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The effect of three whitening oral rinses on enamel micro-hardness

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research
The effect of three whitening oral
rinses on enamel micro-hardness
SADJ May 2014, Vol 69 no 4 p154 - p157
E Potgieter1, Y Osman2, SR Grobler3
Summary
The purpose of this study was to determine the effect on hu-
man enamel micro-hardness of three over-the-counter whit-
ening oral rinses available in South Africa. Enamel fragments
were gathered into three groups of 15 each. One group was
exposed to Colgate Plax Whitening Blancheur, the second
group to White Glo 2 in 1 and the third to Plus White, in each
case for periods recommended by the respective manu-
facturers. Surface micro-hardness of all groups was meas-
ured before and after a 14 day treatment period. pH levels
of the oral rinses were also determined with a combination
pH electrode. Pre- and post- treatment data were analysed
by the Wilcoxon Signed Rank Sum Test. According to the
micro-hardness values no significant (p>0.05) enamel dam-
age was found as a result of treatment. However, it was
observed that Colgate Plax and White Glo decreased the
enamel hardness, an early sign of enamel damage, while
Plus White showed a small increase in hardness. The three
whitening oral rinses on the South African market do not
damage the tooth enamel significantly when used as rec-
ommended by the manufacturers. However, extending the
contact period and increasing the frequency of application
might lead to damage of enamel.
Key words: enamel micro-hardness, oral rinses, whitening.
INTRODUCTION
Today’s society has the expectation that people should have
exceptionally white (and straight) teeth. Oral rinses have be-
come a popular means for whitening the teeth.
Different bleaching techniques have been advocated over
time. The demand in dental practice for tooth whitening to
lighten discoloured teeth has increased exponentially over the
last decade.1 Most whitening methods include the use of per-
oxide bleaching agents.2 Tooth bleaching occurs by the dif-
1. E Potgieter: BSc, BSc (Hons), HED, Dipl OH. Department of Oral
Hygiene, Faculty of Dentistry, Tygerberg, South Africa.
2. YI Osman: BChD, MChD, Hons BBA, MBA, PGDHM.
Department of Restorative Dentistry, Faculty of Dentistry, University
of the Western Cape, Tygerberg, South Africa.
3. SR Grobler: BSc, BSc (Hons), MSc (Phys. Chem), DSc (Chem),
PhD (Dent). Oral and Dental Research Institute, Faculty of Dentistry,
University of the Western Cape, Tygerberg, South Africa.
Corresponding author
SR Grobler:
Oral and Dental Research Institute, Faculty of Dentistry, University of the
Western Cape, Tygerberg. E-mail: srgrobler@uwc.ac.za
ACRONYMS
OTC: over-the-counter
VHN: Vickers Hardness Values
fusion of the bleaching agent in and through enamel/dentine
where oxidation takes place with a resulting decomposition of
organic pigments, particularly within the dentin.3 Tooth whiten-
ing therefore involves direct contact of a bleaching agent with
the enamel/dentine for periods of time which vary according
to the directions determined by the manufacturers. This occa-
sioned concerns about the possible adverse effects of such
strong oxidising agents on enamel/dentine. The available lit-
erature is contradictory.2 Some studies reported changes in
the surface morphology of enamel following bleaching with
carbamide peroxide or hydrogen peroxide products, while
others reported no alterations.4-12 For example, Hegedüsa et
al, in an atomic force microscopy study, demonstrated that
carbamide peroxide and hydrogen peroxide were capable
of causing alterations in the enamel surface.13 According to
Pugh, low concentrations of hydrogen peroxide are not ex-
pected to adversely affect the enamel and pulpal enzymes.14
However, a recent study revealed that Opalescence products
having four different peroxide concentrations, (from 3.35-15%
H2O2), all damaged enamel, which was most severe when
teeth were treated for longer periods.3 From the literature it
becomes clear that variations in the different bleaching prod-
ucts and their concentrations, as well as the specific bleach-
ing agent and its pH; the application periods; heat and light
sources; as well as the type of original tooth discolouration; all
influence the effect on enamel or dentine.2
Sales of over-the-counter (OTC) tooth-whitening products
have escalated because of heightened consumer demand
for aesthetic care together with energetic promotion by prod-
uct manufacturers. The items are available in pharmacies,
department stores and on the Internet. Many are marketed
directly to consumers. The cost is much less than in of-
fice whitening treatment delivered by a dental health profes-
sional. The availability of these products is not controlled in
South Africa nor in many other countries. One study did find
that enamel surfaces treated with over-the-counter bleach-
ing products did not show any significant colour improve-
ment whilst no significant changes in micro-hardness values
from baseline were recorded.5 However, over-the-counter
bleaching products have not undergone rigorous testing
and hence their efficacy and safety have not been explored.
On the South African market only a few oral rinses for tooth
whitening are available OTC. Therefore, the purpose of this
www.sada.co.za / SADJ Vol 69 No. 4
research <
155

in vitro study was to determine the effect of three OTC whit-

ening oral rinses on human enamel micro-hardness.

