A Critical Review of Modern Concepts for Teeth Whitening

Matthias Epple, Frederic Meyer, Joachim Enax, Matthias Epple, Frederic Meyer, Joachim Enax

Abstract

Besides prevention of caries and periodontitis, an increasing number of oral care products focus on teeth whitening. The aim of this review is to summarize and discuss frequently used whitening agents and their efficacy from a chemical viewpoint. Therefore, a comprehensive literature survey on teeth whitening agents and products was conducted. The current whitening methods are analyzed and discussed from a chemist's viewpoint. Frequently used whitening agents are abrasives (mechanical removal of stains), antiredeposition agents (prevention of deposition of chromophores), colorants (intended to lead to a white color), proteases (degradation of proteins), peroxides (oxidation of organic chromophores), and surfactants (removal of hydrophobic compounds from tooth surface). In-office bleaching using peroxides is effective, but side effects like tooth sensitivity or a damage of the natural organic matrix of enamel and dentin may occur. The applicability of abrasives in teeth whitening is limited due to potential tooth wear, especially when toothpastes with high RDA values are used. The effect of other whitening agents in vivo is often unclear because of a shortage of placebo-controlled clinical trials.

Keywords: abrasives; peroxides; teeth; toothpaste; whitening.

Conflict of interest statement

The authors declare that there is no conflict of interest.

