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Dr. Meenakshi
Post Graduate student, Department of Conservative Dentistry and Endodontics, School
of Dental Sciences, Sharda University, Greater Noida
Dr. G Ratna
Reader, Department of Conservative Dentistry and Endodontics, School of Dental
Sciences, Sharda University, Greater Noida *Corresponding Author
Dr. Ekta
Professor and Head, Department of Conservative Dentistry and Endodontics, School of
Dental Sciences, Sharda University, Greater Noida
Several corrective measures were introduced in the field of esthetic
dentistry to treat discolored teeth. Laminate veneers, direct resin
restorations, crowns or fixed prostheses were included in those
corrective measures. A conservative treatment option i.e. dental
bleaching is useful when restorative procedures are performed to
correct color abnormalities
Tobacco, tea, coffee, red wine, medicines etc. can cause extrinsic
staining of teeth. These substances contains chromogens, (e.g.
polyvalent metal salts in iron supplements and cation antiseptics in
chlorhexidine) that may get attached to the tooth, and creates black or
brown characteristic stains.
Prophylactic procedures are successful in removing the extrinsic
stains; but persistent stains requires bleaching procedure.
One of the most effective tooth bleaching agents is the hydrogen
peroxide, whose application in dentistry was described by Harlan as
early as 1884.
Although hydrogen peroxide provides better outstanding results, the
related clinical side effects remains inevitable. The scientific evidence
of change in surface texture, composition, and micro hardness of
enamel are reported when bleaching is done with hydrogen peroxide.
The enzymes like Proteases could help degrade the stained films as
extrinsic stains are incorporated in pellicle. Papaya is a compatible
bleaching agent due to presence of proteolytic enzymes such as papain
and chymopapain Some in vitro study reported that a dentifrice .
containing papain and Bromelain were helpful in removing stains than
the dentifrice without them.
To evaluate bleaching efficiency of solutions containing hydrogen
peroxide and extract of Pineapple & Papaya as an additive on human
enamel in two different timings, using reflectance spectrophotometer.
Specimen collection
One hundred twenty maxillary central incisors were collected that
were extracted due to periodontal disease. The defective teeth (i.e. the
one with visible cracks, caries defects, and decalcifications) were
discarded. Then, the teeth were cleaned of calculus and the remaining
soft tissue using an ultrasonic scalar (Satelec, India). They were stored
in 0.2% Thymol, and refrigerated at 4°C until use.
Preparation of pineapple extract
Two hundred grams of pineapple were peeled and cut into small pieces.
The pieces were smashed and blended in a blender with 25 ml of
distilled water. The obtained filtrate was further centrifuged at 2000
rpm for 2 min at a temperature of 4°C. The clear liquid was filtered out
and refrigerated at 4°C.
Preparation of Papaya extract
Unripe papaya was washed with distilled water, peeled, deseeded and
the flesh was blended in a blender. Papaya pulp was squeezed through a
mesh cloth to produce the unripe pulp juice (UPJ). The UPJ was
centrifuged at 2000 RPM at 4°C for 15 minutes. Then the supernatant
was filtered using a sterile 0.22 μm syringe filter. The sterilized UPJ
was used immediately.
Staining of specimen
Deionized water (100 ml) was boiled and a tea bag was dipped into it.
The solution was cooled to room temperature after 5 min. The strained
solution was used for staining. Staining was achieved by immersing
the teeth for 24 h in this solution. The teeth were properly washed and
stored at 37°C, 100% humidity.
Baseline color value
Baseline color values were established by randomly selecting twenty
stained specimens. Specimens were measured over a white background
using a reflectance spectrophotometer (X-Rite Gretag Macbeth). This
was helpful in recording the color variables in accordance with
commission Internationale de l'Eclairage (CIE) laboratory system.
