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The effect of a calcium carbonate/perlite toothpaste on the removal of extrinsic tooth stain in two weeks
Abstract
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.
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.
The study was performed at 4-Front Research UK Limited, Maldon, UK.
152 adult subjects with at least eight assessable incisors/ canines with natural extrinsic tooth stain completed the study.
The extrinsic tooth stain on the facial surfaces of incisors and canines was measured using the Macpherson modification of the Lobene Stain Index.
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).
Twice daily brushing for two weeks with a calcium carbonate/perlite toothpaste removes more extrinsic stain than a silica control toothpaste.
... Nitrification is one of the most important methods of thermochemical treatment of the surface. It is based on nitrogen implantation on the surface layer forming a TiN coating increases the hardness and resistance to both wear and corrosion [14]. ...
... Dentocult-SM® Strip Mutans (Orion Diagnostica, Espoo, Finland) is the ''chair side'' test measuring the MS level in stimulated saliva, based on research that indicated that the quantity of MS in the saliva is reflecting the number of dental areas that have been colonized with the same microorganism [11]. Numerous studies confirmed that Dentocult Strip Mutans (DSM) method of determining MS from the saliva is efficient in comparison to conventional laboratory methods of determining the MS level [10,12,13,14]. ...
... The need for detecting and enumerating MS with patients, and especially children is unquestionable. Since the efficiency of the DSM test for determining the level of salivary MS was proved through a series of studies [10,13,14,20], this method was taken as a reference in our research and two modified manners of detecting MS were confirmed with this method. In daily work with the patients, in cases of higher need for a timely detection of these cariogenic microorganisms -with small children, taking of saliva samples in order to detect MS is severely difficult and in many cases, impossible. ...
... En esta tabla se recogen aquellos estudios en los que se evalúa la eficacia de los dentífricos blanqueantes sin peróxidos en pacientes con tinciones previas. En algunos estudios se valora el grado de tinción con el que llegan los pacientes mediante el Índice de Lobene 1,3,4,5,8,20,24,26 , mientras que otros se basan en características de los pacientes como ser fumadores o tener un color base A32 3,25,27 . En cada estudio, se utiliza un dentífrico blanqueante con una composición química determinada y se suele comparar con dentífrico control fluorado que no contenga los componentes específicos abrasivos y/o químicos con efecto "blanqueante" [1][2][3][4][5]8,20,[23][24][25][26][27]30 . ...
... En algunos estudios se valora el grado de tinción con el que llegan los pacientes mediante el Índice de Lobene 1,3,4,5,8,20,24,26 , mientras que otros se basan en características de los pacientes como ser fumadores o tener un color base A32 3,25,27 . En cada estudio, se utiliza un dentífrico blanqueante con una composición química determinada y se suele comparar con dentífrico control fluorado que no contenga los componentes específicos abrasivos y/o químicos con efecto "blanqueante" [1][2][3][4][5]8,20,[23][24][25][26][27]30 . En general, las diferencias estadísticamente significativas se observan en el cuerpo del diente, por lo que la eficacia de la pasta blanqueante se asocia, como en estudios anteriores al efecto abrasivo del cepillado 20,22,23 (Tabla 4). ...
... Respecto al modo de medición de la eficacia de las pastas o colutorios blanqueantes, no existe consenso sobre mejor método para medir el efecto blanqueante a nivel clínico 22 27 . El índice de Lobene modificado está recomendado por la Asociación Dental Americana (ADA) y es usado frecuentemente en publicaciones científicas para medir de forma numérica la intensidad y el área de la zona manchada [1][2][3][4][5]8,[19][20][21]23,25,32 y así evaluar la eficacia del dentífrico blanqueante. ...
... It improves tooth lightness by removing extrinsic tooth stain when incorporated into chewing gums [9] and intrinsic stain when added in den- tifrices [10]. Calcium carbonate, on the other hand, is almost insoluble in water and forms strong abrasive particles which help to reduce plaque from teeth and improve tooth lightness by polishing the enamel surface111213. Without having access to the detailed formulation of the confectionary whitening gum (C), calcium carbonate and sodium bicarbonate were identified in the 3 tested chewing gums but sodium carbonate was only found in the NRT chewing gums. ...
... Without having access to the detailed formulation of the confectionary whitening gum (C), calcium carbonate and sodium bicarbonate were identified in the 3 tested chewing gums but sodium carbonate was only found in the NRT chewing gums. Subsequently the additional presence of this molecule could contribute to the differences in whitening effect reflected by the higher stain removal with the NRT chewing gums A and B. The calcium present in saliva may react with the carbonate from sodium carbonate , resulting in formation of insoluble calcium carbonate , which has polishing properties111213. Similar tooth whitening effects could be assumed for all other flavoured Nicotinell chewing gums, which contain the same amount of calcium carbonate, bicarbonate sodium and sodium carbonate as Nicotinell Mint coated and Nicotinell Mint Thrive chewing gums used in this study. ...
... Considering all the above points, the in vitro mastication system is a suitable method for assessing the mechanical removal of extrinsic stain by abrasive or polishing agents such as sodium bicarbonate and carbonate calcium respectively. However this procedure might not allow to underscore the effect of agent like xylitol or carbamide on reduced dental plaque formation, which contribute also to tooth whitening appearance111213. ...
Extrinsic staining of teeth may result from the deposition of a variety of pigments into or onto the tooth surface, which originate mainly from diet or from tobacco use. More recently, clinical studies have demonstrated the efficacy of some chewing gums in removing extrinsic tooth staining. The aim of this study was to assess the effectiveness of two nicotine medicated chewing gums (A and B) on stain removal in an in vitro experiment, when compared with a confectionary whitening chewing gum (C) and human saliva (D).
Bovine incisors were stained by alternating air exposure and immersion in a broth containing natural pigments such as coffee, tea and oral microorganisms for 10 days. Stained enamel samples were exposed to saliva alone or to the test chewing gums under conditions simulating human mastication. The coloration change of the enamel samples was measured using a spectrophotometer. Measurements were obtained for each specimen (average of three absorbances) using the L*a*b scale: lightness (L*), red-green (a) and yellow-blue (b).
Medicated chewing gums (A and B) removed a greater amount of visible extrinsic stain, while the confectionary chewing gum with a whitening claim (C) had a milder whitening effect as evaluated by quantitative and qualitative assessment.
The tested Nicotine Replacement Therapy (NRT) chewing gums were more effective in the removal of the extrinsic tooth stain. This visible improvement in tooth whitening appearance could strengthen the smokers' motivation to quit smoking.
... Participant eligibility requirements for the relevant clinical study At least eight natural anterior teeth (incisors and canines) that are assessable for extrinsic stain and readily available for all study appointments are required of adult male and female patients, aged 18 to 50, who also maintain good general and oral health and oral hygiene. 11 Although the participants' noncooperative behavior met the exclusion criterion, Individuals having a history of medication side effects, allergies to toothpaste ingredients, or any other significant pertinent issues, ladies who are expecting or nursing, Patients who had undergone dental prophylaxis within eight weeks of screening, patients with fixed orthodontic equipment, patients who had professional teeth whitening within the last six months, or patients with considerable calculus on the canine or incisor facial surfaces. ...
... 28 A study by Collins et al. (2005) showed that, in the comparatively short period of two weeks, the calcium carbonate/perlite abrasive combination effectively decreases discoloration. 11 In an additional study, Chandu et al. (2009) evaluated the effectiveness of whitening toothpaste with perlite as an abrasive for two weeks in order to remove stains and prevent new ones. 29 They discovered that the toothpaste with perlite showed a notable decrease in extrinsic stain over that time. ...
... Extrinsic stains are caused by the adsorption of materials contained in cigarettes and dietary intake of tannin-rich foods (e.g., tea, coffee, soft drinks, etc.). [7][8][9] Use of toothpastes are recommended due to their positive chemical effects and delivery of several therapeutic agents. The cleansing effect of toothpastes depends mainly on their abrasive agents. ...
