Stain removal efficacy of two manual toothbrushes.

PURPOSE: To evaluate the dental stain removal efficacy of two commercially-available manual toothbrushes. METHODS: This was a randomized, examiner-blind, parallel-group, two treatment clinical trial of 2 weeks duration. Subjects qualifying for the study had a mean Modified Lobene Stain Index of ≥ 1.5 on at least two anterior teeth. Subjects were randomly allocated to one of two groups, receiving a test manual toothbrush (Oral-B 3D White Radiant) or a positive control (PC) manual brush to be used for 1 minute, twice daily for 2 weeks with a standard, anti-cavity fluoride dentifrice. Subjects were given written and verbal instructions, and the first use was supervised at the baseline visit. Stain was measured at baseline and after 2 weeks of product use. Stain measurements were conducted using the Modified Lobene Stain Index (MLSI) and the Interproximal Modified Lobene Stain Index (IMLSI). RESULTS: Use of the two manual brushes resulted in statistically significant reductions of surface stain relative to baseline after 2 weeks of use. The mean MLSI composite stain reductions versus baseline were 1.37 for White Radiant and 0.87 for PC (P < 0.001 for both). Using the IMLSI, the mean stain reductions for composite, gingival and interproximal regions were 1.68, 1.20 and 1.68 for White Radiant (P < 0.001) and 1.25, 0.97 and 1.43 for PC (P ≤ 0.002). ANCOVA yielded statistically significant between group differences, with greater composite stain removal observed for White Radiant using both indices (P ≤ 0.025).

A Randomized Clinical Study Investigating the Stain-Removal Potential of Two Experimental Dentifrices.

OBJECTIVE: To evaluate the ability of two experimental desensitizing dentifrices, both containing a chemical cleaning agent, one with ultra-low abrasivity and one with low abrasivity, a standard fluoride dentifrice, and a daily-use whitening dentifrice to remove extrinsic tooth stain. METHODS: This was a single-center, examiner-blind, randomized, controlled, four-treatment, parallel-group study in healthy adults. Extrinsic stain was evaluated using the Macpherson modification of the Lobene Stain Index (MLSI). At baseline, eligible subjects with a total MLSI (area x intensity [A x I]) score of 15 for the facial surfaces of the 12 anterior teeth were stratified (based on total MLSI [A x I] score [< 45 = low; ≥ 45 = high] and smoking status) and randomized to treatment with one of four dentifrices: an experimental ultra-low abrasivity desensitizing dentifrice (relative dentin abrasion [RDA] -12); an experimental low abrasivity desensitizing dentifrice (RDA -40); a standard fluoride dentifrice with moderate abrasivity (RDA -80); and a whitening dentifrice with higher abrasivity (RDA -142). Both desensitizing dentifrices contained 5% potassium nitrate and 5% sodium tripolyphosphate (a chemical cleaning agent). Treatment effects were evaluated after four and eight weeks of twice-daily brushing. RESULTS: In total, 142 subjects were randomized and 133 subjects completed the study. All study dentifrices demonstrated statistically significant reductions in extrinsic tooth stain from baseline after four and eight weeks of twice-daily use (p < 0.01). There were no statistically significant between-treatment differences for the primary variable (mean MLSI [A x I] score across all assessed sites) at four or eight weeks, and no notable trends were observed. CONCLUSION: All study dentifrices reduced extrinsic tooth stain. The experimental ultra-low and low abrasivity desensitizing dentifrices containing 5% sodium tripolyphosphate performed similarly to both a moderate abrasivity standard fluoride dentifrice and a higher abrasivity whitening dentifrice.

Salivary parameters and caries indices in children with black tooth stains.