References

    1. Dorozhkin S.V., Epple M. Biological and medical significance of calcium phosphates. Angew. Chem. Int. Ed. 2002;41:3130–3146. doi: 10.1002/1521-3773(20020902)41:17<3130::AID-ANIE3130>;2-1.
    1. Enax J., Epple M. Synthetic hydroxyapatite as a biomimetic oral care agent. Oral Health Prev. Dent. 2018;16:7–19.
    1. Meyer F., Amaechi B.T., Fabritius H.-O., Enax J. Overview of calcium phosphates used in biomimetic oral care. Open Dent. J. 2018;12:406–423. doi: 10.2174/1874210601812010406.
    1. Lowenstam H.A., Weiner S. On Biomineralization. Oxford University Press; New York, NY, USA: 1989.
    1. Brown P.W., Constantz B. Hydroxyapatite and Related Materials. CRC Press; Boca Raton, FL, USA: 1994.
    1. Forien J.-B., Zizak I., Fleck C., Petersen A., Fratzl P., Zolotoyabko E., Zaslansky P. Water-mediated collagen and mineral nanoparticle interactions guide functional deformation of human tooth dentin. Chem. Mater. 2016;28:3416–3427. doi: 10.1021/acs.chemmater.6b00811.
    1. Forien J.B., Fleck C., Cloetens P., Duda G., Fratzl P., Zolotoyabko E., Zaslansky P. Compressive residual strains in mineral nanoparticles as a possible origin of enhanced crack resistance in human tooth dentin. Nano Lett. 2015;15:3729–3734. doi: 10.1021/acs.nanolett.5b00143.
    1. LeGeros R.Z. Apatites in biological systems. Prog. Cryst. Growth Charact. 1981;4:1–45. doi: 10.1016/0146-3535(81)90046-0.
    1. Jowett A.K., Marlow I., Rawlinson A. A double blind randomised controlled clinical trial comparing a novel anti-stain and calculus reducing dentifrice with a standard fluoride dentifrice. J. Dent. 2013;41:313–320. doi: 10.1016/j.jdent.2012.12.005.
    1. Hannig M., Hannig C. Der initiale orale Biofilm—Pathogen oder protektiv? Oralprophylaxe Kinderzahnheilkunde. 2007;29:73–82.
    1. Algarni A.A., Ungar P.S., Lippert F., Martinez-Mier E.A., Eckert G.J., Gonzalez-Cabezas C., Hara A.T. Trend-analysis of dental hard-tissue conditions as function of tooth age. J. Dent. 2018;74:107–112. doi: 10.1016/j.jdent.2018.05.011.
    1. Joiner A. Whitening toothpastes: A review of the literature. J. Dent. 2010;38(Suppl. 2):e17–e24. doi: 10.1016/j.jdent.2010.05.017.
    1. Fejerskov O., Kidd E. Dental Caries: The Disease and its Clinical Management. Wiley; Hoboken, NJ, USA: 2009.
    1. Kassebaum N.J., Bernabe E., Dahiya M., Bhandari B., Murray C.J., Marcenes W. Global burden of untreated caries: A systematic review and metaregression. J. Dent. Res. 2015;94:650–658. doi: 10.1177/0022034515573272.
    1. Meyer F., Enax J. Early childhood caries: Epidemiology, aetiology, and prevention. Int. J. Dent. 2018;2018:1–7. doi: 10.1155/2018/1415873.
    1. Meyer F., Karch A., Schlinkmann K.M., Dreesman J., Horn J., Rubsamen N., Sudradjat H., Schubert R., Mikolajczyk R. Sociodemographic determinants of spatial disparities in early childhood caries: An ecological analysis in Braunschweig, Germany. Community Dent. Oral Epidemiol. 2017;45:442–448. doi: 10.1111/cdoe.12308.
    1. Van Loveren C. Toothpastes. Volume 23 Karger; Basel, Switzerland: 2013.
    1. Yaacob M., Worthington H.V., Deacon S.A., Deery C., Walmsley A.D., Robinson P.G., Glenny A.M. Powered versus manual toothbrushing for oral health. Cochrane Database Syst. Rev. 2014:Cd002281. doi: 10.1002/14651858.CD002281.pub3.
    1. Epple M., Enax J. Moderne Zahnpflege aus chemischer Sicht. Chem. Unserer Zeit. 2018;52:218–228. doi: 10.1002/ciuz.201800796.
    1. Schlagenhauf U., Kunzelmann K.-H., Hannig C., May T.W., Hösl H., Gratza M., Viergutz G., Nazet M., Schamberger S., Proff P. Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible orthodontic patients: A randomized, controlled 6-month trial. J. Invest. Clin. Dent. 2019;10:e12399. doi: 10.1111/jicd.12399.
    1. Marsh P.D. Contemporary perspective on plaque control. Br. Dent. J. 2012;212:601–606. doi: 10.1038/sj.bdj.2012.524.
    1. Cieplik F., Kara E., Muehler D., Enax J., Hiller K.-A., Maisch T., Buchalla W. Antimicrobial efficacy of alternative compounds for use in oral care towards biofilms from caries-associated bacteria in vitro. MicrobiologyOpen. 2018;695:1–10. doi: 10.1002/mbo3.695.
