Whitening Dentifrices Effect on Enamel with Orthodontic Braces after Simulated Brushing

Effect of Different Desensitizer Treatments on the Shear Bond Strength of Orthodontic Metal Brackets Following In-Office Bleaching: An In Vitro Study

OBJECTIVE

 One of the adverse effects of in-office bleaching is tooth hypersensitivity, which could be neutralized with a desensitizing agent. In-office bleaching and the application of desensitizing agents will affect the morphology of the enamel surface. These morphological changes have potential effects on the shear bond strength (SBS) and bonding of orthodontic brackets. This study analyzed the effects of fluoride and nonfluoride desensitizing agents after in-office bleaching on the SBS of metal brackets with resin composite cementation.

MATERIALS AND METHODS

 Twenty-seven postextraction premolars (n = 27) were bleached with 37% hydrogen peroxide and then divided into three groups: control group (group 1), fluoride-based desensitizing agent (group 2), and nonfluoride-based desensitizing agent (group 3). After treatment, the brackets were bonded using Transbond, and then the SBS test was performed using a universal testing machine. The adhesive remnant index (ARI) was analyzed after the SBS test, whereas enamel morphological changes were observed under a scanning electron microscope. After this assessment, energy-dispersive X-ray spectroscopy was conducted to determine calcium and phosphorus elements in the enamel surface after treatments. SBS data were analyzed using the one-way analysis of variance, followed by the Tukey test, whereas ARI scores were subjected to the Kruskal-Wallis test and the Mann-Whitney test with a significance level of 5%.

RESULTS

 The SBS increased significantly in group 2 compared with groups 1 and 3 (p < 0.05). In group 2, an ARI of 2 (55.56%) was frequent, whereas in group 3, an ARI of 3 (55.56%) appeared most frequently.

CONCLUSION

 The application of the desensitizing agent fluoride after in-office bleaching increased the SBS and more adhesive remains on the tooth surface compared with that when nonfluoride desensitizing agents were applied on metal brackets with composite resin cementation.

Comparative Evaluation of the Effect of Different Types of Bleaching Dentifrices on Shear Bond Strength of Orthodontic Metal Brackets Bonded by Conventional Composite to Human Teeth: An In Vitro Study

AIM

This study aims to evaluate and compare the effect of different types of bleaching dentifrices on the shear bond strength of orthodontic metal brackets bonded by light-cured composite adhesive to human teeth.

MATERIALS AND METHODS

Forty-five human premolar teeth were randomly divided into three groups, receiving the following treatments: Group 1 (control group; teeth in this group were not bleached), Group 2 (teeth in this group were treated with active oxygen bleaching dentifrice), and Group 3 (teeth in this group were treated with peroxide bleaching dentifrice). Orthodontic brackets were bonded using a light-cured composite adhesive. A universal measuring device was used to assess the shear bond strength with a crosshead speed of 0.5 mm/min. One-way ANOVA, post hoc Tukey tests, and an independent t-test were used to analyse the data.

RESULTS

There was a highly significant difference (p≤0.001) in the mean shear bond strength of orthodontic brackets bonded to untreated teeth as compared to teeth treated with bleaching dentifrice. There was no significant difference in the mean shear bond strength of orthodontic brackets bonded to teeth treated with peroxide bleaching dentifrice or active oxygen bleaching dentifrice.

CONCLUSION

There was a significant reduction in the mean shear bond strength of orthodontic metal brackets when bonded to human teeth treated with bleaching dentifrices.

Over-the-counter products in tooth bleaching: A scoping review

OBJECTIVE

To map and summarize the current scientific evidence concerning the active ingredients, effectiveness, and adverse effects of over-the-counter (OTC) bleaching products.

DATA AND SOURCE

This study was conducted according to the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform.

STUDY SELECTION

Database searches were conducted in PubMed/MEDLINE, Embase, and Scopus up to January 2024. All in vitro, in situ, and clinical studies evaluating the effectiveness and adverse effects of OTC bleaching products were included. A descriptive analysis of the included studies was performed.

RESULTS

A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28). The main OTC bleaching products identified were whitening or stain-removing toothpastes (n = 42), followed by whitening strips (n = 39). Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies. The main adverse effects associated with OTC bleaching agents were tooth sensitivity and gingival irritation.