The teeth were randomly divided into three groups of 40 teeth each,
based on the concentration of hydrogen peroxide as follows:
Group 1 (n = 40) – Hydrogen peroxide
Group 2 (n = 40) – Hydrogen peroxide with Pineapple extract
Group 3 (n = 40) – Hydrogen peroxide with Papaya extract
They were further subdivided into two subgroups of 20 teeth each
Subgroup A (n = 20) – 20 min
Subgroup B (n = 20) – 10 min
The crown and roots of all teeth were separated by cutting at
cementoenamel junction. Using acrylic resin, they were mounted
Dental Science
International Journal of Scientific Research
Volume-9 | Issue-4 | April-2020 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr
Aim: To evaluate bleaching efficiency of solutions containing hydrogen peroxide and extract of Pineapple & Papaya as an additive on human
enamel in two different timings, using reflectance spectrophotometer
Materials and Methods: Baseline color values of 20 randomly selected artificially stained incisors were obtained. The specimens were divided
into three groups of 40 teeth each: Group 1 – 30% hydrogen peroxide, Group II – Hydrogen peroxide with Pineapple extract, and Group III
–Hydrogen peroxide with Papaya extract. They were further divided into 2 subgroups, according to time of bleaching, i.e. 20 min (Subgroup A) and
10 min (Subgroup B).
Statistical Analysis: The results were statistically analysed using using Kruskal Wallis test
Results: The mean ΔE values of Group 1A (11.49), Group 2A (12.57), and Group 3A (15.82) showed higher values when compared to the mean Δ E
values of Group 1B (10.74), Group 2B (12.21), and Group 3B (15.60).
Conclusion: Natural enzymes enhances the bleaching effect when used along with hydrogen peroxide.
Bleaching, Bromelain, Papain, Spectrophotometer
Volume-9 | Issue-4 | April-2020
International Journal of Scientific Research
exposing the labial surface.
Bleaching protocol
The bleaching solution contains 1 ml of Pineapple/ Papaya extract + 1
ml of phosphate buffered solution + 28 ml of hydrogen peroxide. The
teeth in group 1 were bleached with hydrogen peroxide, group 2 were
bleached in combination with pineapple extract, and group 3 in
combination with papaya extract. The specimens were immersed in
solutions for 20 min and 10 min from subgroup A and B, respectively.
The teeth were rinsed and stored in artificial saliva at 37°C for 24 h
after bleaching.
Testing methodology
The testing was done with reflectance spectrophotometer over a white
background, which recorded color variables L*, a*, b* in accordance
to CIEL*a*b color system using a formula:
∆E = ([∆L*] 2+ [∆a*] 2+ [∆b*] 2)½
The results were statistically analysed using using Kruskal Wallis test.
The results of this in vitro study are given in bar graphs 1 and 2.
Bar graph 1. Depicting mean ΔE in subgroup A for all 3 Groups
Bar graph 2. Depicting mean ΔE in subgroup B for all 3 Groups
The mean ΔE values of Group 1A (11.49), Group 2A (12.57), and
Group 3A (15.82) showed higher values when compared to the mean Δ
E values of Group 1B (10.74), Group 2B (12.21), and Group 3B
(15.60) as shown in Table 1.
Table 1. Shows mean ΔE values of all the groups
Managing discolored dentition is a common procedure in day to day
practice. Teeth discoloration can either be intrinsic or extrinsic. The
management protocol basically depends on the etiology starting from
the most conservative procedure like bleaching to extensive full
coverage veneer.
Commercially available bleaching agents contain a wide spectrum of
the concentration of hydrogen peroxide or its precursor Carbamide
peroxide. Side effects would include the injuries to the hard and soft
tissues of the oral cavity, surface roughness, postoperative sensitivity
and irritation or burns to the soft tissues in the oral cavity.
The use of enzymes has been proposed as a viable alternative for
In this study the vegetative enzyme extracted from Pineapple &
Papaya were used for bleaching. Pineapple contains Bromelain,
catalase, and polyphenol peroxidase. The pH of extract was 3 to 6.5; in
this pH, the components of the extract are stable. At this pH, the extract
causes disruption of adhered proteins causing stains. Papaya contains
enzyme Papain-sulfhydryl protease consisting of single polypeptide
chain. This enzyme is able to hydrolyse the peptide bonds. It can be
used as a non-abrasive whitening agent.
Colorimeter is an alternative mode to evaluate the change in colors. It
is not able to detect color in the curved surface like tooth structure.
Spectrophotometer demonstrates the high level of accuracy and
rep ro ducibil it y. Th e c ol or ch ange value s obtai ne d f rom t he
spectrophotometer were analyzed on the basis of CIE values.
Within the limitation of this study Pineapple & Papaya extract when
used as a bleaching agent resulted in significant colour change on
stained enamel. It can be concluded that natural enzymes along with
hydrogen peroxide are more effective when compared to 30%
hydrogen peroxide alone.
