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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 3  |  Page : 306-311

The In vitro Evaluation of the effect of xyliwhite, probiotic, and the conventional toothpastes on the enamel roughness and microhardness


1 Department of Pediatric Dentistry, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
2 Department of Pediatric Dentistry, Center of Dental Sciences, Gulhane Training Hospital, Ankara, Turkey

Date of Acceptance01-Jun-2017
Date of Web Publication09-Mar-2018

Correspondence Address:
Dr. E Arat Maden
Department of Pediatric Dentistry, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_431_16

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   Abstract 


Aim: The aim of this study was to evaluate the effect of fluoride, Xylitol, Probiotic, and Whitening toothpastes on the permanent teeth enamel roughness and microhardness. Materials and Methods: One hundred and twenty teeth were randomly divided into 2 groups, each group having 60 samples. G1: The group in which enamel roughness was examined (n = 60). G2: The group in which enamel microhardness was examined (n = 60). Then, these groups were randomly divided into 4 groups among themselves (n = 15). Each group was brushed using four different toothpastes for 1 week with a battery-powered toothbrush in the morning and evening for 2 min. Vicker's hardness tester was used to measure the changes in microhardness, and the profilometer was used to measure the changes in surface roughness. Results: No statistically significant differences were found on surface roughness and microhardness values measured after tooth brushing process in group brushed with Colgate MaxFresh toothpaste (P > 0.01). Statistically significant decrease was observed on Vicker's hardness values measured after tooth brushing process in groups brushed with Ipana White Power Carbonate toothpaste, Xyliwhite Toothpaste Gel, and Periobiotic Probiotic Toothpaste (P < 0.01). Statistically significant increase was observed on surface roughness values in groups brushed with Ipana White Power Carbonate toothpaste, Xyliwhite Toothpaste Gel, Periobiotic Probiotic Toothpaste (P < 0.01). Conclusions: As a result, Colgate MaxFresh abrasive-free toothpaste with fluoride has no effect on permanent tooth enamel surface roughness and microhardness. Xyliwhite, Periobiotic, and Ipana White Power Carbonate-containing abrasive toothpastes led to changes negatively on permanent tooth enamel surface roughness and microhardness.

Keywords: Dental enamel, microhardness, permanent tooth, roughness, toothpastes


How to cite this article:
Maden E A, Altun C, Polat G G, Basak F. The In vitro Evaluation of the effect of xyliwhite, probiotic, and the conventional toothpastes on the enamel roughness and microhardness. Niger J Clin Pract 2018;21:306-11

How to cite this URL:
Maden E A, Altun C, Polat G G, Basak F. The In vitro Evaluation of the effect of xyliwhite, probiotic, and the conventional toothpastes on the enamel roughness and microhardness. Niger J Clin Pract [serial online] 2018 [cited 2019 Nov 22];21:306-11. Available from: http://www.njcponline.com/text.asp?2018/21/3/306/226974




   Introduction Top


Removal of tooth decay from oral cavity forms the first step of tooth treatments and preserving dental health. The idea of taking protective and preventive precautions before deterioration of mouth and dental health and turning toward conservative methods on treatment services has gained prominence. Toothpastes used with toothbrushes for this purpose are the most common mechanical and chemical plaque control methods used for the removal of plaque.[1] Toothpaste has been used for many years and this substance has had an important role in dental health.[2]

Toothpastes contain mechanical cleaners, moisturizers, foaming agents, odor substances, taste substances, preservatives, water, and bonding and separating (anti-decay, anti-tartar, whitener, desensitizer, etc.,) agents. Ideal toothpaste should be effective in removal of bacteria plaque, remove surface stains, and cause minimum abrasion and surface roughness on tooth hard tissue and restorative materials. However, the literature reports reduction in tooth enamel surface hardness and roughness caused by abrasives.

Abrasives inside toothpastes are used for the purpose of removing bacteria plaque and colorations.[3] Abrasive roughening must not exceed bacteria plaque adherence index (0.2 μm). Toothpaste composition, force applied to toothbrush and duration, and tooth hard tissue are among the leading factors that affect tooth enamel hardness and surface roughness.[4] Fluoride, xylitol, probiotic, and similar substances are effective agents for preventing decays by administering on oral cavity via toothpaste. In recent years, use of toothpastes that contain fluoride and xylitol has had an important place in mouth and dental health. Present in bones, bodily fluids and teeth, fluoride is a trace element that is effective in preventing tooth decay or stopping newly formed tooth decay. Toothpastes with fluoride have various types as effective agents for preventing decays and it is accepted in most developed countries as the main factor in reduction of decay prevalence.[5] Xylitol, a sugar alcohol that is one of the sugar variates, is a substance intensely researched after fluoride for decay prophylaxis and periodontal tissue health. A natural sweetener, xylitol, has been known for years to have an important impact on dental health and use of toothpastes with xylitol has been included in preventive dentist programs.[6]

