International Dental Journal (2005) 55 , 194196

The measurement of enamel and dentine abrasion by tooth whitening products using an in situ model
A Joiner, L Z Collins, T F Cox and M J Pickles
Bebington, UK

E Weader, C Liscombe and J S Holt

Capenhurst, UK
Objectives: To determine the enamel and dentine wear of two whitening toothpastes using an in situ model with ex vivo brushing. Methods: Human enamel/dentine (approximately 50:50) blocks (approximately 4 x 4mm) were placed in the upper buccal aspects of full or partial dentures of a group of 25 subjects. Subjects brushed the specimens ex vivo with either a calcium carbonate/perlite or silica containing whitening toothpaste under exaggerated conditions as compared to normal for 30s, twice per day. Specimens were removed after 4, 8 and 12 weeks and the wear to the enamel and dentine was determined. Enamel wear was determined by change in Knoop indent length and dentine wear was determined from the enamel-dentine step height, measured using optical profilometry. Results: The mean wear after 12 weeks was for enamel 0.27 and 0.19 microns, and for dentine 34.3 and 61.1 microns, for the calcium carbonate/perlite and silica toothpastes respectively. There were no significant differences between products after 12 weeks. The rate of wear was found to decrease throughout the duration of the study. Conclusion: There were no significant differences between the two whitening toothpastes in terms of enamel and dentine wear after 12 weeks brushing.

Key words: Abrasion, tooth wear, toothpaste, dentifrice

Manufacturers of oral care products continually aim to improve the efficacy and appeal of existing products and develop new products in order to meet the demanding expectations of patients and consumers. Indeed, with the growing interest among consumers for tooth whitening products, many new toothpaste formulations to enhance the removal and/or prevention of extrinsic stain have been described13. The primary stain removal ingredient in a toothpaste is the abrasive. It is well documented that if very low abrasive toothpaste is used then extrinsic stain usually accumulates on the surfaces of the teeth and it is now widely accepted that toothpastes require a certain amount of abrasivity in order to remove or prevent extrinsic stains from forming47. A new tooth whitening toothpaste has been developed that contains calcium carbonate, perlite and silica microgranules as the abrasive system. This toothpaste has been clinically proven to have extrinsic stain
2005 FDI/World Dental Press 0020-6539/05/03194-03

removal efficacy after two weeks use8. The objectives of the current work were to investigate the enamel and dentine wear of this new whitening toothpaste and compare it to a commercial silica-based whitening toothpaste over a 12-weeks period using a recently described in situ model with ex vivo brushing9.
Materials and methods

Specimens of enamel-dentine were prepared as previously described9 and attached to the same side of the upper buccal surface of full dentures. Each subject had three inserts aligned so that the enamel/dentine interface was parallel to the occlusal surface of the denture teeth. The subjects consisted of adult volunteers and exclusion criteria included subjects suffering from any condition that affects their ability to participate, pregnancy, or those participating in other dental clinical trials. Informed consent was obtained and

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the protocol reviewed by an Independent Ethics Committee. The study consisted of two parallel monadic groups and tested the enamel and dentine wear effects of the calcium carbonate/perlite (n=13) toothpaste and a marketed silica tooth whitening toothpaste containing 3.3% pyrophosphate and sodium bicarbonate (n=12). The panellists were asked to remove their dentures for cleaning twice per day. During the first week, the specimens were cleaned twice daily for 30s with water and a toothbrush in order to allow pellicle formation. After 1 week, subjects received the test toothpaste and were instructed to brush their denture ex vivo with the test toothpaste and to brush along the inserts, parallel with the teeth to simulate a scrub technique where the toothbrush passes over the cervical area and contacts the enamel and dentine simultaneously. Subjects were instructed to ensure the enamel-dentine specimens were brushed for 30s, twice daily, for the following 12 weeks. In addition, subjects were instructed to wear their dentures continually for 24 hours and not to use any other toothpaste, mouthwash, dental floss or denture cleaner for the duration of the study. After 4, 8 and 12 weeks of brushing with the test toothpastes, one enamel-dentine specimen was removed for subsequent wear measurements as previously described9.
Results

two toothpastes was found only at 8 weeks (p=0.003), but not at the other time points. No significant differences were found for mean dentine wear for the two toothpastes at any of the time points (p>0.05).
Discussion