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PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr
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Full-text available
To evaluate the stain removal efficacy of a novel dentifrice containing papain and bromelain extracts (Glodent) in comparison with a control dentifrice (Colgate regular). This was a randomized, positive-controlled, double-blinded, clinical study. Subjects were randomly divided into one of the two study groups. Pre-treatment and post treatment photographs of the 4 anterior teeth were recorded under standardized conditions and analyzed for lightness or luminosity values using Adobe Photoshop. The difference between the mean pre-treatment luminosity of test and control groups was not statistically significant. In both test and control groups, the post-treatment luminosity was significantly higher than pre- treatment luminosity (P < 0.001 and P = 0.003 respectively). The mean post-treatment luminosity for test group was found to be significantly higher than control group. The mean percentage removal of stains for test group was significantly higher than control group. The test dentifrice showed significant stain removal when compared to control which could be attributed to the role of proteolytic enzymes in the test dentifrice.
Full-text available
Unlabelled: Since bleaching has become a popular procedure, the effect of peroxides on dental hard tissues is of great interest in research. Purpose: The aim of this in vitro study was to perform a qualitative analysis of the human enamel after the application of in-office bleaching agents, using Scanning Electron Microscopy (SEM). Materials and methods: Twenty intact human third molars extracted for orthodontic reasons were randomly divided into four groups (n=5) treated as follows: G1- storage in artificial saliva (control group); G2- four 30-minute applications of 35% carbamide peroxide (total exposure: 2h); G3- four 2-hour exposures to 35% carbamide peroxide (total exposure: 8h); G4- two applications of 35% hydrogen peroxide, which was light-activated with halogen lamp at 700mW/cm² during 7min and remained in contact with enamel for 20min (total exposure: 40min). All bleaching treatments adopted in this study followed the application protocols advised by manufacturers. Evaluation of groups submitted to 35% carbamide peroxide was carried out after two time intervals (30 minutes and 2 hours per session), following the extreme situations recommended by the manufacturer. Specimens were prepared for SEM analysis performing gold sputter coating under vacuum and were examined using 15kV at 500x and 2000x magnification. Results: Morphological alterations on the enamel surface were similarly detected after bleaching with either 35% carbamide peroxide or 35% hydrogen peroxide. Surface porosities were characteristic of an erosive process that took place on human enamel. Depression areas, including the formation of craters, and exposure of enamel rods could also be detected. Conclusion: Bleaching effects on enamel morphology were randomly distributed throughout enamel surface and various degrees of enamel damage could be noticed. Clinical significance: In-office bleaching materials may adversely affect enamel morphology and therefore should be used with caution.
Full-text available
To evaluate the effect of external bleaching on the color and luminosity of fluorotic stains and adjacent, normally mineralized enamel areas by means of CIE L*a*b* colorimetry. Eighteen adolescents with mild to moderate fluorotic stains were randomly assigned to either bleaching group A (n = 9) or control group B. Eligibility criteria were fluorotic stained maxillary incisors or canines and the informed consent of the participants and their guardians. Using a colorimeter, CIE L*a*b* values of maxillary incisors and canines were assessed at baseline (T1) in the center of the fluorotic stained area (F1) and at adjacent, normally mineralized enamel areas (F2). Then, external bleaching with Illumine office (30% hydrogen peroxide, Dentsply DeTrey) was performed for 60 minutes, followed by color reassessment (T2). After 14 days (T3), a 2-week home bleaching period with a daily bleaching time of 1 hour with Illumine home (15% carbamide peroxide, Dentsply DeTrey) was conducted with subsequent color determination (T4). After completion of bleaching therapy, 96.0% of all fluorotic areas (F1) and 100% of normal enamel areas (F2) showed a significant change within group A, compared to 29.4% in control group B. Comparing the collective DeltaE (L*, a*, b*) of F1 and F2, 60.0% of all areas showed significant differences after completion of bleaching therapy, compared to 88.0% initially. Of group B sites, 82.4% showed color differences in the beginning (T1) and 88.2% at the end (T4). Whereas a single 1-hour session of in-office bleaching with 30% hydrogen peroxide does not significantly affect the color and luminosity of fluorotic teeth, a 14-day period of home bleaching leads to an assimilation of the color of the fluorotic stain with the color of surrounding enamel areas due to different responses of sound and fluorotic enamel to the bleaching regime.
