Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study.

AIM: The aim of the present study was to assess the stain removal ability and color stability of three distinct dentifrices on artificially stained enamel surface. MATERIALS AND METHODS: This study included 75 intact, healthy premolars free of dental caries that were extracted during orthodontic therapy. The samples were allowed to dry for 6 hours after being submerged in the prepared tea solution for roughly 18 hours every day. Then this procedure was repeated for seven successive days. All samples were randomly divided into three experimental groups with 25 samples in each group. Group I: control dentifrice, group II: dentifrice containing hydrogen peroxide, group III: dentifrice containing papain and bromelain. A specially designed toothbrushing simulator was used to brush every sample in the relevant group. Using a spectrophotometer and a measurement program, color measurement was evaluated after staining process after 4 weeks and 8 weeks of teeth cleaning. Using a profilometer, the surface roughness values (Ra) were assessed. RESULTS: After 8 weeks of brushing of stained samples, the color stability was better in dentifrice containing hydrogen peroxide (1.14 ± 0.11) followed by dentifrice containing papain and bromelain (1.22 ± 0.08) and control group (1.30 ± 0.09). And after 8 weeks of brushing of stained samples, the surface roughness was more in dentifrice containing hydrogen peroxide (0.237 ± 0.02) followed by dentifrice containing papain and bromelain (0.229 ± 0.13) and control group (0.207 ± 0.05). CONCLUSION: The present study concluded that the dentifrice containing hydrogen peroxide showed a superior whitening effect on the stained enamel surface than dentifrice containing papain and bromelain and control dentifrice. CLINICAL SIGNIFICANCE: The development of various dentifrice products has been greatly aided by the increased demand for an improved esthetic appearance. Teeth's natural color and any external stains that could accumulate on the tooth surface combine to determine a tooth's color. Additionally, the use of whitening dental pastes to remove external stains has grown in favor. With the development of these whitening toothpastes, dentifrices' ability to lessen or eliminate extrinsic dental stains has increased. How to cite this article: Mishra D, Kamath DG, Alagla M, et al. Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study. J Contemp Dent Pract 2024;25(1):68-71.

Novel in-office peroxide-free tooth-whitening gels: bleaching effectiveness, enamel surface alterations, and cell viability.

To evaluate the bleaching ability, the effect on enamel surface and cytotoxicity of novel tooth-whitening formulations containing papain, ficin, or bromelain. Forty bovine dental discs (6 cm ×4 cm) were pigmentated and randomly allocated into the following groups (n = 10): Group 1, 20 wt% carbamide peroxide (control); group 2, 1% papain-based whitening; group 3, 1% ficin-based whitening; and group 4, 1% bromelain-based whitening. The whitening gels were prepared and applied on the enamel three times per day once a week, for 4 weeks. Color measurement was obtained by CIEDE2000. Enamel Knoop microhardness and roughness were evaluated. The WST-1 assay was used to evaluate the cell viability of mouse fibroblast cells (L929). Data were statistically analyzed by one-way analysis of variance (ANOVA) and Student Newman Keuls's post hoc test at α = 0.05 significance level. Bromelain, ficin-based, and carbamide peroxide bleaching gels showed a similar color change (p < 0.001). Higher enamel hardness decrease and higher enamel roughness were caused by the carbamide peroxide (p < 0.05). The experimental whitening gels did not affect cell viability. Tooth bleaching gels containing bromelain, papain, or ficin have substantial clinical potential to be used in the development of peroxide-free tooth whitening gels.

Clinical Value of Debriding Enzymes as an Adjunct to Standard Early Surgical Excision in Human Burns: A Systematic Review.

