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Original Article

Influence of tea and cola on tooth

color after two in-office bleaching
applications
Muhammet Karadas, Erhan Tahan1, Sezer Demirbuga2, Nilgun Seven3
Departments of Restorative Dentistry and 1Endodontic Treatment, Recep Tayyip Erdogan University, Rize, 2Departments of Restorative Dentistry, Erciyes University,
Kayseri, 3Atatrk niversity, Erzurum, Turkey

Address for correspondence: Dr. Muhammet Karadas, Recep Tayyip Erdoan niversity, Faculty of Dentitsry, Department of Restorative Dentistry, Rize - 53100,
Turkey. E-mail: muhammet. 2005@hotmail.com

ABSTRACT

Aim: To evaluate color changes of teeth after immersion in tea and cola following the application of
two in-office bleaching products. Materials and Methods: A total of 60 specimens were obtained from
60 extracted sound human maxillary central teeth. The specimens were randomly divided into three
groups (n = 20). Group A was the control group (no bleaching). In Group B, the specimens were bleached
with Opalescence Xtra Boost (Ultradent), and in Group C, they were bleached with Smartbleach (High
Tech Laser). These groups were then divided into two subgroups (n = 10 in each) according to the
colorant solution used: tea and cola. Each bleaching agent was applied to the specimens according to
the manufacturers recommendations. After bleaching, the first color of the specimens was determined
with a spectrophotometer according to the CIELAB color system (E). Following immersion in the
staining solutions, the color was determined after 15 min, 6 h (second day), and 36 h (sixth day), and
the color change values were calculated. The results were analyzed statistically by two-way analysis of
variance (ANOVA) and Tukeys honest significant difference (HSD) test (P < 0.05). Results: The bleached
specimens showed more staining than the unbleached specimens (control group). In all the groups,
the staining was more severe in the cola solutions than in the tea solutions. There were no statistically
differences in staining of the teeth in the control group (P > 0.05). In the specimens bleached with
Smartbleach, staining in cola solution was greater than tea solution and this difference was statistically
significant (P < 0.05). Conclusions: The staining of the bleached specimens was similar in the tea and
cola solutions. The bleached specimens showed more staining than the unbleached specimens. The
staining of the specimens in the tea and cola increased at all the time intervals evaluated.

Keywords: Bleaching, colour change, spectrophotometer

INTRODUCTION
Cosmetic dentistry has become a significant part
of restorative dental treatment. Having whiter and
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DOI:
10.4103/2321-4619.136643

aesthetically pleasing teeth is very important to patients

and is often related to the perception of health and
fineness. Thus, cosmetic systems have become more
desirable as standards of living have developed,[1] and
vital tooth bleaching is rapidly gaining popularity
with patients and dentists as a conservative technique
to lighten natural teeth.[2] Bleaching treatments can
be administered in-office by dentists using agents
containing high concentrations of hydrogen peroxide
or carbamide peroxide. They can also be applied in
the home by the patient, under the direction of the
dentist, using a less concentrated hydrogen peroxide or
carbamide peroxide solution.[3]

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Karadas, et al.: Office bleaching pruducts

There are several in-oce techniques for bleaching vital

teeth, all based on the use of concentrated hydrogen or
carbamide peroxide solution, in order to provide faster
and more eective treatment.[4] For this purpose, some
use heat and light to catalyze or speed up the reaction,
whereas others do not. A main advantage of using a light
source is that it assists in the release of the free radicals
in the bleaching agent for a faster bleaching procedure.[5]
The disadvantage of this method is that it increases tooth
sensitivity because the use of light and heat sources leads
to a higher pulpal temperature. As noted elsewhere,
dentists should consider pulp health before rendering
oce bleaching with light sources on vital teeth.[6]
The exposure of tooth surfaces to bleaching agents has
been shown to sometimes result in microstructural
changes in the enamel surface. [7] Using scanning
electron microscopy evaluation, one study found
demineralization, surface defects, and degradation of
sound enamel.[8] Other studies found that these alterations
may facilitate the recurrence of extrinsic staining[9] and
that there may be a loss of organic components from
bleached enamel and dentin surfaces.[10] Studies have
also revealed that changes in the microstructure of
teeth may be partly due to the loss, or denaturing, of
protein.[11] Coloring beverages, such as tea, cola and
coffee, consumed during the period of a bleaching
treatment may lead to staining of bleached and possibly
more porous enamel structure.[12] Therefore, dentists
advise patients to reduce the consumption of coee and
tea and to avoid smoking or any other habit that may
stain the teeth.[13]
To the best of our knowledge, there have been no studies
investigating the staining eect of tea and cola solutions
on tooth color after oce bleaching. Thus, this study was
performed to investigate the staining eect of tea and
cola after the application of in-oce bleaching.

