Efficacy of non-hydrogen peroxide mouthrinses on tooth whitening: An in vitro study

The effect of different whitening mouthwashes and simulated tooth brushing on surface roughness and microhardness of nanohybrid resin composite: an in vitro study

BACKGROUND

This study investigated the effects of whitening mouthwashes containing active ingredients on a nanohybrid resin composite's surface roughness (Ra) and Vickers microhardness (VHN) under distinct brushing conditions.

METHODS

Fifty-four disc-shaped specimens (10 mm diameter × 2 mm thickness) were fabricated and randomly assigned to three experimental conditions (n = 18): distilled water (Control), Patent Blue V-containing mouthwash (Colgate Optic White, COW), and activated charcoal-containing mouthwash (Colgate Plax White + Charcoal, CPWC). Each group was subdivided into brushed and non-brushed subgroups (n = 9). Non-brushed specimens were immersed in 20 mL of the assigned solution at 37 °C for 6 h (T1) and 12 h (T2). Brushed specimens underwent 5 000 and 10 000 brushing cycles before immersion at T1 and T2, respectively. Surface roughness was measured using a contact profilometer, and microhardness was assessed with a Vickers hardness tester. Data were analyzed using three-way mixed ANOVA, one-way ANOVA, repeated measures ANOVA, and Bonferroni correction (α = 0.05).

RESULTS

Significant differences were observed in Ra values based on mouthwash type and brushing (p < 0.05), while VHN remained unaffected (p > 0.05). In non-brushed specimens, CPWC exhibited the highest Ra increase (31.2%, + 0.296 μm), significantly higher than Control (1.6%, + 0.015 μm, p = 0.001) and COW (5.9%, + 0.055 μm, p = 0.001). Under brushed conditions, CPWC again showed the most significant increase (33.3%,+ 0.311 μm,p = 0.012). Microhardness showed no statistically significant changes across time points or groups (p > 0.05). However, at T2, CPWC (non-brushed) presented the most significant reduction (- 3.38%, - 1.4 VHN), which was significantly lower than Control (+ 1.98%, + 0.8 VHN) and COW (+ 3.3%, + 1.3 VHN) (p = 0.001). A 5.33% increase (+ 2.1 VHN, p = 0.756) was observed in the brushed CPWC group.

CONCLUSIONS

Activated charcoal-containing whitening mouthwashes significantly increased surface roughness, particularly under brushing conditions, indicating a synergistic effect of chemical and mechanical wear. Microhardness values remained stable, suggesting the preservation of the internal structure. These findings highlight the need for cautious recommendation of charcoal-based mouthwashes for patients with resin restorations due to potential surface degradation risks.

Which Whitening Mouthwash With Different Ingredients Is More Effective on Color and Bond Strength of Enamel?

OBJECTIVE

To examine the effects of six whitening mouthwashes on tooth color and immediate bond strength to the enamel.

MATERIALS AND METHODS

Human incisors were divided into seven groups (n = 10) according to mouthwashes (R.O.C.S Black Edition White, Splat White Plus, Colgate Plax White Charcoal, Signal White Now, Listerine Advanced White, Colgate Optic White, and distilled water). After the initial color measurements, the teeth were exposed to mouthwash for 4 weeks. Then, the color measurements were repeated. Then, cylindrical composite resin blocks were immediately applied to the enamel surfaces and subjected to shear bond strength tests. Data were analyzed using Kruskal-Wallis and Bonferroni tests (α = 0.05).

RESULTS

Δ𝑏, Δ𝐿, and ΔE 00 values did not present significant differences among the groups. Significant differences among the groups were determined for Δ𝑎 and ΔWI D values (p < 0.05). R.O.C.S Black Edition White and Splat White Plus produced clinically acceptable color changes. Signal White Now, Splat White Plus, and Listerine Advanced White created acceptable whiteness changes. The mouthwashes did not statistically affect the bond strength compared to the distilled water (p > 0.05).

CONCLUSIONS

Whitening mouthwash containing blue covarine revealed more acceptable color and whitening changes. Mouthwash containing charcoal led to the lowest enamel bond strength values.

