Charcoal-based mouthwashes: a literature review

Mouthwashes: Alternatives and Future Directions

This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.

Dynamicity, emerging patterns, and spatiotemporal trends of scientific production on the use of activated carbon in oral health: a scientometric study

BACKGROUND

The use of activated carbon (AC) in oral hygiene products has gained significant interest; however, its potential benefits for oral health remain uncertain. This study aimed to conduct a scientometric analysis to examine the dynamicity, emerging patterns, and trends over time in scientific production concerning the use of AC in oral health.

METHODS

The Web of Science database was searched for articles published between 2005 and 2022. Various bibliometric indicators, including the H-index, annual growth, Lotka's law, Bradford's law, and Sankey diagram, were used for data analysis. Overlay maps, timezone visualization, and three field plots were used to evaluate visualization patterns, time-temporal relationships, and trends. Information retrieval process was performed on March 11, 2023.

RESULTS

The analysis revealed that only six studies constituted the top references with the highest number of citations in recent years, with Brooks' 2017 study demonstrating the most significant increase in citation. The dual-map overlay demonstrated a close citation relationship between cluster 4 (Molecular Biology Immunology) and the areas of Environmental, Toxicology, and Nutrition. The visualization graph of publication patterns indicated the journals that accumulated the highest number of citations during the study period.

CONCLUSION

This scientometric study provides valuable insights into the use of AC in oral health and its impact on the field of dentistry. It determines the most productive journals, authors, and countries with the greatest influence. AC effectively removes pollutants and is gaining interest for use in dental effluent treatment. Thus, it may be a viable option for professionals.

Effect of Charcoal, Probiotic, and Chlorhexidine Mouthwashes on Mechanical Properties and Surface Characterization of Ceramic-Coated Nickel-Titanium Orthodontic Arch Wires: A Comparative In-Vitro Study

AIM AND OBJECTIVES

To determine the impact on the mechanical properties and surface features of ceramic-coated nickel-titanium (CC-Ni-Ti) archwires when subjected to charcoal, probiotic, and chlorhexidine mouthwashes in in vitro conditions.

MATERIALS AND METHODS

Eighty samples of 25 mm were cut from the posterior end of preformed maxillary 0.016'' CC-Ni-Ti super elastic archwires (Koden Company, USA) and distributed into four equal groups. Each group of wires was immersed in artificial saliva (Wet Mouth Mouthwash, ICPA Health Products Ltd., India) (control), charcoal mouthwash (Hello activated charcoal extra freshening mouthwash, Hello Products LLC, USA), probiotic mouthwash (Perfora, Probiotic Rinse, India), and 0.2% chlorhexidine gluconate mouthwash (Sensorange, Orange Biotech, Pvt., Ltd., India) (experimental groups) for 90 min at 37 °C. All samples were taken out of their respective solutions and washed with distilled water prior to testing. A three-point bending test was performed on 15 samples from each group using a universal testing device. During the loading and unloading of the archwires, the yield strength (YS), flexural modulus of elasticity (E), and spring back ratio (YS/E) were calculated. The remaining five wires from each group were observed under the scanning electron microscope (SEM) for surface topography evaluation.

RESULTS

The mean differences of loading YS, E, and YS/E between chlorhexidine and charcoal are 302.91 MPa, 4.28 GPa, and 0.0004, whereas unloading values are 172.32 MPa, 4.16 GPa, and 0.0003, respectively, with a statistical significance of <0.001 in terms of YS and E. The mean differences of loading YS, E, and YS/E between charcoal and probiotic are 305.36 MPa, 4.54 GPa, and 0.0005, whereas unloading values are 173.77 MPa, 3.66 GPa, and 0.0003, respectively, with a statistical significance of <0.001 in terms of YS and E. The mean differences of loading YS, E, and YS/E between chlorhexidine and probiotic are 2.45 MPa, 0.26 GPa, and 0.00007, whereas unloading values are 1.44 MPa, 0.49 GPa, and 0.0000533, respectively, with no statistical significance of >0.001 in terms of YS, E, and YS/E. Surface topography alteration was clearly appreciated in the charcoal and probiotic mouthwash groups compared to charcoal mouthwash.

CONCLUSIONS

Loading and unloading of 0.016" ceramic-coated nickel-titanium archwires showed an increase in mechanical properties except for the spring back ratio on exposure to chlorhexidine, probiotic, and charcoal mouthwashes. Chlorhexidine and probiotic mouthwashes had a higher yield strength and flexural modulus of elasticity in comparison with charcoal mouthwash and artificial saliva on 0.016" ceramic-coated nickel-titanium archwires. More corrosive changes were seen on 0.016" ceramic-coated nickel-titanium archwires when immersed in chlorhexidine, followed by probiotic and charcoal mouthwashes.

EFFECTIVENESS AND ABRASIVENESS OF ACTIVATED CHARCOAL AS A WHITENING AGENT: A SYSTEMATIC REVIEW OF IN VITRO STUDIES

INTRODUCTION

Tooth whitening is currently one of the most requested treatments to change the color of teeth. There are different types of whitening in the dental office and at home. There are also many whitening agents on the market. Nowadays, the public has shown great interest in a new natural compound: activated charcoal. It has an abrasive effect and it is included in toothpastes to whiten teeth quickly and easily.

OBJECTIVES

The main objective of the systematic review is to perform a qualitative synthesis of the available literature on the use of activated charcoal-based toothpaste for tooth whitening.