Probiotics are bacteria that are added to various foods for their effects beneficial to human health. Fermented fresh dairy products such as yogurt were the first food products found to be suitable for probiotic bacteria to stay alive and the first yogurt products including probiotics were introduced in Europe at the beginning of 1980s. With the help of advancing food technologies, probiotics have been added to many other food products (fruit juices, potable milk, certain cheese types, ice cream, bubble gum, fermented meat products, breakfast cereals (cornflakes), soy milk products, etc.). Today, many products, mainly dairy products, are produced with added probiotics and they attract great attention. The main function of probiotic foods that contain live organisms that have a positive effect on health is to turn the intestinal flora transformed because of modern lifestyle back to a natural flora. Preserving mouth and dental health by probiotics is a new approach that is getting more and more attention. Recent studies have proved that the use of probiotic bacteria in mouth and dental health for preventing tooth decay and gingival diseases has positive effects.[7] Certain clinical studies show that milk, yogurt, or cheese which contain probiotics help in reducing the amount of cariogenic bacteria on saliva and tooth plaque. Probiotics that are added to gums, drops, and mouthwashes for dental health have also been added to toothpastes.[8]

In recent years, toothpastes are being marketed by emphasizing on their tooth whitening and shining features. Based on the demand in this regard, toothpastes have harder abrasive substances such as calcium carbonate, anhydrous dibasic calcium phosphate, or silica. This type of toothpaste can be extremely abrasive based on their abrasive amount, quality, particle size, and crystal characteristics. The increasing demand on dental esthetics has made tooth whitening an important function of toothpastes.[9] Toothpastes that claim to have whitening effects contain either abrasive particles or bleaching agents such as peroxide and sodium bicarbonate or proteolytic enzymes that remove stains. The use of sodium bicarbonate has a long history of being used in mouth hygiene. In a series of studies published in 1998, it was shown that toothpastes which contained sodium bicarbonate had anti-plaque, gingivitis-healing, removing colorations, and reducing mouth odor features.

In our study, our aim was in vitro investigation and evaluation of the effects of fluoride, xylitol, probiotic, and whitening agents on enamel microhardness and surface roughness of permanent teeth.


   Materials and Methods Top


Sample preparation and allocation

This study was carried out on the enamel surfaces of 120 newly pulled permanent incisor teeth with no decay or surface fault. First, 120 teeth were randomly assigned to 2 groups with each group having 60 samples. Those were later divided into 4 subgroups [Table 1].
Table 1: Study groups

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Enamel sample preparation

One hundred twenty newly pulled permanent incisor teeth with no decay or surface fault were cleaned immediately after being pulled and kept in 10% formaldehyde solution. Debris layer on teeth was removed by polishing using plastic brush and pumice and teeth were kept in deionized distilled water to prevent teeth from dehydrating. Using silicon molds, each tooth was buried in self-polymerizing acrylic resin block with roots inside the block, crown sections parallel to the surface, and enamel surface on the open. Samples were put into deionized distilled water as soon as acryl polymerization was completed. Smoothing and polishing of the samples were carried out with a sanding and polishing device (Metkon Gripo 2V, Bursa). Device rotation speed had digital control and had adjustable speed between 20 and 600 rotations/min. The discs had a diameter of 250 mm and had two-way rotation ability. Polishing table was able to spray water with the help of a magnetic valve with adjustable flow rate. Enamel surfaces of burrowed teeth were sanded by 600, 800, and 1000 grains and paper with minimal tissue loss.

Experimental procedure

Each group was brushed by battery powered toothbrushes for 1 week, day and night, for 2 min with 4 different toothpastes. [Table 2] shows the contents and manufacturing companies of the toothpastes used in the study. Toothbrush head was placed parallel to enamel surface for all hair to contact enamel surfaces and applied by the same operator without pressure. A new toothbrush head was used for each toothbrush application. Power loss was prevented by changing toothbrush batteries every 100 min. Toothpaste on brushed surface was washed away with running water.
Table 2: The contents and manufacturing companies of the toothpastes

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Microhardness measurement

There are researches that use Vicker's microhardness device for enamel microhardness measurement. Surface microhardness measurement of the sample prepared (n = 60) was carried out in Ankara University Faculty of Dentistry Endodontics Clinic Laboratory. The microhardness measurement device in our laboratory (Graigar HVS-1000, Digital Display Microhardness Tester, Zhejiang, China) was used in this study. With the touchscreen panel on the device, it was possible to adjust the load between 98.07 mN and 19,914 N and test duration between 5 and 999 s. The device had oculars with ×10 and ×40 zoom. The smallest unit of 0.01 μm on diagonal length of the device provided a measurement accuracy valid within today's standards. Three measurements were made for each sample before and after brushing enamel samples by applying 300 gr (2943 N) force for 15 s. The trace created on samples were evaluated and measured with ×10 zoom, and the averages of the values were taken to obtain Vicker's microhardness values.

