Comparison of effectiveness of abrasive and enzymatic action of whitening toothpastes in removal of extrinsic stains - a clinical trial

The Effect of Whitening Toothpastes on the Color Stability of a Smart Monochromatic Composite Resin

OBJECTIVE

The aim of this study was to evaluate the color stability of smart monochromatic composite resin after coloring with coffee solution, thermal aging and brushing with four different kinds of toothpaste.

MATERIALS AND METHODS

According to the manufacturer's instructions, 40 smart monochromatic composite resin (Omnichroma, Tokuyama Dental, Japan) specimens were prepared with a thickness of 2 mm and a diameter of 10 mm. The samples were divided into four groups. The first group (SFM) was brushed with Sensodyne Fresh Mint (Sensodyne GSK, UK), the second group (CW) with Colgate 2 in 1 Whitening (Colgate Palmolive, USA), the third group (OW) with Opalescence Whitening (Ultradent Products, Inc., USA), the fourth group (COW) with Colgate Optic White With Charcoal (Colgate Palmolive, USA). At time point t0, no brushing and thermal cycles were performed. For time point t1, simulations corresponding to 10 days of staining, thermal aging and brushing were performed. For time point t2, simulations corresponding to one year of staining, thermal aging and brushing were performed. The color of all specimens was measured at t0, t1 and t2 with a spectrophotometer. To examine the color change, ΔE00 values were calculated with the CIEDE 2000 color system. Shapiro Wilk, Kolmogorov Smirnov, Wilcoxon Signed Rank, Kruskal Wallis, and Mann-Whitney U tests were used to analyze the data.

RESULTS

According to the results of the intergroup comparison, there is no statistically significant difference between the groups in ΔE00(t0-t1) values in terms of t0-t1 time period measurement (p>0.05). There is a statistically significant difference between the groups in ΔE00(t1-t2)values in terms of t1-t2 time period measurement (p<0.05). The COW group had the lowest ΔE00(t1-t2) value and the OW group had the highest ΔE00(t1-t2) value. There is a statistically significant difference between the groups in ΔE00 (t0-t2) values in terms of t0-t2 time period measurement (p<0.05). The COW group had the lowest ΔE00(t0-t2) value and the OW group had the highest ΔE00(t0-t2) value.

CONCLUSION

The whitening efficacy of different kinds of toothpaste whitening mechanisms may differ from each other. Toothpastes also show whitening on composite resins. The lowest discoloration was observed in the group brushed with toothpaste containing activated charcoal and blue covarine. The efficacy of whitening toothpastes should be supported by in vivo studies.

Tooth color change promoted by different whitening toothpastes under alternate cycles of staining and brushing

OBJECTIVES

To compare the effect of whitening toothpastes with different mechanisms of action on discolored teeth subjected to additional staining/or not.

METHODS

One hundred twenty tooth specimens were stained for 14 days (staining broth under constant agitation and pH=7) and then allocated into the groups of toothpastes with different whitening ingredients (n=10): 1. Regular - Colgate Total 12 Clean Mint; 2. CLWI - Colgate Luminous White Instant (blue pigment); 3. CLWA - Colgate Luminous White Advanced Expert (hydrogen peroxide); 4. CLWAC - Colgate Luminous White Activated Charcoal (activated charcoal); 5. OB3D - Oral-B 3D WHITE Brilliant Fresh (abrasive); 6. TW - Teeth Whitening (charcoal powder). Specimens were submitted to two experimental models: A. Daily staining-toothbrush cycling: staining solution (5min), toothbrushing (45 strokes) and artificial saliva (3h), 2x/day, for 5days; B. Only toothbrushing (30.000 brushing strokes). Color change was determined with a spectrophotometer (CIEDE2000 and Whitening Index for Dentistry - WID) and statistically analyzed (α=0.05).