OBJECTIVE: Black tooth stain in children has been associated commonly with a low caries experience. The present study aimed to to compare salivary factors and caries indices in children with and without black tooth stain and to investigate the relationship between caries and caries associated salivary factors in these children. STUDY DESIGN: Salivary flow rate, pH, buffering capacity, total calcium and phosphorus were determined. Calcium and phosphorus levels were assayed by Inductive Coupled Plasma with Atomic Emission Spectrometry. DMFT and dft indices were evaluated according to WHO criteria. RESULTS: Significantly higher levels of salivary buffering capacity and calcium, and lower flow rate were found in children with black tooth stain compared with those of without black tooth stain (p < 0.01, p = 0.044 and p = 0.037, respectively). The differences in phosphorus and pH were not significant between the groups. The dft index was found to be significantly lower in children with black tooth stain than children without black tooth stain (p = 0.030). However, DMFT did not change between the groups. There is no relationship between salivary parameters and caries indices in children with black tooth stain. CONCLUSION: It is suggested that low caries tendency seen in children with black tooth stain may be associated with high salivary calcium and buffering capacity.

Effect on dental stain occurrence by chewing gum containing sodium tripolyphosphate--a double-blind six-week trial.

OBJECTIVE: A six-week controlled double-blind clinical study was conducted to assess and to measure the efficacy of a sugar-free chewing gum containing sodium tripolyphosphate (1%) on dental stain occurrence versus a placebo sugar-free chewing gum. METHODS: One-hundred and eleven subjects who had a Lobene Modified Index for stain extent score between 0.33 and 1.5 in their frontal teeth joined this study. Each subject entered in the test or the control group using a random table which allowed for an equal distribution of smokers and habitual tea users. Participants agreed to chew two gums (two grams each) three times per day, after meals, for ten minutes over six weeks. All received the same dentifrice containing only fluoride as the active agent. After six weeks, participants were scored for dental stain with the Lobene Modified Index. Data were scored by the same blinded operator for all measurements. Comparisons between the groups with respect to baseline scores were performed using an unpaired t-test, and inside the groups with a paired t-test (alpha = 0.05). RESULTS: One-hundred and eight subjects completed the trial; three left, but none reported problems linked to sodium tripolyphosphate. The mean difference for stain extent index after the six-week trial was 0.04 (+/- 0.08) in the control group, and -0.05 (+/- 0.08) in the test group (p < 0.001). A statistically significant reduction was also reported for intensity and composite indexes. The initial mean for stain extent index in the test group was 0.8 (+/- 0.34), and at six weeks was 0.74 (+/- 0.33; p < 0.001). The initial mean for extent index in the control group was 0.78 (+/- 0.3), and at six weeks was 0.81 (+/- 0.32; p < 0.005). CONCLUSION: This trial showed a reduction in dental stain by a chewing gum containing sodium tripolyphosphate after six weeks.

Practice implications with an alcohol-free, 0.07% cetylpyridinium chloride mouthrinse.

PURPOSE: Behavioral research was conducted to ascertain the relevance of an alcohol-free, 0.07% cetylpyridinium chloride (CPC) therapeutic mouthrinse to contemporary dental practice over a 6-month usage period. METHODS: A randomized, single-blind study was conducted to assess practice-relevant compliance, acceptability and side effects associated with two mouthrinses. The target population was healthy adult mouthrinse users with a history of routine dental prophylaxis and maintenance care. Subjects were randomly assigned to a therapeutic mouthrinse with 0.07% CPC (Crest Pro-Health Rinse) or a cosmetic rinse control (Scope). Other oral hygiene was not standardized. Subjects completed a questionnaire and were examined by dental hygienists at baseline, and again after 3 and 6 months rinsing. At study completion, a dental prophylaxis was administered. RESULTS: Compliance was generally favorable, with 273 subjects (89%) completing the 6-month rinsing study. Rinsing time generally stayed the same or increased relative to baseline. Groups differed among the subset who historically used an essential oils rinse (N=137), where those assigned to the alcohol-free therapeutic rinse exhibited significantly (P= 0.02) longer rinsing times compared to subjects using the alcohol-containing cosmetic rinse. Subject evaluations were generally positive with respect to both rinses. Side effects were minimal, with no between-group differences in hygienist-rated calculus or stain accumulation, or prophylaxis time. CLINICAL SIGNIFICANCE: In a 6-month study, a high bioavailable 0.07% CPC therapeutic mouthrinse showed generally high compliance and favorable user acceptability, with similar side effects to those seen with a cosmetic mouthrinse. These findings suggest that the 0.07% CPC mouthrinse may be readily incorporated within the contemporary recall dental practice.