Optimal pH and temperature conditions for proteolytic activity of pineapple fruit bromelain were determined using five different substrates: azocasein and azoalbumin (pH 3–10 at 20–70°C), casein and sodium caseinate (pH 2–10 at 20–70°C), and haemoglobin (pH 2–6.5 at 30–60°C). Fruit bromelain has shown optimum activity at pH 7.5 for azoalbumin and at 6.5 for azocasein, all at 55°C. Fruit bromelain activity determined with casein and sodium caseinate has shown optimum activity at 59°C, while the optimum pH was 7.7 for casein and 6.5 for sodium caseinate. Optimum hydrolysis conditions of fruit bromelain towards haemoglobin showed a sharp peak at an acidic pH 2.9 at 37°C. The lowest results of Km and the highest results of Vmax/Km were found for azocasein and azoalbumin. These substrates are highly recommended for fruit bromelain activity determination.
In-office tooth whitening using hydrogen peroxide (H2O2) has been practised in dentistry without significant safety concerns for more than a century. While few disputes exist regarding the efficacy of peroxide-based at-home whitening since its first introduction in 1989, its safety has been the cause of controversy and concern. This article reviews and discusses safety issues of tooth whitening using peroxide-based materials, including biological properties and toxicology of H2O2, use of chlorine dioxide, safety studies on tooth whitening, and clinical considerations of its use. Data accumulated during the last two decades demonstrate that, when used properly, peroxide-based tooth whitening is safe and effective. The most commonly seen side effects are tooth sensitivity and gingival irritation, which are usually mild to moderate and transient. So far there is no evidence of significant health risks associated with tooth whitening; however, potential adverse effects can occur with inappropriate application, abuse, or the use of inappropriate whitening products. With the knowledge on peroxide-based whitening materials and the recognition of potential adverse effects associated with the procedure, dental professionals are able to formulate an effective and safe tooth whitening regimen for individual patients to achieve maximal benefits while minimising potential risks.
This article presents clinical cases in which different bleaching modalities have been used to successfully treat unsightly teeth. Depending upon the type and severity of discoloration, in-office vital and nonvital bleaching procedures were carried out. Discoloration of a single tooth has been managed using nonvital bleaching alone or with a combination of other minimally invasive modalities for an acceptable esthetic outcome. The case selection was done by considering the patient's needs and expectations, the type and cause of discoloration and patient economics. Moreover, prime importance was given to the conservation of the existing tooth structure and acquiring a complete change in the shade of teeth, which was comparable to that of the adjacent teeth. The desire to have a bright smile has become an important esthetic need of patients. The article explores various forms of bleaching and their successful usage in day-to-day clinical practice.
This paper explores the implications of bleaching procedures on restorative dentistry. The effects of tooth whitening systems on the bond strength, marginal integrity, color and other properties of restorative materials are reviewed. Also, clinical considerations in combining bleaching and aesthetic restorative techniques are discussed.
The aim of the present study was to evaluate the effect of three peroxide-containing bleaching agents, Opalescence, Nite White and a 30% hydrogen peroxide solution, on enamel surfaces using Atomic Force Microscopy (AFM). Fifteen non-carious human incisors (ten maxillary and five mandibular, extracted for periodontal reasons) were used. The teeth were divided randomly into three groups of five, according to the bleaching agents. The labial surface of each tooth was imaged by AFM before and after treatment. Each bleaching agent was applied for a total of 28 h (in individual 4 h treatments). The specimens were examined only after 28 h of treatment. On comparing the AFM images of untreated and treated enamel, surface alterations were observed after 28 h of treatment with Opalescence, Nite White and 30% hydrogen peroxide solution. Several grooves present in the enamel surface of untreated teeth became deeper after the bleaching procedure. The depths of the grooves increased in each case. The increase in the depth of grooves was more pronounced in the case of the 30% H2O2 solution. Home-use bleaching agents are capable of causing enamel surface alterations. It is hypothesized that the peroxide-containing bleaching agents affect the organic phase of enamel. Peroxides can affect not only the surface but also the inner structure of enamel. As a result of its low molecular weight, hydrogen peroxide can penetrate into the enamel. Thus, inner oxidative effects are more likely to occur in the subsurface enamel where more organic material is present and oxidation is capable of altering the outer enamel and the surface.
The role of prophylaxis in pediatric dentistry
American Academy of Pediatric Dentistry. (2000).The role of prophylaxis in pediatric dentistry. Pediatr. Dent. 22(7): 37.