RESULTS

For both models, ΔE00 and Δa did not differ significantly between the whitening toothpastes and the regular. All groups showed a decrease in tooth yellowness (-Δb) and an increase in WID. Group Teeth Whitening exhibited a decrease in luminosity (-ΔL). In model A, Groups did not differ significantly from the Regular in terms of ΔL (p=0.35) and Δb (p=0.74). Groups CLWI and OB3D exhibited a decrease in luminosity. Reduced redness (-Δa) occurred only in Group CLWI. In Model B, Groups OB3D (p=0.021) and CLWA (p=0.001) exhibited higher change in luminosity than in Group Teeth Whitening. All exhibited increased redness (+Δa) and lightness (+ΔL), except the Regular, CLWAC and Teeth Whitening. Group OB3D had a significantly higher change in Δb than the Regular (p=0.021).

CONCLUSIONS

Irrespective of the mechanism of action, all toothpastes reduced tooth yellowness and promoted similar overall color change. Exposure of the teeth to additional staining during the toothbrushing cycles did not influence the effect of the whitening toothpastes.

CLINICAL SIGNIFICANCE

Whitening toothpastes should be tested in conditions that more closely simulate their use in a clinical scenario, in which alternate cycles of staining and brushing occur on a daily basis. However, even in such conditions, they were unable to promote a color change that differed from that of a regular toothpaste.

Effectiveness and Safety of Over-the-Counter Tooth-Whitening Agents Compared to Hydrogen Peroxide In Vitro

(1) This study investigated the whitening effect, cytotoxicity and enamel surface alterations induced by different over-the-counter (OTC) bleaching agents in comparison to hydrogen peroxide. (2) Human teeth (n = 60) were randomly assigned into 6 groups (n = 10), stained with coffee solution for 7 d, followed by a whitening period of 7 d with either placebo, bromelain, sodium bicarbonate, sodium chlorite, PAP or hydrogen peroxide. Color measurements were performed with a spectrophotometer. Scanning electron micrographs (SEM) were taken to assess the enamel structure. Cytotoxicity of the tested substances was assessed based on the cell viability of primary human fibroblasts. (3) The application of all whitening gels resulted in a greater color difference of the enamel (ΔE) in comparison to the negative control. Hydrogen peroxide caused the greatest color difference. Bromelain and PAP treatment showed no enamel surface changes, in contrast to hydrogen peroxide treatment, which showed very mild interprismatic dissolution. Bromelain was the only non-cytotoxic agent. (4) The maximum effect achieved by all OTC bleaching agents was the removal of stains, whereas hydrogen peroxide was capable of further whitening the teeth. Bromelain treatment was neither cytotoxic, nor resulted in enamel surface alterations, and its whitening effect was less, yet still effective, compared to hydrogen peroxide.

Effects of different toothpastes on the color and whiteness of stained anterior composite resin

PURPOSE

To evaluate changes in the color of an anterior nanohybrid composite resin and differences in its whitening index after 30 days of brushing with six brands of whitening toothpaste in vitro to simulate the situation in individuals with high coffee consumption.

METHODS

Eighty-four disk-shaped resin specimens were prepared (shade A2). For initial staining, the samples were immersed in coffee solution for 14 days and then divided into eight groups for treatment with various toothpastes. Color was assessed at the baseline, after initial staining, and on days 7, 14, and 30 of the staining-and-brushing cycle. Color stability was evaluated based on the CIEDE2000 color difference (ΔE00), and differences in whiteness were determined using the whitening index for dentistry (WID).

RESULTS

The highest ΔE00 and ΔWID values were obtained with Colgate Herbal, followed by Opalescence Whitening and Crest Baking Soda and Peroxide, whereas the lowest values were obtained with distilled water, followed by Yotuel Pharma B5, on day 30 of the staining-and-brushing cycle.

CONCLUSION

In terms of improving the color and whiteness of coffee-stained anterior nanohybrid composite resin, Colgate Herbal, Opalescence Whitening, and Crest Baking Soda and Peroxide yielded promising results after 30 days of continuous use.

Does the application of whitening dentifrices during at-home bleaching affect the bond strength of resin composite to dentin?

AIM

This study aimed to evaluate the effect of using whitening dentifrices during at-home bleaching on the shear bond strength (SBS) of resin composite to dentin, and investigate whether the increased polymerization time would improve SBS.

