|Year : 2012 | Volume
| Issue : 3 | Page : 151-155
Comparative assessment of sodium chloride, sodium bicarbonate dissolved in vinegar and hydrogen peroxide as bleaching agents to reduce intrinsic dental stains: In vitro study
Rohit Miglani1, Gundabaktha Nagappa Karibasappa2, Arun Suresh Dodamani2, Girija Balaraddi Mallana3, K Rajeshwari4
1 Department of Conservative and Endodontics, ACPM Dental College, Dhule, India
2 Department of Public Health Dentistry, ACPM Dental College, Dhule, India
3 Department of Prosthodontics, ACPM Dental College, Dhule, India
4 Department of Prosthodontics, Annasaheb Chudaman Patil Memorial Medical College, Dhule, Maharastra, India
|Date of Submission||26-Oct-2012|
|Date of Acceptance||07-Feb-2013|
|Date of Web Publication||29-Apr-2013|
Gundabaktha Nagappa Karibasappa
Department of Public Health Dentistry, Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharastra - 424 001
Source of Support: None, Conflict of Interest: None
Purpose : With the increasing concern for aesthetics, dentists are working hard to give their patient what is called the 'perfect smile'. Discolouration of teeth is an aesthetic problem, which requires effective treatment. Bleaching is the simplest, common most effective treatment to reduce the stains, but unfortunately which is not within the reach of all individuals. Hence an attempt has been made to evaluate the effectiveness of various indigenous agents like sodium chloride, sodium bicarbonate dissolved in vinegar containing 4% acetic acid and hydrogen peroxide, as bleaching agents to reduce intrinsic dental stains.
Materials and Methods : Forty extracted premolars having mild degree of dental fluorosis were selected and thoroughly cleaned with pumice slurry. All the polished 40 teeth were randomly divided into 4 groups each containing 10 teeth. Bleaching was performed on ten teeth per group by immersing them in solutions containing either 1.5% hydrogen peroxide, 10% w/v of sodium chloride + vinegar containing 4% acetic acid, 10% w/v of sodium bicarbonate + vinegar containing 4% acetic acid or distilled water for 5 minutes each. The intrinsic colour of teeth was measured with a spectrophotometer using the standard L*a*b* colour scale and the shade was evaluated at day 0, 7, 14 and 21.
Results: Compared to baseline tooth colour, hydrogen peroxide and sodium chloride dissolved in vinegar were significantly effective in removing the intrinsic tooth stain ( P < 0.001) where as sodium bicarbonate dissolved in vinegar demonstrated no significant change.
Conclusions: Sodium chloride dissolved in vinegar was more effective at reducing intrinsic tooth stain than sodium bicarbonate dissolved in vinegar.
Keywords: Home remedies, LFNx01aFNx01bFNx01 colour scale, mild dental fluorosis, spectrophotometer
|How to cite this article:|
Miglani R, Karibasappa GN, Dodamani AS, Mallana GB, Rajeshwari K. Comparative assessment of sodium chloride, sodium bicarbonate dissolved in vinegar and hydrogen peroxide as bleaching agents to reduce intrinsic dental stains: In vitro study. Indian J Oral Sci 2012;3:151-5
|How to cite this URL:|
Miglani R, Karibasappa GN, Dodamani AS, Mallana GB, Rajeshwari K. Comparative assessment of sodium chloride, sodium bicarbonate dissolved in vinegar and hydrogen peroxide as bleaching agents to reduce intrinsic dental stains: In vitro study. Indian J Oral Sci [serial online] 2012 [cited 2019 Nov 20];3:151-5. Available from: http://www.indjos.com/text.asp?2012/3/3/151/111177
| Introduction|| |
It is said that the face is the mirror of the human mind. A beautiful face achieves good first impressions easily while the opposite provides an uphill struggle. Not surprisingly, our teeth draw in a great deal of attention and are a significant factor in judging attractiveness. So clean, white and shiny teeth can play a crucial role in how we are first perceived by many. Lustrous teeth portray our confidence and eventually help us to win the hearts of those we interact with.