MATERIALS AND METHODS

Specimen preparation
Freshly extracted, non-carious human molar teeth were col-
lected and stored in water, with a few preservative thymol
crystals. The roots were removed using a double-sided dia-
mond saw driven by a low-speed motor (Metaserv, Universal
Polisher, UK). Enamel blocks of 5x5 mm,2 sectioned longi-
tudinally to the crowns, were examined under a stereomi-
croscope (10x magnification) and any with stains or cracks
were discarded,2,3 Forty five selected enamel blocks were
individually embedded in acrylic in one cm high PVC rings
which had been cut from 25mm diameter electrical tubing.
The samples were set horisontally with the enamel surface
exposed above the acrylic.2,3 The enamel was finely pol-
ished using water cooled carbide paper up to a grit of 1200.
The specimens were randomly divided into three treatment
groups with 15 specimens each.
One group was exposed to Colgate Plax Whitening Blancheur
(Colgate-Palmolive, Brazil) (CPW) for 1 minute twice a day,
the second group to White Glo 2 in 1 (Sunpac Ltd, Gauteng,
South Africa) (WG) for 30s twice a day and the third to Plus
White (CCA Industries Inc, USA) (PW) for 30s twice daily.,
The exposure times were according to the manufacturer’s
instructions. The trial extended over 14 days. Between ap-
plications the samples were stored in artificial saliva.2 Table
1 presents the composition of each of the whitening oral
rinses, as provided by the respective manufacturer.
Micro-hardness measurement
Surface micro-hardness of the enamel specimens was
measured on each, using a digital hardness tester with
a diamond indenter (Zwick Roell Indentec, ZHV;Indentec
UK).2,3 The saliva stored specimens were gently wiped with
Table 1: Composition of the Rinses
Product Composition
Aqua, Sorbitol, Alcohol, 4%
Hydrogen Peroxide, Poloxamer
A. Colgate Plax Whitening
338, Polysorbate 20, Methyl
Blancheur
Salicylate, Menthol, Sodium
Saccharin.
Purified Water, Ethanol 95SG,
Sorbitol, Polysorbate 80,
Eucalyptol, Methyl Salicylate,
B. White Glo 2 in 1
Menthol Crystal, Cetylpyridinum
Chloride, Benzoic Acid, Sodium
Saccharin,Caramel.
Water, Glycerin, Poloxomer 338,
Flavour, Sodium Saccharin,
C. Plus White Cetylpyridinum Bromide, FD&C
Blue, Tetrasodium EDTA, Diso-
dium EDTA, Methylparaben.
Figure 1: Box and Whisker plot showing the maximum, minimum, 25th percen-
tile, median and 75th percentile differences in micro-hardness values.
a tissue paper, rinsed with distilled water and tissue blot-
dried before each micro-hardness measurement. Before
any treatment, four indentations were made on the pol-
ished enamel surface of each enamel block with a 300g
load applied for 15 seconds. This enabled the determina-
tion of base-line hardness values. The process was re-
peated after 14 days of active bleaching treatment, with the
new indents being placed about 10µm from the baseline
indents.2,3 All data were saved as Vickers Hardness Val-
ues (VHN), destined for statistical analysis (Wilcoxon Rank
Sum Test). The before and after data were compared, each
sample serving as its own control.
The pH levels of the oral rinses were also measured, using an
Orion Expandable ion Analyzer EA940 (Orion Research Inc.
MA, USA) and an Orion 9165BNWP Sure-Flow®, Epoxy-body
combination pH electrode (Thermo Electron Corporation,
Beverley, MA, USA). The pH electrode was calibrated using
three buffer solutions of pH values 3.0, 4.0 and 7.0 (Beckman
Instruments Irvine, CA, USA) and the electrode response to
the buffer solutions was checked (and recalibrated if neces-
sary) after every six sample measurements. Three samples
of each product were measured, and the electrode was then
completely cleaned by thorough washing and rinsing with
distilled water before the next set of readings was taken. The
mean pH values were recorded and noted (Table 1).
RESULTS
The median Vickers micro-hardness values of the test speci-
mens before and after the 14 day treatment period are reflected
in Table 2. Box and Whisker plots were prepared to indicate
the distribution of the micro-hardness values (Figure 1) for:
the groups treated respectively, by Colgate Plax Whitening
Blancheur, White Glo 2 in 1 and Plus White. In Figure 1, the
top line shows the maximum and the bottom line, the minimum
hardness values, while the box part shows the location of 50%
of the values. The line in the box depicts the median hardness
value of the difference in micro-hardness between base-line
and after treatment.