Burns are a significant public health burden worldwide. In addition to those who die, millions remain with life-threatening deformities and disabilities resulting in stigma and rejection. Surgical excision is currently the standard of care for removing necrotic tissues in burn wounds to prepare the wound bed for grafting or enhancing the healing process. However, there is a growing interest on enzymatic debridement as an adjunct therapy in burn wounds. The aim of this study was to investigate clinical trials using debriding agents for burn wound in humans in a systematic review. This was a systematic review of electronic databases including CINAHL, PubMed, Ovid Medline, Web of Science, Google Scholar, and Embase from January 1969 to February 2019. The study protocol was registered in PROSPERO registry. The following keywords were searched: "burn wounds", "enzymatic debridement", "papain", "papain-urea", "pine apple", "Bromelain", "collagenases", "Nexobrid", "Debrase", "Debridase", "Actinidia deliciosa", "Sutilains", "Debrace", "piruvat acid". Those studies fulfilling the inclusion and exclusion criteria with low score of bias based on Cochrane Bias Tool were reviewed. Sixteen investigations fulfilled our inclusion criteria to be reviewed. Six, seven, and three clinical trials on humans were found regarding collagenase, bromelain, and miscellaneous agents. Collagenase has been reported to be effective in burns below 25% of TBSA, especially in outpatients' clinics. However, Nexobrid has been shown to be effective in deep burns and decreases the percentage of graft without significant adverse effects. There was not enough evidence supporting the clinical values of Papain, Sutilains, Urea, etc. Surgical excision still remains the standard of care for burn wounds debridement. However, enzymatic debridement, especially Bromelain might help to reduce sessions for surgical debridement or area under graft as an adjunct treatment. Despite the fact, more studies with larger sample sizes and with less conflicts of interest are needed to clearly elucidate the exact role of Bromelain.

Dentin Topographic Features following Chemomechanical Caries Removal in Primary Teeth.

AIM: Study the topographic features of dentin after caries removal with a chemomechanical agent (Papacarie) compared with the conventional drilling method. STUDY DESIGN: The sample included 7 exfoliated and extracted primary teeth with carious dentin lesions, not reaching the pulp. Each tooth was sectioned longitudinally through the center of the carious lesions into two halves. The teeth were then divided into two groups according to the method of caries removal. Following caries removal, dentin topography and the cut section were examined using the scanning electron microscope. RESULTS: Papacarie produced an irregular, porous, rough and globular dentin appearance. The dentin surfaces were generally free of smear layer, visible bacteria and the dentinal tubules were opened. The dentin cut surfaces showed patent dentinal tubules with open orifices. The drilling method created a smooth and amorphous surface with a continuous smear layer occluding the dentinal tubules. Numerous bacteria were also observed. The cut dentin surfaces showed patent dentinal tubules with their orifices plugged with smear layer. CONCLUSIONS: Papacarie produced a rough and porous surface with partial or complete removal of the smear layer and opened dentinal tubules, while the drill produced a smooth surface with uniform smear layer occluding the dentinal tubules.

The use of papain gel cream and sunflower oil in promoting healing in a wound in dogs: three case reports / Uso de gel creme de papaína na cicatrização de feridas em cães: relato de três casos

Papain is a proteolytic enzyme removed from the leaves of green papaya and/or latex. This enzyme is widely known as a medicinal fruit used extensively in human medicine for the treatment of wounds of various etiologies. However, studies and reports in veterinary medicine are scarce. Another herbal drug widely used in wound healing is Sunflower oil (Helianthus annus). It has inflammatory and antimicrobial properties which stimulate the local neovascularization, promoting tissue granulation, cell migration, fibroblast proliferation, and differentiation. Three dogs were treated with infected necrosis wounds, considered large, extent, and severe, with varied etiology. All cases were treated with papain gel with the exception of one dog, which was given the sunflower oil at the end of the treatment. Papain gel shows effectiveness in the treatment of wounds especially with wound debridement and removal of necrotic tissue. In addition, the healing time was shorter when compared to the treatment with sunflower oil. Finally, the herbal drugs have a low cost and high accessibility. This study contributes to create a new research regarding the use of this drug in animal wound healing.(AU)