The natural colour of a tooth is determined by the enamel translucency enabling the underlying dentin colour to be visible. Discolouration of teeth is due to extrinsic stains, which lie on the surface of the teeth, whereas intrinsic stains lie within the dental tissues. Dental fluorosis is a type of intrinsic stain which can be defined as hypoplasia or hypo mineralization of tooth enamel or dentin produced by the chronic ingestion of excessive amounts of fluoride during the period when teeth are developing. . Dental fluorosis is considered to be a major public health problem in India because 25 million people have been affected and 66 million people are at risk including children below 14 years.  Dental fluorosis produces physical disfigurement of the teeth, psychologically distresses the person and affected individual will have social stigma.
With the increasing concern for aesthetics, dentists are working hard to give their patient what is called the 'perfect smile'. Discoloration of teeth is an aesthetic problem, which requires effective treatment. Bleaching is the simplest, common, most effective treatment to reduce the stains; but unfortunately bleaching agents require professional supervision and expensive materials so they are not within the reach of the entire population. Majority of the people in India are residing in the rural areas and are affected by the dental fluorosis (Janakiram, 2004). A breakthrough would be to look out to surmount the problem of dental fluorosis by the use of home remedies. A home remedy is a means of curing a disease or ailment that employs certain spices, vegetables, or other common items. Such home remedies should be effective, easily available, traditionally acceptable, economical and safe. Hence an in vitro experimental study was designed to assess and compare the intrinsic stain (dental fluorosis) reducing capabilities of:
Research hypothesis: 10% w/v of sodium chloride, 10% w/v of sodium bicarbonate dissolved in vinegar containing 4% acetic acid are highly effective in reducing intrinsic dental stains compared to 1.5% hydrogen peroxide.
- 10% w/v of sodium chloride + vinegar containing 4% acetic acid
- 10% w/v of sodium bicarbonate + vinegar containing 4% acetic acid
- 1.5% hydrogen peroxide (active control)
- Distilled water (as passive control)
| Materials and Methods|| |
The present study is an experimental epidemiological study with concurrent parallel design (in vitro study) done on extracted human premolars. Permission was obtained from the textile department of Vidyavardhak institute of engineering and technology, to use the spectrophotometer and from the department of oral pathology and microbiology, ACPM dental college and hospital, to use the chemical balance and to prepare artificial saliva.
Criterion based sampling was employed to collect the specimens. A total of 40 non-carious premolars having mild degree of dental fluorosis freshly extracted for orthodontic purposes were collected from one dental college and private clinics in Dhule city. Mild degree of dental fluorosis was assessed by modified Dean's fluorosis index.  Mild degree of dental fluorosis is characterized by the white, opaque area on the surfaces of the teeth involve at least half of the tooth surface. The extracted teeth were washed with water and stored in the artificial saliva. All 40 teeth were polished with pumice slurry to remove any residual plaque or extrinsic stains by using contra-angled micro motor hand piece and cone shaped polishing brush. Prior to the application of bleaching agents, standardization was done with respect to materials, instruments and the methodology by adhering to a strict protocol. The application of the bleaching agents for each specimen was comprehensively carried out by the investigator.
All the polished 40 non carious premolars having mild degree of dental fluorosis were randomly divided into 4 groups each containing 10 teeth. Random allocation was done using lottery method.
Group 1 : Included teeth that were planned to be treated with 1.5% Hydrogen peroxide
Group 2 : Included teeth that were planned to be treated with 10% w/v of sodium chloride + vinegar (4% acetic acid)
Group 3 : Included teeth that were planned to be treated with 10% w/v of sodium bicarbonate + vinegar (4% acetic acid)
Group 4 : Included teeth that were planned to be treated with distilled water
Before exposing the specimens (teeth) to their respective test solutions base line color of each tooth was assessed using computer controlled spectrophotometer which measured the value and hue based on standard L*a*b* color scale.  Discoloration can be evaluated with different instruments and techniques. In assessing chromatic differences, the Commission Internationale de l'Eclairage (CIE L*, a*, b*) system was chosen for the present study. According to this system, L* represents the lightness of the sample, a* describes green-red axis (−a = green; +a = red) and b* describes blue-yellow axis (−b = blue; +b = yellow). It is also possible to calculate the total color change (ΔE*ab), which considers the changes of L*, a* and b*. Various studies have different thresholds of color difference values which are perceptible to the human eyes. However, the clinically acceptable value for color changes in dental materials is assumed to be ΔE*ab ≤ 3.3.