CLINICAL SIGNIFICANCE

The content of whitening mouthwashes affected the degree of tooth whitening and shear bond strength to enamel.

The effects of the use of whitening mouthwash after home bleaching on the color stability and surface hardness of enamel

BACKGROUND

To evaluate the effectiveness of whitening mouthwashes, both with and without hydrogen peroxide (HP), after at-home teeth whitening in preserving the achieved whiteness and assessing their impact on enamel surface hardness.

METHODS

One hundred extracted human premolar teeth were divided into two groups, and home bleaching agents (Philips Zoom NiteWhite 22% Carbamide Peroxide, Ultradent Opalescence PF 16% Carbamide Peroxide) were applied to the groups. The teeth subjected to home bleaching were further divided into five subgroups, and each subgroup underwent a four-week cycle of application of a coloring agent and whitening mouthwash (Colgate Optic White (COW)(%2 HP), Rocs Black Edition (Rocs) (%1 HP), SPLAT Professional Bioactive gargle white Plus (SPLAT) (Ananas sativus fruit extract containing), Listerine Advanced White (Listerine) (Pyrophsphate containing), and distilled water (DW) (control)). Color and microhardness measurements were recorded at baseline, after home bleaching, and after treatment with whitening mouthwashes.

RESULTS

Compared with those treated with Opalescence PF, the samples treated with Zoom achieved a significantly greater degree of whitening (p < 0.001). When the effects of postwhitening mouthwash were evaluated (ΔE002), Listerine presented the lowest ΔE002 value in both home bleaching groups, whereas the control group presented the highest ΔE002 value. Both home-bleaching agents caused a significant increase in the initial WID values (p < 0.05). After home-bleaching, the increased WID values (WID2) significantly decreased in all mouthwash groups following exposure to the staining and whitening mouthwash cycle (WID3) (p < 0.05). The impact of home bleaching agents on microhardness was not significantly different (p = 0.151). When we examined the impact of whitening mouthwashes on microhardness, in the Zoom group, no statistically significant difference was observed in surface hardness (p > 0.05). However, in the Opalescence PF group, only the Listerine group showed a statistically significant increase (p < 0.05).

CONCLUSIONS

Higher concentrations of carbamide peroxide provide faster and more effective whitening. Whitening mouthwash containing HP and pyrophosphate is effective in maintaining tooth whiteness after home bleaching; however, its impact on enamel microhardness depends on the formulation. Notably, only Listerine in the Opalescence PF group significantly increased surface hardness. Given the drawbacks of HP, pyrophosphate-based mouthwash may serve as a safer alternative.

Efficacy and safety of peroxide-based mouthrinse on whitening treatment: A randomized controlled clinical trial

OBJECTIVES

This randomized controlled clinical trial evaluated the efficacy and safety of peroxide-based mouthrinse on whitening treatment. The patient's satisfaction and treatment longevity were also assessed.

MATERIAL AND METHODS

Participants (N = 45) were randomly allocated to three different groups: WM (Whitening mouthrinse - 2.5% hydrogen peroxide); PM (Placebo mouthrinse - 0% hydrogen peroxide); and WG (Whitening gel - 10% carbamide peroxide). The treatment was performed twice daily for 30 s over 90 days for WM and PM and once daily for 2 h over 14 days for WG. Tooth color was evaluated with shade guides (ΔSGU) and with a spectrophotometer (ΔE00 and WID) after 14, 30, 60, 90, 120 days, and 2 years. Tooth sensitivity, gingival condition, and patient satisfaction were also evaluated.

RESULTS

WG resulted in the highest color change over time for visual (ΔSGU) and objective (ΔE00 and WID) analyses. With WM, significant visual color alteration was detected in the 60-day assessment compared with PM. After 2 years, no color rebound was observed for the treatments. A very low intensity of sensitivity was found for WM and WG. No gingival irritation was detected. All the participants were satisfied with the whitening treatment outcomes.

CONCLUSIONS

The peroxide-based mouthrinse effectively changed tooth color, with relevant effect detected after 60 days of use. However, the whitening result obtained with the conventional carbamide peroxide gel treatment was more pronounced. No relevant adverse effects were observed, and the outcomes were maintained for 2 years.