A papaína é uma enzima proteolítica retirada do mamão-papaia verde e/ou do látex das folhas do mamoeiro, tendo propriedades medicinais conhecidas na medicina humana para tratamento de feridas de diversas etiologias. Estudos e/ou relatos na medicina veterinária são escassos. Nesse sentido, objetivou-se descrever três casos de cães, que foram atendidos no Hospital Veterinário da Universidade Federal de Lavras, Brasil, todos com feridas infectadas, necrosadas, com etiologia variada e consideradas de grande extensão e gravidade, sendo tratados com gel de papaína. O tratamento demonstrou efetividade na recuperação das feridas, com a formação de grande quantidade de tecido de granulação, em um período menor que os tratamentos convencionais. Por se tratar de um fitoterápico, de baixo custo e alta acessibilidade, o gel de papaína pode ser utilizado no tratamento de feridas de grande extensão em cães e, assim como em humanos, parece ter um efeito benéfico no processo de cicatrização. Pesquisas devem ser conduzidas para elucidar a ação desse produto nos tecidos, bem como as diferentes concentrações a serem administradas.(AU)

Comparison of effectiveness of abrasive and enzymatic action of whitening toothpastes in removal of extrinsic stains - a clinical trial.

OBJECTIVE: To compare the effectiveness of abrasive component (perlite/calcium carbonate) and enzymatic component (papain and bromelain) of whitening toothpaste in removal of extrinsic stains. METHODS: This study is a randomized, triple blind and parallel group study in which 90 subjects aged 18-40 years were included. At baseline, stains scores were assessed by Macpherson's modification of Lobene Stain Index and subjects were randomly assigned to two groups with 45 subjects in each. Group 1 used whitening toothpaste with enzymatic action and group 2 with abrasive action. After 1 month, stain scores were assessed for the effectiveness of the two toothpastes and 2 months later to check the stain prevention efficacy. Wilcoxson's test was used to compare between baseline 1 and 2 months stain scores, and Mann-Witney U-test was applied for intragroup comparison. RESULTS: The mean baseline total stain score for the subjects allocated to the enzymatic toothpaste was 37.24 ± 2.11 which reduced to 30.77 ± 2.48 in 1 month, and for the abrasive paste, total stain reduced from 35.08 ± 2.96 to 32.89 ± 1.95. The reductions in total stain scores with both the pastes were significant compared with baseline stain scores (at 1 month Group 1, P = 0.0233 and Group 2, P = 0.0324; at 2 months, Group 1 P = 0.0356). Both the toothpastes proved to be equally good in removal of extrinsic stains; however, the enzymatic paste showed better results as compared to abrasive toothpaste. CONCLUSION: Whitening toothpaste with abrasive action and enzymatic action are equally effective in removal of extrinsic stains; however, whitening toothpaste with abrasive action needs to be used with caution.

Chemomechanical caries removal in primary molars : evaluation of marginal leakage and shear bond strength in bonded restorations--an in vitro study.

OBJECTIVES: To evaluate and compare the efficiency, marginal leakage and shear bond strength of Carisolv and Papacarie in primary molars. METHOD: Freshly extracted 60 human carious primary molars were randomly divided into two experimental groups--Group I [caries removal by Carisolv] and Group II [caries removal by Papacarie]. The amount of time taken for complete caries removal was recorded using a stopwatch. After bonded restorations, both the experimental groups were further randomly subdivided into four experimental groups and subjected to marginal leakage and shear bond strength evaluation. RESULTS: Papacarie [337.67 +/- 18.13] was clinically more efficient than Carisolv [461.33 +/- 27.76] in removing caries with respect to time in seconds. 66.7% of teeth treated with Carisolv did not show any marginal leakage as compared to 20% with Papacarie. The mean [ +/- SD] shear bond strength of Carisolv [9.67 +/- 3.80] treated teeth was slightly more when compared to Papacarie [8.36 +/- 4.51]. CONCLUSION: Papacarie was clinically more efficient in caries removal but showed significantly more marginal leakage than Carisolv.

Stain removal efficacy of a novel dentifrice containing papain and Bromelain extracts--an in vitro study.