... The present study is a randomized, concurrent parallel arm, controlled trial designed to compare the effect of the whitening toothpastes on extrinsic dental stains. Subjects with good general health, dentate, 8,14,15 and/or at least 20-24 teeth suffer from visible extrinsic stain on the labial surfaces of U/L anteriors (incisors) with Lobene 1,16,17 stain index > 1 6 . Subjects with generalized malocclusion who underwent professional tooth whitening within last six months, smoking, intrinsic stains, using iron tonics, and antibiotic therapy for atleast 3 months prior were excluded. ...
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.
... Since tooth bleaching is a conservative treatment, it is considered as a first choice among alternative treatments in aesthetic dentistry. Extrinsic stains are usually the result of surface precipitation of coloring agents and pigments in the diet (black tea, coffee, red wine) or habits (smoking) on the acquired film of enamel 1-3 , whereas intrinsic stains are determined by the layer of dentin underlying the enamel surface, which becomes discolored as a result of fluorosis, trauma, use of antibiotics, systemic conditions and natural aging of teeth 3,4 . To remove these stains, teeth can be bleached with bleaching agents and/or bleaching dentifrices, which have different action mechanisms. ...
... It is known that these bleaching dentifrices in some way promote dental bleaching by removing and/or controlling extrinsic stains on the tooth surface through the abrasion process 1,2 . The following abrasive agents are typically found in these bleaching dentifrices: hydrated silica, calcium carbonate, dicalcium phosphate dihydrate (DCPD), calcium pyrophosphate, alumina, sodium bicarbonate and perlite 3,4,19 . The abrasiveness of dentifrices depends on particle hardness, shape, size, distribution range and concentration [20][21][22][23] . ...
The aim of this study was to assess in vitro the surface roughness (Ra) of human enamel exposed or not exposed to the action of a bleaching agent containing 10% carbamide peroxide (CP) after brushing with different dentifrices. Ninety-six human enamel specimens were divided into 2 groups: GI--exposed to the action of 10% CP; GII--not exposed. These were subdivided into 4 brushing subgroups: (CEW) Close-Up Extra Whitening, (CUB) Colgate Ultra Branco, (CCP) Crest Cavity Protection and (DW) Deionized Water. The specimens from Group GI were exposed to 10% CP for 6 hours/14 days and those from Group GII were stored in artificial saliva for 14 days. Then they were submitted to 35.600 brushing cycles. Ra was measured before and after brushing. Ra difference was compared by two-way ANOVA. Ra was compared between subgroups using ANOVA and Tukey's test. Ra was compared between groups using T-test (alpha = 0.05). Final and initial Ra were compared by Paired t-test; using SPSS (15.0). Two-way ANOVA difference in the outcome revealed that the use of bleaching agent did not affect the difference in Ra (p = 0.45). Brushing significantly influenced the difference in Ra (p < 0.001), but the interaction between the two factors was not significant (p = 0.20). Among the brushing subgroups, a significant increase in Ra was observed for Subgroup CEW--GI: Rai 0.691 (0.112)a, Raf 0.993 (0.264)a; Raf-Rai: 0.303a (43. 7%)--G2: Rai 0.794 (0.167)a, Raf 1.006 (0.488)a; Raf-Rai: 0.212a (26.7%) with a statistical difference for Subgroup CUB--GI: Rai 0.639 (0.163)a, Raf 0.506 (0.113)b; Raf-Rai: -0.133b (-20.8%)--GII: Rai 0.647(0.166)a, Raf 0.472b (0.260); Raf-Rai: -0.134b (-0.27%). Regardless of whether or not the enamel had been exposed to 10% CP, Ra values varied according to the abrasives in the composition of the different dentifrices.
... Dentifrices relying on abrasive systems for extrinsic stain prevention or removal will generally employ a mixture of abrasive materials to form an abrasive system. An example of such a system is one where a certain quantity of perlite has been added to the main abrasive being used 61,62 . Perlite is a highly processed amorphous mixed glassy silicate that is milled to produce fine plate-like particles that combine superior stain removal and polishing properties, in conjunction with relatively low abrasivity. ...
... Perlite is a highly processed amorphous mixed glassy silicate that is milled to produce fine plate-like particles that combine superior stain removal and polishing properties, in conjunction with relatively low abrasivity. Whether added to toothpaste with a silicabased abrasive system or one based upon calcium carbonate, perlite abrasive enhancement appears to have achieved clinically superior extrinsic stain removal 62 . ...
Since the mid-20th century, a great deal of research and development has been directed to improve the quality, effectiveness and functionality of toothpastes. This review considers the technological advances and scientific background to the development of dentifrices for a variety of expressed different purposes, from caries reduction through incorporation of fluoride, through periodontal disease prevention by use of anti-microbials to tooth whitening, breath freshening and reducing hypersensitivity and calculus formation.
... For example, CaCO 3 is found in biomineral structures such as nacre and sea urchin spicules [1][2][3][4] and plays an essential role in such structures' remarkable mechanical properties [5,6]. Due to its unique physical and mechanical properties, researchers are not only developing biomimetic materials based on its biomineral structures [7][8][9] but also utilizing it as additives for the applications in our daily life such as abrasive additives in toothpaste to help remove plaque, debris and surface stains [10,11]. There exist three polymorphs of CaCO 3 -calcite, aragonite, and vaterite [12]. ...
... Twelve studies qualitatively expressed ESR assessed through Lobene, Lobene modified by Macpherson (composite index), and the Shaw and Murray index. 13,[25][26][27][28][29][30][31][32][33][34][35] All 12 studies revealed higher stain removal with the WD than with the RD, behavior that was confirmed by the meta-analysis of stain area and intensity using either Lobene (11 studies 12,36-45 with 1962 participants) or Lobene modified by Macpherson (6 studies 13,22,46-49 with 2576 participants) indexes (Table 1). For either outcome, the heterogeneity level was considered high (72%-91%). ...
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.
... The Lobene Stain Index was used to score the amount of stains on specimens in the current study. This index is widely used for the assessment of stainability of composite resins, and its reliability has been confirmed in many previous studies (30)(31)(32)(33)(34)(35). However, this measure is subjective and may be considered a limitation of the current study. ...
Background:
Color change is one major drawback of tooth-colored resin-based restorations.
Objectives:
This study aimed to assess the color stability of three commonly used resin-based restorative materials upon exposure to tea and coffee.
Materials and Methods:
Discs were fabricated from Spectrum TPH (Dentsply/Caulk), Denfil (Vericom), and Filtek Z250 (3 M) microhybrid composites and immersed in coffee and tea solutions for two hours on the first day and the whole of the second, third, and fourth days. The color was assessed visually and recorded using the Lobene Stain Index after each period of immersion. The color change of the three composite resins was compared using the Kruskal-Wallis test, Mann-Whitney U test, and Friedman test. The level of significance was set at 0.05. The Cohen’s Kappa was also calculated to assess inter-rater agreement.
Results:
The three composite resins showed statistically significant color changes after four days of immersion in a coffee solution (P = 0.014), but their color change in the tea solution was not significant (P > 0.05). A comparison of color changes in the composites after one (two hours) and four days of immersion in tea and coffee solutions revealed a significant difference in color changes between Spectrum TPH and the other two composites (P < 0.001).
Conclusions:
The three microhybrid composites used in this study showed variable color stability upon exposure to a coffee solution. The color stability of Spectrum TPH was inferior to that of Denfil and Filtek Z250.
... Perlite has superior stain removal as well as polishing properties. [16,17] Sodium bicarbonate, amorphous calcium phosphate, sodium hexametaphosphate are other abrasive materials that smoothen the enamel surface and improve the luster. [18] The ultimate effect is achieved by the combined effect of abrasives and the toothbrush bristles. ...
Dentifrices are oral health care products that are used by individuals on a daily basis to promote personal oral hygiene. Toothpastes serve as essential vehicles to carry biologically active and inert substances that provide therapeutic and cosmetic benefits. They offer several advantages such as anti-bacterial action, reduce hypersensitivity and improve remineralization of teeth. Despite the benefits, toothpastes also have the potential to bring about both hard and soft tissue destruction by virtue of their ingredients. Dental professionals are always faced with the challenge of advising their patients the most effective dentifrice based on the evidences available. This review emphasizes on the benefits and drawbacks of abrasives, one of the inactive ingredient of dentifrice. Further it highlights about the tooth whitening dentifrices and the various means by which it works.