METHODS

Ninety-six bovine incisors were divided into 4 groups of 24, according to the whitening treatment applied as follows: group 1, at-home bleaching + brushing with a regular dentifrice; group 2, at-home bleaching + brushing with a whitening dentifrice containing ozone; group 3, at-home bleaching + brushing with a commercial whitening dentifrice; and group 4 (control), no whitening/brushing treatment. Each group was divided into two subgroups (n = 12) to assess the effect of curing time (20 versus 80 s) on SBS. A self-etch adhesive was bonded to dentin, and after 2-day water storage, SBS was determined.

RESULTS

SBS was significantly affected by the whitening treatment (P = 0.03), but increasing the curing time had no significant effect on SBS (P = 0.137). Bond strength in group 1 was comparable to the control group (P > 0.05). The specimens in group 3 displayed significantly lower SBS than either group 4 or group 1 (P > 0.05). No significant difference was observed between the SBS of group 2 compared to any other group (P > 0.05). There was no significant association between the treatment group and failure type (P > 0.05).

CONCLUSION

The bonding interface was not negatively influenced by the at-home bleaching procedure. However, using a commercial whitening dentifrice during at-home bleaching produced a significant detrimental effect on SBS. Extending the curing time would have no beneficial effect on adhesion to a whitened dental substrate.

The effect of two different prophylaxis paste applying processes on color stability in-office bleaching: 24-month clinical follow-up

OBJECTIVE

The purpose of this study was to examine the effect of applying two different prophylaxis pastes with various protocols on the degree of bleaching and color stability in the office bleaching process with a bleaching agent containing 40% hydrogen peroxide.

MATERIAL AND METHOD

The 300 teeth of 15 (9 female, 6 male) patients were included in our study, and 5 different study groups were randomly formed. The bleaching process with Ultradent Opalescence Boost (Ultradent, South Jordan, USA) was performed according to the manufacturer's instructions. Two different prophylaxis pastes, Ultrapro (Ultradent, Cologne, Germany) and Cleanic (Kerr, Rastatt, Germany), were applied with protocols determined according to the groups. The effect on color stability at 6-, 12-, and 24-month follow-up was determined using the CIE L* a* b* color system. The changes in the parameters were analyzed using the one-way ANOVA, chi-square, and Tukey test (p > 0.05).

RESULTS

The evaluation rate of the treatments was 100% at the end of 24 months. Control group 6-month ΔE (0-6) and 12-month ΔE (0-12) values were higher than 24-month ΔE (0-12) values. UU + UU, KC + KC, and UU group 6-month ΔE (0-6) values were higher than 12-month ΔE (0-12) values. In addition, 6-month ΔE (0-6) and 12-month ΔE (0-12) values were higher than 24-month ΔE (0-24) values. KC group 6-month ΔE (0-6) and 12-month ΔE (0-12) values were higher than 24-month ΔE (0-24) values. Control, UU + UU, KC + KC, UU, and KC group ΔE (1-6) values at 6 months were lower than 12-month ΔE (1-12) and 24-month ΔE (1-12) values in all groups. In addition, 12-month ΔE (1-12) values were lower than 24-month ΔE (1-24) values. According to the study data, there was no statistically significant difference between the groups according to the prophylaxis paste and prophylaxis procedure (p > 0.05). However, it was observed that whiteness decreased in all groups over time.

CONCLUSIONS

Discoloration was observed at 6 months, 12 months, and 24 months after bleaching. However, at the end of 24 months, the tooth color was significantly whiter than the initial color.

CLINICAL RELEVANCE

Pre-bleaching prophylaxis application and pre-bleaching and post-bleaching prophylaxis application have no effect on color stability.

In vitro efficacy of commercial and experimental proteolytic enzyme-based whitening dentifrices on enamel whitening and superficial roughness

OBJECTIVE

To evaluate the whiteness index (W_ID ) and surface roughness (Ra) of bovine enamel after simulated tooth brushing with different commercial and experimental whitening dentifrices.

MATERIALS AND METHODS

Cylindrical enamel bovine specimens were acid etched, stained, and divided in nine groups (n = 8): Colgate® Optic White®, Crest® Baking Soda and Peroxide, Arm and Hammer® Advanced White™ Extreme Whitening, Rembrandt® Deeply White® + Peroxide, Close up® White Attraction Natural Glow, Hinode Prowhite, and experimental dentifrice containing papain (PP), bromelain (PB), or papain and bromelain (PPB). Ra and W_ID were obtained initially and after 600, 1200, and 3,600 cycles of simulated tooth brushing. Data were analyzed using two-way analysis of variance test (α = 0.05).

