Effect of toothpaste with natural calcium carbonate/perlite on extrinsic tooth stain

Investigation of the constituents of commercially available toothpastes

OBJECTIVES

Toothpaste plays a pivotal role in oral and dental hygiene. This cross-sectional study not only investigates the constituents of toothpastes available in the market and their frequency across different brands but also delves into the potential side effects, irritations, or unfavourable outcomes of these constituents, emphasizing the broader health and environmental implications.

METHODS

The largest of the five major chain markets in each district of Istanbul was visited, and adult toothpastes were included in this study. All the constituents that make up the toothpaste were individually recorded in an Excel database. Subsequently, literature regarding the purposes, toxic and potential side effects of each ingredient was gathered using databases such as Google Scholar, PubMed and ScienceDirect. The percentages of these ingredients' occurrence among all the toothpastes were calculated, and the ingredients were categorized into 15 distinct groups based on their usage purposes.

RESULTS

There were 160 different varieties of toothpaste belonging to 19 different brands on the market shelves. Although a total of 244 different ingredients were identified, only 78 of them were included in the study. Among the analysed toothpaste types, 105 of them were found to contain 1450 ppm fluoride, whilst 26 toothpaste variants were discovered to have fluoride levels below this value. Among the various ingredients analysed, particular attention was drawn to commonly debated compounds in oral care products. Specifically, titanium dioxide was found in 68% (n = 111) of the varieties, sodium lauryl sulphate in 67% (n = 108) and paraben in 2% (n = 4), respectively.

CONCLUSION

Whilst certain ingredients may raise concerns for potential side effects and health considerations within the human body, the toothpaste has long been regarded as an indispensable tool for maintaining optimal oral and dental health. However, gaining a deeper understanding and conducting research on each constituent that comprises the toothpaste, as well as raising awareness in this regard, holds significant importance for human health.

Colour stability of stained composite resins after brushing with whitening toothpaste

OBJECTIVE

The aim of this study was to evaluate the effect of brushing with whitening toothpaste on the colour change of composite resins discoloured with coffee.

METHODS

Disc-shaped samples were prepared using one nano-hybrid (Clearfil Majesty Esthetic), one micro-hybrid (GC G-aenial Anterior) and one nano-ceramic composite (Zenit) (n = 6). After initial colour measurements, the samples were coloured in the coffee solution for 5 days. Colour measurements were made again after the colouring process, and brushing simulation was applied for 7, 15 and 30 days with two different whitening toothpastes containing calcium carbonate+perlite (Signal whitening system, SWN) and hydrated silica+hydrogen peroxide (Colgate optic White, COW) and a conventional non-whitening toothpaste containing hydrated silica (Sensodyne pronamel, SPN). Colour change (∆E₀₀ ) after brushing was calculated using the CIEDE2000 system. Repeated measures variance analysis was used for the analysis of data.

RESULTS

G-aenial anterior and Zenit showed significant coloration compared to Majesty esthetic after coloration with coffee (p < 0.05). The colour change in all composite resins was above the clinically acceptable limit (ΔE₀₀  > 1.8). Colour change over time after brushing with both whitening toothpastes differed significantly (p < 0.05). SWN and COW exhibited a significantly higher whitening effect than SPN (p < 0.05). While there was no significant difference in composite groups brushed with the SWS (p > 0.05), there was a significant difference between Majesty esthetic, G-aenial anterior and Zenit in groups brushed with COW (p < 0.05).

CONCLUSIONS

Colour change was high in micro-hybrid and nano-ceramic composites which were discoloured in coffee. The whitening toothpastes were effective in reducing the coloration caused by coffee.