    1. Meireles S.S., Goettems M.L., Dantas R.V., Bona A.D., Santos I.S., Demarco F.F. Changes in oral health related quality of life after dental bleaching in a double-blind randomized clinical trial. J. Dent. 2014;42:114–121. doi: 10.1016/j.jdent.2013.11.022.
    1. Pavicic D.K., Kolceg M., Lajnert V., Pavlic A., Brumini M., Spalj S. Changes in quality of life induced by tooth whitening are moderated by perfectionism: A randomized, double-blind, placebo-controlled trial. Int. J. Prosthodont. 2018;31:394–396. doi: 10.11607/ijp.5499.
    1. Silva E.M.D., Maia J.N.D.S.M., Mitraud C.G., Russo J.D., Poskus L.T., Guimaraes J.G.A. Can whitening toothpastes maintain the optical stability of enamel over time? J. Appl. Oral Sci. 2018;26:e20160460. doi: 10.1590/1678-7757-2016-0460.
    1. Viscio D., Gaffar A., Fakhry-Smith S., Xu T. Present and future technologies of tooth whitening. Compend. Contin. Educ. Dent. Suppl. 2000;21:S36–S43.
    1. Carey C.M. Tooth whitening: What we now know. J. Evid. Based Dent. Pract. 2014;14:70–76. doi: 10.1016/j.jebdp.2014.02.006.
    1. Andreasen F.M. Transient apical breakdown and its relation to color and sensibility changes after luxation injuries to teeth. Dent. Traumatol. 1986;2:9–19. doi: 10.1111/j.1600-9657.1986.tb00118.x.
    1. Lippert F. An introduction to toothpaste—Its purpose, history and ingredients. Monogr. Oral Sci. 2013;23:1–14.
    1. Fearon J. Tooth whitening: Concepts and controversies. J. Ir. Dent. Assoc. 2007;53:132–140.
    1. Sherwood I.A. Fluorosis varied treatment options. J. Conserv. Dent. 2010;13:47–53. doi: 10.4103/0972-0707.62631.
    1. Addy M., Moran J. Mechanisms of stain formation on teeth, in particular associated with metal ions and antiseptics. Adv. Dent. Res. 1995;9:450–456. doi: 10.1177/08959374950090041601.
    1. Attin T., Paqué F., Ajam F., Lennon Á.M. Review of the current status of tooth whitening with the walking bleach technique. Int. Endod. J. 2003;36:313–329. doi: 10.1046/j.1365-2591.2003.00667.x.
    1. Joiner A., Hopkinson I., Deng Y., Westland S. A review of tooth colour and whiteness. J. Dent. 2008;36:S2–S7. doi: 10.1016/j.jdent.2008.02.001.
    1. Gron P., Van Campen G.J., Lindstrom I. Human dental calculus. Inorganic chemical and crystallographic composition. Arch. Oral Biol. 1967;12:829–837.
    1. Jones C.G. Chlorhexidine: Is it still the gold standard? Periodontol. 2000. 1997;15:55–62. doi: 10.1111/j.1600-0757.1997.tb00105.x.
    1. Ellingsen J.E., Eriksen H.M., Rolla G. Extrinsic dental stain caused by stannous fluoride. Scand. J. Dent. Res. 1982;90:9–13. doi: 10.1111/j.1600-0722.1982.tb01518.x.
    1. Kensche A., Holder C., Basche S., Tahan N., Hannig C., Hannig M. Efficacy of a mouthrinse based on hydroxyapatite to reduce initial bacterial colonisation in situ. Arch. Oral Biol. 2017;80:18–26. doi: 10.1016/j.archoralbio.2017.03.013.
    1. Joiner A., Luo W. Tooth colour and whiteness: A review. J. Dent. 2017;67:S3–S10. doi: 10.1016/j.jdent.2017.09.006.
    1. Stookey G.K., Burkhard T.A., Schemehorn B.R. In vitro removal of stain with dentifrices. J. Dent. Res. 1982;61:1236–1239. doi: 10.1177/00220345820610110501.
    1. Joiner A. Tooth colour: A review of the literature. J. Dent. 2004;32:3–12. doi: 10.1016/j.jdent.2003.10.013.
    1. Terezhalmy G.T., Walters P.A., Bartizek R.D., Grender J.M., Biesbrock A.R. A clinical evaluation of extrinsic stain removal: A rotation-oscillation power toothbrush versus a dental prophylaxis. J. Contemp. Dent. Pract. 2008;9:1–8. doi: 10.5005/jcdp-9-1-1.
    1. Demarco F.F., Meireles S.S., Masotti A.S. Over-the-counter whitening agents: a concise review. Braz. Oral Res. 2009;23(Suppl. 1):64–70. doi: 10.1590/S1806-83242009000500010.
    1. Vaz M.M., Lopes L.G., Cardoso P.C., Souza J.B., Batista A.C., Costa N.L., Torres E.M., Estrela C. Inflammatory response of human dental pulp to at-home and in-office tooth bleaching. J. Appl. Oral Sci. 2016;24:509–517. doi: 10.1590/1678-775720160137.