OBJECTIVE: To assess the in vitro stain removal efficacy of a novel commercially available dentifrice. MATERIALS AND METHODS: Twenty four human molar teeth (12 in test and 12 in control group) were cut to obtain enamel specimens approximately 9 mm(2) and placed on a microscopic slide using mounting adhesive. They were cycled in human saliva, staining model and dried for brushing regimen using a customized brushing apparatus. Lightness values were recorded at baseline, after staining and after brushing regimen using Adobe Photoshop software. Stain removal efficacy was tested using the either of the two dentifrice slurries for 2 one minute brushing cycles. RESULTS: The mean lightness increment for test and control after brushing regimen was 13.7 ± 6.35 and 3.16 ± 1.29 respectively. There was statistically significant difference in percentage removal of stains for test and control groups (66.99 ± 9.57 and 25.89 ± 16.2 P < 0.001). CONCLUSION: There was significant stain removal with new whitening dentifrice when compared with control. Further clinical trials are recommended to evaluate this significant difference.

Digestive enzyme supplementation for autism spectrum disorders: a double-blind randomized controlled trial.

To examine the effects of a digestive enzyme supplement in improving expressive language, behaviour and other symptoms in children with Autism Spectrum Disorder. Randomized, double-blind placebo-controlled trial using crossover design over 6 months for 43 children, aged 3-8 years. Outcome measurement tools included monthly Global Behaviour Rating Scales, Additional Rating Scales of other symptoms by parents and therapists, and monthly completion of the Rescorla Language Development Survey. Compared with placebo, treatment with enzyme was not associated with clinically significant improvement in behaviour, food variety, gastrointestinal symptoms, sleep quality, engagement with therapist, or the Language Development Survey Vocabulary or Sentence Complexity Scores. A small statistically significant improvement on enzyme therapy was seen for the food variety scores. No clinically significant effect improvement of autism symptoms with enzyme use was shown with this trial, however, possible effects on improvement in food variety warrants further detailed investigation.

Enzymes, trophoblasts, and cancer: the afterlife of an idea (1924-2008).

In the early 20th century, advocacy of the enzyme therapy of cancer was primarily the work of one man, John Beard, DSc (1858-1924). He and his collaborators made a determined effort to establish this mode of therapy, especially in the years 1905 to 1911. Despite a brief flowering of international interest, Beard's efforts came to naught. During the 20th century, there was a succession of American researchers who continued to investigate this topic. This included Marshall William McDuffie, MD (1882-1945), Frank LeForest Morse, MD (1876-1953), Franklin Lloyd Shively, MD (1887-1971), and William Donald Kelley (1926-2005). In central Europe, India, and other parts of the globe, the use of pancreatic enzymes as an adjuvant treatment for cancer has become a fairly routine practice, at least among those doctors who utilize complementary and alternative medicine (CAM). It is also a well-established method for reducing inflammation and mitigating the adverse effects of cytotoxic treatment.

Antitumor effects in vitro and in vivo and mechanisms of protection against melanoma B16F10-Nex2 cells by fastuosain, a cysteine proteinase from Bromelia fastuosa.

In the present work, the antitumor effect of fastuosain, a cysteine proteinase from Bromelia fastuosa, was investigated. In the intravenous model of lung colonization in C57Bl/6 mice, fastuosain and bromelain injected intraperitoneally were protective, and very few nodules of B16F10-Nex2 melanoma cells were detected. Tumor cells treated with fastuosain showed reduced expression of CD44 and decreased invasion through Matrigel, lost their cytoplasmic extensions and substrate adherence, and became round and detached, forming strongly bound cell clusters in suspension. Peritoneal cells recruited and activated by fastuosain treatment (mainly monocytic cells and lymphocytes) migrated to the lung, where pulmonary melanoma metastases grew. Adoptive transference of peritoneal cells recruited by fastuosain had no protective effect against lung metastases in recipient mice. Treatment of green fluorescent protein-chimeric animals with fastuosain did not change the number of cells that migrated to the lung, compared to PBS-injected control mice, but the number of positive major histocompatibility complex class II cells increased with fastuosain treatment. Murine antibodies against fastuosain, bromelain, and cathepsins B and L cross-reacted in ELISA and recognized surface and cytoplasmic components expressed on B16F10-Nex2 cells. Anti-fastuosain antibodies were cytotoxic/lytic to B16F10-Nex2 cells. Antitumor effects of fastuosain involve mainly the direct effect of the enzyme and elicitation of protective antibodies.