Efficacy and Adverse Effects of Whitening Dentifrices Compared With Other Products: A Systematic Review and Meta-analysis

Whitening dentifrices (WDs) are widespread and accessible worldwide, claiming to whiten teeth. Therefore, this systematic review aimed to assess the extrinsic stain removal (ESR), the whitening potential, and the adverse effects of WDs. Randomized controlled trials comparing WDs with regular dentifrices (RDs) and other home-based whitening products were searched at NCBI-PubMed, Cochrane-CENTRAL, EBSCO-Host, and clinicaltrials.gov. The studies were screened and had data extracted by two independent researchers. Eligible studies presented outcomes of ESR, color change, and adverse effects, with no restriction of publication date. Data were meta-analyzed using RevMan 5.3, and the level of evidence was rated according to GRADE criteria. Eleven studies (n=1962) assessed reduction of stain area and intensity through Lobene Stain index, with a mean difference (MD) of -0.33 ([-0.41;-0.25]; p=0.00001) and -0.34 ([-0.44;-0.25]; p=0.00001), respectively. When the modified Lobene Stain index was used (six studies; n=2576), MD was -0.42 ([-0.58;-0.25]; p=0.00001) and -0.30 ([-0.39;-0.21]; p=0.00001), respectively. Mean color change through shade guide tabs (three studies; n=1322) was -1.80 ([-2.33;-1.26]; p=0.00001). All differences were in favor of the WDs, which also produced a risk of adverse effects (RR=1.74; [1.20, 2.52]; p=0.003; four studies; n=1322). The comparison of WDs with paint-on gel (two studies; n=58) yielded similar efficacy and adverse effects (p>0.05), whereas the comparison of WDs with white strips (two studies; n=87) yielded higher efficacy of the latter (p=0.00001) and similar adverse effects (p=0.52). The quality of evidence varied from low to moderate. WDs are more effective in reducing extrinsic stain and producing a whitening-like effect in teeth than RDs, although they also produce more adverse effects. Whitening efficacy of WDs is similar to paint-on gel and lower than white strips. Higher-quality evidence demands larger, well-conducted, independent studies.

Influence of coffee and red wine on tooth color during and after bleaching

OBJECTIVE

The aim of this study was to evaluate the influence of coffee and red wine staining on tooth color during and after bleaching.

MATERIALS AND METHODS

Blocks obtained from human molars were divided into 11 groups (n = 5) in accordance with the bleaching treatment-peroxide carbamide 10%, 15% or 20%-and in accordance with the stain therapy-coffee, wine or without staining (control). Color change analysis was performed by photo-reflectance using a spectrophotometer, during (3-times/week) and after (7, 15 and 30 days) the bleaching treatment. During the experiment, the samples were stored in artificial saliva. The results were submitted to statistical analysis with the Dunnet and Tukey tests (p < 0.05).

RESULTS

The concentrations of carbamide peroxide (10%, 15% and 20%) did not differ significantly from the control group during bleaching (up to the 22nd day), with (Tukey, p > 0.05) or without storage in pigment solution. After the bleaching, there were statistically significant differences between the groups treated with coffee (30th day) and wine (7th and 30th days) relative to the control, which was treated with whitening agents.

CONCLUSION

During bleaching, remineralization of the enamel with artificial saliva and the subsequent bleaching session were effective in preventing enamel staining. After the whitening procedures, both stain therapies-coffee and wine-caused enamel color changes; however, the wine led to greater staining than did coffee.

Whitening toothpastes: a review of the literature

OBJECTIVES

To review and summarise the whitening agents contained within tooth whitening toothpaste formulations, their mode of action in tooth whitening, and the in vitro and clinical methods used to evaluate and demonstrate their efficacy.

METHODS

Original scientific full papers or reviews listed in ISI Web of Science and Medline were included in this review using the search terms white*, toothpaste and dentifrice.

CONCLUSIONS

Due to the reported consumer and patient dissatisfaction with their perceived tooth color, toothpaste manufacturers have responded by developing a vast array of contemporary whitening toothpastes. One of the key functional ingredients in whitening toothpastes is the abrasive system. In general, these have been designed to give effective removal of extrinsic stains and help prevent tooth stains from reforming without undue abrasivity towards the dental hard tissues. Whitening toothpastes may contain additional agents that augment the abrasive cleaning by aiding the removal and/or prevention of extrinsic stains, for examples, peroxide, enzymes, citrate, pyrophosphate and hexametaphosphate, or optical agents such as blue covarine which can improve tooth whiteness following tooth brushing. In vitro methods used to evaluate tooth whitening efficacy typically determine the ability of a toothpaste formulation to remove/prevent model extrinsic stains on substrates such as enamel or hydroxyapatite or changes in the intrinsic color of tooth specimens. Clinical protocols for evaluating the efficacy of whitening toothpastes typically determine either stain removal or prevention, where changes in natural stain or chlorhexidine/tea induced stain are measured typically over 2-6 weeks. In some clinical studies the overall tooth color change was measured using techniques such as Vita shade guides, colorimeters and image analysis of digital photographs of teeth.