Solutions were prepared every day freshly by mixing 10% w/v of sodium chloride with 10 ml of vinegar (4% acetic acid) and 10% w/v of sodium bicarbonate with 10 ml of vinegar (4% acetic acid). The specimens were immersed for 5 minutes daily in their respective allocated solutions. They were immediately transferred and kept stored in the artificial saliva for the rest of the day. Artificial saliva was prepared freshly every day. Artificial saliva was prepared as given by Seick et al. the sodium chloride, potassium chloride, sodium dihydrogen phosphate, sodium sulphate, bovine albumin were weighed to the accurate values as given by Seick et al., and added to the distilled water, stirred and kept for ten minutes so that all the ingredients were dissolved. This treatment was continued for 21 days. The trained examiner measured a specimen's color by computer controlled spectrophotometer using standard L*a*b* color scale before and after the bleaching agent applications at various time intervals (0, 7, 14 and 21 days). Before each group of specimens was measured, the colorimeter was calibrated with a standard white card. All colour testing were carried out according to the CIE-Lab-colour system. Values were recorded using the Commission International de l' Eclairage L*a*b colour system. The CIE (Commission International de l' Eclairage) system uses the three dimensionless colorimetric measurements. L* characterizes the lightness of the colour and can be ranged between 0 (dark) and 100 (light); a* defining a colour on a red-green axis; and b* describing the blue part of the colour. For each sample, four repeated measurements were taken to determine the colorimetric values. The mean values of ΔL, Δa and Δb after four measurements were automatically calculated by colorimeter and recorded. The total colour difference ΔE for each sample was calculated using the following equation:
ΔE = [(ΔL) 2+ (Δa) 2+ (Δb) 2 ] 1/2
Where ΔL* = L* (time 0) - L* (time t)
Δa* = a* (time 0) - a* (time t)
Δb* = b* (time 0) - b* (time t)
Statistical analysis was done using personal computer with SPSS (Version 11) USA software. Statistical tests employed for the obtained data in our study were one-way ANOVA and post-hoc Tukey's test. One way ANOVA was done to test the differences among groups. Pair wise comparison was done by using post-hoc Tukey's test.
| Results|| |
[Table 1] and [Figure 1] shows the mean L*a*b* scores in study groups at different time intervals. At baseline values in all the 4 groups are more or less same and or not statistically significant. After the intervention the mean L*a*b* scores in group 1 and group 2 increased linearly from baseline to 21 st st day and it was statistically significant with the P < 0.05. Where as in group 3 the mean L*a*b* score decreased from baseline to 21 st day. While in group 4 the mean L*a*b* score remained constant and are not statistically significant with the P > 0.05.
[Table 2] shows that at baseline, the difference between mean L*a*b* scores are same. After intervention the mean L*a*b* scores between group 1 and 3, group 1 and 4 is statisticallyignificant with the P < 0.005 at day. Whereas at 14 th and 21 st day the mean L*a*b* scores between group 1 and 2, 1 and 3, 1 and 4, 2 and 3 are statistically significant with the P < 0.05.
|Table 2: Pair wise comparison between different groups at 0,7,14 and 21 day|
Click here to view
| Discussion|| |
Sodium chloride, also known as salt, common salt, table salt, or halite, is an ionic compound with the formula NaCl. Its biological applications are preservation of food and also act as a mild abrasive agent.  Vinegar is an acidic liquid processed from the fermentation of ethanol in a process that yields its key ingredient acetic acid. The acetic acid concentration typically ranges from 4-8% by volume for table vinegar. Its medical uses are management of diabetes as well as antimicrobial and detoxification agent.  Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula NaHCO 3 . Sodium bicarbonate is used in an aqueous solution as an antacid taken orally to treat acid indigestion and heartburn. It may also be used orally to treat chronic forms of metabolic acidosis such as chronic renal failure and renal tubular acidosis. Sodium bicarbonate is well known as a cleaning agent and deodorizer.  In the present study sodium chloride and sodium bicarbonate are used as bleaching agents because these are easily available, culturally acceptable and many rural people are using these as their dentifrices.