O enfermeiro frente ao paciente com lesão neuropática: relato de experiência / The Nurse in face to the patient with naturopathic injury: experience report

Este estudo avaliou a evolução do tratamento de um paciente diabético com Neuropatia, relatou os efeitos do uso da papaína e do Àcido Graxo Essencial (AGE) na aceleração do processo de cicatrização. Quanto ao tipo de estudo, pode-se dizer que trata-se do estudo de um caso, qualitativo. Apesar da amostra estudada não ser significativa, observou-se uma ótima melhora da ferida com estes produtos e que a papaína e o AGE são valiosos recursos terapêuticos no tratamento de lesões. Este trabalho nos possibilitou realizar uma avaliação da ferida, que contribuiu para a realização das intervenções e a escolha do produto apropriado.

Nontraditional wound care: A review of the evidence for the use of sugar, papaya/papain, and fatty acids.

With global travel and immigration, WOC nurses may see or be asked questions about wound care practices that are different from those traditionally taught in their educational programs. The purpose of this article is to review the evidence about 3 commonly used wound products, namely, sugar, papaya/papain, and essential fatty acids. Although these products are used in numerous countries, their application in Brazil will provide the examples of use in this article. Nontraditional wound care is still frequently practiced even in countries where access to evidence-based products is fairly good. Research studies about sugar, papain/papaya, and essential fatty acids generally are case reports/studies and descriptive. Protocols in the use of the products varied. Use of these products is often based on tradition and economics. WOC nurses need to be knowledgeable regarding nonstandard wound care products and procedures so they can respond appropriately in situations where these products are used.

Box jellyfish (Carybdea alata) in Waikiki. The analgesic effect of sting-aid, Adolph's meat tenderizer and fresh water on their stings: a double-blinded, randomized, placebo-controlled clinical trial.

The study measured the analgesic effects of three popular Hawaii remedies for stings from the box jellyfish, Carybdea alata. Analysis of data showed that aerosol sprays of Sting-Aid (an aluminum sulfate solution), Aldolph's meat tenderizer dissolved in water, and fresh water neither increased nor decreased the pain of box jellyfish stings more than the control (seawater).

Impact of complementary oral enzyme application on the postoperative treatment results of breast cancer patients--results of an epidemiological multicentre retrolective cohort study.

