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A six-week clinical study to compare the stain removal efficacy of three dentifrices.

The objective of this double-blind clinical study was to compare the tooth whitening efficacy (stain removal) of a new commercially available tooth whitening dentifrice (Colgate Total Plus Whitening Toothpaste) containing 0.2% triclosan and 3.0% PVM/MA copolymer in a 0.243% sodium fluoride/high cleaning silica base, with that of two commercially available dentifrices, Crest Multi-Care Advanced Cleaning Toothpaste and Colgate Winterfresh Gel Fluoride Toothpaste. Following a baseline examination to assess extrinsic tooth stain, qualifying adult male and female subjects were randomized into three treatment groups which were balanced for gender, age and level of extrinsic tooth stain. Subjects were asked to brush their teeth twice (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' use of the study dentifrices. One-hundred and twenty-three (123) subjects complied with the protocol and completed the study. At the six-week examination, subjects assigned to the Colgate Total Plus Whitening Toothpaste treatment group exhibited statistically significant reductions in extrinsic tooth stain area and extrinsic tooth stain intensity relative to those subjects assigned to the Crest Multi-Care Advanced Cleaning Toothpaste and the Colgate Winterfresh Gel Fluoride Toothpaste.

Adolescent↗

A prospective clinical study of a multipurpose adhesive used for the cementation of resin-bonded bridges.

A clinical trial was conducted to assess comparatively the clinical performance of anterior resin-bonded bridges (RBBs) cemented with Panavia 21 Opaque (PO) or Scotchbond Multi-Purpose Plus (SBMP) used in conjunction with Scotchbond Resin Cement (SRC). Thirty-three bridges were cemented with PO and 31 bridges with SRC. The bridges were assessed six months after placement via a postal questionnaire. Two bridges (one in each group) failed at that stage. Clinical assessments at one year revealed that one PO bridge and five SRC bridges had failed. Chi-squared analysis, however, showed no significant difference (p > 0.05) in the retention rate of the two groups. At the end of two years, eight bridges had failed (three PO and five SRC). Chi-squared analysis again revealed no significant difference in the retention rate provided by the two adhesives. Greyness of the abutment teeth of bridges cemented with SRC was a drawback in using this material. Many operators who participated in the trial felt the use of SRC/SBMP was time-consuming and rather complicated.

Adolescent↗

A comparison of the Braun Oral-B 3D plaque remover and the Sonicare plus electric toothbrush in removing naturally occurring extrinsic staining.

PURPOSE: To compare the extrinsic stain-removing properties and the safety of the Braun Oral-B 3D Plaque Remover and the Sonicare Plus electric toothbrush. MATERIALS AND METHODS: This randomized, parallel group, investigator-blinded study involved 67 subjects and was conducted over 6 weeks. After recruitment, the subjects received a baseline stain assessment (Lobene stain index) and a soft and hard tissue examination, and were then randomized to use either the Sonicare or the 3D device. All subjects were trained to use both devices, and instructed to brush twice daily with their assigned device for 2 min. The subjects' brushing technique was checked after 2 weeks. After a further 4 weeks, the subjects underwent a final stain assessment and soft and hard tissue examination. A questionnaire was also completed. RESULTS: At 6 weeks, oral hard and soft tissue examinations revealed no abrasion or damage in either group. Both brushes produced significant (P < 0.001) reductions from baseline in total stain score, stain area and intensity, but group comparisons showed that these reductions were significantly (P < 0.001) greater for the 3D device.

Adolescent↗

Stain removal efficacy of two new fluoride dentifrices containing essential oils.

PURPOSE: To assess in vitro the stain removal efficacy of two new antiplaque/antigingivitis dentifrices utilizing a modification of a previously validated Stookey method. MATERIALS AND METHODS: The modifications to the original Stookey method are the following: (1) study design; three 5 x 5 Latin Squares were employed to minimize bias stemming from position or test run in the study. (2) statistical success criteria; a test formulation was judged to be effective if the lower one-sided 95% confidence limit was "equal to or higher than" 50 since a minimum PCR (pellicle cleaning ratio) score of 50 is needed for a dentifrice to show clinical efficacy. The two test dentifrice formulations contained a fluoride source, a silica abrasive system, and four essential oils. The ADA reference abrasive material (calcium pyrophosphate) and placebo toothpaste were included as positive and negative controls, respectively. RESULTS: Compared to the negative control, the positive control exhibited a statistically higher PCR score; therefore, the validity of this modified Stookey method was confirmed. Additionally, the lower limits of the one-sided 95% confidence interval for the two dentifrice formulations were above the threshold PCR of 50; therefore, this modified Stookey method should predict that both essential oil-containing dentifrices possess acceptable stain removal power.

