How to Remove Iron Stains From Baby Teeth

Int J Clin Pediatr Dent. 2019 Jan-Feb; 12(1): 10–14.

Efficacy of 3 Toothpastes in Iron Stain Removal from Primary Teeth

Alireza Heidari

^1–3Department of Pediatric Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Islamic republic of iran

Mehdi Shahrabi

^1–3Department of Pediatric Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Islamic republic of iran

Marzieh South Shahrabi

^i–3Department of Pediatric Dentistry, Schoolhouse of Dentistry, Tehran University of Medical Sciences, Tehran, Islamic republic of iran

Abstract

Aim

This study aimed to assess the iron stain removal efficacy of three toothpastes in extracted primary teeth.

Materials and methods

In this in vitro study, 60 extracted sound main teeth were selected, decoronated at the cementoenamel junction, and their pulp chambers were filled with a blended. The teeth were then immersed in ferrous sulfate solution and brushed 3,000 times in an automatic tooth-brushing automobile using Colgate, whitening Crest, and conventional Crest dentifrices. Stain removal was done in four groups using a prophylaxis paste. Digital images were obtained from the teeth before and after brushing with dentifrices and the changes in colour parameters were measured using Photoshop and iColor software programs. Changes in color parameters were statistically analyzed using i-way ANOVA while multiple comparisons were done past Tukey's test.

Results

The greatest modify in chroma was observed in the prophylaxis group and then in the whitening Crest, Colgate, and conventional Crest (mean values of −65.ii, −31.07, −21.27, and −0.73, respectively). Prophylaxis completely removed the stains. The greatest reduction in value occurred in conventional Crest, Colgate, and whitening Crest (−18.07, −12.23, and −0.4, respectively). In the L*a*b* organization, the least reductions were noted in the whitening Crest, Colgate, and conventional Crest (hateful values of −1.96, −three.92, and −iii.37, respectively). Prophylaxis significantly improved tooth brightness (a hateful increment of 4.26).

Conclusion

None of the toothpastes in this study were capable of effectively removing iron stains. Crest whitening toothpaste was slightly effective in this regard.

Clinical significance

Iron drops are routinely prescribed for children younger than 2 years of historic period to prevent iron deficiency and iron deficiency anemia. Still, iron stains on teeth are a common business organisation for many parents. Finding toothpastes with greater efficacy for fe stain removal can help in this respect.

How to cite this commodity

Heidari A, Shahrabi Thousand, et al. Efficacy of Three Toothpastes in Iron Stain Removal from Principal Teeth. Int J Clin Pediatr Dent 2019;12(1):10–14.

Keywords: Iron, Primary teeth, Stain, Toothpastes

INTRODUCTION

Now, dental esthetics is especially important and many patients present to dental offices complaining of unesthetic and discolored anterior teeth and demand esthetic restorations. In full general, two types of molar discolorations may occur, namely discoloration due to extrinsic factors and congenital/systemic discoloration. To find the etiology of tooth discoloration and proper handling planning are oftentimes challenging for clinicians.

The master reason for molar discoloration is the aggregating of external stains on the surface or inside the pellicles covering the tooth surfaces.¹ Such stains are formed within the salivary pellicles due to chromogens present in foods and drinks, such every bit tannins in tea and coffee or habits like smoking.^i,ii The staining power of some coloring agents such as blackness tea and coffee is further enhanced when cationic mouthrinses, such as chlorhexidine or salts of polyvalent metals such every bit tin and fe are used.³ Adsorption and deposition of different agents on the tooth surfaces are responsible for extrinsic staining. Such adsorption occurs due to electrostatic forces, hydration, hydrogen bonds, and hydrophilic reactions. Notwithstanding, the exact machinery of adhesion of these stains to tooth surfaces is withal to be conspicuously understood.⁴