CONCLUSION

A wide variety of OTC bleaching products is available for consumer self-administered use. Clinical studies have mainly confirmed the bleaching effectiveness of whitening strips, while the validation for toothpastes, mouth rinses and whitening trays has mainly relied on in vitro studies. Nevertheless, the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes.

CLINICAL SIGNIFICANCE

Some over-the-counter bleaching products may have whitening properties supported by clinical studies, particularly those containing hydrogen or carbamide peroxide. Nonetheless, clinicians must be aware of the potential risks associated with excessive self-administration of these products, which may result in adverse effects.

Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review

Aim

To summarize and analyze all the available literature on the use of over-the-counter toothpaste and mouthwashes with whitening agents and their possible effects on orthodontic treatment.

Background

Tooth color change frequently occurs during orthodontic treatment and represents a self-perceived need. According to the patient's perspective, there is a preference for the use of toothpaste and mouthwashes with some whitening effect.

Materials and methods

An electronic bibliographic search in English was carried out until June 2022, in PubMed, Scopus, and Web of Science databases. Randomized or nonrandomized clinical trials and experimental laboratory studies were included.

Review results

A total of 57 papers were obtained from an electronic search and 11 studies were included in the review. Outcomes such as strength force elastomeric, color stability, frictional resistance, ion release, shear bond strength (SBS), and adhesive remnant index (ARI) were evaluated.

Conclusion

Toothpaste and mouthwashes with whitening action did not have a favorable effect on most of the outcomes evaluated. In some cases regular toothpaste showed a better effect and in other cases, there were no differences with the control group. Only in the outcome release of ions from wires to whitening effect in teeth with or without attached brackets, they have a better performance.

Clinical significance

Due to the unfavorable effects of over-the-counter whitening toothpaste and mouthwashes on orthodontic materials and appliances, their use should be justified during treatment.

How to cite this article

Chinchay-Ruesta S, Ortiz-Pizarro M, Rodríguez-Díaz DR, et al. Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review. Int J Clin Pediatr Dent 2023;16(S-3):S311-S316.

Which whitening toothpaste with different contents is more effective on color and bond strength of enamel?

OBJECTIVE

To evaluate the effects of six whitening toothpastes with different whitening ingredients as follows: abrasives, polyphosphates, activated charcoal and hydrogen peroxide on the color, and shear bond strength (SBS) of enamel.

MATERIALS AND METHODS

Thirty-five extracted human molars were sectioned in mesiodistal direction, providing 70 enamel specimens and randomly divided into seven groups having different whitening ingredients (n = 10). After baseline color measurements, the specimens were brushed three times daily for the 30 s. At the end of 2 weeks, spectrophotometric readings were repeated, and color change parameters were calculated. Then, composite cylinders were built on the enamel surfaces and the specimens were subjected to SBS test. Failure modes were determined under a stereomicroscope (×10). One specimen from each group was examined with scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis, Wilcoxon signed, one-way-ANOVA (p = 0.05).

RESULTS

Clinically acceptable color change was observed in all whitening toothpastes. There were no significant differences among the groups for Δa, ΔL, ΔE₀₀ , and ΔWI_D (p > 0.05). The differences among the groups were not significant regarding SBS and failure mode distributions (p > 0.05). SEM findings were in line with the SBS test and failure mode distribution results.

CONCLUSIONS

All the tested whitening toothpastes showed similar and clinically acceptable efficacy on the color change of the enamel and led to comparable SBS values.

CLINICAL SIGNIFICANCE

The tested whitening toothpastes had an acceptable whitening efficacy and did not have a negative effect on the bond strength to the enamel.

Does the application of whitening dentifrices during at-home bleaching affect the bond strength of resin composite to dentin?

AIM

This study aimed to evaluate the effect of using whitening dentifrices during at-home bleaching on the shear bond strength (SBS) of resin composite to dentin, and investigate whether the increased polymerization time would improve SBS.