Analysis of Variance↗

The whitening effect of bleaching agents on tetracycline-stained rat teeth.

This study compared the whitening effect of three bleaching agents on the teeth of rats and demonstrated differences in bleaching where dentin was exposed or enamel was thin. Thirty Albino rats were peritoneally injected with tetracycline solution daily for two weeks. Thirty-two disc-shaped specimens were cut from the crowns of incisors removed from sacrificed rats and were irradiated with UV light for 16 hours. Sections were stored in saline. Eight sections served as controls and were not bleached. Three bleaching agents (Opalescence, Rembrandt and Nite White) were applied to eight specimens each, five times a day for two weeks, and images of the sections were recorded at the following times: before bleaching (baseline), day 1, day 3, day 5, day 7, day 9, day 11 and day 14. Mean colors to demonstrate any change (deltaE) from baseline for each time period were as follows: control-9.78 (baseline), 9.17, 9.36, 9.65, 9.40, 9.99, 10.57, 11.36; Opalescence-10.08, (baseline) 7.63, 6.72, 6.04, 5.10, 4.87, 4.89, 4.27; Rembrandt-9.83 (baseline), 11.27, 9.55, 8.36, 7.75, 6.94, 7.11, 7.04; Nite White-10.44 (baseline), 9.92, 7.58, 6.80, 5.45, 5.05, 4.73, 4.01. All bleached teeth were lightened (p<.01). Another 56 tetracycline-stained rat incisors were UV irradiated for three days. Three different penetration depths were tested: penetration through lingual dentin and labial enamel (DN group), penetration through labial enamel only (RE group) and penetration through labial enamel covered with 1.0 mm human enamel (HE group). Specimens were bleached with Opalescence for one hour five times a day for one week or four weeks. A control group of unbleached teeth was also examined. Results (deltaE) were as follows: control--11.67; 1-week DN--13.55; 1-week RE--12.80; 1-week HE--12.07; 4-week DN--7.48; 4-week RE--7.50; 4-week HE--11.69. The color change in the 4-week DN and the 4-week RE groups showed the greatest reduction (p<.01).

Analysis of Variance↗

Present and future technologies of tooth whitening.

Dental stains can be broadly classified as intrinsic or extrinsic. Intrinsic stains are a result of defects in tooth development, fluorosis, or acquired through the use of tetracycline. Extrinsic stains are localized mainly in the pellicle and are generated by the reaction between sugars and amino acids or acquired from the retention of exogenous chromophores in the pellicle. Three clinical methods are currently used for measuring stain removal and tooth whitening in the development of new whitening technologies: Lobene Stain Index, Shade Guide Color Change, and Minolta ChromaMeter. Professional tooth whitening products rely on proven technologies--35% hydrogen peroxide for in-office power bleaching or 10% to 15% carbamide peroxide for at-home bleaching--to reduce intrinsic stain and change the inherent tooth color. Over-the-counter tooth whitening products use a combination of surfactants, abrasives, anticalculus agents, and low levels of hydrogen peroxide to reduce extrinsic stain and help maintain tooth whiteness after professional treatment. Future technologies for whitening teeth could involve the use of activating agents to enhance the performance of hydrogen peroxide and natural enzymes.

Color↗

Clinical study to compare extrinsic stain formation in subjects using three dentifrice formulations.