Iron drops are routinely prescribed for children younger than ii years of age to prevent iron deficiency and iron deficiency anemia. Iron drops have several advantages and ameliorate iron intake in children. Even so, they can cause black discoloration of teeth. Such discoloration would take an adverse outcome on the personality and mood of children and may affect their power to communicate with their peers and may result in their isolation and family concerns. At nowadays, a low speed paw piece with a rotary castor and prophylactic paste are used for atomic number 26 stain removal. This is done in dental clinics and requires the cooperation of children. Lack of cooperation of children may complicate the procedure of stain removal. Whitening toothpastes are used at home for removal of atomic number 26 stains from teeth in children. This study aimed to assess the atomic number 26 stain removal efficacy of 3 toothpastes in extracted primary teeth.

MATERIALS AND METHODS

This in vitro experimental study was conducted on 60 audio primary anterior teeth with no caries, restorations, developmental defects, enamel cracks, or external discoloration. The teeth had been extracted due to orthodontic reasons. Using randomization blocks, the teeth were randomly divided into four groups. Soft tissue residues were manually removed from the teeth surfaces and the teeth were immersed in 5.25% sodium hypochlorite solution (Shamin Chemical, Tehran, Iran) for 30 minutes. The teeth were then stored in sterile 0.9% sodium saline solution (DaruPakhsh, Tehran, Islamic republic of iran) at room temperature until the experiment was consummate. In the next stride, the teeth were cut at the cementoenamel junction (CEJ) and the pulp sleeping room was evacuated. The CEJ surface area and the pulp chamber were filled with flowable composite resin. The teeth were starting time etched for thirty seconds, rinsed and the bonding agent was applied and calorie-free cured for x seconds. The flowable composite was then injected to fill up up the area. The teeth were mounted on a specific mold containing an automobile polymerizing acrylic resin. The teeth were and so immersed in ferrous sulfate solution (iron drop) for 30 hours. The teeth were photographed by a digital camera (Canon). The method and angulation of lighting and photography were the same for all specimens. The digital camera was fixed to a tripod and the tripod was as well fixed to the ground. The camera was adjusted at xx cm altitude from the specimen surface. Mounted teeth were photographed against a greenish background. Colgate children's toothpaste was used for teeth in grouping A, Crest adults' toothpaste was used in group B, Crest whitening toothpaste was used in group C, and group D teeth were subjected to prophylaxis using a prophylactic rotary brush and paste. The afore-mentioned toothpastes and 45 Gum 411 toothbrushes were obtained from the official representatives.

The teeth were brushed using an automatic molar-brushing car iii,000 times. For this purpose, 8 toothbrushes were simultaneously installed in V8 cross-brushing machine and the specimens were fixed beneath the toothbrushes in their respective location. Adjacent, 25 yard of the toothpaste was dissolved in 100 mL of h2o and a solution of each toothpaste was prepared. A dissever toothbrush was used for each tooth. A total of xv teeth were brushed with a low speed hand slice and prophylactic paste for 10 seconds. Digital photographs were taken once again at the same conditions from the specimens. Images were transferred to a computer and evaluated using Adobe Photoshop CS5 and iColor software programs. For this purpose, the L*, a*, and b* parameters were determined for specimens in Photoshop software, while the L (value), C (blush), and H (hue) parameters were calculated using the iColor software.

The range of changes for the Fifty*, a* and b* parameters in Adobe Photoshop 7.0 software varies from 0 to 255. Nevertheless, in the CIE L*a*b* system, the Fifty* parameter varies from 0 to 100 and a* and b* range from −120 to +120. Thus, because the different ranges of change in Fifty*, a*, and b* values in Photoshop software with the CIE Fifty*a*b* parameters, the post-obit equations were used for conversion of values to the CIE system:

ΔDue east was then calculated using the equation below:

The L*, a*, and b* parameters were calculated in Photoshop software before and later the use of toothpastes, while the LCH parameters were calculated in the iColor software before and after the intervention. The differences in the treatment groups in terms of changes in the L*, a*, and b* parameters in Photoshop software and LCH parameters in iColor software were analyzed using one-way ANOVA. In cases for which the results of ANOVA became significant, pairwise comparing of groups was carried out using Tukey's multiple comparison test.