RESULTS

Ra was significantly influenced by both dentifrice (p = 0.043) and period of tooth-brushing simulation (p < 0.001). Except for PP and PPB, all groups showed a statistically significant increase in Ra after simulated tooth brushing. After staining and brushing, none of the materials tested increased the initial W_ID .

CONCLUSIONS

The effect of commercial whitening dentifrices may be related to their high abrasiveness. Experimental formulations tested provided a similar effect without undesired wear of enamel. Whitening dentifrices only act through an abrasive effect rather than bleaching the tooth structures. When used, special care must be taken for avoid undesired wear of enamel. Experimental dentifrices provided similar removal of extrinsic stains without undesired abrasiveness; however, this effect may be due to the use of less aggressive abrasives in their formulations.

A visual evaluation of oral plaque removal utilizing an adjunct enzyme pre-rinse in orthodontic subjects

OBJECTIVE

To determine if an adjunct proteolytic pre-rinse along with contemporary methods of dental cleaning may more effectively remove visual plaque in subjects with fixed orthodontic appliances.

MATERIALS AND METHODS

Forty-three orthodontic subjects, ages 10 to 25, completed this single site, double-blind, crossover clinical trial. Subjects randomly received bromelain enzyme or a powdered-sugar placebo pre-rinse, followed by manual tooth brushing and use of a Waterpik. Subjects received the alternate pre-rinse during the subsequent visit. Baseline and residual plaque accumulation were recorded via disclosing tablet and digital photography. A single, blinded examiner scored visual plaque scores from randomized photographs. Treatment effects on composite plaque score were evaluated using repeated-measures analysis of variance. A 5% significance level was used for all tests.

RESULTS

No significant differences in plaque scores were noted at baseline or post-rinse between the enzyme and placebo. The changes from baseline to post-rinse (P = .190), post-brushing (P = .764), and post-Waterpik (P = .882) were not significantly different between interventions. Significant reduction in plaque scores were observed in both arms of the study after brushing (P < .01) and waterjet use (P < .01). Neither age (P = .220) nor gender (P = .449) impacted plaque scores.

CONCLUSIONS

Use of a bromelain enzyme pre-rinse alone did not significantly enhance plaque removal. A significant reduction in retained plaque was observed with the application of brushing and or Waterpik.

Influence of different types of whitening tooth pastes on the tooth color, enamel surface roughness and enamel morphology of human teeth

Background: Tooth whitening usually includes the direct use of gels containing carbamide or hydrogen peroxide on the tooth enamel surface through a wide variety of products formulas. A generally new advancement in whitening of teeth uses the significant importance of the tooth color shift from yellow to blue in delivering a general enhancement in the observation of tooth whiteness. The aim of the current work was to measure the tooth whitening effects, surface roughness and enamel morphology of six different types of blue covarine-containing and blue covarine-free toothpastes using in vitro models. Methods: A total of 70 sound extracted human premolars were randomly and equally divided into seven groups, and each subjected to tooth brushing using different toothpastes. Tooth color and enamel surface roughness were measured before and after the brushing procedure using a white light interferometer, and scanning electron microscopy (SEM) was used to assess tooth surface after the procedure. Results: Toothpaste containing blue covarine resulted in the greatest improvement in tooth color amongst all groups as well as a statistically significant color difference when compared to blue covarine-free toothpaste.  Furthermore, blue covarine-containing toothpaste resulted in fewer morphological changes to the enamel surface. This was confirmed with SEM images that showed smooth enamel surfaces with fine scratches.   Conclusions: The results from the present study show that blue covarine containing toothpastes are reliable, effective in tooth whitening and produce less surface abrasion when compared to blue covarine-free toothpastes.

Effect of Whitening Toothpastes on Extrinsic Dental Stains

Aim and objectives:

To compare the effectiveness of the stain removing property of the whitening toothpastes (silica [Colgate Visible White], silica, papain and bromelain [Whitospark], and silica and calcium carbonate [Snowdent] containing toothpastes) on extrinsic dental stains and to assess the lasting of tooth whitening effect produced by the whitening toothpastes.