METHODS

Ninety-six bovine incisors were divided into 4 groups of 24, according to the whitening treatment applied as follows: group 1, at-home bleaching + brushing with a regular dentifrice; group 2, at-home bleaching + brushing with a whitening dentifrice containing ozone; group 3, at-home bleaching + brushing with a commercial whitening dentifrice; and group 4 (control), no whitening/brushing treatment. Each group was divided into two subgroups (n = 12) to assess the effect of curing time (20 versus 80 s) on SBS. A self-etch adhesive was bonded to dentin, and after 2-day water storage, SBS was determined.

RESULTS

SBS was significantly affected by the whitening treatment (P = 0.03), but increasing the curing time had no significant effect on SBS (P = 0.137). Bond strength in group 1 was comparable to the control group (P > 0.05). The specimens in group 3 displayed significantly lower SBS than either group 4 or group 1 (P > 0.05). No significant difference was observed between the SBS of group 2 compared to any other group (P > 0.05). There was no significant association between the treatment group and failure type (P > 0.05).

CONCLUSION

The bonding interface was not negatively influenced by the at-home bleaching procedure. However, using a commercial whitening dentifrice during at-home bleaching produced a significant detrimental effect on SBS. Extending the curing time would have no beneficial effect on adhesion to a whitened dental substrate.

Charcoal-based dentifrices and powders: analyses of product labels, Instagram engagement, and altmetrics

This study identified charcoal-based dentifrices and abrasive powders sold in Brazil and analyzed their label information. The products were searched in four online shopping platforms. The same products were searched on Instagram and their engagement metrics were investigated. Furthermore, a literature review of international publications assessing charcoal dentifrices and powders was conducted, and altmetrics were collected (Altmetric and PlumX). Thirty-six products were found with prices between $0.4-22 USD. Most frequent words in product description were sodium, stain, whitening, oil, xylitol, and coconut. Only 3 products contained fluoride. Bactericidal, antiviral, antifungal, and anti-inflammatory activities were indicated, in addition to non-scientific claims such as calming teeth or increasing oral immunity. In total, 72% of products had Instagram profiles, which generally showed low engagement rates (81%) and medium audience quality scores (65%). Twenty-two articles were found in the literature, from which 21 were in vitro studies. The single clinical study was sponsored by a charcoal product and had no control group. In total, 23% of studies showed positive results and 55% reported negative results for the charcoal products, which included no whitening ability, increased roughness, surface alterations, and lower demineralization prevention ability. Altmetric scores for the included articles varied from 0 to 55, with 40.9% of studies mentioned online. In conclusion, charcoal-based products are using marketing strategies on Instagram but their current engagement with the public is not high. Consumers are being exposed to charcoal products whose potential risks to health are still unknown.

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.

Influence of topical fluoride on shear bond strength of orthodontic brackets and enamel white spot lesions formation

Abstract Introduction Fluoride is considered a key element in the remineralization process of tooth enamel. Objective To evaluate the influence of a topical solution of sodium fluoride (NaF) on the shear bond strength of orthodontic brackets and white spot lesions formation. Material and method Sixty bovine teeth were divided into three groups (n=20). Group 1 (Control): shear bond strength; Group 2: shear bond strength after pH cycling; Group 3: shear bond strength after pH cycling and treatment with 0.04% NaF solution. Groups 2 and 3 underwent pH cycling with demineralizing (6hs) and remineralizing (17hs) solutions at pH of 4.3 and 7.0 respectively for 15 days. The specimens were submitted to the shear bond strength and the Adhesive Remnant Index was verified (ARI). The specimens of each group (n=3) were qualitatively analyzed by means of Scanning Electron Microscopy (SEM). Kruskal-Wallis test assessed the shear bond strength and Fisher's exact test evaluated ARI, with significance level of 5%. Result There was no significant difference among the three groups in shear bond strength (p=0.2679). Significant difference was found in ARI (p=0.0199). The frequency of ARI 1 was 55% in group 1, 90% in group 2, and 80% in group 3. SEM showed difference between the enamel and bonding. Group 2 showed structural change of the enamel surface, adjacent to the bond area; and group 3 showed enamel with characteristics similar to those of group 1. Conclusion It was concluded that there was no NaF influence on the bracket shear bond strength and even in low concentrations it prevented the development of areas of demineralization of white spot lesions.