RESULTS

In group A, using Colgate children'due south toothpaste, the 50* parameter, the b* parameter, and the a* parameter changed by iii.92 ± 1.99, 8.09 ± 4.72, and 22.78 ± 3.51, respectively, after the intervention (tooth brushing with the toothpaste). In grouping B, using the Crest adults' toothpaste, the 50* parameter, the b* parameter, and the a* parameter inverse by three.37 ± 2.33, iv.27 ± 4.95, and xx.33 ± 4.43, respectively, after the intervention (tooth brushing with the toothpaste). In group C, using the Crest whitening toothpaste, the L* parameter, the b* parameter, and the a* parameter changed by 1.96 ± 2.14, 9.29 ± 4.31, and 23.22 ± 3.81, respectively, subsequently the intervention (tooth brushing with the toothpaste). In group 4 (prophylaxis), the L* parameter, the b* parameter, and the a* parameter changed by 4.26 ± two.6, 12.11 ± 10.23, and 22.53 ± 8.02 later the intervention, respectively. The ΔE of teeth in the 4 groups A, B, C, and D was found to be 24.83 ± 4.55, 21.63 ± 4.79, 25.44 ± four.29, and 27.67 ± 8.69, respectively, using the Photoshop software (positive values point the increase in parameters while negative values indicate reduction in parameters after molar brushing) (Table i).

Table 1

The hateful and standard deviation of changes in the L*, a*, and b* parameters in the Photoshop software later on toothbrushing with dissimilar toothpastes (test groups) and prophylaxis (control)

Group	Parameter	Mean	SD	Minimum	Maximum	Number
Toothpaste Colgate children's	Fifty*	−three	one.99	−half dozen.67	0.39	15
	b*	−8.09	4.72	−16.94	i.88	15
	a*	−22.78	3.51	−29.18	−16.0	15
	ΔEastward	24.83	4.55	16.12	33.77	15
Crest adults'	50*	−3.37	2.33	−half dozen.67	0	15
	b*	−iv.27	4.95	−16.0	iv.71	xv
	a*	−20.33	4.43	−27.29	−12.24	15
	ΔE	21.63	4.79	thirteen.32	29.75	xv
Crest whitening	50*	−1.96	2.14	−5.one	ii.75	15
	b*	−9.29	four.31	−xv.06	1.88	fifteen
	a*	−23.22	3.81	−31.06	−16.0	15
	ΔE	25.44	4.29	17.xiii	32.6	xv
Prophylaxis	50*	4.26	2.half dozen	−i.18	8.24	fifteen
	b*	−12.11	10.23	−28.24	16.94	15
	a*	−22.53	eight.02	−32.94	−7.53	15
	ΔE	27.67	8.69	14.29	43.45	15

1-mode ANOVA revealed significant differences in the range of changes in L* (p < 0.0001), b* (p < 0.02), and ΔE (p < 0.05) amidst different toothpaste groups; however, no pregnant difference was noted among groups in terms of the range of changes in a* parameter (p = 0.45). Considering the significant results of one-fashion ANOVA for L*, b*, and ΔE, pairwise comparison of groups in this regard was carried out using Tukey'due south multiple comparison exam. The results showed that the Colgate children's toothpaste and Crest adults' toothpaste (p = 0.91), and likewise Colgate children's toothpaste and Crest whitening toothpaste (p = 0.33) were not significantly different in terms of changes in the 50* parameter after the intervention. However, group A (Colgate children's toothpaste) and group D (p < 0.0001), group B (Crest adults' toothpaste) and grouping D (p < 0.0001), and too group C (Crest whitening toothpaste) and group D (p < 0.0001) showed significant differences in this regard.

