days), with five different toothpastes (four commercially available and an experimental one) containing fluoride and hydroxyapatite. After that, teeth were demineralized with 37% orthophosforic acid (Ultra Etch^®, Ultradent Products Inc., South Jordan, UT, USA) for 60 s. We repeated the brushing protocol for another 21 days on demineralized enamel. Enamel vestibular surfaces were examined using a spectrophotometer (Vita EasyShade -Vita Zahnfabrik, Bad Sackingen, Germany) and a Scanning Electron Microscope (Inspect S^®, FEI Company, Hillsboro, OR, USA). Differences were statistically significant for colour parameters L* and ΔE*. SEM evaluation reveals demineralized enamel mineral gain after brushing with selected toothpastes. Toothpastes with specific ingredients can represent a balance between aesthetic and mineralization, and an oral hygiene correct algorithm is able to preserve enamel characteristics during ortodontic treatement with fixed appliances.

Effect of High Light Intensity Bleaching Protocol versus Descending Light Intensities Bleaching Protocol on Post Bleaching Teeth Sensitivity: A Randomized Clinical Trial

AIM

The study aimed to compare teeth sensitivity and shade after bleaching protocol with descending different light intensities versus bleaching protocol with the same high light intensity.

MATERIAL AND METHODS

Sample size was twenty-four patients. Each group consisted of twelve patients. Group, I patients received bleaching protocol of descending different light intensities. Group II patients received bleaching protocol with the same high light intensity; both groups used the same home bleaching gel kit for seven days according to manufacturer instructions and protocol. Baseline records were digital photographs, teeth sensitivity and teeth shade for 12 anterior teeth. Teeth sensitivity was assessed using five points verbal rating scale and Standardized 100 mm Visual analogue scale after 1 day, after 2 days and after 1 week. Teeth shades for twelve anterior teeth were recorded by VITA Easy Shade V (VITA Zahnfabrik H. Rauter GmbH & Co. KG, Germany) after 1 week by VITA Easy Shade V. Mann-Whitney test (non-parametric test, 2 independent samples) was used to compare teeth sensitivity between both bleaching protocols at each period. A paired t-test (parametric test, 2 related samples) was performed to compare the colour change in shade guide units (SGU) and ∆E values within high light intensity bleaching protocol. While Wilcoxon Signed-Rank test (non-parametric test, 2 related samples) was used to compare colour change light intensities bleaching protocol. Comparison of bleaching effectiveness (∆SGU and ∆Ediff) between both bleaching protocols was performed by the Mann-Whitney test.

RESULTS

Descending light intensities protocol showed a lower teeth sensitivity than high light intensity protocol after 1 and 2 days. There was no teeth sensitivity reported at 1-week post-bleaching. Regarding the teeth shade, descending light intensities protocol had a little higher effect on colour change in shade guide units (SGU) than high light intensity protocol effect. Both bleaching protocols showed there was no significant difference in ∆SGU recorded after bleaching between high and descending light intensities protocols.

CONCLUSION

Descending different light intensities protocol showed a lower teeth sensitivity than high same light intensity protocol. Descending light intensities protocol had a little higher effect on colour change in shade guide units (SGU) than high light intensity protocol effect.