MATERIALS AND METHODS

This study was approved by Ethical Commi ee of the
Atatrk University (200928803). Sixty extracted sound
human maxillary central incisors were used within
one month of extraction. Excessively dark or light teeth
were not included. After extraction, the teeth were
stored in 8% thymol solution. The roots were sectioned
from the crowns at the dentinoenamel junction using
a water-cooled diamond saw (Imptech PC10; Equilam
Lab Equip, Diadema, Brazil). Using rectangle moulds,
each specimen, with the labial surface exposed, was
submerged separately in chemically cured acrylic resin,
which allows light to pass through it. Then, the enamel
surfaces were polished with a prophylaxis paste, using
a polishing brush, and washed. The specimens were
randomly divided into three groups (n = 20). Group A

was the control group (no bleaching). In Group B, the

specimens bleached with Opalescence Xtra Boost, and
in Group C, they were bleached with Smartbleach. The
groups were then divided into two subgroups according
to the colorant solutions used (n = 10, tea and cola).
Each bleaching agent was applied to the specimens
according to the manufacturers recommendations. The
characteristics of the bleaching products are given in
Table 1.
Opalescence Xtra Boost, the mixture was prepared and a
0.5-1 mm layer of the mixture was applied immediately
to the specimens, using a dispenser tip. After 15 min,
the bleaching agent was removed from the specimens
using cotton, and then rinsed. The procedure was
repeated three times at the same si ing, and the process
was repeated after 1 week. Smartbleach, 35% hydrogen
peroxide gel was prepared shortly before use by mixing
about 5 ml of peroxide with the buering red powder.
The gel mixture was applied to the specimen surface;
then, using a kariumtitaniumphosphoric (KTP) acid
light (SmartLite; Deka, Firenze, Italy), each specimen
was irradiated with 532 nm wavelength and 1 wa
power for 30 s. The bleaching agent was removed after
10 min. This procedure was repeated three times at the
same si ing, and the process was repeated after 2 weeks.
After the bleaching treatments, the gels were carefully
removed with sterile gauze and tap water. Between
bleaching intervals, the specimens and control group
were maintained in artificial saliva,[14] which was changed
daily, at 37C.
After bleaching, the specimens in the subgroups
were immersed in tea (Yellow Tea, Lipton, Turkey)
or cola (Coca-Cola, Turkey). The tea mixture was
prepared by leaving a tea bag in 165 ml of boiling water
for 5 min. The specimens were immersed in the tea
and cola for 15 min on the first day and for 6 h on the
second and subsequent days (six successive days). The
specimens were removed from the solutions, washed
with distilled water for 15 sec, and color measurements
were performed. They were then immersed in artificial
saliva for the remainder of the day. Staining solutions
were renewed daily.
The first color of the specimens was measured by
one experienced and qualified examiner using a
spectrophotometer (Shadepilot; DeguDent GmbH,
Hanau, Germany) after the bleaching. Specimens were
Table 1: Characterization of the bleaching products
Materials
Opalescence
Xtra Boost
Smartbleach

84 Journal of Restorative Dentistry / Vol - 2 / Issue - 2 / May-Aug 2014

Manufacturer
Ultradent, Product Inc,
South Jordan, USA
High Tech Laser for
SBI, Herzele, Belgium

Concentration
38% Hydrogen
peroxide
35% Hydrogen
peroxide

Mean pH
7.0
910

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Karadas, et al.: Office bleaching pruducts

washed with distilled water for 15 s after immersion.