The effect of a calcium carbonate/perlite toothpaste on the removal of extrinsic tooth stain in two weeks.

OBJECTIVE: To assess the effect of a calcium carbonate/perlite toothpaste on the levels of extrinsic stain removed at two weeks compared to a silica control toothpaste. DESIGN: In this parallel group, double-blind study, subjects were stratified by natural baseline stain and tobacco use and allocated at random to one of the two study toothpastes. Subjects brushed with their allocated toothpaste twice daily for two weeks before extrinsic tooth stain was again assessed. SETTING: The study was performed at 4-Front Research UK Limited, Maldon, UK. PARTICIPANTS: 152 adult subjects with at least eight assessable incisors/ canines with natural extrinsic tooth stain completed the study. METHODS: The extrinsic tooth stain on the facial surfaces of incisors and canines was measured using the Macpherson modification of the Lobene Stain Index. RESULTS: Both of the toothpaste groups had significantly less stain after two weeks of use compared to the baseline value (p<0.001). Analysis of covariance on the sum of the whole mouth stain scores showed that the calcium carbonate/perlite toothpaste removed significantly more stain over the two week study than the silica control toothpaste (p<0.05). CONCLUSIONS: Twice daily brushing for two weeks with a calcium carbonate/perlite toothpaste removes more extrinsic stain than a silica control toothpaste.

The prevention of induced stain using two levels of sodium hexametaphosphate in chewing gum.

OBJECTIVE: This study was a randomized, controlled, examiner-blind, four-period crossover design that examined the prevention of induced stain deposition through the use of chewing gums containing either 2.0% or 3.0% sodium hexametaphosphate (Na Hex). METHODOLOGY: The test treatments were an experimental chewing gum containing 2.0% Na Hex, a second experimental chewing gum containing 3.0% Na Hex, a placebo chewing gum (0.0% Na Hex) and no chewing gum. The study was carried out over a four-week period, with each treatment period lasting two days. Treatment periods were separated by a washout period of three to five days. Twelve subjects who met the inclusion and exclusion criteria were given a thorough dental prophylaxis limited to the anterior twelve teeth, and then underwent a baseline digital imaging assessment (DIA) procedure. Each treatment period involved two days of stain induction, which consisted of rinsing for 60 seconds with 10 ml of 0.12% chlorhexidine, followed by chewing with two pellets of the assigned chewing gum for five minutes or by no gum chewing, followed by rinsing with 10 ml of cold tea solution for 60 seconds. This regimen was repeated eight times throughout the day, approximately once an hour. Imaging was completed at baseline and at the end of day 2 of the induced stain regimen. Subjects refrained from any oral hygiene during the two-day stain induction periods. RESULTS: Average baseline L* scores ranged from 76.30 to 76.57. At the end of the two-day stain induction regimen (eight hourly cycles per day) when no gum was chewed ("no gum"), subjects' teeth were 5.18 units darker on average than they were at baseline. At the end of the two-day regimen when the placebo gum was chewed, subjects' teeth were 4.54 units darker on average than they were at baseline. The difference between "no gum" and placebo gum was statistically significant (p = 0.017), and represented a 12.4% reduction in tooth darkness for the placebo gum treatment. Use of the 2.0% Na Hex gum resulted in teeth 3.64 units darker on average versus baseline, and the 3.0% Na Hex gum resulted in teeth 4.02 units darker. Both the 2.0% and 3.0% Na Hex gums resulted in teeth that were statistically significantly less dark (p < or = 0.042) than both the "no gum" and placebo gum treatments. On average, the reduction in tooth darkness for the 2.0% Na Hex gum was 29.7% versus "no gum" and 19.8% versus the placebo gum. The 2.0% Na Hex and 3.0% Na Hex gum treatments did not differ significantly (p = 0.114). CONCLUSION: This study demonstrated that 2.0% and 3.0% levels of Na Hex in a chewing gum prevented the deposition of extrinsic dental stain better than a chewing gum without Na Hex, which in turn prevented the deposition of stain better than no chewing gum.