... The Lobene Stain Index was used to score the amount of stains on specimens in the current study. This index is widely used for the assessment of stainability of composite resins, and its reliability has been confirmed in many previous studies (30)(31)(32)(33)(34)(35). However, this measure is subjective and may be considered a limitation of the current study. ...
... 10 Bahsedilen çalışmaya benzer şekilde değişik diş macunlarının temizleyici etkilerinin araştırıldığı, birbirleriyle kıyaslandığı birçok çalışma mevcuttur. [23][24][25] Bu çalışmaların ortak yönü, diş macunlarının hepsinin değişen miktarlarda olmak üzere diş yüzeylerindeki lekeleri çıkarmalarıdır. ...
OBJECTIVE: Structural changes on dental tissues or accumulation of debris on the tooth surfaces may cause tooth discoloration. The purpose of this study was to evaluate the effects of individual’s age, amount of dental plaque, frequency of tooth brushing, frequency of dental floss use and consumption of colored beverage on tooth color change. MATERIALS AND METHOD: 202 volunteers (85 female, 117 male) were included in the study. Individuals were asked to fill in questionnaires. The mean plaque index in the upper right or left central, lateral incisor and canine was measured. Color values of the teeth were measured by using a digital color measurement device. Correlation analysis, Kruskal-Wallis and Mann-Whitney U tests were used for the statistical analyses. RESULTS: Color saturation values increased with the increase in the individuals' age (p=0.0001<0.05; r=0.391). Color saturation values increased also with the increase of the mean plaque index values (p=0.0001<0.05; r=0.255). Significant differences in terms of color values were observed between groups with different tooth brushing frequencies (p=0.0001<0.05, Kruskal-Wallis test). Significant differences in terms of color values was observed also between groups with different dental floss usage frequencies (p=0.0001<0.05, Kruskal-Wallis test). Significant differences in terms of color values were observed also between groups with different colored beverage consumption frequencies (p=0.016<0.05, Kruskal-Wallis test). CONCLUSION: The saturation of the tooth color increases with an increase of the age. Increase in frequencies of tooth brushing and dental floss usage provides a brighter and lighter tooth color. Increase in consumption of colored beverages causes a darker and lusterless tooth color.
... There are numerous other applications (Perlite Institute, 2009). Perlite has been studied as an ingredient in toothpaste (Collins et al., 2005;Stamm, 2007), a dietary supplement for broilers (Tatar et al., 2012), a component of swine-fodder (Duchstein, 1982), a component of landfill liners for the in situ leachate treatment of landfills (Ozel et al., 2012), for the removal of cadmium, nickel, and lead from aqueous solutions (Aminifard et al., 2011;Malakootian et al., 2011;Torab-Mostaedi et al., 2010), as a passive material in the form of ceiling tile for removal of ozone from indoor air (Cros et al., 2011), in mycotoxin detoxification of animal feed (Huwig et al., 2001), and as a component of a stormwater filter (Gironás et al., 2008). ...
Abstract Perlite is a generic name for an amorphous volcanic alumina-silicate rock that expands by a factor of 4-20 when rapidly heated to 1400-1800 °F (760-980 °C). Both the ore and the expanded product have extensive and widespread commercial applications. Limited data on the toxicology of perlite in animal studies indicate that the LD50 (oral ingestion) is more than 10 g/kg and, from a chronic inhalation study in guinea pigs and rats, that the NOAEL for the inhalation pathway is 226 mg/m(3). Health surveillance studies of workers in US perlite mines and expansion plants (including some workers exposed to levels greater than prevailing occupational exposure limits (OELs) conducted over 20 years indicate that the respiratory health of workers is not adversely affected. Studies in Turkish mines and expanding plants had generally similar results, but are more difficult to interpret because of high smoking rates in these populations. A recent mortality study of permanent residents of the island of Milos (Greece) exposed to various mining dusts (including perlite) resulted in non-significant increases in standard mortality ratios for pneumonia and chronic obstructive pulmonary disease (COPD), whereas a companion morbidity study revealed elevated odds ratios for allergic rhinitis, pneumonia, and COPD when compared to another industrial area of Greece. Residents were exposed to other mining dusts and other possible causes or contributing factors and no ambient monitoring data were presented so it is not possible to use this study for risk calculations of perlite-exposed populations. Perlite is regulated as a "nuisance dust" in most countries.
... Aesthetic dentistry and tooth whitening continue to be expanding areas of interest that have been fuelled by the demand of patients for both healthy and cosmetically attractive smiles 1 . This has led to the availability of a range of professional in-office and mass-market home use tooth whitening products 2-6 , including whitening toothpastes 7,8 . These latter products are generally based on optimised abrasive technology to remove and control extrinsic staining which forms in the acquired pellicle 9,10 . ...
To determine the enamel abrasivity of three whitening toothpastes and a silica toothpaste and to measure the brushing forces used.
Polished human enamel blocks were indented with a Knoop diamond and attached to dentures of adult volunteers. The blocks were brushed ex vivo, twice per day with either a whitening toothpaste containing Perlite (White System), a commercial whitening toothpaste (A and B) or a silica toothpaste. After four and twelve-weeks, one block per subject was removed and the Knoop indent remeasured. From the changes in the indent length, the amount of enamel wear was calculated.
The mean enamel wear (sd) for White System, silica toothpaste, whitening toothpaste A and B after four-weeks was 0.14 (0.15), 0.09 (0.16), 0.14 (0.12) and 0.89 (0.93) and after twelve-weeks was 0.24 (0.21), 0.37 (0.73), 0.36 (0.52) and 1.04 (0.98) microm respectively. After four-weeks, the differences in enamel wear between whitening toothpaste B and all other toothpastes were of statistical significance (p < 0.003), but not after twelve-weeks. The mean ex vivo normal brushing force (sd) was 2.67 (1.33) N.
All three whitening toothpastes did not give significantly more enamel wear than a silica toothpaste after twelve-weeks in situ with ex vivo brushing.
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.
Toothpaste is one of the most significant tools and contains a great number of ingredients for eliminating dental plaque, which triggers periodontal disease and dental caries, from the hard tissues of the teeth, and is an essential component of oral and dental hygiene practices. With these ingredients, which are composed of several active or inactive components, issues such as cavities, tartar, and malodor can be addressed. In addition, the building blocks in their structures, the majority of which are considered inactive agents, can boost the efficacy of the therapeutic drug in the paste or protect it from external causes. However, some of these substances pose a threat not only to oral health, but also to the health of the entire body, causing tissue damage. In this study, the components of toothpastes in market aisles were analyzed, and their frequency of occurrence among pastes was found.
Objective
The aim of this study was to evaluate the effect of brushing with whitening toothpaste on the color change of composite resins discolored 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 color measurements, the samples were colored in the coffee solution for 5 days. Color measurements were made again after the coloring process, and brushing simulation was applied for 7 days, 15 days, 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). Color change (∆E00) after brushing was calculated using the CIEDE2000 system. Repeated measures variance analysis was used for the analaysis of data.
Results
G-aenial anterior and Zenit showed significant coloration compared to Majesty esthetic after coloration with coffee (p<0.05). The color change in all composite resins was above the clinically acceptable limit (ΔE00>1.8). Color 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
Color change was high in micro-hybrid and nano-ceramic composites which were discolored in coffee. The whitening toothpastes were effective in reducing the coloration caused by coffee.