Table 2: The mean pH and the length of exposure time for each of the oral rinses and the median Vickers micro-hardness values for each
group before and after treatment.
Oral Rinse pH Total exposure time (min) Before treatment After treatment
A. CPW 3.74 28 318 301
B. White Glo 2 in 1 3.59 14 308 295
C. Plus White 5.00 14 301 311
156 > research
The Wilcoxon Signed Rank Sum Test showed no statistical
significant differences, (at a 5% level), between baseline val-
ues and the values obtained after a 14 day treatment period
for all three different oral rinses.
DISCUSSION
It is evident from the literature that many factors such as differ-
ent bleaching agents with differing concentrations, type and
concentration of acid, pH, temperature, exposure time and
frequency of exposure, can all contribute to enamel erosion/
demineraliszation.2,3,4 The initial stage of caries development
has been identified as surface-softening lesions of enamel.15
Today it is generally accepted that micro-hardness determi-
nations give a reliable indication of this softening, (damage/
demineraliszation), of enamel or dentine and this criterion is
now employed worldwide for this purpose. 2,3,16-19
Most solutions with low pH levels are known to soften and
erode enamel.10,11,20 According to Goldstein, the acidic prop-
erty of the bleaching agents can also cause changes in the
mineral content of enamel and may therefore result in dam-
age to dental structures even under prescribed conditions.21
Minor alterations of the enamel may facilitate the future pen-
etration of bacteria, debris or staining substances, affecting
the success of bleaching.5 The pH values of the three oral
rinses used in this study, ranged from 3.59 to 5.00 (Table 1).
Such acidic levels would normally be considered as hazard-
ous towards teeth and could be expected to decrease the
enamel hardness. Significant enamel demineralisation and
root resorption have been reported when the pH falls below
5.2.22 Some studies reported demineraliszation of enamel
at a pH below 5.2, while others reported a pH of 5.5 as
the critical pH.23,24 However, Dawes recently reported that
the critical pH at which enamel starts to, should rather be
regarded as being in a range of 5.1 to 6.5, depending also
on the concentrations of calcium and phosphate present in
the solution.25 Most solutions/beverages which are known
to soften enamel and produce dental erosion have low pH
levels.26-28 In an in vitro study, Hunter et al observed that
increasing the frequency of exposure to a drink having a
low pH resulted in a non-proportional increase in dental ero-
sion.29 Reducing the frequency of exposure by half did not
result in a similar reduction in tissue loss.
The pH of whitening products changes inside the oral cavity
during the bleaching process. However, it is not known if the
change in pH occurs at the same rate for products containing
hydrogen peroxide (H2O2) or carbamide peroxide (CH6N2O3)
or if this pH change would adversely affect oral soft and
hard tissues.22 Of the three oral rinses tested, Colgate Plax
contains hydrogen peroxide while the other two probably
depend mainly on the acidity of the rinse to whiten teeth
(Table 1). An overall lowering in the median enamel hardness
values as a result of the normal treatment by the three rinses
was demonstrated, although these changes were not statis-
tically significant (Figure 1). The sample treated with Colgate
Plax recorded the greatest decrease in enamel hardness,
followed by the White Glo sample. These two oral rinses
have the lowest pH values (3.74 and 3.59; Table 1) which
gives an indication of a strong relationship between acidity
and the extent of enamel damage by demineralisation. On
the other hand, treatment with Plus White (Table 1), with a
higher pH of 5.0, gave a small increase in the hardness for
the third group. Perhaps it is of relevance that the total ex-
posure time of Colgate Plax (28 min) was twice that of the
other two products. That may be expected to contribute to
the relatively greater softening of enamel by Colgate Plax in
comparison with the effects seen in the sample treated with
White Glo, even though that product has a somewhat lower
pH (3.59 vs 3.74).
The whitening effects of the three oral rinses, (Colgate Plax
Whitening Blancheur, White Glo 2 in 1 and Plus White), have
been reported to be unsuccessful when applied according
to the manufacturers’ instructions.30 It is likely that if users
cannot see changes in the whiteness of their teeth they will
tend to practise longer exposure periods to the oral rinses
and to reduce the intervals between rinses This will diminish
the time when teeth are bathed in saliva, thereby reducing
the associated remineralisation effects and increasing the
chances of significant damage to enamel.
CONCLUSION
This study confirms that over the counter whitening rinses
do affect the enamel surfaces and cautions users not to
extend the application periods and frequency of use be-
yond the recommendations of the manufacturers because
of possible enamel damage.
Ethics statement: For the purpose of this study only extracted
teeth were used. These were all discarded specimens collected
from the Department of Maxillofacial and Oral Surgery, Faculty of
Dentistry, UWC.
Acknowledgement: This study is financially supported by the DDF
fund of the South African Dental Association and the UWC.
Disclaimer: The South African Dental Association does not neces-
sarily support the findings or conclusions made in this article.
Declaration: No conflict of interest declared.
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