An In-vitro analysis of the staining effect of different chemical mouthwashes

Dr. Ravi Gupta¹*, Dr. Namith Rai²

¹MDS, Assistant Professor, Department of Conservative Dentistry, Faculty of Dentistry, Melaka Manipal Medical College (Manipal campus), Manipal Academy of Higher Education, Manipal -576104, Karnataka, India.

²MDS, Assistant Professor, Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal - 576104, Karnataka India.

*Corresponding Author E-mail: ravigupta641@gmail.com

ABSTRACT:

Aim: To evaluate the staining potential of three commercially available types of mouthwashes. Materials and Methodology: Sixty extracted maxillary central incisor teeth were used for the study. The teeth were divided into three groups (N=30). Teeth were immersed in three different mouthwash solutions for 2 months. The color change was measured with a spectrophotometer before immersion in solution (baseline) and after 2 months. L*a*b* values were used to calculate color changes (ΔE). Statistical analysis was done using ANOVA test and Paired T-test. Results: Greater staining was caused by Listerine and Chlorhexidine mouth was has compared to Chlorhexidine mouthwash with ADS after 2months. Conclusion: Chlorhexidine mouthwash with ADS is a better choice as a mouthwash to minimize tooth staining.

KEYWORDS: Staining, Flouride, Chlorhexidine, Mouthwash, Spectrophotometer.

INTRODUCTION:

Every patient desire to have a radiant white smile without any tooth staining. Discoloration of teeth can occur due to trauma to teeth, necrosis of the pulp tissue and after root canal treatment and due to various restorative materials like amalgam.^1,2Root canal treatment also leads to staining of the tooth due to the use of medicaments during the treatment. This results in an alteration in the optical properties of the dentin and light reflection.^3,4,5 There is an increasing trend in the use of mouthwash to maintain oral hygiene and to keep gums healthy. Most popular in the market are chlorhexidine mouthwash and the Listerine mouthwash. But when used for a long time, these mouthwashes have many side effects including staining of the teeth. Nowadays chlorhexidine mouthwash with Anti Discoloration Solution (ADS) is available to reduce staining of teeth. Therefore, this study was conducted to evaluate the staining potential of three commercially available types of mouthwashes.

MATERIALS AND METHODS:

Sixty extracted maxillary central incisor teeth were used for the study. The teeth were randomly divided into three groups: group A and B, C.

Group A: Listerine (Listerine Mouthwash Original)

Group B: Chlorhexidine mouthwash – 0.12% (Hexedine Mouthwash)

Group C: Chlorhexidine mouthwash with Anti Discoloration Solution (ADS) (Cur sept ADS Mouthwash)

Teeth were immersed in three different mouthwash solutions for 2 months. The color change was measured with a spectrophotometer before immersion in solution (baseline) and after 2 months. The color change was measured with a spectrophotometer (Data color 600 USA) b. The ΔE > 3.5 was considered as a clinically perceptible color change.

STATISTICAL ANALYSIS:

The data were subjected to analysis using SPSS version 23.0 (IBM, Chicago). Statistical analysis was done using ANOVA test and Paired T-test.

The ΔE value of three groups from baseline to 2 months:

Group	Mean	Std Dev	SE of Mean	95% CI for Mean		P-Value	Sig diff btw
				Lower Bound	Upper Bound
Grp A	4.041	2.588	0.850	3.118	6.964	0.012*	A vs C (P=0.010)
Grp B	2.355	1.173	0.687	1.801	4.910
Grp C	1.862	1.03	0.412	1.030	2.894

RESULTS:

Greater staining was caused by Listerine mouthwash and Chlorhexidine mouthwash between the baseline and 2 months’ time interval compared to Chlorhexidine mouthwash with ADS, which was statistically significant (P<0.05).

DISCUSSION:

The poor appearance of a discolored tooth affects the patient quality of life and his self-esteem.⁶ The common reason for the patient visit toa dental clinic is the discoloration of the upper anteriors⁷. Tooth discoloration after root canal therapy is a common aesthetic problem for the patient due to various reasons like root canal sealers, inadequate cleaning of the pulp chamber and restorative materials.^8,9,10

In the present study, a spectrophotometer was used which can readily record color changes that are not even clinically visible. These color changes were also detected much earlier when compared to the traditional methods of tooth color assessment.¹¹

In the present generation, there is an increase in the trend of using mouthwashes like Chlorhexidine and Listerine to maintain oral hygiene as an adjunct to tooth brushing and flossing. Chlorhexidine (CHX) is the chemical agent which is effective in plaque control and reducing bacteria load after gums surgery.^12,13 It is used as an ingredient in mouthwash, gel, sprays.¹⁴

Chlorhexidine is considered as the best agent for plaque control and gum problems but it has many disadvantages like the unpleasant taste, staining of teeth, tongue enlargement ,throat irritation and altered taste sensation . Because of this, it should not be used for than 1-2 weeks. Many studies in the past both invitro and invivo have identified that the chlorhexidine causes staining of teeth.^15,16,17,18 Recently, a new product is launched in the market which claims of reduced staining by chlorhexidine mouthwash. The product contains an anti-discoloration system (ADS) based on ascorbic acid and sodium metabisulphite. A study conducted by Addy et al showed that slight discoloration is shown by Chlorhexidine mouthwash with ADS.¹⁹ The results of our study are similar to this study. But in our study, it was shown that Maximum staining was caused by Listerine followed by Chlorhexidine mouthwash and least by Chlorhexidine mouthwash with ADS. Further studies are required to establish the role of this new mouthwash.