The roots, twigs and stems of Salvadora persica (S. persica) also known as miswak have been used for centuries as oral hygiene tools. The cleansing efficacy of S. persica is thought to be attributed to the mechanical effects of its fibres. However, there is no study focus on S. persica whitening behaviour. Therefore, this study is conducted to preliminarily assess the whitening effects of S. persica on coffee and tea stained teeth. The bark of S. persica stems were peeled off and the pulps were dried and ground to produce powder. Scanning Electron Microscopy (SEM) and Energy dispersive X-ray spectroscopy (EDX) were carried out to study the properties of S. persica fibre. SEM revealed the presence of crystals of various shapes and sizes that act as natural abrasive agents and might contribute to its whitening effects while EDX identified that these minerals constitute of O (43.44 wt%), C (31.2 wt%), S (11.7 wt%), Ca (11.2 wt%), Na (1.3 wt%) and K (1.04 wt%). The powder later formulated into paste of various concentrations; 0.3%, 0.4%, 0.5% (w/w). Extracted permanent premolar teeth were cleaned and stained with tea and coffee solutions. Formulations of S. persica fiber paste were then used to brush the teeth and being compared to commercial whitening toothpaste. The teeth shade changes were evaluated using VITAPAN® Classical Shade. After brushing under standardized condition using a brushing simulator machine, it was found that the staining of teeth buccal surface was reduced at least one tone of shade according to the VitaPan® shade.
This chapter begins with an introduction to the structure of the dentition and its environment followed by a review of the optical properties of teeth. Tooth colour will be reviewed with particular emphasis on colour distribution and variation. Important factors that influence tooth colour and its perception will be discussed. With the current interest in tooth whitening, this chapter will then describe approaches to quantifying tooth whiteness and the measurement of tooth colour, in particular, visual assessment approaches and instrumental techniques. In addition, methods to improve tooth colour will be reviewed including whitening toothpastes, tooth bleaching and microabrasion.
Objective
To compare the effectiveness of abrasive component (perlite/calcium carbonate) and enzymatic component (papain and bromelain) of whitening toothpaste in removal of extrinsic stains.Methods
This study is a randomized, triple blind and parallel group study in which 90 subjects aged 18–40 years were included. At baseline, stains scores were assessed by Macpherson's modification of Lobene Stain Index and subjects were randomly assigned to two groups with 45 subjects in each. Group 1 used whitening toothpaste with enzymatic action and group 2 with abrasive action. After 1 month, stain scores were assessed for the effectiveness of the two toothpastes and 2 months later to check the stain prevention efficacy. Wilcoxson's test was used to compare between baseline 1 and 2 months stain scores, and Mann–Witney U-test was applied for intragroup comparison.ResultsThe mean baseline total stain score for the subjects allocated to the enzymatic toothpaste was 37.24 ± 2.11 which reduced to 30.77 ± 2.48 in 1 month, and for the abrasive paste, total stain reduced from 35.08 ± 2.96 to 32.89 ± 1.95. The reductions in total stain scores with both the pastes were significant compared with baseline stain scores (at 1 month Group 1, P = 0.0233 and Group 2, P = 0.0324; at 2 months, Group 1 P = 0.0356). Both the toothpastes proved to be equally good in removal of extrinsic stains; however, the enzymatic paste showed better results as compared to abrasive toothpaste.Conclusion
Whitening toothpaste with abrasive action and enzymatic action are equally effective in removal of extrinsic stains; however, whitening toothpaste with abrasive action needs to be used with caution.
This study sought to evaluate the effect of different toothpastes with whitening action on the average surface roughness (Ra) of a microhybrid composite resin. Twenty-five specimens of composite resin were prepared and distributed randomly among 5 experimental groups (n = 5). Groups 1-3 were treated with whitening toothpastes: Close-up Extra Whitening, Colgate Ultra White, and Colgate Total 12 Whitening. Group 4 was a negative control group (with samples brushed with deionized water), and Group 5 was a positive control group (with samples brushed using a non-whitening toothpaste). A profilometer was used to determine Ra before and after brushing. A simulated brushing machine was used for all groups, providing horizontal back and forth movement with an amplitude of 3.8 cm applying an axial load of 200 g and a speed of 356 rpm, totaling 20,000 cycles. To determine the Ra in each specimen, 6 readings were taken at various positions before and after brushing. The results were submitted to variance analyses and Tukey's test. (P < 0.05). Groups 1, 2, 3, and 5 demonstrated statistically significant differences between initial and final averages. Based on these results, it was determined that brushing with toothpaste, regardless of formulation, significantly increased the Ra of the resin composite evaluated in this study.
In terms of novel formulations, there seems to have been a shift in emphasis from anti-caries/anti-gingivitis to anti-calculus/whitening toothpastes in recent years. The anti-calculus and whitening effects of toothpastes are to some extent based on the same active ingredients: compounds of high affinity for tooth mineral. Due to this affinity, crystal growth may be hindered (anti-calculus) and chromophores be displaced (whitening). Besides these common ingredients, both types of toothpaste may contain agents specifically aimed at each condition. Clinical studies have shown that these active ingredients can be successfully formulated in fluoride toothpastes to give significant reductions in supragingival calculus and stain formation and facilitate their removal. Some of the ingredients are formulated in toothpastes that additionally contain anti-plaque and anti-gingivitis ingredients, making these toothpastes (together with the fluoride) truly multi-functional. The development of these products is not straightforward because of interaction between formulation components and because the active ingredients must maintain their beneficial characteristics during the shelf life of the paste. Neither a therapeutic benefit (in terms of less gingivitis or less caries) nor a societal benefit (in terms of less treatment demand) has been demonstrated as a result of the anti-calculus and whitening effects of toothpastes.
To determine whether natural smoking stain could be removed/inhibited effectively by a toothpaste containing 5% d-limonene. For comparison and contrast, the effects of d-limonene on tea stain were also assessed.
The design was a randomized controlled double-blind trial with parallel groups. Toothpastes were: A: positive control with perlite whitening formulation; B: A+5% d-limonene; C: D + 5% d-limonene; D: negative control. The extrinsic stains were measured using Lobene Stain Index. Following baseline examination, all subjects were randomly assigned to one of the four toothpaste groups and instructed to brush with the assigned products twice daily. Subjects returned to the clinic after 4-week brushing for stain removal assessment, then all extrinsic stains, plaque and supragingival calculus were removed and use of assigned products was continued for another 4 weeks, and the stain scores were repeated for inhibition assessment.
A total of 408 subjects, 201 with smoking stains and 207 with tea stains, participated in the trial. 5% d-limonene combined with Perlite whitening formulation significantly reduced stain scores both for smoking stain removal and inhibition (P < 0.05). Furthermore, 5% d-limonene alone (in negative formulation) exhibited an additional advantage for smoking stain inhibition (P < 0.05), but the advantage was not found for long-standing smoking stain removal (P > 0.05). The additional advantage of 5% d-limonene was shown neither for removal nor for inhibition in the tea stain study (P > 0.05). All test products were well tolerated over the study period.
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.
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.
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.
The studies described in this paper aimed to assess the stain removal efficacy, fluoride efficacy and abrasivity to enamel and dentine of a new whitening toothpaste containing calcium carbonate and perlite, using appropriate in vitro models.
Stain removal efficacy was assessed using the pellicle cleaning ratio (PCR) method. Fluoride efficacy was assessed using remineralisation, demineralisation and fluoride-uptake methods. Abrasivity was assessed using an enamel and dentine wear method.
The results showed that the new whitening toothpaste was able to remove extrinsic tooth stain more effectively than three commercially available toothpaste formulations. The fluoride efficacy was superior to a non-fluoridated control and was not significantly different to a clinically tested fluoride-containing toothpaste. The abrasivity data showed that the calcium carbonate/perlite toothpaste is no more abrasive to enamel or dentine than two other commercially available whitening toothpastes.
The studies show that the new whitening toothpaste is effective in extrinsic stain removal, has an efficacious fluoride source and does not have an undue degree of abrasivity to enamel or dentine compared to other relevant commercially available products.
To determine the enamel and dentine wear of two whitening toothpastes using an in situ model with ex vivo brushing.
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.
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.
There were no significant differences between the two whitening toothpastes in terms of enamel and dentine wear after 12 weeks brushing.
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.
Unlabelled:
Often the first evidence of variation from normal in human dentition is an observable difference in the color of the teeth. During the past decade, the demand for conservative esthetic dentistry has grown dramatically. Tooth discoloration is a frequent dental finding, associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location, severity, and firmness in adherence to the tooth surface. Basically, there are two types of tooth discolorations: those caused by extrinsic factors and those caused by intrinsic congenital or systemic influence. The intensity of stains may be worsened if there are enamel defects. Tooth discoloration presents two major challenges to the dental team. The first challenge is to ascertain the cause of the stain; the second is its management.