CLINICAL SIGNIFICANCE

Peroxide-based mouthrinse is an effective alternative whitening treatment, although it promotes less color change compared with the conventional at-home technique without inducing significant adverse effects. Patients should be warned about the prolonged treatment and the need for compliance.

Randomised clinical trial to compare the efficacy of dental whitening with 37.5 % Hydrogen Peroxide gel and 6 % Hydrogen Peroxide whitening strips

OBJECTIVE

to evaluate the efficacy and chromatic stability after 4weeks, in all three thirds of the central incisor of two whitening treatments: in-office 37.5 % hydrogen peroxide (HP) treatment alone, and 37.5 % in-office HP followed by use of 6 % HP whitening strips (WS).

METHODS

60 participants were randomly divided into two groups of 30. Group 1 was treated solely with in-office 37.5 % HP. Group 2 followed the same in-office 37.5 % HP protocol, followed by WS over 2 weeks. The CIELAB colour were measured before and after every treatment stage. Colour differences were quantified and compared to the perceptibility thresholds.

RESULTS

In-office 37.5 % HP treatment created a statistically significant increase in the L* coordinate and a statistically significant decrease in the a* and b* coordinates, resulting in perceptible colour changes in over 80 % of participants in all thirds of the tooth. In the group that used WS, the increase in L* and the decrease in a* and b* were maintained in the cervical and middle thirds after 4 weeks, whereas only the decrease in b* was maintained in the incisal third. In the group that did not use WS, the decrease in a* and b* was maintained in all thirds of the tooth after 4 weeks, but the increase in lightness was lost.

CONCLUSIONS

The use of WS helped maintain that increase in lightness over 4 weeks. The decrease in the a* and b* coordinates caused by the 37.5 % HP treatment persisted after 4 weeks, whether WS were used or not. All the colour changes evaluated were perceptible in over 70 % of participants.

CLINICAL SIGNIFICANCE

In-office treatment with 37.5 % HP increases lightness and decreases the quantity of yellow and red immediately but, if WS are not used, the impact on lightness is lost after 4 weeks. WS are a valid and effective treatment option in combination with in-office treatments to temporally extend the clinical treatment's whitening effect.

Evaluation of Relative Dentin Abrasivity in Whitening Toothpastes Containing Acids

INTRODUCTION AND AIMS

This study aimed to evaluate the relative dentin abrasivity of whitening toothpastes containing acids using the Radioactive Dentin Abrasivity - Profilometry Equivalent (RDA-PE).

METHODS

A total of 100 bovine dentin specimens were prepared and assigned to the following groups (n = 10): 5 hydrogen peroxide (HP) whitening toothpastes (WTH1-WTH5) with or without acid (citric acid, ethylenedinitrilotetraacetic acid disodium, and phosphoric acid), 2 whitening toothpastes with silica and containing citric or phosphoric acid (WTS1 and WTS2), one conventional toothpaste (CT), and 2 reference slurries (RS). All specimens were brushed for 4,000 or 10,000 strokes using toothbrush and toothbrushing machine. The average dentin depth was measured using a noncontact profilometery, and the RDA-PE value was calculated based on the RS. The pH of the solution, average particle size, particle content, and particle hardness were measured. The RDA-PE data were analysed using one-way analysis of variance and Tukey's test, and the effects of the 4 measured factors on RDA-PE were investigated via multiple regression analysis.

RESULTS

The RDA-PE values of the HP whitening toothpastes (mean value: 19-46) were significantly lower, whereas those of the silica whitening toothpastes (80 or 111) were similar to those of the RS after 4,000 strokes (100). The RDA-PE values of all whitening toothpastes were significantly lower than the RS values after 10,000 strokes (242). The HP whitening toothpastes were slightly acidic (pH ≤6) compared to the other solutions. The HP (2.9%-3.7%) and silica (8.9% or 9.9%) whitening toothpastes had significantly lower particle content than RS (16.6%). The particle content significantly influenced the RDA-PE values by multiple regression results.

CONCLUSIONS

The RDA-PE values of whitening toothpastes varied. The particle content in the solution was a key factor affecting the RDA-PE value.