Regarding the b* color parameter, pregnant differences were not found between group A (Colgate children's toothpaste) and group B (Crest adults' toothpaste) (p = 0.38), grouping A (Colgate children'southward toothpaste) and grouping C (Crest whitening toothpaste) (p = 0.96), group A and group D (p = 0.34), group B and group C (p = 0.16), and group C and group D (p = 0.64). However, the difference between group D and grouping B (Crest adults') in the b* parameter was found to be statistically significant afterwards the intervention (p < 0.009).

Comparison of ΔEastward revealed significant differences only between groups B and D (p < 0.03) and no other significant differences were found (p = 0.45 for groups A and B, p = 0.99 for groups A and C, p = 0.55 for groups A and D, p = 0.29 for groups B and C and p = 0.73 for groups C and D).

The iColor software revealed that Colgate children's toothpaste changed hue by 2.13 ± iv.26, blush by 21.27 ± 15.46, and value past 12.33 ± 7.84 units after the intervention. Crest adults' toothpaste changed hue by 2.53 ± ii.85, chroma by 19.83 ± 0.73, and value by eighteen.07 ± 10.23 units later the intervention. Crest whitening toothpaste inverse hue by three.28 ± 0.07, chroma past 31.07 ± 18.96, and value by xv.38 ± 0.4 units later on the intervention. Prophylaxis changed hue by 3.59 ± ane.8, chroma by 65.2 ± 16.88, and value by 34.07 ± thirteen.72 units (Table 2) (positive values indicate an increment in parameters, while negative values indicate a reduction in parameters).

Tabular array two

The mean and SD of differences in hue, chroma, and value in the iColor software afterward toothbrushing with different toothpastes (exam groups) or prophylaxis (control group)

Group	Parameter	Mean	SD	Minimum	Maximum	Number
Toothpaste Colgate children's	Hue	−2.13	4.26	−8.0	9.0	15
	Blush	−21.27	15.46	−43.0	9.0	15
	Value	−12.33	7.84	−26.0	0	15
Crest adults'	Hue	−2.53	2.85	−7.0	2.0	xv
	Chroma	−0.73	19.83	−25.0	59.0	15
	Value	−18.07	10.23	−35.0	−vi.0	15
Crest' whitening	Hue	−0.07	3.28	−half-dozen.0	6.0	15
	Chroma	−31.07	eighteen.96	−58.0	8.0	15
	Value	−0.four	15.38	−26.0	37.0	15
Prophylaxis	Hue	−1.8	3.59	−viii.0	v.0	15
	Chroma	−65.2	xvi.88	−98.0	−46.0	fifteen
	Value	34.07	13.72	thirteen.0	59.0	fifteen

One-manner ANOVA showed that the four groups were not significantly different in terms of changes in hue (p = 0.25) just they showed significant differences in terms of changes in chroma (p < 0.0001) and value (p < 0.0001).

Because the significant differences in chroma and value, a pairwise comparison of groups was washed using Tukey'southward test. In terms of chroma, the differences between Colgate and Crest adults' (p < 0.01), Colgate and group D (p < 0.0001), Crest adults' and Crest whitening (p < 0.0001), Crest adults' and group D (p < 0.0001) and Crest whitening and group D (p < 0.0001) were statistically meaning. However, no significant difference was found between Colgate children's toothpaste and Crest whitening toothpaste (p = 0.44) in terms of chroma in the iColor software.

In terms of value, the divergence between Colgate and Crest adults' (p = 0.57) was not pregnant but the differences between Colgate children's toothpaste and Crest whitening (p = 0.05), Colgate children'south and group D (p < 0.0001), Crest adults' and Crest whitening (p < 0.001), Crest adults' and group D (p < 0.0001) and Crest whitening and grouping D (p < 0.0001) were statistically pregnant.