Clinical significance:
This article reviews the etiology and clinical presentation of dental stains and outlines treatment options.
A major drawback to clinicians prescribing and patients using chlorhexidine rinse is the development of extrinsic staining. In order to assess the effectiveness of a whitening dentifrice in controlling chlorhexidine stain, fifty-seven subjects rinsed with chlorhexidine twice daily while brushing twice daily with either fluoridated whitening or a fluoridated regular dentifrice. Stain was assessed at 1, 2, and 3 month intervals using a stain index with two components; one with parameters for color intensity and one for tooth percentage covered with stain. Facial surfaces accumulated less stain than lingual surfaces. For many, although not all surfaces, and at many, although not all time periods, the group utilizing the whitening dentifrice exhibited less staining.
It is advantageous to recommend a whitening dentifrice that has demonstrated stain suppression when prescribing a chlorhexidine rinse. Improved patient satisfaction leading to increased compliance with the antimicrobial regimen is a desired outcome.
Objectives: To compare the stain removal and prevention efficacy of a whitening toothpaste (White System) and a standard silica toothpaste and to determine if any increase in tooth whitening benefits caused an increase in enamel abrasive wear. Methods: The products were evaluated in a laboratory-cleaning test and in a clinical study evaluating the removal and prevention of natural extrinsic stain over a four-week period. Enamel abrasive wear was determined using an in situ model where enamel blocks were placed on a denture worn in the mouth for four weeks and brushed twice daily. Results: The White System gave a statistically (p<0.001) higher level of in vitro stain removal as compared to the standard silica toothpaste. The White System was significantly superior to the standard silica toothpaste in the clinical study in terms of extrinsic stain removal (p<0.03) and prevention (p<0.02). The product difference in the in situ enamel wear for these two toothpastes was not of statistical significance. Conclusions: The White System toothpaste was shown to be more effective in stain removal and prevention than a standard silica toothpaste. These enhanced tooth-whitening benefits did not give rise to a concomitant statistically significant increase in the level of wear to enamel.
Objective To carry out an extensive review of the literature on tooth staining with particular regard to some of the more recent literature on the mechanisms of tooth staining involving mouthrinses.Design Comprehensive review of the literature over four decades.Conclusions A knowledge of the aetiology of tooth staining is of importance to dental surgeons in order to enable a correct diagnosis to be made when examining a discoloured dentition and allows the dental practitioner to explain to the patient the exact nature of the condition. In some instances, the mechanism of staining may have an effect on the outcome of treatment and influence the treatment options the dentist will be able to offer to patients.
Sixty-five subjects were assigned to use Crest or Rembrandt dentifrice with either a placebo or Peridex rinse for eight weeks. One group, using Peridex, started with Crest and switched to Rembrandt at week four of the study. There were no significant differences among the groups on gingivitis, plaque, or calculus by the conclusion of the study. On the stain intensity index there was a significant statistical difference on buccal surfaces between Crest and Rembrandt with placebo compared to Crest with Peridex. On lingual surfaces, Rembrandt with placebo rinse was significantly lower than all Peridex rinse groups by the end of the study. From baseline to the conclusion of the study, Crest with placebo had no change in stain intensity, while Rembrandt with placebo had a significant drop on both buccal and lingual surfaces. The Peridex groups had increases on buccal stain intensity. On stain area scores, by the conclusion of the study both Crest and Rembrandt with placebo were significantly different from Crest with Peridex on buccal and lingual surfaces. Over time there was no significant change in stain area for the Crest with placebo groups. Rembrandt and placebo was significantly lower on stain area from baseline to week eight on buccal surfaces. The Peridex groups had increases in stain area over the study period.
The acquired pellicle formed on the approximal, labial and lingual surfaces of human incisors has been examined in the electron microscope. The characteristics of the pellicle were different on the three surfaces. The approximal surface was penetrated by the pellicle to form a "dendritic" structure for several microns below the enamel surface and the pellicle itself was penetrated by the dental plaque. The labial surface contained pellicle that was relatively thicker and more free from plaque compared with the approximal surface. A laminated calcification and differential staining with silver, approximately parallel to the enamel surface, was occasionally observed in the pellicle on the labial surface. The pellicle on the lingual surface was always observed to be calcified to some degree. There was no evidence of penetration of the pellicle into either the labial or the lingual surfaces of the enamel. Histochemical staining showed the presence of both carbohydrate and protein in the pellicle of all surfaces.
Significant differences in stain removal have been demonstrated in a laboratory study comparing two tartar control dentifrices: Platinum, containing 1.3% soluble pyrophosphate and 1.5% of a copolymer, and Crest Tartar Control, containing 5% soluble pyrophosphate. The purpose of this clinical study was to evaluate the same tartar control dentifrices, and a low abrasive dentifrice for their ability to reduce Peridex-induced stain. Eighty-five subjects were given Peridex (0.12% chlorhexidine digluconate) and a low abrasive dentifrice for 4 weeks. The 76 subjects with sufficient stain were stratified using the Lobene index on buccal and lingual surfaces of anterior teeth, and randomly assigned one of the three dentifrices for 8 weeks. At the end of the study, total stain evaluations were significantly lower in the Platinum dentifrice group (mean 0.84) compared to both Crest Tartar Control dentifrice (1.08) and the low abrasive dentifrice (1.09) at p<0.05 by ANOVA. In this 8-week clinical study, Platinum dentifrice was significantly more effective than Crest Tartar Control dentifrice or a low abrasive dentifrice in reducing Peridex-induced stain, and this finding correlates well with laboratory data on removal of tea and coffee stain.
The effect of twice-daily brushing with one of three different dentifrices (Arm & Hammer Dental Care, Arm & Hammer Dental Care Extra Whitening, Crest) on stain removal and tooth whitening was examined in 115 volunteers over a period of 12 weeks. The facial surfaces of 12 anterior teeth were assessed for stain using a published, modified version of a standard stain index. Whiteness was measured on teeth 8 and 9 using a single Vita Lumin-Vaccum Shade Guide for consistency. At baseline, the mean facial stain scores were significantly higher (p < 0.05-0.01) for both Arm & Hammer dentifrices than for Crest. In addition, the tooth shades, as indicated by the stain guide, specifically the b* values representing yellowness, were quantified using a Minolta spectrophotometer. Arm & Hammer Dental Care Extra Whitening formula was found to be significantly better than Crest at removing naturally occurring extrinsic stain. The difference between Arm & Hammer Dental Care Extra Whitening and Crest became significant (p < 0.01) after two weeks of use, and remained intact during the balance of the study, achieving p values of 0.0002 for at least one of the three assessed parameters (total stain, proximal, and facial) at weeks 4 and 12. The study also found that Arm & Hammer Dental Care produced a significant increase in tooth whiteness by week 12, whereas Crest showed no such increase at any time during the study. These results suggest that the two Arm & Hammer Baking Soda products are more effective in reducing stain and increasing whiteness than the standard silica-based dentifrice. Their effectiveness is not related to abrasivity since they are less abrasive to tooth enamel than the silica-based product tested.
To evaluate a modified tooth stain index and determine the effect of dietary factors on stain formation.
At baseline, 182 adult volunteers were given a full oral prophylaxis followed by stain assessment using a modification of the Lobene index. This involved assigning separate scores to the mesial (M) and distal (D) sites of each tooth, in addition to the standard gingival area (G) and tooth body (B). For each site, stain intensity and areas were scored. The sum of (intensity X area) scores was calculated for all sites (GBMD-value) and for the gingival and body sites only (GB-value). The subjects used a standard abrasive dentifrice and a soft toothbrush for 6 weeks.
Stain was reassessed and the average increase in GBMD-value was 20.9 (sd=9.9) (buccal aspect) and 29.9 (sd=18.0) (lingual aspect). The corresponding GB-values were 4.4 (sd=4.8) and 12.5 (sd=10.2). The coefficients of variation of the GBMD index values were consistently lower than those of the GB values. Smoking and tea-drinking were found to be the only significant (p<0.001) factors investigated for stain formation.