Immersion color measurements were performed after
15 min, 6 h (second day) and 36 h (sixth day). The color
of each specimen was assessed according to the CIELAB
color system with the spectrophotometer connected
to a personal computer under standard conditions.
Each prepared specimen was placed on the table. The
suitable mouthpart of the spectrophotometers camera
was later placed at a 90 angle on the specimen surface,
which was centered in the yellow target box represented
on the computer monitor. The spectrophotometer was
calibrated prior to measurement of each color with white
and green ceramics provided by the manufacturer. The
spectrophotometric documents of each specimen were
saved by the same operator on the personal computer. All
color measurements were taken three times at dierent
places on the middle third of each specimen surface,
using the built-in synchronized image program. The
average of the three measurements was taken as the color
of each specimen and used for overall document analysis.
In the CIELAB color system, L* represents the
value (lightness or darkness), a* is a measure of
redness (positive a*) or greenness (negative a*) and
positive b* indicates a yellow direction, whereas negative
b* indicates a blue direction. Total color dierences
between the two colors (E) were calculated using
the following formula: E* = [(L*)2 + (a*)2 + (b*)2]1/2.
When E was 3.7 or less, it was considered clinically
acceptable in the study.[15]

Statistical analysis
The distribution of the data was checked, and parametric
tests were used for homogeneously distributed data.
The average values of the color parameters (E) were
compared using a two-way analysis of variance (ANOVA)
and Tukeys honest significant difference (HSD)
test (P < 0.05). Statistical analysis was performed using
the Statistical Package for Social Sciences program (SPSS,
version 16.0, Chicago, IL, USA).

RESULTS
The mean values and the standard deviations of E are
represented in Table 2. The bleached specimens showed
more staining than the unbleached specimens (control
group) in the tea and cola solutions at all the time
intervals evaluated and staining in all the groups was
increased. In all the groups, staining in cola solutions
was greater than in the tea solutions, but there was
no statistically significant difference in the staining
between solutions in control group at any of the all time
intervals evaluated (P > 0.05). There were no statistically
significant differences in the staining between the
specimens bleached with Opalescence Xtra Boost after
15 min (P = 0.99), whereas there was a statistically

significant dierence in the staining at the other time

intervals evaluated (P = 0.001). In the specimens bleached
with Smartbleach, there were statistically significant
dierences in staining between the staining solutions at
all the time intervals evaluated (P < 0.05).
Dierences in the staining of the bleached and unbleached
specimens in the tea solutions were not statistically
significant at 15 min or 36 h, whereas the dierences in
the staining bleached and unbleached specimens in the
cola solutions were statistically significant at all the time
intervals evaluated. There were no statistically significant
differences in the staining between the specimens
bleached with Opalescence Xtra Boost and Smartbleach
after immersed in the tea or cola at any of the time intervals
evaluated. The staining of the specimens in the tea and
cola increased at all the time intervals evaluated, and this
increase was statistically significant for all groups.
After 15 min immersion in tea and cola solutions, color
changes in the specimens were acceptable, with the
exception of cola solution in Group C. E values in the
bleached specimens were greater than 3.7 after 6 and
36 h immersion. The changes in the L-values (L), in
the a-values (a) and in the b-values (b) are depicted
in Figures 1-3, respectively. L values were decreased,
whereas a and b values were increased.

DISCUSSION
The color change of the bleached teeth stained with
tea and cola was evaluated using an objective method,
a spectrophotometer. Spectrophotometers provide
more reliable results than shade tabs and colorimeters.
However, they are dicult to transport, expensive and
aected by the tooth structure. In addition, it is dicult
to ensure repeatable tooth repositioning, as shown in a
previous study.[16] Changes in tooth color were measured
one day after bleaching treatment to avoid the eects of
dehydration.
Table 2: Mean E and standard deviations (SD) values for
each groups in the solutions
Groups
A
Tea
Cola
B
Tea
Cola
C
Tea
Cola

15 min

6h

36 h

1.140.38A, a
1.320.22A, a

2.250.64A, b
3.361.05AB, b

5.761.28A, c
7.101.70A, c

2.851.27ABC, a
3.201.86BC, a

5.541.67B, b
11.053.27C, b

8.731.94A, c
24.303.65B, c

2.070.76AB, a
3.982.26C, a

3.891.19AB, b
10.552.91C, b

7.561.86A, c
24.922.36B, c

Same letters indicate mean values that are not significantly different; capital letters are
considered in the vertical direction and lowercase letters are considered in the horizontal
direction, SD=Standard deviation

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Karadas, et al.: Office bleaching pruducts