The purpose of this study was to compare the degree of extrinsic dental stain formed with the use of three dentifrices: (1) a new dentifrice formulation containing 5.0% potassium nitrate and 0.454% stannous fluoride in a silica base (Colgate Sensitive Maximum Strength Toothpaste, Colgate-Palmolive Co.); (2) a commercially available dentifrice containing 5.0% potassium nitrate and 0.243% sodium fluoride in a silica base (Sensodyne Fresh Mint Toothpaste, Block Drug Company, Inc.); and (3) a dentifrice containing 0.243% sodium fluoride in a silica base (Colgate Winterfresh Gel, Colgate-Palmolive Co.). A total of 121 participants were entered into the study and stratified into 3 balanced groups according to baseline mean Lobene Stain Index scores. A thorough dental prophylaxis was completed on each participant after completion of the baseline examination. The three groups were randomly assigned to use one of the three dentifrices. The groups were well balanced with regard to mean baseline stain index scores, gender, and tobacco habits. Participants were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice and a commercially available soft-bristled toothbrush. Extrinsic dental stain examinations, which measured dental stain area and dental stain intensity, were conducted at baseline and 4 and 8 weeks. Examinations were conducted by the same dental examiner at each examination. After 4 and 8 weeks' use of the test dentifrices, there was no statistically significant difference regarding extrinsic stain formation with the use of any of the dentifrices. Thus, it can be concluded from this study that the use of a new formulation dentifrice containing 5.0% potassium nitrate and 0.454% stannous fluoride in a silica base will not result in a greater formation of extrinsic dental staining than that which is formed by two commercially available dentifrices not known to cause extrinsic dental stain.

Adolescent↗

Effect of peroxide concentration and brushing on whitening clinical response.

This clinical trial compared the effects of hydrogen peroxide concentration and toothbrushing on clinical response to vital bleaching. Tooth bleaching was accomplished with a flexible, polyethylene strip coated with a hydrogen peroxide bleaching gel worn for 30 minutes twice daily over a 14-day period. A total of 36 subjects were randomized to 1 of 3 treatment groups: 5.3% hydrogen peroxide strip plus prebrushing, 6.5% hydrogen peroxide strip plus prebrushing, or 6.5% hydrogen peroxide strip without prebrushing. Two groups brushed with regular anticavity toothpaste immediately before bleaching, while the other group performed ad libitum brushing only. Tooth color was measured over a 14-day period using digital images of the anterior dentition. Over the 14-day treatment period, all 3 strip groups experienced highly significant (P < 0.001) whitening as evidenced by decreased yellowness (delta b*) and increased brightness (delta L*), as well as composite color change (delta E*) relative to baseline. Keeping brushing constant, the 6.5% hydrogen peroxide strip plus prebrushing group experienced a 31% to 60% improvement in whitening relative to the 5.3% hydrogen peroxide standard. Keeping concentration constant at 6.5% hydrogen peroxide, the prebrushing group experienced a directional 5% to 33% improvement in whitening relative to no prebrushing. All treatments were generally well tolerated. This study demonstrates that for strip-based delivery, increasing hydrogen peroxide concentration to 6.5% results in a significant improvement in efficacy with few tolerability trade-offs.

Adult↗

Tooth whitening in children.

Although there are several case reports of vital tooth bleaching in children, there is limited clinical trial evidence of the safety or efficacy of this practice. Accordingly, a new clinical trial was conducted to evaluate the effects of 2 different bleaching systems, a 6.5% hydrogen peroxide strip system and a 10% carbamide peroxide tray system, in a population of preteens and teens. A total of 106 volunteers, aged 11 to 18 years, took part in this 8-week study. Patients were randomized by a ratio of 2:1 to the strip or tray groups, with each group treating the maxillary arch first and then the mandibular arch for 4 consecutive weeks each. Individuals assigned to the strip group used the system twice daily for 30 minutes (a total of 56 contact hours over the 8-week study). Those assigned to the tray group used that system overnight (approximately 448 contact hours). Digital images were obtained at baseline and after every 2-week treatment period. Average tooth color was determined in L*, a*, b* color space, where L* indicated lightness, a* indicated red-green, and b* indicated yellow-blue. Both systems significantly whitened teeth (P < 0.0001). While there were no significant differences between groups with respect to the primary whitening response (delta b*) on the maxillary teeth, 4 weeks of overnight treatment with the 10% carbamide peroxide tray (approximately 224 contact hours) yielded statistically significant whitening (P < 0.05) on the mandibular teeth compared with the 6.5% hydrogen peroxide strip used for 28 hours. Both tooth-whitening systems had similar sensitivity/irritation reported after instructed use. This research demonstrates that tooth whitening in teens may be safely accomplished using either the short-contact-time hydrogen peroxide bleaching strips or the overnight carbamide peroxide tray systems tested in this study.

Adolescent↗

Daily use of whitening strips on tetracycline-stained teeth: comparative results after 2 months.