Surface roughness measurement

Surface roughness measurement of the samples (n = 60) was carried out in Ankara University Faculty of Dentistry Research Laboratory. In our study, we used a desktop surface roughness measurement device that gave printouts (Mahr Perthometer M2/M3, Gottingen, Germany). We measured surface roughness of each sample before and after brushing enamel samples. All values gathered were saved as printouts. All samples were measured three times, and their averages were calculated.

Statistical analysis

We used SPSS version 15.0 (SPSS Inc., Chicago, IL., USA) package program for statistical analysis. Descriptive statistics were given as average ± standard deviation, median (lowest-highest). Kruskal–Wallis test was used for group comparisons. In case of any difference, Mann–Whitney U-test with Bonferroni correction was used to determine which group or groups were the reason for the difference. Wilcoxon signed-rank test was used for in-group before-after comparisons. P < 0.05 was considered statistically significant.


   Results Top


Microhardness findings

Based on Wilcoxon signed-rank test, there was a statistically significant difference (P< 0.01) between Vicker's microhardness values before and after brushing in all groups except Colgate MaxFresh toothpaste. For Colgate MaxFresh toothpaste, there was no statistically significant difference (P > 0.01) between enamel microhardness values measured before and after brushing.

[Figure 1] shows enamel surface microhardness change percentages between before and after brushing. There was a statistically significant reduction (P< 0.01) in groups brushed by Ipana White Power Carbonate Toothpaste, Xyliwhite Toothpaste Gel, and Periobiotic Probiotic Toothpaste on Vicker's microhardness values measured after the tooth brushing.
Figure 1: Enamel surface microhardness change percentages between before and after brushing

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Based on Kruskal–Wallis test, when investigating groups brushed with different toothpastes on themselves, there was a statistically significant (P > 0.01) reduction in the reduction of enamel surface microhardness for Ipana White Power Carbonate Toothpaste, Xyliwhite Toothpaste Gel, and Periobiotic Probiotic Toothpaste after the tooth brushing process.

Surface roughness findings

Based on Wilcoxon signed-rank test, there was a statistically significant difference (P< 0.01) between surface roughness values before and after brushing in all groups except the group brushed with Colgate MaxFresh toothpaste [Figure 2]. For Colgate MaxFresh toothpaste, there was no statistically significant difference (P > 0.01) between enamel surface roughness values measured before and after brushing. Ipana White Power Carbonate Toothpaste caused a statistically significant (P< 0.01) increase in surface roughness on enamel samples. A statistically significant (P< 0.01) increase was observed on enamel samples brushed by Xyliwhite toothpaste when comparing measured surface roughness values of the beginning and after brushing. A statistically significant (P< 0.01) increase in surface roughness values was detected on enamel samples brushed by Periobiotic Probiotic toothpaste after the brushing process. After Kruskal–Wallis test, when comparing all groups, statistically significant differences were found between the groups brushed by various toothpastes. Among toothpastes, Ipana White Power Carbonate toothpaste had caused more surface roughness on enamel surface, enough to create a statistically significant difference (P< 0.01). Enamel samples brushed with Xyliwhite had minimal increase in surface roughness. Colgate MaxFresh toothpaste did not cause any increase in surface roughness. When sorting toothpastes based on increases in enamel surface roughness from low to high, it was Xyliwhite < Periobiotic < Ipana White Power Carbonate.
Figure 2: Enamel surface roughness change percentages between before and after brushing

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   Discussion Top


According to many authors, abrasive effect of toothpastes on enamel and dentin depends on abrasives in the toothpaste and hair hardness of toothbrushes.

When combined, the corrosive effects of toothpastes and the mechanical effects of toothbrushes can cause abrasions.[10] To prevent abrasion with abrasive concentration, all samples had the same toothbrush used by the same operator with similar force applied. As in most investigations, microhardness calculation must be done on a smooth surface with a very good polish.[11] Because, it is thought that preventing any change on morphology of cut and smoothened enamel surface is advantageous.[12] The current study has included polishing process before measurements.