Review of the extrinsic stain removal and enamel/dentine abrasion by a calcium carbonate and perlite containing whitening toothpaste

There has been an increase in the demand from consumers and patients for products that whiten teeth. To meet this demand, a whitening toothpaste containing calcium carbonate and perlite as the abrasive system and an efficacious fluoride source has recently been launched. The aim of the current paper is to review the toothpaste's stain removal efficacy and its effects on enamel and dentine wear. It has been shown to be effective at removing model extrinsic stain in vitro. Further, it has been shown to be more effective in removing naturally occurring extrinsic tooth stain than a silica non-whitening control toothpaste after two weeks of twice daily brushing in a parallel group, double-blind clinical study using 152 adult volunteers. In addition, the enhanced whitening effect did not give a clinically relevant level of wear to enamel or a significant increase in dentine wear compared to marketed non-whitening toothpaste formulations, as shown by using an in situ type model with ex vivo brushing.

The measurement of enamel and dentine abrasion by tooth whitening products using an in situ model

OBJECTIVES

To determine the enamel and dentine wear of two whitening toothpastes using an in situ model with ex vivo brushing.

METHODS

Human enamel/dentine (approximately 50:50) blocks (approximately 4 x 4mm) were placed in the upper buccal aspects of full or partial dentures of a group of 25 subjects. Subjects brushed the specimens ex vivo with either a calcium carbonate/perlite or silica containing whitening toothpaste under exaggerated conditions as compared to normal for 30 s, twice per day. Specimens were removed after 4, 8 and 12 weeks and the wear to the enamel and dentine was determined. Enamel wear was determined by change in Knoop indent length and dentine wear was determined from the enamel-dentine step height, measured using optical profilometry.

RESULTS

The mean wear after 12 weeks was for enamel 0.27 and 0.19 microns, and for dentine 34.3 and 61.1 microns, for the calcium carbonate/perlite and silica toothpastes respectively. There were no significant differences between products after 12 weeks. The rate of wear was found to decrease throughout the duration of the study.

CONCLUSION

There were no significant differences between the two whitening toothpastes in terms of enamel and dentine wear after 12 weeks brushing.

The effect of a calcium carbonate/perlite toothpaste on the removal of extrinsic tooth stain in two weeks

OBJECTIVE

To assess the effect of a calcium carbonate/perlite toothpaste on the levels of extrinsic stain removed at two weeks compared to a silica control toothpaste.

DESIGN

In this parallel group, double-blind study, subjects were stratified by natural baseline stain and tobacco use and allocated at random to one of the two study toothpastes. Subjects brushed with their allocated toothpaste twice daily for two weeks before extrinsic tooth stain was again assessed.

SETTING

The study was performed at 4-Front Research UK Limited, Maldon, UK.

PARTICIPANTS

152 adult subjects with at least eight assessable incisors/ canines with natural extrinsic tooth stain completed the study.

METHODS

The extrinsic tooth stain on the facial surfaces of incisors and canines was measured using the Macpherson modification of the Lobene Stain Index.

RESULTS

Both of the toothpaste groups had significantly less stain after two weeks of use compared to the baseline value (p<0.001). Analysis of covariance on the sum of the whole mouth stain scores showed that the calcium carbonate/perlite toothpaste removed significantly more stain over the two week study than the silica control toothpaste (p<0.05).

CONCLUSIONS

Twice daily brushing for two weeks with a calcium carbonate/perlite toothpaste removes more extrinsic stain than a silica control toothpaste.