The upper surface of the enamel, called prismless enamel,

is of great clinical significance because it is the surface
subjected to daily wear and undergoes repeated cycles
of demineralization and remineralization.[17] In some
previous studies.[13,18,19] SiC abrasive paper was used to
fla en the upper surface layer of the enamel to provide
a more uniform surface. As reported previously, this
procedure will make the specimens more susceptible to
staining because the aprismatic layer of the upper enamel
surface is usually more highly mineralized than the
subsurface and is more resistant to demineralization.[20]
A previous study observed extensive structural alterations
in enamel when a hydrogen peroxide-containing
whitening agent and preoperative etching and light
irradiation were used. [21] Another study described
morphological changes in the form of increased surface
roughness and an etched-like appearance in dental
surfaces in contact with highly concentrated peroxide
gels.[22] Using scanning electron microscopy, Miranda
et al.,[23] showed that in-oce bleaching agents aected
the structure of human enamel. Shannon et al.,[24] found
that the most severe changes in enamel occurred with
bleaching agents with a lower pH. Unbleached surfaces
were more stain resistant than bleached surfaces. Cola
had the lower pH and showed the higher E* value at
all the time intervals evaluated after immersion.
Specimens were stored in artificial saliva throughout the
experiment to simulate the remineralization. There is no
consensus regarding whether microstructural defects
can be repaired by remineralization.[12] However, it was
found that peroxide-containing vital tooth bleaching
agents altered enamel surfaces, despite the neutral pH of
the agents, which produces a specific eect on enamel.[21]
On the other hand, some studies have shown that the
neutrality of bleaching agents plays a significant role
in preventing roughening of the enamel surface.[24,25]
In this study, the staining susceptibility increased after
bleaching.
Park et al.,[26] reported that hydrogen peroxide specifically
dissolves organic materials and minerals from teeth and
makes the surface of the enamel soft and less compact,
although this does not mean that the bleaching agent
is unsafe for teeth. Bizhang et al., [27] evaluated the
mineral loss of bovine enamel after dierent bleaching
treatments (10% carbamide peroxide, 5.3% hydrogen
peroxide) or cola beverage (1 h/day) and reported
significantly greater mineral loss with the cola beverage.
In addition, some studies [28,29] have reported that
highly pigmented acidic beverages cause both tooth
discoloration and dissolution of hard tooth structures.
In the present experiment, staining of the bleached
specimens was greater in the control group, and the
cola caused more staining than did the tea solution. The

increased tooth discoloration in the bleached specimens

compared with that of the control group might be
explained by the dissolution of the tooth structure and
acidic beverages causing tooth discoloration because low
pH has been associated with increased enamel surface
dissolution.[28] Thus, dentists should advise patients to
avoid certain drinks, food containing artificial colorants
and acidic beverages in particular to maintain the color
stability of teeth after bleaching treatments.
A in et al.,[12] examined the eects of tea on intrinsic
coloration and reported that the application of tea
after bleaching with 10% carbamide peroxide did not
significantly aect the outcome of a bleaching treatment.
In the present study, the staining in tea after bleaching
was increased compared with that of the control group.
Although some studies [13,18] evaluated the effect of
0
-2
-4
-6
-8
-10
-12
-14
-16
-18

L
Group AT Group BT Group CT Group AC Group BC Group CC

15 minutes

6 hours

36 hours

Figure 1: Mean L values for each subgroups in the solutions.

T: Tea; C: Cola

7
6
5
4
3
2
1
0
Group AT

Group BT

Group CT

15 minutes

Group AC
6 hours

Group BC

Group CC

36 hours

Figure 2: Mean a values for each subgroups in the solutions.

T: Tea; C: Cola
b

20
15
10
5
0

Group AT Group BT Group CT Group AC Group BC Group CC

15 minutes

6 hours

36 hours

Figure 3: Mean b values for each subgroups in the solutions. T:

Tea; C: Cola

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Karadas, et al.: Office bleaching pruducts

red wine and coee on teeth color during and after

bleaching treatments, they did not examine the eect of
tea and cola after bleaching. As reported previously, the
color stability after bleaching is strongly linked to the
dietary habits of patients.[18] The choice of materials and
bleaching techniques should be based on factors, such
as the patients habits.

CONCLUSION
The staining of bleached specimens was almost similar
in the tea and cola solutions. The bleached specimens
showed more staining than the unbleached specimens.
The staining of the specimens in the tea and cola was
increased at all the time intervals evaluated. The
staining in the cola solutions was greater than in the
tea solutions.

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How to cite this article: Karadas M, Tahan E, Demirbuga S, Seven N.
Influence of tea and cola on tooth color after two in-office bleaching
applications. J Res Dent 2014;2:83-7.

Source of Support: Nil, Conflict of Interest: Nil.

Journal of Restorative Dentistry / Vol - 2 / Issue - 2 / May-Aug 2014 87