    1. Yao C.S., Waterfield J.D., Shen Y., Haapasalo M., Macentee M.I. In vitro antibacterial effect of carbamide peroxide on oral biofilm. J. Oral Microbiol. 2013;5:20392.
    1. Marson F.C., Sensi L.G., Vieira L.C., Araujo E. Clinical evaluation of in-office dental bleaching treatments with and without the use of light-activation sources. Oper. Dent. 2008;33:15–22. doi: 10.2341/07-57.
    1. Enax J., Epple M. Die Charakterisierung von Putzkörpern in Zahnpasten. Deutsche Zahnärztliche Zeitschrift. 2018;73:100–108.
    1. Harks I., Jockel-Schneider Y., Schlagenhauf U., May T.W., Gravemeier M., Prior K., Petersilka G., Ehmke B. Impact of the daily use of a microcrystal hydroxyapatite dentifrice on de novo plaque formation and clinical/microbiological parameters of periodontal health. A randomized trial. PLoS ONE. 2016;11:e0160142. doi: 10.1371/journal.pone.0160142.
    1. Hagenfeld D., Prior K., Harks I., Jockel-Schneider Y., May T.W., Harmsen D., Schlagenhauf U., Ehmke B. No differences in microbiome changes between anti-adhesive and antibacterial ingredients in toothpastes during periodontal therapy. J. Periodont. Res. 2019 doi: 10.1111/jre.12645. (in press)
    1. Niwa M., Sato T., Li W., Aoki H., Daisaku T. Polishing and whitening properties of toothpaste containing hydroxyapatite. J. Mater. Sci. Mater. Med. 2001;12:277–281. doi: 10.1023/A:1008927502523.
    1. Lelli M., Putignano A., Marchetti M., Foltran I., Mangani F., Procaccini M., Roveri N., Orsini G. Remineralization and repair of enamel surface by biomimetic Zn-carbonate hydroxyapatite containing toothpaste: A comparative in vivo study. Front. Physiol. 2014;5:333. doi: 10.3389/fphys.2014.00333.
    1. Fabritius-Vilpoux K., Enax J., Herbig M., Raabe D., Fabritius H.O. Quantitative affinity parameters of synthetic hydroxyapatite and enamel surfaces in vitro. Bioinspired Biomim. Nanobiomater. 2019;8:141–153. doi: 10.1680/jbibn.18.00035. (in press)
    1. Dabanoglu A., Wood C., Garcia-Godoy F., Kunzelmann K.H. Whitening effect and morphological evaluation of hydroxyapatite materials. Am. J. Dent. 2009;22:23–29.
    1. Jin J., Xu X., Lai G., Kunzelmann K.H. Efficacy of tooth whitening with different calcium phosphate-based formulations. Eur. J. Oral Sci. 2013;121:382–388. doi: 10.1111/eos.12063.
    1. Kim B.I., Jeong S.H., Jang S.O., Kim K.N., Kwon H.K., Park Y.D. Tooth whitening effect of toothpastes containing nano-hydroxyapatite. Key Eng. Mater. 2006;309:541–544.
    1. Bommer C., Flessa H.P., Xu X., Kunzelmann K.H. Hydroxyapatite and self-assembling peptide matrix for non-oxidizing tooth whitening. J. Clin. Dent. 2018;29:57–63.
    1. Schemehorn B.R., Moore M.H., Putt M.S. Abrasion, polishing, and stain removal characteristics of various commercial dentifrices in vitro. J. Clin. Dent. 2011;22:11–18.
    1. LeGeros R.Z. Chemical and crystallographic events in the caries process. J. Dent. Res. 1990;69:567–574, 634–636. doi: 10.1177/00220345900690S113.
    1. LeGeros R.Z. Biological and synthetic apatites. In: Brown P.W., Constantz B., editors. Hydroxyapatite and Related Materials. CRC Press; Boca Raton, FL, USA: 1994. pp. 3–28.
    1. Terezhalmy G.T., Biesbrock A.R., Farrell S., Barker M.L., Bartizek R.D. Tooth whitening through the removal of extrinsic stain with two sodium hexametaphosphate-containing whitening dentifrices. Am. J. Dent. 2007;20:309–314.
    1. Tao D., Smith R.N., Zhang Q., Sun J.N., Philpotts C.J., Ricketts S.R., Naeeni M., Joiner A. Tooth whitening evaluation of blue covarine containing toothpastes. J. Dent. 2017;67:S20–S24. doi: 10.1016/j.jdent.2017.10.014.
    1. Amri E., Mamboya F. Papain, a plant enzyme of biological importance: A review. Am. J. Biochem. Biotechnol. 2012;8:99–104.
    1. Kalyana P., Shashidhar A., Meghashyam B., Sreevidya K.R., Sweta S. Stain removal efficacy of a novel dentifrice containing papain and Bromelain extracts—An in vitro study. Int. J. Dent. Hyg. 2011;9:229–233. doi: 10.1111/j.1601-5037.2010.00473.x.
    1. Clark D.P., Pazdernik N.J. Chapter 9—Proteomics. In: Clark D.P., Pazdernik N.J., editors. Biotechnology. 2nd ed. Academic Cell; Boston, MA, USA: 2016.