CLINICAL RELEVANCE

Whitening toothpastes containing acids did not cause significant dentin abrasion.

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.

3D Master Toothguide Is Adequate to Subjective Shade Selection?

Background and Objectives: To study the validity and the degree of representability of the toothguide 3D Master, with 26 physically shade tabs, on the natural tooth colour on a sample of the Spanish population. Materials and Methods: Natural tooth colour was measured in a sample of 1361 Spanish participants of both genders distributed within an age range of 18 and 89 years of age. The colour coordinates were calculated and the frequency of the 26 physically shade tabs of the toothguide as well as the “intermediate shades” (without physical representation in toothguide) through the Easyshade Compact (Vita-Zahnfabrik) spectrophotometer using the 3D Master System nomenclature. The colour differences between the “intermediate shades” were calculated using the Euclidean formula (ΔEab*). The program used for the present descriptive statistical analysis of the results was SAS 9.1.3. Results: A total of 49 “intermediate shades” were registered in 816 participants (60%). The colour coordinates of the 49 ‘intermediate shades’ cover colour coordinates ranging from 0M1.5 (L* 100.0, C* 7.70, h* 112.2) to 5M2.5 (L* 56.8, C* 35.8, h* 78.5). Not all possible 3D Master System’s “intermediate shades” were registered in the population studied. 82.4% of the colour differences among the “intermediate shades” were clinically unacceptable (ΔEab* ≥ 5.5 units). Conclusions: Only 40% of the population studied presented a natural tooth colour belonging to the 3D Master Toothguide’s physical shade tabs.

Evaluation of the Effects of Mouthwash on the Morphology and Cell Viability of Osteoblast-Like Cells

This study evaluated the effects of multiple mouthwashes on the cellular viability or the morphology of preosteoblasts. Mouse calvarial osteoblast-like cells were cultured and treated with mouthwashes of (1) benzydamine hydrochloride; (2) cetylpyridinium chloride and benzalkonium chloride; (3) methyl salicylate, menthol, eucalyptol, and thymol; and (4) sodium fluoride, xylitol, and chitosan. The treatment times were 30 seconds, 90 seconds, and 270 seconds. Cell morphology was evaluated with a microscope, and the viability of the treated cells was analyzed quantitatively using a commercially available kit. The untreated control group exhibited well-stretched fibroblast-like morphology. Treatment with mouthwash resulted in morphological changes in all groups. Treatment with sodium fluoride resulted in more noticeable changes. Treatment with mouthwash for 30 seconds produced a significant decrease in cell viability. An increase in time to 90 and 270 seconds did not produce additional noticeable changes. To conclude, commercially available mouthwashes created changes in cell morphology and decreased the cell viability of osteoblast-like cells irrespective of ingredients and treatment time.

A review on natural teeth whitening

BACKGROUND

Discoloration of teeth occurs for various reasons. Common ingredients like substances from tea and coffee, as well as antibiotics like tetracycline, or food dyes, can percolate into the teeth, and, as such, these stains may persist in the porous structure of the enamel. Smoking is also contributory to dental discoloration, with toxins of tobacco smoke accumulating in a similar way. With aging, teeth tend to be discolored with accumulation of various stains in addition to the enamel gradually eroding to expose the yellow dentin.

HIGHLIGHT

This review focused on the effect of several natural ingredients with teeth-whitening properties and their daily clinical application. Metabolic dental bleaching mechanisms, as well as tooth discoloration and decay, were also reviewed. The current scientific literature (mostly from 2000 to 2020) was consolidated from manuscripts retrieved from Scopus, PubMed, ResearchGate, and Google Scholar.

CONCLUSION

Natural teeth whitening effectively lightens the natural color of teeth without eroding dental surfaces. On the other hand, commercially available whiteners containing hydrogen peroxide and carbamide peroxide, in high concentrations, can lead to deproteinization and demineralization of teeth through oxidation processes. If used extensively, these compounds may cause a number of adverse effects. Alternative natural teeth-whiteners include ingredients like lemons, strawberries, oranges, papaya, and other fruits. Such natural ingredients offer a milder and safer way of whitening teeth than whiteners containing hydrogen peroxide or carbamide peroxide.