Materials and methods:

It is a randomized, concurrent parallel arm, non-invasive, controlled trial designed to compare the effectiveness of the whitening toothpastes on reducing extrinsic dental stains. Parametric t-test was used.

Results:

A statistically significant difference can be seen between Groups A and B, Groups B and C, and Groups B and D. Maximum mean and percentage reduction was found in Group B at the end of the second month in stain extent and intensity. A statistically significant difference was seen between subgroups B1 and B2. Maximum mean and percentage reduction was found in subgroup B1 at the end of the fourth month in stain extent and intensity.

Conclusion:

Silica, papain, and bromelain containing toothpastes (Whitospark) show effectiveness on reducing extrinsic dental stains.

The combined use of a nonabrasive, activator-containing toothpaste and a light emitting diode device improves the onset time of tooth whitening

Objective

The objective of this randomized clinical study was to assess the onset time of the whitening effect of a combined use of a nonabrasive, activator-containing toothpaste and a light emitting diode (LED) device, compared to that of the toothpaste alone.

Materials and Methods

A nonabrasive, activator-containing toothpaste was used twice daily alone or combined with an LED device for 15 days. The onset of the tooth whitening effect was evaluated through tooth color (a* b*, CIELAB) and tooth whiteness (WIO) by image analysis of standardized images. Local tolerance was assessed at days 1, 8, and 15.

Results

On day 8, a significant (P = 0.003) tooth whitening effect compared to day 1 was observed with the toothpaste and the LED device, sustaining until the end of the study. Whitening using the toothpaste alone was significant compared to day 1 after 15 days, only. One subject reported mild redness, itching, and burning on day 1 on the gum of the lower jaw that was possibly related to with the toothpaste. The subject withdrew from the study. No adverse event was reported in the group using the LED device.

Conclusion

Both tooth whitening methods had a significant whitening effect after 15 days of use. However, the onset of whitening was significantly faster when using the nonabrasive, activator-containing toothpaste combined with an LED device. The toothpaste and LED device were both safe.

Randomized clinical study of alterations in the color and surface roughness of dental enamel brushed with whitening toothpaste

OBJECTIVES

This clinical study evaluated the influence of whitening toothpaste on color and surface roughness of dental enamel.

MATERIALS AND METHODS

Initially, the abrasiveness of the toothpastes used (Sorriso Dentes Brancos [SDB]; Colgate Luminous White and Close up White Now) was tested on 30 (n = 10) plexiglass acrylic plates that were submitted to mechanical tooth brushing totalizing 29,200 cycles. Subsequently, 30 participants were selected, and received a toothbrush and nonwhitening toothpaste (SDB). The participants used these products for 7 days and initial color readouts (Spectrophotometer) and surface roughness of one maxillary central incisors was performed after this period of time. For surface roughness readouts, one replica of the maxillary central incisor was obtained by a polyvinyl siloxane impression material (Express) and polyurethane resin. After baseline measurements, participants were separated into three groups (n = 10), according to the toothpaste used. The participants returned after 7, 30, and 90 days when new color readouts and surface roughness were recorded. The measured values were statistically analyzed (2-way-ANOVA, repeated measures, Tukey, P < .05).

RESULTS

Whitening toothpastes did not promote significant (P > .05) color alteration and nor increased the surface roughness of the dental enamel in brushing time of the study.

CONCLUSIONS

The abrasiveness of whitening toothpaste and the brushing trial period did not affect the surface roughness of dental enamel. However, color changes observed on enamel were above the perceptibility and acceptability thresholds reported in the literature.

CLINICAL SIGNIFICANCE

The over-the-counter toothpastes tested had an effect on dental enamel color above the perceptibility and acceptability thresholds but did not change the surface roughness of the teeth.

Whitening Efficacy of Whitening Mouth Rinses Used Alone or in Conjunction With Carbamide Peroxide Home Whitening

Objectives:

The aim of this study was to compare the effectiveness of whitening mouth rinses on teeth previously whitened or not, exposed to food dyes.