MATERIAL AND METHODS

An electronic search was carried out in PubMed, Web of Science, and Scopus databases. The search included the terms (charcoal-based OR activated charcoal OR charcoal OR soot) AND (toothpaste OR dentifrices OR bleaching OR oral hygiene OR enamel OR teeth). Inclusion criteria were articles that were published in English, that included activated charcoal toothpastes, that assessed the efficacy of activated charcoal bleaching and/or the safety of using activated charcoal toothpastes, that were conducted on humans or extracted teeth regardless of their origin and the year of publication.

RESULTS

Out of 208 articles, 11 met the inclusion criteria, the Risk of Bias of the selected studies was determined as medium-high. Regarding the whitening effect, there is a variety of results depending on the study: in some there are no significant differences between the proposed treatments and in others activated charcoal is not the most whitening agent. Regarding the abrasive effect, most studies agree that activated charcoal toothpaste has a higher abrasive potential.

CONCLUSION

Toothpastes based on activated charcoal possess a lower whitening effect than other alternatives and can be considered as less safe due to its high abrasive potential.

Effectiveness and Adverse Effects of Over-the-Counter Whitening Products on Dental Tissues

The role of bleaching agents (e.g., hydrogen peroxide) in tooth bleaching is quite well-described in a few literature studies and considered as the option choice for those desiring brighter teeth, but alternative methods have emerged to fulfill the desire of patients in a faster, easier, and cheaper way. In this context, whitening over-the-counter (OTC) products are available in several vehicles, such as toothpaste, rinses, gums, paint-on varnishes, and strips, but their effectiveness in terms of bleaching is questioned. This review aimed to describe their mode of action, whitening effectiveness, and harmful effects associated with the indiscriminate use of these products. Dentifrices usually present a combination of abrasives that can induce damage to the tooth surface without evidence of promoting real bleaching. The same was found for rinses, which might present a low pH, with an erosive potential. Charcoal has been included in the composition of these products to improve their whitening effect but there is no evidence supporting it. Regarding strips, they present hydrogen peroxide in a variety of concentrations and are the only OTC products able to promote bleaching. Despite the vehicle, an indication for the use of these products should be made after a careful individual diagnosis of the etiology of the dental staining, considering that most of them seem to be effective only in removing extrinsic stains or preventing their formation over enamel. Also, their indiscriminate use might induce damage and deleterious effects over tooth tissues or gingival tissues. The dentist should be aware of the composition and mode of action of each individual product as they change according to the composition and the vehicle used to recommend the best mode of usage. Still, there is no sound evidence that any of the described OTC products promote a better bleaching effect than the products indicated for a professional.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of novel charcoal-containing whitening toothpaste and mouthwash on color change and surface morphology of enamel

Purpose:

The aim of this in vitro study was to investigate the effectiveness of a novel charcoal-containing whitening toothpaste and a mouthwash on tooth color change and the alterations of enamel that may be induced after toothbrushing, corresponding to a 90-day period.

Materials and Methods:

Forty human canines were used, stained with coffee, and divided into four groups (n = 10) as follows: Group 1 (control) submitted to toothbrushing with deionized water, Group 2 with a regular toothpaste, Group 3 with a whitening toothpaste (1% charcoal), and Group 4 with the same whitening toothpaste in combination with a mouthwash (1% charcoal and 0.5% H₂O₂). After the treatments, ΔΕ of the teeth was evaluated using an ultraviolet/Vis spectrophotometer, whereas the changes in surface morphology were observed by means of a confocal microscope.

Results:

The whitening toothpaste increased significantly ΔΕ (40.5%) compared to the control group (P < 0.001). In addition, the tested whitening toothpaste also increased ΔΕ (17.7%) compared to the regular toothpaste (P = 0.023). The whitening toothpaste presented smoother surfaces after toothbrushing, but more heterogeneous with numerous large craters, whereas the whitening mouthwash did not influence surface morphology changes.

Conclusions:

Charcoal-containing toothpastes may enhance the whitening of the teeth, but they should be used carefully due to changes that may induce on enamel. The patients should consult a dental professional for proper use. A charcoal-containing mouthwash in combination with whitening toothpastes probably cannot offer additional whitening effect.

Investigation the effects of whitening toothpastes on color change of resin-based CAD/CAM blocks

INTRODUCTION

Some colorant foods and beverages cause undesired discoloration on dental restorations. The aim of this study was to investigate the effect of whitening kinds of toothpaste with different active ingredients on the color change of resin-based CAD/CAM blocks.

MATERIAL AND METHODS

In the study, resin-based CAD/CAM block samples sized 1.5 × 7 × 12 mm, were prepared. Then, to simulate the time-dependent color change, the samples were immersed in coffee (Nescafe Classic, Nestlé) for 14 days. After the color change values of the samples colored in coffee were measured by spectrophotometer, the samples were brushed with different types of whitening toothpastes for 4 minutes. Statistical analysis of the color change (ΔE₀₀ ) was performed using the one-way analysis of variance (ANOVA).

RESULTS

Color differences occurring on all resin-based CAD/CAM blocks immersed in coffee for 14 days exceeded the 50%:50% perceptibility threshold (PT) (ΔE₀₀ :0.8). There was no statistical significant difference between the whitening toothpastes containing activated charcoal, hydrogen peroxide (HP), blue covarine pigment, and microparticles in color improvement on resin-based CAD/CAM blocks (P > .05).

CONCLUSION

It has been verified that the discoloration on resin-based CAD/CAM blocks exhibiting color difference above the PT after coffee immersion can be reduced by utilizing toothpastes containing whiteners.

CLINICAL SIGNIFICANCE

Color changes that occur over time in resin-based CAD/CAM blocks can be a clinical problem. These color changes in the materials can be reduced below the PT level using whitening toothpastes.