In vitro comparison of natural tooth-whitening remedies and professional tooth-whitening systems

Background

An increasing number of patients are using natural homemade remedies such as strawberries, banana peels, coconut oil rinse, basil, lemon, activated charcoal, apple cider vinegar, baking soda, and turmeric to obtain whiter teeth. However, studies on these natural whitening products are limited.

Aim

To evaluate the effectiveness of different homemade tooth-whitening agents in vitro.

Materials and methods

Ninety caries-free extracted anterior and premolar teeth were collected, cleaned, and sectioned at the roots. The teeth were mounted in epoxy resin (buccal surface) and stored in 0.2 % thymol solution, and were treated with one of the following six whitening agents: baking soda, activated charcoal, lemon juice, strawberries, Colgate Optic Whitening toothpaste, and Opalescence 20 % home-bleaching system. The enamel shade in each sample was measured four times using a spectrophotometer. Baseline measurements for ΔE and (L*, a*, b*) were obtained, and the second measurement was obtained after 5 days. The third reading was obtained on the 10th day, and the fourth reading was obtained at the 4th week to measure colour stability. One-way analysis of variance and post-hoc Tukey tests were used for statistical analysis.

Results

ΔE measurements showed a significant difference on the 10th day in all groups except the lemon group (P = 0.164), while all groups showed a statistically significant difference at the 4th week. The mean colour change differed remarkably between the first and fourth readings. The highest change was observed in the lemon group (44.0 ± 2.9), closely followed by the Opalescence 20 % and Colgate Optic Whitening toothpaste groups. The lowest change was observed with strawberries (38.2 ± 4.8). ΔE showed a significant difference in all groups except the turmeric group.

Conclusion

Statistically significant differences were obtained with baking soda, activated charcoal, strawberries, lemon juice, Colgate Optic Whitening toothpaste, and Opalescence 20%. Further studies are required to evaluate the effects of these agents on surface roughness and colour stability.

Knowledge and Attitude of Dentists and Patients Toward Use and Health Safety of Dental Amalgam in Saudi Arabia

Objective  The aim of this study was to assess: (1) the perceptions of dentists in Saudi Arabia concerning the amalgam controversy, (2) their attitude toward the ethical responsibility of patient information, and (3) patients’ knowledge and attitude toward the use of dental amalgam.

Materials and Methods  A total of 1,139 dentists were sampled on convenience by electronic survey. The questionnaire contained questions about the safety of dental amalgam, use of amalgam, case selection, alternate materials, and informing their patients about risks of amalgam. Also, 425 patients were sampled on convenience and information collected on their knowledge about amalgam and its acceptance in their oral cavities.

Results  A total of 201 dentists and 425 patients participated in the study. A total of 60% of dentists and specialists declared it safe. A total of 32.4% (31) of general dental practitioners and 41% (43) specialists considered it a moral obligation to inform patients about the potential health risks associated with amalgam. Mercury toxicity was identified as the most common health hazard. About 57.3% dentists and 36.2% specialists opted for superior longevity as the principle advantage. Majority of patients (52.2%) in Saudi Arabia had no knowledge about dental amalgam. While 23.1% (98) had concern about poor color, 8.7% (30) knew it contained silver while only 7.8% (27) patients were aware of its mercury content.

Conclusion  Majority of dentists in Saudi Arabia found it safe to use amalgam while the patients had little knowledge about the possible issues with amalgam. It is recommended to improve public awareness about impact of mercury containing products on the environment.

The color differences between different thicknesses of resin veneered over amalgam

STATEMENT OF PROBLEM

Composites and compomers are popular in dental practice. However, little is known about their esthetic appearance as veneering restorative materials over amalgam restorations.

PURPOSE

This in vitro study was designed to assess the color differences of composite and compomer restorative materials, placed in thicknesses of 1 mm and 2 mm over amalgam.

MATERIAL AND METHODS

Thirty six cylindrical Teflon molds were filled with amalgam (13 mm diameter, 2 mm thickness) and stored at 37 degrees C and 100% relative humidity for 7 days. Nine veneers (for each thickness of 1 and 2 mm) were fabricated from four types of tooth-colored restorative material, Dyract AP (DYR), Compoglass F (COMP), Herculite XRV (XRV), and Vitalecense (VIT), over amalgam specimens using Teflon-split molds and following the manufacturers' instructions. A spectrophotometer was used to measure the color difference DeltaE* between the two thicknesses.

RESULTS

Color difference DeltaE* values for 1 mm thickness veneers [XRV (2.52), Comp (5.46), VIT (6.73), and DYR (6.88)] were statistically significantly higher than the 2 mm thickness [XRV (1.32), Comp (3.24), VIT (4.89), and DYR (4.83)]. Although the XRV material had the lowest DeltaE* values, no statistically significant difference was found between the two thicknesses. The color measurements at L*, a*, and b* showed most materials became darker in color at either thickness.

CONCLUSION

The thicker veneer specimens were found to be closer in color to the controls than the thinner specimens. Only XRV had color differences (DeltaE*) small enough to be considered clinically acceptable (2.52 and 1.32 at 1 mm and 2 mm, respectively).

CLINICAL IMPLICATIONS

In this in vitro study the color of XRV was affected the least when veneered on amalgam. Opaquers may be needed to be used with thinner veneers to minimize the effect of amalgam background.