The samples were kept inside deionized water at room temperature during the whole process to prevent dehydration. Some researchers preferred distilled water, and some kept their samples inside artificial saliva in 37°C.[13]

We used Vicker's microhardness tester for microhardness measurement. A group of researchers used Knoop Hardness tester (Miniload, Leitz, Wetzlar, Germany)[13],[14] and other studies used Vicker's microhardness tester.[15]

In our study, we assumed that most of the brushing in a 2-min brushing happened on buccal surface of teeth, therefore approximately 5 s was spent 2 times/day for each buccal surface. In this study, we thought that a total brushing time of 28 min was approximately equal to brushing of any buccal surface for approximately 1 year. To minimize the possible effects of toothbrush on surface hardness and roughness of enamel, soft toothbrush heads were used in the current study.

In a study by Kielbassa et al.,[16] abrasive effects of toothpastes and acidic flour gels on healthy and demineralized enamel sections from cattle incisor teeth were investigated. The brushing process was carried out using a medium microhardness toothbrush by applying 275 gr load. Abrasion was calculated using laser profilometer and found to be 50% less on demineralized enamel compared to healthy enamel (P< 0.001).

PerioBiotic (Designs for Health, Inc.,) is a natural oral hygiene support that does not contain fluoride and contains Lactobacillus paracasei which is not found in any other toothpaste.[17] In a study by Philip et al.[18] in 2011 conducted on the effects of toothpastes with probiotic on patients with chronic gingivitis, it was found to be more effective against plaque and gingivitis compared to other toothpastes. No study was deemed necessary for toothpastes with probiotics as these are oral hygiene products which have just been introduced to the market. In the current study, we compared the biomechanical effects of toothpastes with probiotics which also include abrasives with the effects of other toothpastes.

Studies on comparing abrasiveness of whitening toothpastes and traditional toothpastes have varying results. Some studies report that whitening toothpastes cause more abrasion than traditional toothpastes, others have found that whitening toothpastes cause the most abrasion.[19] A study conducted by Joiner et al.[20] states that there is no difference between enamel abrasiveness of whitening toothpastes and standard toothpastes. Zimmerman et al.[21] stated that tooth whitening treatments may change the mechanical features of enamel. There was a statistically significant difference between surface roughness of composite control group and composite study group but no apparent difference was found between enamel sample groups in a study by Khamverdi et al.[22] conducted on the effects of two different whitening toothpastes on enamel and micro-hybrid composite microhardness. The results showed that sodium bicarbonate, silica, sodium tripolyphosphate and similar substances in whitening toothpastes may affect surface features of composite materials. Minimal or insignificant reductions in enamel microhardness may be resulting from the fact that toothpastes used in the study may not contain safe abrasives. In a study of Johannsen et al.[23] conducted on abrasiveness of toothpastes, it was found that there were significant differences between the abrasions caused on tooth structure by two different whitening pastes and the traditional toothpaste. In our study, we found that Ipana White Power Carbonate toothpaste had the most abrasion on tooth enamel. In defining abrasiveness of toothpastes, it is important to consider surface roughness values.

We have used 4 different toothpastes in our study to examine their effects on enamel microhardness. There was a statistically significant difference between Vicker's microhardness values before and after brushing on all groups except the group brushed with Colgate MaxFresh toothpaste. Toothbrushes with soft hair were used to reduce the effects of toothbrushes on enamel microhardness. Statistically significant reduction in Vicker's microhardness was found on enamel samples brushed by Ipana White Power Carbonate Toothpaste, Xyliwhite Toothpaste Gel, and Periobiotic Probiotic Toothpaste. However, the difference in reduction on the enamel samples of these toothpastes was not statistically significant. Colgate MaxFresh did not cause any change in enamel microhardness.

Care must be given when comparing in vitro findings with clinic conditions. Because, tooth abrasion is a multifactorial phenomenon in which erosion, abrasion, and attrition play roles, with erosion being a dominant factor in its formation.[24] As it is difficult for in vitro studies to fully reflect oral environment, we suggest long-term clinical studies in addition to laboratory studies in order to investigate surface roughness on tooth hard tissue caused by toothpastes. Furthermore, roughness of the toothpastes used in our study can be tested on various materials.


   Conclusions Top


In this study in which the effects of toothpastes with different contents on enamel surface roughness and microhardness of permanent incisor teeth were investigated in vitro, the reduction in surface roughness of enamel samples brushed with the toothpaste that contained probiotic was more than the one observed in enamel samples brushed with Ipana White Power Carbonate Toothpaste, and more than the one observed in enamel samples brushed with Xyliwhite toothpastes.

Acknowledgment

The authors would like to thank the Colgate Company.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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