PURPOSE: [corrected] To evaluate the impact of postoperative treatment with an oral enzyme (OE) preparation given complementary to an antineoplastic therapy in patients with breast cancer. METHODS: The design of this epidemiological study was a retrolective cohort analysis with parallel groups. Design and conduct of the study were performed to current standards for prospective, controlled clinical trials. A cohort of 2,339 breast cancer patients undergoing surgical intervention and radio-, chemo- or hormonal therapy were studied in 216 centres. Of the 2,339 patients, 1,283 received complementary treatment with OE and 1,056 did not receive OE. Patients with other complementary medications were excluded and the final analysis was performed with the data from 649 patients, of whom 239 (37%) were additionally treated with OE (test group) and 410 (63%) without OE (control group). The median follow-up time for the test group was 485 days and for the control group 213 days. The primary endpoint of the study was to determine whether complementary treatment with OE can reduce typical disease- or therapy-associated signs and symptoms (gastrointestinal symptoms, mental symptoms, dyspnoea, headache, tumour pain, cachexia, skin disorders, infections, and side effects associated with the antineoplastic therapy) in patients with breast cancer. Imbalances for causal effects (covariates) were adjusted for by means of the propensity score. Outcome analysis was performed by estimating the linear regression between change in symptom score and propensity score with all data and using this regression line to calculate the change in symptom score which would be expected for each patient. Tumour-associated events (recurrence, metastasis, and death) were evaluated in terms of the number of events observed and time to event. The safety of treatment with OE was analysed in terms of the number and severity of adverse events, their duration, treatment and outcome. RESULTS: For all symptoms except tumour pain, the adjusted mean improvement in symptom scores was larger in the test group than in the control group. The adjusted difference was statistically significant for all symptoms, except tumour pain and infections. The results show that the typical disease- and therapy-associated signs and symptoms in patients on complementary therapy with OE during postoperative treatment were significantly less. For 75% of the test group and 55% of the control group the physician recorded "no signs and symptoms". A clear reduction in the side effects of radiotherapy and chemotherapy was documented in 74% of the test group and 55% of the control group. Analysis of survival, recurrence, and metastasis demonstrated a reduced number of events in the test group. There was evidence of a beneficial influence of OE on time to event, although the median observation time was too short in these breast cancer patients to draw definite conclusions. The safety component was judged in 98% of the test group and 76% of the control group as "very good" or "good". In the total sample of 2,339 patients, the rate of OE-associated adverse reactions was 3.2%. All side effects were mild to moderate gastrointestinal symptoms. CONCLUSION: Complementary treatment of breast cancer patients with OE improves the quality of life by reducing signs and symptoms of the disease and the side effects of adjuvant antineoplastic therapies. This epidemiological retrolective cohort analysis provides evidence that the patients may also gain benefit by a prolongation of the time to event for cancer recurrence, metastasis and survival. OE was generally well tolerated.

[The effect of the preparation Wobe-Mugos E on the functional and biochemical status of the kidneys in the polyuric stage of sublimate-induced nephropathy]. / Vplyv preparatu Wobe-Mugos E na funktsional'nyi ta biokhimichnyi stan nyrok u poliurychnu stadiiu sulemovoï nefropatiï.

The protective effect of Wobe-Mugos appliance on the kidney function and biochemical state in polyuric stage of sublimate nephropathia at the moment of tubulointerstitial component formation was revealed in experiments on 40 white male rats. It appeared in the increase of hydrogenous ion excretion, titred acids, renal tissue fibrinolytic and proteolytic activity. The succinatdehydrogenase activation in renal cortex matter pointed out on the improvement of energy balance.

Double-blind pilot-study on the efficacy of enzyme therapy in advanced colorectal cancer.

All tested variables showed a tendency in favor for Wobe-Mugos E therapy as addition to standard therapy. Enzymes improve the quality of life by reducing cancer disease typical symptoms, they reduce side effects of chemo-/radiotherapy and they have a potential of prolonging life (preliminary data only).

[Systemic enzymotherapy as a method of prophylaxis of postradiation complications in oncological patients]. / Systemna enzymoterapiia iak metod profilaktyky promenevykh uskladnen' u khvorykh na onkolohichni zakhvoriuvannia.

Set out in the paper are results of treatment of those patients with carcinoma of the lung, uterine cervix, hysterocarcinoma, breast cancer, malignant thymomas, malignant non-Hodgkin's lymphomas, and lymphogranulematosis having been administered combined, chemoradiation or radiation treatments against the background of a complex of accompanying therapy involving systemic enzymotherapy. Polyenzymic drugs were found to be capable of improving results of treatment of acute radiation reactions and preventing postradiation fibrous changes in the lungs, skin, fatty tissue, soft tissue, liver, kidneys. Thus, systemic enzymotherapy is capable of improving the quality of life and results of treatment of oncological patients.

Generalized drug reaction due to papaya juice in throat lozenges.

We report the case of a 55-year-old woman without a history of atopic disease or drug allergy who developed a maculopapular symmetric exanthematous rash about 2 days after taking throat lozenges containing papaya juice. Patch tests gave negative reactions to the European standard series but were positive for papaya juice. A solution of 1% papain in water showed a weak and probably irritant reaction, while a 0.1% solution was negative. To our knowledge this is the first case report of systemic contact dermatitis to papaya without papain hypersensitivity.