All subjects using the calcium carbonate/perlite containing toothpaste completed the study. For subjects using the silica whitening toothpaste, two subjects withdrew from the study for personal reasons. In addition, three of the subjects using the latter product had partial dentures to which it was possible only to attach two enamel/dentine specimens. No adverse events attributable to the protocol were reported by the subjects or observed by the examining clinician. The summary data, showing the mean enamel and dentine wear as well as median values for all time points, are shown in Table 1. A generalised linear model, with a gamma distribution, was fitted to the data for each time point. A significant difference for mean enamel wear for the
Table 1 Enamel Calcium carbonate/perlite Silica

Laboratory methods are commonly used to study the abrasive wear of toothpaste towards dental hard tissues10. Measuring tooth wear processes in vivo is considerably more difficult due to the lengthy time scales needed (often a number of years) together with potential confounding affects from other physical and chemical processes involved in the aetiology of tooth wear11. Therefore, in situ methods have been described that aim to measure toothpaste abrasive wear over considerably shorter time scales2,9,1116. These typically combine the exposure of enamel or dentine specimens to the oral environment, together with the sensitivity of laboratory analyses. For examples, Cowell and Allen12 used gold circumferential clasps cemented to lower premolars in vivo to attach 2mm2 sections cut from the cemento-enamel junction of extracted human teeth. Davis13 used flattened enamel/dentine specimens set into the labial surface of an upper incisor porcelain crown. This was examined periodically by taking replicas of the test area. More recent approaches2,9,11,1416 have attached specimens to either full or partial dentures or intra-oral devices. In the current study, the specimens are attached to dentures and this is advantageous as it is much less invasive to the subject, quick, simple and offers the potential to study a large number of specimens and products. The time of 30s per brushing period may be considered as being exaggerated, since the typical in vivo brushing time has been reported to be 50s in total17 and a typical tooth surface in vivo will therefore only be brushed for 5s per day16. However, the current protocol with 30s brushing time allows wear to be measured within a few weeks, rather than months or years. The level of enamel wear for the calcium carbonate/ perlite toothpaste in the current study is comparable to previously reported values for a silica/perlite containing toothpaste of 0.20, 0.44 and 0.60 microns after 4, 8

Mean(sd) and median enamel and dentine wear (microns) 4-weeks 0.19(0.15) med = 0.13 0.11(0.13) med = 0.06 4-weeks 29.6(30.6) med = 23.1 33.5(32.1) med = 37.3 8-weeks 0.41(0.39) med = 0.32 0.11(0.06) med = 0.09 8-weeks 34.5(39.2) med = 18.0 45.4(40.7) med = 48.8 12-weeks 0.27(0.17) med = 0.32 0.19(0.18) med = 0.11 12-weeks 34.4(36.5) med = 23.2 61.1(42.7) med = 76.8

Dentine Calcium carbonate/perlite Silica

Joiner et al.: Enamel and dentine abrasion measurement in situ

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and 12 weeks respectively16, and 0.137 microns after 4 weeks2, using a similar protocol with human enamel specimens. Thus, the current protocol and subsequent laboratory measurements are highly reproducible and consistent in terms of enamel wear. In terms of dentine wear, it is clear from the data that the rate of wear is not constant with time. Indeed, the greatest rate of wear occurs in the first four-week period with subsequent time periods showing a much reduced wear rate. This phenomena has been reported in other in situ studies used to measure dentine wear9,14,15. For example, Kodaka et al.14 observed mean in situ dentine wear values of 52.2, 82.4 and 142.5 microns after 2, 4 and 8 weeks respectively, with brushing for 1 minute per day. In contrast, in vitro dentine wear has been reported to be generally linear with brushing time18,19. Thus, the wear behaviour of dentine specimens in vitro is different to specimens exposed to the oral cavity in situ. This difference in behaviour between in vivo and in situ is speculated to be due to a number of factors, including, the formation of a protective salivary pellicle20, and the potential effects of fluoride on the dentine surface21. The level of dentine wear reported by Pickles et al.9 for three marketed standard toothpastes containing silica or calcium carbonate was found to be in the range 31.0742.63 microns after 12 weeks, using a similar in situ protocol. The level of dentine wear found in the current study for the calcium carbonate/ perlite containing toothpaste was within this range. This indicates that this whitening toothpaste has similar wear behaviour to these non-whitening marketed toothpastes. However, the silica whitening toothpaste tested in the current study has a slightly elevated wear rate towards dentine compared to these marketed toothpastes.
Conclusion