Methods and Materials:

One hundred twenty enamel-dentin specimens, 3 mm in diameter, were obtained from bovine incisors. The specimens were stained for 14 days in staining broth. After staining, the initial color reading was performed via a spectrophotometer CM-2600d (Konica Minolta). Half of specimens were submitted to whitening (10% carbamide peroxide [CP]) for 14 days. They were then divided into three groups and were submitted to cycles of staining (five minutes) and mouth rinses (two minutes) for 12 weeks, with the following: CP-LI, Listerine Whitening; CP-PL, Plax Whitening; CP-BP, bromelain + papain; CP-DW, deionized water. LI, PL, BP, and DW groups were submitted to the same cited cycles but with no prior bleaching. The color measurements were performed after four, eight, and 12 weeks of treatment with mouth rinses. Data were submitted to repeated measures analysis of variance (ANOVA) and Tukey's test for multiple comparisons, with significance level at 5%.

Results:

The results showed that the CP-LI, CP-PL, LI, and PL groups had greater color change than did the others. The CP-BP and BP groups were similar to CP-DW and DW.

Conclusions:

We therefore conclude that Listerine Whitening mouth rinse presented the highest bleaching effect, followed by Plax Whitening mouth rinse. Both maintained CP bleaching effect after 12 weeks of dye-rinse cycles. However, none of these rinses were able to produce whitening similar to CP. Bromelain- and papain-containing mouth rinses did not show bleaching effect, being similar to the control groups.

Anti-plaque and anti-gingivitis effect of Papain, Bromelain, Miswak and Neem containing dentifrice: A randomized controlled trial

BACKGROUND

Patients undergoing fixed orthodontic therapy may have difficulty in maintaining a good oral hygiene due to the difficulty posed by the appliances in accessing such areas. This study aimed to compare anti-plaque and anti-gingivitis efficacy of dentifrice containing Papain, Bromelain, Miswak and Neem with a standard dentifrice among patient's undergoing fixed orthodontic treatment.

MATERIAL AND METHODS

Single center, single blind, parallel arm, randomized controlled clinical trial with an allocation ratio of 1:1 was conducted. Evaluation of plaque and gingivitis was done using Williams modification of Silness and Loe Plaque Index (PI) for use in orthodontic subjects and Loe and Silness's Gingival Index (GI) at baseline and one month.

RESULTS

Inter-group comparison showed there was significantly lower mean plaque index in test (0.88 ±0.05) than in control group (1.17 ±0.05) after adjusting for the baseline plaque index (p<0.001). Similarly, there was significantly lower mean gingival index in test (0.87 ±0.04) than in control group (1.14 ±0.04) after adjusting for the baseline gingival index (p<0.001).

CONCLUSIONS

The efficacy of the test dentifrice in limiting plaque and gingivitis suggests that it can be used as a home based adjunct to clinical therapy in orthodontic patients. Key words:Bromelain, gingivitis, miswak, neem, papain, plaque.

A comparative evaluation of plaque-removing efficacy of air polishing and rubber-cup, bristle brush with paste polishing on oral hygiene status: A clinical study

Objectives:

Over the years, professional dental prophylaxis has involved the use of rubber-cup, bristle brush, and abrasive paste for coronal polishing. Although air polishing is an excellent alternative for removal of tooth stain and dental plaque, very few studies have compared their efficacy in vivo. The present study attempts to evaluate and compare the efficacy of air polishing (test) alone versus rubber-cup polishing (control).

Materials and Methods:

A total of 35 individuals having generalized mild to moderate gingivitis were enrolled as the study population after obtaining their informed consent. Before commencement of the study, all subjects underwent scaling to remove calculus deposits (if any), following which the ipsilateral quadrant of the patient's mouth was randomly assigned as the test side and the contralateral quadrant of the same arch was assigned as the control side for polishing procedures. Time employed for both methods of polishing was held constant at 5 min for each technique. Subjects were assessed before and immediately after polishing and again after 15 days following treatment, for plaque and gingival status along with gingival bleeding.

Results:

Overall, the results of the intra-group comparison of both the polishing procedure sites indicated similar but significant plaque and gingival status changes, whereas the inter-group comparison showed no significant difference between the efficacies of both the groups.

Conclusions:

Air polishing and the rubber-cup, bristle brush with paste polishing demonstrated equivalent efficacy regarding removal of supragingival plaque and in reducing gingival inflammation.