It is concluded that the modified index may well be advantageous to its conventional counterpart because sites with most visible stain are assessed separately and because it may also offer higher discriminatory power due to a lower coefficient of variation.
To carry out an extensive review of the literature on tooth staining with particular regard to some of the more recent literature on the mechanisms of tooth staining involving mouthrinses.
Comprehensive review of the literature over four decades.
A knowledge of the aetiology of tooth staining is of importance to dental surgeons in order to enable a correct diagnosis to be made when examining a discoloured dentition and allows the dental practitioner to explain to the patient the exact nature of the condition. In some instances, the mechanism of staining may have an effect on the outcome of treatment and influence the treatment options the dentist will be able to offer to patients.
A nine-week, double blind clinical trial was conducted to evaluate the effectiveness of a novel tartar control whitening dentifrice with a silica-based abrasive system on induced dental stain. The study model involved three weeks of stain induction followed by six weeks of unsupervised brushing to assess efficacy. To induce stain, 222 healthy adult volunteers received a dental prophylaxis, and then began a limited brushing regimen supplemented by three-times daily rinsing with tea and once daily rinsing with 15 ml of 0.12% chlorhexidine. This regimen was suspended, and 187 subjects with tooth stain were entered into a six-week clinical trial where they were randomized to either a silica-based tartar control whitening dentifrice or a marketed regular dentifrice control, balancing for stain levels and smoking status. At baseline, three and six weeks, stain area and stain intensity were measured on the 8 anterior teeth using the Lobene Index. After six weeks' use, composite Lobene means were 35% lower for the whitening dentifrice compared to the regular control. In addition to the overall reductions, there were statistically significant reductions in stain area (p < 0.015) and stain intensity (p < 0.01) at both three and six weeks. The tartar control whitening dentifrice was effective in removing stain on the gingival margins and elsewhere on the body of the tooth. Safety profiles for the two test dentifrices were generally similar. After three and six weeks' use, the tartar control whitening dentifrice reduced chlorhexidine and tea stain compared to the marketed control.
A nine-week, randomized and controlled clinical trial was conducted to compare the stain removal efficacy of a 0.243% sodium fluoride dentifrice containing 7% sodium hexametaphosphate (5% hexametaphosphate anion) to that of a 0.243% sodium fluoride control dentifrice. Following prophylaxis and a three-week pre-treatment period to induce extrinsic stain, healthy adult volunteers with tooth stain were randomized to the sodium hexametaphosphate dentifrice or the control. Stain area and intensity were assessed at baseline, three and six weeks. At both three and six weeks, the sodium hexametaphosphate dentifrice was statistically significantly superior to the control for all overall stain measures (p < 0.04). After six weeks of product usage, the sodium hexametaphosphate dentifrice demonstrated reductions of 29% in composite stain, 24% in stain intensity, and 25% in stain area relative to the control. Significant reductions in composite stain were seen on both gingival and body regions for the sodium hexametaphosphate dentifrice versus the control at three and six weeks. Both products demonstrated favorable safety profiles, as determined by oral soft tissue evaluations and recording of subject-reported adverse events.
A six-week, randomized and controlled, examiner blind, parallel group clinical trial was conducted to evaluate the stain prevention efficacy of an experimental whitening dentifrice containing a combination of sodium hexametaphosphate and soluble pyrophosphate relative to a marketed high-abrasive dentifrice and a marketed control dentifrice. Following the collection of baseline stain scores and subsequent prophylaxis, healthy volunteers were randomized to one of three treatment regimens, balancing for stain levels and smoking status. Throughout the six-week treatment period, subjects brushed twice daily with the assigned dentifrice while following a rinse regimen of three times daily tea and once daily chlorhexidine. At baseline, three and six weeks, dental stain was measured on the facial and lingual surfaces of the eight anterior teeth using the Lobene Index. A total of 96 subjects completed the study. At three and six weeks, adjusted stain scores were highest in the control group and generally lowest in the sodium hexametaphosphate group for all Lobene parameters (intensity, area and composite). At three weeks, stain area and composite stain scores for the sodium hexametaphosphate dentifrice were statistically significantly (p < 0.05) lower relative to the control, representing reductions of 30% and 33%, respectively. Similar numerical trends were observed after six weeks, with the sodium hexametaphosphate group showing reductions of 21% (p = 0.068) in stain area and 26% (p = 0.055) in composite stain relative to the control. The high-abrasive dentifrice was directionally, though not statistically superior to the control at three and six weeks. All three test products were well-tolerated.
Repeated exposure to chlorhexidine and tea has long been recognized to promote extrinsic tooth stain. Previously, the merits of a modified, rapid clinical trial model using chlorhexidine and tea in combination with restricted brushing to accelerate staining have been established. A nine-week randomized and controlled, examiner blind, parallel group clinical trial was conducted to compare selected chemical and mechanical approaches for stain removal using this model. After prophylaxis, stain was induced during a 3-week pre-treatment period, and then the healthy adult volunteers were randomized to one of three treatment groups: an experimental whitening dentifrice containing a combination of sodium hexametaphosphate and soluble pyrophosphate; a marketed alumina-based high abrasive dentifrice; or a lower abrasive control dentifrice. At baseline, three and six weeks, dental stain was measured on the facial and lingual surfaces of the eight anterior teeth using the Lobene index. A total of 94 subjects completed the study. Both the chemical and abrasive dentifrices showed statistically significant reductions in stain area (p < 0.05) relative to the control after three weeks. After six weeks, adjusted mean stain area scores were 0.35, 0.41 and 0.49 for the sodium hexametaphosphate, alumina and regular dentifrice groups, respectively. While the alumina dentifrice showed only a directional benefit, the sodium hexametaphosphate differed statistically (p = 0.023) from the control. Subjects in both the chemical and abrasive dentifrice groups showed statistically significant reductions relative to baseline for Lobene composite stain, stain area and stain intensity (p < 0.05) at six weeks. There were no statistically significant differences in stain levels between the sodium hexametaphosphate and alumina dentifrice groups at any time. This study demonstrates that following six weeks of treatment, sodium hexametaphosphate-containing dentifrices are effective in removing extrinsic tooth stain, with performance at least comparable to that seen with more abrasive dentifrices.
The objective of this double-blind clinical study was to investigate the tooth whitening efficacy of a formulation variant of a commercially available dentifrice (Colgate Total Plus Whitening Toothpaste) obtained by the addition of high-cleaning silica, relative to that of its currently marketed formulation (Colgate Total Toothpaste). Following a baseline examination for extrinsic tooth stain, qualifying adult male and female subjects from New Jersey and Florida were randomized into two treatment groups which were balanced for gender, age, and level of extrinsic tooth stain. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice using a soft-bristled toothbrush. Examinations for extrinsic tooth stain were repeated after six-weeks', three-months' and six-months' use of the study dentifrices. Eighty-six (86) subjects complied with the protocol and completed the entire study. At the six-month examination, subjects assigned to the new dentifrice formulation group exhibited statistically significantly lower levels of extrinsic tooth stain area and extrinsic tooth stain intensity than did those subjects assigned to the Colgate Total Toothpaste group. Thus, the results of this double-blind clinical study support the conclusion that the new dentifrice formulation variant is efficacious, compared to the control dentifrice, for the removal of extrinsic tooth stain.
The objective of this double-blind clinical study was to investigate the tooth whitening efficacy of a formulation variant of a commercially available dentifrice (Colgate Total Plus Whitening Toothpaste) obtained by the addition of high cleaning silica, relative to that of its currently marketed formulation (Colgate Total Toothpaste). Following a baseline examination, qualifying adult male and female subjects were randomized into two treatment groups which were balanced for age, gender and level of extrinsic tooth stain. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice, using a soft-bristled toothbrush. After one, and again after two weeks' use of the assigned dentifrices, a randomly selected panel of subjects was examined for soft tissue findings. Examinations for extrinsic tooth stain were repeated for all subjects after six weeks' use of the study dentifrices. Ninety-seven (97) subjects complied with the protocol and completed the entire study. At the six-week examination, subjects assigned to the new dentifrice formulation group exhibited statistically significantly (p < 0.05) lower levels of extrinsic tooth stain area and extrinsic tooth stain intensity than did those subjects assigned to the Colgate Total Toothpaste group. Thus, the results of this double-blind clinical study support the conclusion that the new dentifrice formulation variant is efficacious for the removal of extrinsic tooth stain.