Exploration of literature reveals that vinegar is also another natural product which is famous as a teeth whitening solution. Vinegar can always be mixed with a little bit of soda, which will be enough to form a paste, and this paste can be used to brush the teeth.  Vinegar and sodium bicarbonate are known as tooth whitening agents, as these agents have been propagated in various electronic media as the bleaching agent without appropriate scientific studies conducted, might affect the public.  Hence the current study was carried out to test these food products as bleaching agents.
The rationale for fixing 5 minutes exposure time to the allocated intervention is based on the following observation:-
The sodium bicarbonate and vinegar create a foaming composition which may be an effervescent type of foam and include small conveniently sized bubbles and/or may provide a half life of about 10 minutes. In order to standardize the procedure 5 minutes time was fixed.
The mechanism of action of hydrogen peroxide is that it provides an atom of nascent oxygen readily and acts as a strong oxidizing agent in acidic as well as alkaline solutions. Artificial saliva was used in order to simulate the natural oral cavity. In the current study, among all the intrinsic stains of teeth, fluorosed teeth were taken because it is the most common and most prevalent intrinsic stain affecting the human kind posing a public health problem. In the present study lower concentration (10% w/v) of sodium chloride was used as higher concentration of sodium chloride induces gingival swelling. In the present study hydrogen peroxide has shown reduction in stain which is in agreement with the study done by Kleber et al., , 10% w/v sodium bicarbonate + vinegar containing 4% acetic acid have not shown significant reduction in stain which is contradictory to the study done by Kleber et al., , The possible reason could be the use of lower concentration of sodium bicarbonate and vinegar containing 4% acetic acid. Whereas sodium chloride dissolved in vinegar containing 4% acetic acid showed reduction in stains. The mechanism of action sodium chloride + vinegar containing 4% acetic acid is still unknown. Dentin hypersensitivity is a common painful condition observed in clinics. Dietary habits have been much associated with its development. The influence of acid in the diet as a factor in dentin sensitivity was demonstrated in some studies.  Evidence in vitro indicates that weak and strong acids, which are the content of food and beverage acids, can remove smear layer and expose dentinal tubules. , Zandim DL et al., conducted an in vitro study to evaluate the influence of vinegar on the removal of smear layer and exposure of dentinal tubules. They conclude that the contact of vinegar may remove smear layer and expose dentinal tubules, regardless of the type of application.  Limitations of the present study are: We have not assessed the adverse effects of vinegar containing 4% acetic acid on enamel like enamel erosion and surface roughness. Future more studies have to be conducted to know the possible adverse effects of hard and soft tissues in the oral cavity like occasional sensitivity, pulpal irritation and surface morphological alterations and also to assess the effectiveness of sodium chloride and vinegar in reducing varying degree of dental fluorosis. Further studies are required with varying concentrations of sodium chloride, sodium bicarbonate and hydrogen peroxide to evaluate the whitening effect, long lasting effect of ingredients and also to recommend the safety tolerance dose of ingredients such as sodium chloride, sodium bicarbonate dissolved in vinegar. In the future, more studies have to be conducted to know the effectiveness of sodium chloride and vinegar in reducing varying degree of dental fluorosis and also the possible adverse effects of hard and soft tissues in the oral cavity like occasional sensitivity, pulpal irritation and surface morphological alterations.
| Conclusion|| |
The present study showed sodium chloride dissolved in vinegar was more effective in reducing intrinsic tooth stain such as mild degree of dental fluorosis than sodium bicarbonate dissolved in vinegar.
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[Table 1], [Table 2]