    1. Adams S.E., Arnold D., Murphy B., Carroll P., Green A.K., Smith A.M., Brading M.G. A randomised clinical study to determine the effect of a toothpaste containing enzymes and proteins on plaque oral microbiome ecology. Sci. Rep. 2017;7:43344. doi: 10.1038/srep43344.
    1. Vaz V.T.P., Jubilato D.P., Oliveira M.R.M., Bortolatto J.F., Floros M.C., Dantas A.A.R., Oliveira Junior O.B. Whitening toothpaste containing activated charcoal, blue covarine, hydrogen peroxide or microbeads: Which one is the most effective? J. Appl. Oral Sci. 2019;27:e20180051. doi: 10.1590/1678-7757-2018-0051.
    1. Walsh T.F., Rawlinson A., Wildgoose D., Marlow I., Haywood J., Ward J.M. Clinical evaluation of the stain removing ability of a whitening dentifrice and stain controlling system. J. Dent. 2005;33:413–418. doi: 10.1016/j.jdent.2004.10.021.
    1. Imfeld T., Sener B. In-vitro-Untersuchung der mechanischen Wirkung von Whitening-Zahnpasten des Schweizer Marktes. Acta Med. Dent. Helv. 1999;4:195–200.
    1. Markowitz K. Pretty painful: Why does tooth bleaching hurt? Med. Hypotheses. 2010;74:835–840. doi: 10.1016/j.mehy.2009.11.044.
    1. Gillam D.G. Dentine Hypersensitivity: Advances in Diagnosis, Management, and Treatment. Springer; Berlin/Heidelberg, Germany: 2015.
    1. Kielbassa A.M., Maier M., Gieren A.K., Eliav E. Tooth sensitivity during and after vital tooth bleaching: A systematic review on an unsolved problem. Quintessence Int. 2015;46:881–897.
    1. Schulte J.R., Morrissette D.B., Gasior E.J., Czajewski M.V. The effects of bleaching application time on the dental pulp. J. Am. Dent. Assoc. 1994;125:1330–1335. doi: 10.14219/jada.archive.1994.0177.
    1. Vano M., Derchi G., Barone A., Genovesi A., Covani U. Tooth bleaching with hydrogen peroxide and nano-hydroxyapatite: A 9-month follow-up randomized clinical trial. Int. J. Dent. Hyg. 2015;13:301–307. doi: 10.1111/idh.12123.
    1. Browning W.D., Cho S.D., Deschepper E.J. Effect of a nano-hydroxyapatite paste on bleaching-related tooth sensitivity. J. Esthet. Restor. Dent. 2012;24:268–276. doi: 10.1111/j.1708-8240.2011.00437.x.
    1. Hiller K.-A., Buchalla W., Grillmeier I., Neubauer C., Schmalz G. In vitro effects of hydroxyapatite containing toothpastes on dentin permeability after multiple applications and ageing. Sci. Rep. 2018;8:4888. doi: 10.1038/s41598-018-22764-1.
    1. Hu M.L., Zheng G., Zhang Y.D., Yan X., Li X.C., Lin H. Effect of desensitizing toothpastes on dentine hypersensitivity: A systematic review and meta-analysis. J. Dent. 2018;75:12–21. doi: 10.1016/j.jdent.2018.05.012.
    1. Meyer F., Fabritius H.-O., Enax J. Spezielle Zahnpflege bei Dentinhypersensibilität. ZMK. 2017;33:865–868.
    1. Haywood V.B., Cordero R., Wright K., Gendreau L., Rupp R., Kotler M., Littlejohn S., Fabyanski J., Smith S. Brushing with a potassium nitrate dentifrice to reduce bleaching sensitivity. J. Clin. Dent. 2005;16:17–22.
    1. Martin J., Fernandez E., Bahamondes V., Werner A., Elphick K., Oliveira O.B., Jr., Moncada G. Dentin hypersensitivity after teeth bleaching with in-office systems. Randomized clinical trial. Am. J. Dent. 2013;26:10–14.
    1. Wuelknitz P. Cleaning power and abrasivity of European toothpastes. Adv. Dent. Res. 1997;11:576–579. doi: 10.1177/08959374970110042701.
    1. Dinc Ata G., Gokay O., Mujdeci A., Kivrak T.C., Mokhtari Tavana A. Effect of various teas on color stability of resin composites. Am. J. Dent. 2017;30:323–328.
    1. Arocha M.A., Mayoral J.R., Lefever D., Mercade M., Basilio J., Roig M. Color stability of siloranes versus methacrylate-based composites after immersion in staining solutions. Clin. Oral Investig. 2013;17:1481–1487. doi: 10.1007/s00784-012-0837-7.
    1. Zhao X., Zanetti F., Majeed S., Pan J., Malmstrom H., Peitsch M.C., Hoeng J., Ren Y. Effects of cigarette smoking on color stability of dental resin composites. Am. J. Dent. 2017;30:316–322.
    1. Heimer S., Schmidlin P.R., Stawarczyk B. Discoloration of PMMA, composite, and PEEK. Clin. Oral Investig. 2017;21:1191–1200. doi: 10.1007/s00784-016-1892-2.

Source: PubMed

3
Subscribe