Rapid innovation in vital bleaching has increased the popularity of tooth whitening among dental professionals and patients. A broad range of peroxide-based treatments are currently available including those that are professionally-administered (in-office), professionally-dispensed (custom-tray-based systems), and self-directed (over-the-counter). Recently, a novel, flexible polyethylene bleaching strip was introduced that delivers a hydrogen peroxide bleaching gel to the anterior dentition. This “trayless” system, available in professional-strength and over-the-counter versions, reportedly offers advantages with respect to overall peroxide dose, contact time, and ease-of-use compared to other delivery systems. This paper reviews the relevant published clinical research on whitening strips tested among a broad range of patients commonly encountered in contemporary dental practices.
Citation
Gerlach RW, Zhou X. Vital Bleaching with Whitening Strips: Summary of Clinical Research on Effectiveness and Tolerability. J Contemp Dent Pract 2001;(2)3: 001-016.
A major drawback to clinicians prescribing and patients using chlorhexidine rinse is the development of extrinsic staining. In order to assess the effectiveness of a whitening dentifrice in controlling chlorhexidine stain, fifty-seven subjects rinsed with chlorhexidine twice daily while brushing twice daily with either fluoridated whitening or a fluoridated regular dentifrice. Stain was assessed at 1, 2, and 3 month intervals using a stain index with two components; one with parameters for color intensity and one for tooth percentage covered with stain. Facial surfaces accumulated less stain than lingual surfaces. For many, although not all surfaces, and at many, although not all time periods, the group utilizing the whitening dentifrice exhibited less staining. It is advantageous to recommend a whitening dentifrice that has demonstrated stain suppression when prescribing a chlorhexidine rinse. Improved patient satisfaction leading to increased compliance with the antimicrobial regimen is a desired outcome.
An 8-week randomized, double-blind, parallel group clinical study was conducted to assess the extrinsic stain prevention efficacy of three commercially available dentifrices: 1) a dentifrice containing 0.243% sodium fluoride with copolymer, tetrasodium pyrophosphate, and sodium tripolyphosphate in a silica base (Product 1); 2) a dentifrice containing 0.243% sodium fluoride, baking soda and peroxide, tetrasodium pyrophosphate, and sodium tripolyphosphate in a silica base (Product 2); and 3) a dentifrice containing 0.243% sodium fluoride in a silica base (Product 3). After the collection of baseline stain scores by a trained examiner and a subsequent oral prophylaxis, 126 volunteers were randomized to one of the three treatment groups (balanced for composite extrinsic stain scores). Throughout the 8-week treatment period, subjects brushed their teeth twice daily with their assigned dentifrice. At baseline, 4-, and 8-week evaluations, extrinsic dental stain was measured on the facial surfaces of the six maxillary anterior teeth and on the facial and lingual surfaces of the six mandibular anterior teeth using the Lobene Index. A total of 120 subjects completed the study. No adverse events were reported, and subjects who discontinued the study did so for reasons unrelated to the dentifrices. At the 4-week evaluation, composite stain scores were statistically significantly lower (P < .05) for both Product 1 (44.9%) and for Product 2 (34.6%) relative to Product 3. At the 8-week evaluation, composite stain scores were statistically significantly lower (P < .05) for both Product 1 (28.4%) and for Product 2 (29.6%) relative to Product 3. The results of this clinical study demonstrate that both dentifrices, one containing 0.234% sodium fluoride with copolymer, tetrasodium pyrophosphate, and sodium tripolyphosphate in a silica base; and one with 0.243% sodium fluoride with copolymer, tetrasodium pyrophosphate, and sodium tripolyphosphate in a silica base are more effective in preventing natural extrinsic stain formation on teeth as compared with a marketed control dentifrice.
The objective of this six-month, double-blind clinical study, conducted in harmony with American Dental Association guidelines, was to provide a comparison between Colgate Total Toothpaste and Crest Gum Care Toothpaste with respect to their levels of efficacy for the control of supragingival dental plaque and gingivitis, and with respect to the levels of tooth staining associated with their use. Adult male and female subjects from the Edinburgh, Scotland area were entered into the study and stratified into two treatment groups which were balanced for age, sex, baseline Quigley-Hein Plaque Index scores and baseline Löe-Silness Gingival Index scores. Subjects received an oral prophylaxis, and were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice, using a soft-bristled toothbrush. Examinations for plaque, gingivitis and extrinsic tooth staining were conducted after three months' and again after six months' use of the study dentifrices. One-hundred and nine (109) subjects complied with the protocol and completed the entire six-month clinical study. At both the three- and six-month study examinations, the Colgate Total Toothpaste group exhibited statistically significantly less plaque, gingivitis and extrinsic tooth staining compared to the Crest Gum Care Toothpaste group. At the six-month examination, the magnitude of these differences exceeded 18% for all six parameters measured (18.7% for Plaque Index, 60.5% for Plaque Severity Index, 22.2% for Gingival Index, 85.1% for Gingivitis Severity Index, 45.3% for stain intensity, and 46.3% for stain area). Thus, the results of this six-month clinical study support the conclusion that Colgate Total Toothpaste provides a statistically significant, substantive advantage in efficacy for the control of plaque and gingivitis over Crest Gum Care Toothpaste, while, at the same time, providing better control against the development of extrinsic tooth staining.
The objective of this examiner-blind clinical study was to compare the extrinsic tooth-stain removal efficacy of a novel, nontray, "paint-on" liquid whitening gel containing 18% carbamide peroxide (Colgate Simply White Clear Whitening Gel) with a commercially available whitening dentifrice. After a baseline examination for extrinsic tooth stain, qualifying adult men and women from Canada were randomized into two treatment groups balanced for age, gender, and level of extrinsic tooth stain. Subjects were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice (Group 1: nonwhitening dentifrice; Group 2: whitening dentifrice). The subjects in Group 1 also were instructed to use the paint-on whitening gel for 30 minutes twice daily. Examinations for extrinsic tooth stain were repeated after 2 and 3 weeks. Ninety-seven subjects complied with the protocol and completed the entire study. At both the 2- and 3-week examinations, subjects assigned to the liquid whitening gel-treatment group exhibited statistically significant reductions in extrinsic tooth stain (P < .05) with respect to stain area (22.7% reduction at 3 weeks), stain intensity (26.3% reduction at 3 weeks), and overall stain removal (32% reduction at 3 weeks) compared with the commercially available whitening dentifrice group. Thus, the results of the examiner-blind clinical study support the conclusion that Colgate Simply White Clear Whitening Gel provides a significantly greater level of extrinsic tooth-stain removal efficacy than a commercially available whitening dentifrice.
To review current knowledge with respect to tooth colour and its measurement.
'Medline' database for the period 1966 to the present day and 'ISI Web of Science' database for the period 1974 to the present day were searched electronically with key words tooth, teeth, colour and color.
The colour and appearance of teeth is a complex phenomenon, with many factors such as lighting conditions, translucency, opacity, light scattering, gloss and the human eye and brain influencing the overall perception of tooth colour. The measurement of tooth colour is possible via a number of methods including visual assessment with shade guides, spectrophotometry, colourimetry and computer analysis of digital images. These methods have successfully been used to measure longitudinal tooth colour changes when the dentition has undergone tooth whitening procedures.
The objective of this six-week, examiner-blind clinical study was to assess the tooth whitening and extrinsic stain prevention efficacy of a new dentifrice delivering 1.0% hydrogen peroxide, 0.243% sodium fluoride, and sodium tripolyphosphate in a high-cleaning silica base (Test Dentifrice) relative to that of a commercially available hexametaphosphate-containing whitening dentifrice (Positive Control Dentifrice).