DISCUSSION

This study showed meaning differences in the range of changes in the 50*, b* and ΔDue east color parameters after tooth brushing with different toothpastes; however, the deviation in the range of changes in the a* parameter was not meaning amid groups. The greatest ΔDue east was noted in group D (prophylaxis) followed by grouping C (Crest whitening), grouping A (Colgate children's), and group B (Crest adults') with a hateful value of 27.67, 25.44, 24.83, and 21.63, respectively. In other words, all the interventions in the electric current study caused color changes in teeth just the color changes were non necessarily towards lightening of the colour shade. The difference between group D and group B in terms of hateful ΔEast was meaning simply the remaining groups showed no meaning divergence in this regard.

The greatest modify in blush occurred in grouping D followed by group C, grouping A, and group B (65.2, 31.07, 21.27, and 0.73, respectively). In total, the teeth became slightly lighter but prophylaxis completely removed the stains.

The greatest reduction in value was noted in group B, group A, and group C (18.07, 12.33, and 0.four, respectively). This means that the teeth slightly lost value but did not announced darker. Crest whitening toothpaste had the greatest efficacy in this regard and reduction in value due to the application of this toothpaste being negligible. This value significantly increased following prophylaxis and the teeth became lighter (mean value of 34.07). The results of the Fifty*a*b* arrangement also confirmed this finding because the smallest reduction in the L* parameter (lightness) was found in group C (Crest whitening with a mean value of one.96) followed by Colgate children'southward and Crest adults' toothpastes (3.92 and three.37, respectively). Prophylaxis significantly lightened the teeth (a mean value of iv.26).

Color has three parameters hue, value, and chroma. Hue is the perception of observer from the color and depends on the different wavelengths of light beams that reach the eyes. Value is the achromatic dimension of colour and indicates its lightness/darkness. The higher the value, the lighter the color and the lower the value, the darker the color. Blush is the intensity of color. The greater the blush, the richer the color. In full, Crest whitening toothpaste slightly removed the iron stains just Crest adults' and Colgate children's toothpastes did non cause a pregnant divergence in this regard. Prophylaxis successfully removed all stains.

Esfahanizadeh and Ghayumi showed that Crest whitening toothpaste was more effective than Pooneh in stain removal. In our report, Crest whitening toothpaste caused the greatest color alter and was establish to exist more efficient that other toothpastes. In a study by Sharif et al., in 2000, toothpastes containing sodium tripolyphosphate and sodium lauryl sulfate were more constructive in stain removal than toothpastes free from sodium tripolyphosphate.⁵ Ayad et al. evaluated the stain removal efficacy of iii toothpastes from blended restorations and reported that toothpastes containing polymeric phosphates (tetrasodium pyrophosphate and sodium tripolyphosphate) were more effective than toothpastes devoid of these compounds.^{half dozen} Aside from sodium tripolyphosphate, tetra sodium pyrophosphate is also constructive equally an anti-plaque agent for this purpose.⁶ In the study, by Esfahanizadeh and Ghayumi, Crest whitening toothpaste was found to be more than effective than Pooneh in terms of stain removal because Crest whitening toothpaste contains tetrasodium pyrophosphate equally an anti-plaque agent. Thus, this caption also applies to the current study. Polyvinylpyrrolidone (PVP) is some other compound that bonds to tea and chlorhexidine stains and removes them from the tooth surface. A previous study assessed the efficacy of an experimental toothpaste containing PVP and reported that it was more than effective for prevention of stains than commercial toothpastes and water.⁷

Pontefract et al. evaluated the efficacy of Aquafresh experimental toothpaste for stain removal in comparing with commercial toothpastes and water.⁸ The superior efficacy of Aquafresh reported in their report was attributed to the presence of sodium tripolyphosphate, sodium lauryl sulfate, and PVP whitening agent in its formulation.

Moran et al. plant no pregnant difference between an experimental toothpaste containing sodium tripolyphosphate and toothpastes devoid of this compound.⁹ They explained that a combination of concrete methods such as tooth brushing with annoying materials and chemicals present in the formulation of toothpastes decreases dental stains. Reduction in the intensity of stains may be due to the thinning of the stain layer due to the annoying event of tooth brushing with toothpastes, and color of stains turns from brownish to yellow upon exposure to chemicals present in the conception of toothpastes.