This article reviews the efficacy of a new 6.5% hydrogen peroxide tooth-whitening gel strip for bleaching teeth that have been intrinsically stained from tetracycline. Given the severity of staining in the cases presented during a recently conducted clinical trial, the resulting efficacy is dramatic. Additionally, the continuous use of these strips for 30 minutes per day, twice daily for 2 months with no meaningful adverse effects is noteworthy.

Adult↗

Whitening paradigms 1 year later: introduction of a novel professional tooth-bleaching system.

The recent development of a novel "trayless" delivery system for vital bleaching shifted treatment paradigms and spurred surprising growth in tooth whitening. New research on a professional-only system (Crest Professional Whitestrips) further expands treatment options. This easy-to-use hydrogen peroxide strip system represents an effective and safe approach for increased whitening. Clinical applications are extensive, ranging from general, point-of-entry whitening to chronic use in difficult case types.

Humans↗

Effects of a Baking Soda Gum on extrinsic dental stain: results of a longitudinal 4-week assessment.

An evaluation of the effects of ARM & HAMMER DENTAL CARE The Baking Soda Gum (AHDC) on extrinsic dental stain was made in 48 subjects presenting with measurable extrinsic stain. The subjects were randomized to use either the baking soda gum or a non-baking soda placebo gum for 20 minutes twice daily after lunch and dinner while brushing once daily. The procedure of limited brushing was chosen to simulate the level of hygiene normally practiced by participants entering a clinical study. After 4 weeks, the reduction in measurable extrinsic stain in the baking soda gum group was statistically significant (P = .0044) relative to baseline. Statistical analysis of the placebo gum group revealed no significant change in extrinsic stain from baseline. The magnitude of the unadjusted longitudinal reduction in extrinsic stain in the baking soda gum group was 29.7% at 4 weeks.

Chewing Gum↗

Efficacy of baking soda-containing chewing gum in removing natural tooth stain.

A 14-week, double-blind, randomized clinical trial was conducted with 126 healthy volunteers to compare the efficacy of twice-daily use of 3 baking soda-containing chewing gums in removing natural tooth stain when used in conjunction with a program of regular oral hygiene. All 3 chewing gums significantly reduced extrinsic stain (P < .0001) and improved the whitened appearance of teeth (P < .0001) at both the 2-week interim and the final 4-week evaluations. ARM & HAMMER DENTAL CARE The Baking Soda Gum (AHDC) reduced dental stain by 70.8%, compared to reductions of 71.9% and 65.3%, after use of 2 experimental gum formulations. Whitened appearance improved by 1.73 shade tabs using AHDC gum, and up to 2.49 shade tabs with the experimental formulations. These results suggest that the use of baking soda-containing gum after meals, in conjunction with good oral hygiene, can improve both extrinsic dental staining and the whitened appearance of teeth.

Adult↗

A clinical investigation to evaluate reduction in dental stain provided by the once-daily use of a breath mint or chewing gum.

An evaluation of the effects of ARM & HAMMER DENTAL CARE The Baking Soda Gum on extrinsic dental stain was performed on 85 subjects presenting with measurable extrinsic stain. The subjects were randomized to use either the baking soda chewing gum or a breath mint placebo once daily after lunch while brushing once daily. The chewing gum was chewed for 20 minutes for each use and the breath mint was kept in the mouth until completely dissolved. The subjects were instructed to brush once daily to simulate the level of hygiene normally practiced by subjects, thereby avoiding the well-reported Hawthorne effect experienced in clinical trials instituting twice-daily brushing. Examinations postbaseline were performed after 2 and 4 weeks. The reduction in measurable extrinsic stain in the baking soda gum group vs the breath mint control was statistically significant at 2 weeks (P < .0002) and at 4 weeks (P < .0008). Statistical analysis of the data revealed a significant change in extrinsic stain from baseline for both groups. The magnitude of the unadjusted longitudinal reduction in extrinsic stain in the baking soda gum group was 51% at 4 weeks.

Chewing Gum↗

Black stain and dental caries in schoolchildren in Potenza, Italy.

This study examined the correlation between dark pigmented dental plaque (black stain) and caries. Black stain was observed in 67 of 1086 schoolchildren (from 6-12 years old). The mean DMF-T was 0.49 = 1.05 for children with black stain and 0.97 = 1.40 for children with black without black stain (p<0.05). The results suggest an association between black stain and a decreased caries experience at least in the permanent dentition. Further studies are necessary to examine the etiology and whether or not black stain can protect against caries.

Child↗