Effect of novel charcoal-containing whitening toothpaste and mouthwash on color change and surface morphology of enamel

Abstract

Purpose: The aim of this in vitro study was to investigate the effectiveness of a novel charcoal-containing whitening toothpaste and a mouthwash on tooth color change and the alterations of enamel that may be induced after toothbrushing, corresponding to a 90-day period. Materials and Methods: Forty human canines were used, stained with coffee, and divided into four groups ( n = 10) as follows: Group 1 (control) submitted to toothbrushing with deionized water, Group 2 with a regular toothpaste, Group 3 with a whitening toothpaste (1% charcoal), and Group 4 with the same whitening toothpaste in combination with a mouthwash (1% charcoal and 0.5% H 2 O 2 ). After the treatments, ΔΕ of the teeth was evaluated using an ultraviolet/Vis spectrophotometer, whereas the changes in surface morphology were observed by means of a confocal microscope. Results: The whitening toothpaste increased significantly ΔΕ (40.5%) compared to the control group ( P < 0.001). In addition, the tested whitening toothpaste also increased ΔΕ (17.7%) compared to the regular toothpaste ( P = 0.023). The whitening toothpaste presented smoother surfaces after toothbrushing, but more heterogeneous with numerous large craters, whereas the whitening mouthwash did not influence surface morphology changes. Conclusions: Charcoal-containing toothpastes may enhance the whitening of the teeth, but they should be used carefully due to changes that may induce on enamel. The patients should consult a dental professional for proper use. A charcoal-containing mouthwash in combination with whitening toothpastes probably cannot offer additional whitening effect.

Whitening effect of brushing with activated charcoal-based products on enamel: integrative review

“…Currently, there are records of the use of this substance in oral health care in several countries around the world (Brooks et al, 2017), in addition to its use in the food industry as an ingredient and coloring in some countries (Franco et al, 2020). However, due attention is needed to a possible increase in the incidence of caries with brushing using activated charcoal-based products, since supposedly the use of any of these products can increase the surface roughness of enamel, favoring the installation of biofilm, in addition to fact that the vast majority of toothpastes that contain charcoal do not have fluoride or possibly inactivate it, reducing resistance to caries and tooth wear (Brooks et al, 2017;Greenwall et al, 2019;Dionysopoulos et al, 2020;Franco et al, 2020).…”

“…Due to its high capacity to adsorb and retain pigments, chromophores, and stains responsible for changing the color of teeth (Greenwall et al, 2019;Vaz et al, 2019), a few years ago a few charcoal-based products were disseminated as an alternative to conventional bleaching techniques (Franco et al, 2020). However, for tooth bleaching to occur, peroxide-based products are needed to break down the chromophores present inside the dental tissues, through an oxidation-reduction process (Dionysopoulos et al, 2020;Palandi et al, 2020;Silva et al, 2021). With carbamide peroxide and hydrogen peroxide being the bleaching agents commonly used in low and high concentration, at-home and in-office techniques, respectively (Dionysopoulos et al, 2020;Ghajari et al, 2021;Silva et al, 2021).…”

“…However, for tooth bleaching to occur, peroxide-based products are needed to break down the chromophores present inside the dental tissues, through an oxidation-reduction process (Dionysopoulos et al, 2020;Palandi et al, 2020;Silva et al, 2021). With carbamide peroxide and hydrogen peroxide being the bleaching agents commonly used in low and high concentration, at-home and in-office techniques, respectively (Dionysopoulos et al, 2020;Ghajari et al, 2021;Silva et al, 2021). Thus, products containing activated charcoal act only by removing extrinsic stains by the abrasion process caused by brushing, which could promote a certain degree of tooth whitening (Vaz et al, 2019;Dionysopoulos et al, 2020;Franco et al, 2020;Ghajari et al, 2021).…”

“…With carbamide peroxide and hydrogen peroxide being the bleaching agents commonly used in low and high concentration, at-home and in-office techniques, respectively (Dionysopoulos et al, 2020;Ghajari et al, 2021;Silva et al, 2021). Thus, products containing activated charcoal act only by removing extrinsic stains by the abrasion process caused by brushing, which could promote a certain degree of tooth whitening (Vaz et al, 2019;Dionysopoulos et al, 2020;Franco et al, 2020;Ghajari et al, 2021).…”

“…Several studies show a relationship between acidic diet and lesions not caused by caries, leading to loss of dental structures caused by chemical actions, with the cervical region of the teeth being the most affected by non-carious lesions resulting from the ingestion of industrialized beverages, fruits, and citrus juices (Lussi et al, 2012;Barbour et al, 2011;Rios, 2018). Thus, cleaning performed with products containing charcoal may not be the best option to achieve desirable oral health, let alone reach society's desire for a white smile, as some studies suggest the high abrasive capacity of these products (Dionysopoulos et al , 2020;Palandi et al, 2020;Koc Vural et al, 2021), which, when associated with an acidic diet, can result in greater loss of dental structures by mechanical (abrasion) and chemical (biocorrosion) actions (Barbour et al, 2011;Rios, 2018).…”