Following a baseline oral soft tissue examination and scoring of extrinsic tooth stain and tooth shade, qualifying adult male and female subjects from the Mississauga, Ontario, Canada area were randomized into either the Test or Positive Control Dentifrice group. The two groups were balanced for age, tobacco use, extrinsic tooth stain, and tooth shade scores. All subjects received a dental prophylaxis, and were provided with a supply of their assigned product and a soft-bristled adult toothbrush for use at home. Subjects were instructed to brush their teeth for two minutes twice daily (morning and evening) using only the dentifrice provided, and to refrain from using any other oral hygiene products for the entire six weeks of the study. There were no restrictions regarding diet or smoking habits during the course of the study. Oral soft tissue, extrinsic tooth stain and tooth shade assessments for each subject were repeated after two and six weeks of product use. All statistical tests were two-sided and employed a level of significance of alpha = 0.05.
Seventy-six (76) subjects complied with the protocol and completed the entire study. At both the two-week and six-week examinations, the Test Dentifrice prevented statistically significant (p < 0.05) more tooth stain as compared to the Positive Control Dentifrice. Also, at the two-week and six-week examinations, the Test Dentifrice provided statistically significant (p < 0.05) greater tooth whitening as compared to the Positive Control Dentifrice (2.64 and 3.77 shade rank reductions, respectively).
A new whitening dentifrice, delivering 1.0% hydrogen peroxide, 0.243% sodium fluoride, and sodium tripolyphosphate in a high-cleaning silica base provides a statistically significant greater level of efficacy for both tooth whitening and prevention of extrinsic tooth stain than the commercially available Positive Control Dentifrice.
The objective of this six-week, examiner-blind clinical study was to assess the tooth whitening and extrinsic tooth stain removal efficacy of a new dentifrice delivering 1.0% hydrogen peroxide, 0.243% sodium fluoride, and sodium tripolyphosphate in a high-cleaning silica base (Test Dentifrice), relative to that of commercially available hexametaphosphate-containing whitening dentifrice (Positive Control Dentifrice).
Following a baseline oral soft tissue examination and scoring of extrinsic tooth stain and tooth shade, qualifying adult male and female subjects from the Harrisburg, Pennsylvania area were randomized into either the Test or Positive Control Dentifrice group. The two groups were balanced for gender, extrinsic tooth stain, and tooth shade scores. All subjects were provided their assigned dentifrice and a soft-bristled adult toothbrush for home use. Subjects were instructed to brush their teeth for two minutes twice daily (morning and evening) using only the dentifrice provided, and to refrain from using any other oral hygiene products for the entire six weeks of the study. There were no restrictions regarding diet or smoking habits during the course of the study. Oral soft tissue, extrinsic tooth stain, and tooth shade assessments for each subject were repeated after two and six weeks of product use. All statistical tests were two sided and employed a level of significance of alpha = 0.05.
Fifty-six (56) subjects complied with the protocol and completed the entire study. Compared to baseline at both the two- and six-week examinations, the Test Dentifrice group had statistically significant reductions in extrinsic tooth stain area and intensity, and statistically significant mean shade rank reductions, with a six-week reduction of 4.81. In contrast, at six weeks, the Positive Control dentifrice had a statistically significant increase in tooth stain area, a non-significant increase in tooth stain intensity, and a statistically significant mean 1.40 shade rank score reduction. At both the two- and six-week examinations, the Test Dentifrice group had statistically significantly lighter tooth shades and statistically significantly lower levels of extrinsic tooth stain area and intensity than the Positive Control Dentifrice group.
A new whitening dentifrice delivering 1.0% hydrogen peroxide, 0.243% sodium fluoride, and sodium tripolyphosphate in a high-cleaning silica base has significant efficacy in tooth whitening and extrinsic stain removal, and provides a statistically significantly greater level of efficacy for both tooth whitening and extrinsic tooth stain removal than the commercially available Positive Control Dentifrice.
The current study was designed to determine the effect of natural calcium carbonate toothpaste containing Perlite and microgranules (Whitening toothpaste) on extrinsic tooth stain compared to a standard commercial toothpaste formulation with precipitated calcium carbonate (PCC) as abrasive and a commercial toothpaste with dicalcium phosphate dihydrate (DCPD) as abrasive.
The toothpastes were evaluated in a double blind, three-cell, stratified (tobacco use; baseline tooth stain level), parallel group design study involving 600 subjects with extrinsic tooth stain. Subjects brushed twice daily with their allocated toothpaste for four weeks. Extrinsic tooth stain was measured using the Macpherson modification of the Lobene stain index.
ANCOVA showed significant differences between toothpastes (p=0.037). Subsequent multiple comparisons using pairwise t-tests, showed the Whitening toothpaste to be superior to the DCPD toothpaste (p=0.014) and the PCC toothpaste (p=0.067). When a Box-Cox transformation was made to the data (y0.6) to improve normality, these two differences were more accurately estimated at p=0.004 and p=0.03 respectively.
The Whitening toothpaste has been shown to be significantly more effective in tooth stain removal than the two standard commercial toothpaste formulations.
A single centre, randomised single-blind, three-way crossover study was performed, to compare the effect of an experimental test toothpaste with a commercially available whitening toothpaste and water control at inhibiting extrinsic stain promoted by repeated chlorhexidine/tea rinses.
This study used 23 subjects. During the week before the study the subjects received a prophylaxis to remove all staining, plaque and calculus deposits. On the Monday of the following week subjects returned to the clinic to receive their rinses and to check their dentition was stain free. Under direct supervision at both 09:00 and 13:00 hours they rinsed with either a toothpaste slurry or water control that was repeated daily up to and including the following Thursday. Additionally from the Monday to the Thursday each subject rinsed with a 0.2% chlorhexidine mouthrinse, immediately followed by a rinse with a warm black tea solution. This cycle was repeated hourly eight times throughout the day and on the following days until the Friday. Throughout this period volunteers omitted all other forms of oral hygiene except rinsing with the chlorhexidine mouthwash. On the Friday the level of stain on the teeth and dorsum of tongue was assessed using the Lobene stain index for both stain area and intensity. At the end of each trial period each subject received a thorough prophylaxis to remove all plaque, calculus and staining before starting the second and third period of the study.
As expected appreciable amounts of extrinsic stain accumulated on the teeth over each study period. The amount of stain following use of the toothpastes and water control was least with the experimental toothpaste, followed by water control and lastly the commercial whitening paste. For all sites combined there was evidence that the experimental paste was significantly superior to both the commercial paste and water control at reducing stain area (p<0.001), a product of stain area and intensity (p<0.001 and 0.05, respectively) but not stain intensity (p>0.05).
In this stain-prevention model the use of an experimental paste showed a significant reduction in stain accumulation on the teeth compared with a (placebo) negative water control and a commercially available whitening paste. As such the experimental paste would be expected to be of benefit in controlling extrinsic dental staining.
An electron microscopic study of the acquired pellicle and plaque formed on the enamel of a human incisor 11: 10811094. Correspondence to: L Z Collins, Unilever Oral Care, Quarry Road East, Bebington, Wirral CH63 3JW, UK. E-mail: luisa.z.collins@unilever.com 182
- Sa Leach
- Saxton
Leach SA, Saxton CA. An electron microscopic study of the acquired pellicle and plaque formed on the enamel of a human incisor. Arch Oral Biol 1966 11: 10811094. Correspondence to: L Z Collins, Unilever Oral Care, Quarry Road East, Bebington, Wirral CH63 3JW, UK. E-mail: luisa.z.collins@unilever.com 182 International Dental Journal (2005) Vol. 55/No.3 (Supplement)
Removal of tooth stain by bicarbonate, calcium, and phosphate-containing dentifrice
- Putt MS
- Milkman JL
- Milkman KR
The clinical efficacy of a new tooth whitening dentifrice formulation: A six-month study in adults
- Singh S.
- Mankodi S.
- Chaknis P.
Comparative tooth whitening and extrinsic tooth stain removal efficacy of two tooth whitening dentifrices: Six-week clinical trial
- Soparker
Removal of tooth stain by bicarbonate, calcium, and phosphate-containing dentifrice
- Putt