CONCLUSION:

All the mouthwash in the present study caused a certain amount of tooth staining. Chlorhexidine mouthwash with ADS is a promising option and can be considered as a good alternative to traditional mouthwashes.

CONFLICT OF INTEREST:

None.

REFERENCES:

1. Sheets CG, Paquette JM, Wright RS. Tooth whitening modalities for pulp less and discolored teeth. In: Cohen S, Burns RC, editors. Pathways of the Pulp. 8 ed. London: Mosby; 2002. p. 755.

2. Mohamed Abdel Aziz El Sayed, Hosameldein Etemadi. Coronal discoloration effect of three endodontic sealers: An in vitro spectrophotometric analysis. Journal of Conservative Dentistry 2013; 16:347-351

3. Ioannidis K., Beltes P, Lambrianidis T., Kapagiannidis D., Karagiannis V. Crown discoloration induced by endodontic sealers. Spectrophotometric measurement of Commission Internationalde l’ Eclairage’s L chromatic parameters. Oper Dent. 2013. In press.

4. Ioannidis K., Beltes P., Lambrianidis T., Kapagiannidis D, Karagiannis V. Validation and spectrophotometric analysis of crown discoloration induced by root canal sealers. Clin Oral Inv.2013

5. Konstantinos Ioannidis et al. Spectrophotometric analysis of crown discoloration induced by MTA and ZOE based sealers J. Appl Oral Sciences 2013; 21(2):138-144

6. Dugasetal. Quality of life and satisfaction outcome of enodontic treatment J. Endod 2002; 28:819-27

7. Ajeti, N., Pustina-Krasniqi, T et al. Evaluation of Teeth Discoloration Induced by Endomethasone, AH+, Canason and Apexit Paste. Open Journal of Stomatology2014; 4: 507-517

8. van der Burgt TP, Eronat C, Plasschaert AJ. Staining patterns in teeth discolored by endodontic sealers. J Endod 1986; 12: 187–91

9. Parsons JR, Walton RE, Ricks-Williamson L. In vitro longitudinal assessment of coronal discoloration from endodontic sealers. J Endod 2001; 27:699–702

10. Davis MC, Walton RE, Rivera EM. Sealer distribution in coronal dentin. J Endod 2002; 28:464–6

11. CAL E et al. Comparison of digital and spectrophotometric measurements of colour shade guides. Journal of Oral Rehabilitation 2006; 33 (3), 221-228

12. Löe H, Schiott CR. The effect of mouthrinse and topical application of chlorhexidine on development of dental plaque and gingivitis in man. J Periodontal Res. 1970; 5:79–83

13. Guiseppe P, Rosario G, imburgia M. The effect of antimicrobial sprays and mouthrinses on supragingival plaque regrowth. A comparative study. J Periodontol. 2006;77: 248–56.

14. Herrera D, Roldán S, Santacruz I, Santos S, Masdevall M, Sanz M. Differences in antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinse formulations: An in vitro contact test and salivary bacterial counts study. J Clin Periodontol. 2003; 30:307–14

15. Addy, M, Prayitno, S, Taylor, L, Cadogan, S. An in vitro study of the role of dietary factors in the a etiology of tooth staining associated with the use of chlorhexidine. J Periodontal Res 1979; 14:403– 410.

16. Prayitno, S, Taylor, L, Cadogan, S, Addy, M. An in vivo study of dietary factors in the a etiology of tooth staining associated with the use of chlorhexidine. J Periodontal Res 1979; 14: 411– 417.

17. Roberts, WR, Addy, M. Comparison of the bisbiguanide antiseptics alexidine and chlorhexidine. I: effect on plaque accumulation and salivary bacteria. J Clin Periodontol 1981; 8:213– 219.

18. Addy, M, Roberts, WR. Comparison of the bisguanide antiseptics alexidine and chlorhexidine II. Clinical and invitro staining properties. J Clin Periodontol 1981; 8: 220– 230.

19. Addy, M., Sharif, N. and Moran, J. (2005), A non‐staining chlorhexidine mouthwash? Probably not: a study in vitro. International Journal of Dental Hygiene, 3: 59-63.

Received on 15.05.2019 Modified on 20.02.2020

Research J. Pharm. and Tech. 2020; 13(12):6007-6008.

DOI: 10.5958/0974-360X.2020.01047.1