The hard tissue abrasion of enamel and dentine has been assessed using an in situ model with ex vivo brushing for two whitening toothpastes, one containing calcium carbonate/perlite and one containing silica. There were no significant differences found between the toothpastes in terms of enamel and dentine wear after 12 weeks.
References
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424430. 3. Matheson JR, Cox TF, Baylor N et al. Effect of toothpaste with natural calcium carbonate/perlite on extrinsic tooth stain. Int Dent J 2004 54: 321325. 4. Stookey GK, Burkhard TA, Schemehorn BR. In vitro removal of stain with dentifrices. J Dent Res 1982 61: 12361239. 5. Kitchin PC, Robinson HBG. How abrasive need a toothpaste be? J Dent Res 1948 27: 501506. 6. Forward GC. Role of toothpastes in the cleaning of teeth. Int Dent J 1991 41: 164170. 7. Nordbo H. Discoloration of dental pellicle by tannic acid. Acta Odontol Scand 1977 35: 305310. 8. Collins LZ, Naeeni M, Schfer F et al. The effect of a calcium carbonate/perlite toothpaste on the removal of extrinsic tooth stain in 2 weeks. Int Dent J 2005 55: 179182. 9. Pickles M J, Joiner A, Weader E et al. Abrasion of human enamel and dentine caused by toothpastes of differing abrasivity determined using an in situ wear model. Int Dent J 2005 55: 188193. 10. West NX, Jandt KD. Methodologies and instrumentation to measure tooth wear; future perspectives. In: Addy M. Embery G, Edgar WM, Orchardson R (eds) Tooth Wear and Sensitivity. pp 105120. London: Martin Dunitz, 2000. 11. Addy M, Hughes J, Pickles MJ et al. Development of a method in situ to study toothpaste abrasion of dentine. J Clin Periodontol 2002 29: 896900. 12. Cowell CR, Allen RWB. A comparison of dentine wear on prepared tooth sections in vivo using two toothpastes. Br Dent J 1979 146: 339342. 13. Davis WB. The cleaning, polishing and abrasion of teeth by dental products. In: Breuer MM (ed) Cosmetic Science Vol 1. pp 3981. London: Academic Press, 1978. 14. Kodaka T, Kuroiwa M, Kuroiwa M et al. Effects of brushing with a dentifrice for sensitive teeth on tubule occlusion and abrasion of dentin. J Electron Microsc 2001 50: 5764. 15. Hooper S, West NX, Pickles MJ et al. Investigation of erosion and abrasion on enamel and dentine: a model in situ using toothpastes of different abrasivity. J Clin Periodontol 2003 30: 802808. 16. Joiner A, Weader E, Cox TF. The measurement of enamel wear of two toothpastes. Oral Health Prev Dent 2004 2: 383 388. 17. Duke SA, Forward GC. The conditions occurring in vivo when brushing with toothpastes. Br Dent J 1982 152: 5254. 18. West N, Addy M, Hughes J. Dentine hypersensitivity: the effects of brushing desensitizing toothpastes, their solid and liquid phases, and detergents on dentine and acrylic: studies in vitro. J Oral Rehab 1998 25: 885895. 19. Joiner A, Philpotts C, Cox TF. The abrasivity of dentifrices on enamel and dentin in vitro. J Dent Res 2005 84 (Spec Iss A): 2118. 20. Hannig M. The protective nature of the salivary pellicle. Int Dent J 2002 52: 417423. 21. Ganss C, Klimek J, Schffer F et al. Effectiveness of two fluoridation measures on erosion progression in human enamel and dentine in vitro. Caries Res 2001 35: 325330.
Correspondence to: Dr Andrew Joiner, Unilever Oral Care, Port Sunlight Laboratory, Quarry Road East, Bebington, Wirral, CH63 3JW, UK. E:mail: Andrew.Joiner@Unilever.com

International Dental Journal (2005) Vol. 55/No.3 (Supplement)