In a study on toothpastes containing whitening agents such equally sodium tripolyphosphate, sodium lauryl sulfate, and PVP, toothpastes containing these compounds were plant to be more effective in the removal of external stains than other toothpastes. In a study past Esfahanizadeh et al., although both Crest whitening and Pooneh toothpastes contained these 3 compounds, Crest whitening toothpaste was establish to be more efficient than Pooneh. This controversy may be due to the presence of tetra sodium pyrophosphate as an antiplaque agent in the composition of Crest and the small size of tripolyphosphate particles present in Crest toothpaste.

Golpas and Hagh et al. compared Iranian and strange made whitening toothpastes with a conventional toothpaste and reported that all toothpastes were effective in decreasing the stains. Even so, use of different indexes in contempo studies makes accurate comparison of results difficult because the afore-mentioned study was a clinical written report and the intensity of stains was measured using Lobene'south index. Whereas the current study had an in vitro design and measured 50*a*b* colour parameters. In the current report, Crest whitening toothpaste slightly removed the iron stains (by decreasing chroma).

Sharma et al. reported that Colgate and Aquafresh whitening and fluoridated toothpastes were more effective in stain removal than Crest regular toothpaste.¹⁰ In our study, Crest whitening and Colgate children's toothpastes were more than effective in improving tooth colour and removing stains than Crest adults' toothpaste. Yankell et al. reported that Aquafresh whitening toothpaste and Colgate anti-calculus toothpaste were more than efficient in decreasing external stains compared to Crest regular toothpaste.^xi Some other study showed that whitening toothpastes were more capable of decreasing external stains compared to regular toothpastes.¹² Moreover, Colgate toothpaste is capable of removing more than stains than Crest toothpaste subsequently three and 6 months.¹³

Annoying agents like silica incorporated into the formulations of toothpastes physically remove stains. At nowadays, silica is incorporated into the formulations of most toothpastes. Thus, such efficacy may be expected even from regular (not-whitening) toothpastes. Notwithstanding, in the current study, Colgate children's and Crest regular toothpastes showed no efficacy for iron stain removal, which may be due to the nature of stains. Addition of chemicals to whitening toothpastes enables the toothpastes to exert their cleaning effect even on areas that are hard to reach by abrasives. The use of toothpastes and toothbrushes enables benefitting from both the abrasiveness of toothbrushes and the physicochemical backdrop of toothpastes in stain removal. On the other hand, the combination of abrasive and chemical agents in toothpastes changes the nature of stains. Also, the decreased intensity of stains may exist due to the narrowing of the stain layer due to the abrasive action of toothbrush and toothpastes or changed color parameters.

Most previous studies accept only used indexes to mensurate the intensity and extensiveness of stains and digital equipment and software programs have been less usually used for this purpose. Apply of these technologies in the electric current written report increased the accuracy of results. Still, the study of specimens in the clinical setting would be more advantageous. Moreover, since the current report was conducted on primary teeth, comparison and generalization of results to permanent teeth would be difficult.

CONCLUSION

None of the toothpastes in this study were capable of effectively removing atomic number 26 stains. Crest whitening toothpaste was slightly effective in this regard. Thus, none of these toothpastes are recommended for iron stain removal post-obit iron driblet consumption.

CLINICAL SIGNIFICANCE

Iron drops are routinely prescribed for children younger than 2 years of historic period to prevent fe deficiency and iron deficiency anemia. However, iron stains on teeth are a common concern for many parents. Finding toothpastes with greater efficacy for iron stain removal can aid in this respect. This written report showed that none of the toothpastes in this study were capable of effectively removing iron stains. Crest whitening toothpaste was slightly effective in this regard.

Footnotes

Source of support: Cipher

Conflict of interest: None

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How to Remove Iron Stains From Baby Teeth

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710951/

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