journal of dentistry 36s (2008) s21s25

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Instant tooth whitening from a silica toothpaste containing blue covarine

article info
Keywords: Tooth colour Objective measurement Digital imaging

abstract
Objective: To measure the instant whitening effect delivered immediately after brushing with a novel silica whitening toothpaste containing blue covarine. Methods: A controlled, single blind, cross-over study was performed to compare the tooth colour measured in a group of subjects at baseline and immediately after brushing with a silica whitening toothpaste containing blue covarine versus a clear gel negative control toothpaste. Measurements of tooth colour were made using a mobile non-contact camerabased digital imaging system and expressed as CIELAB and WIO whiteness index. Results: Analysis of covariance (ANCOVA) showed that the silica whitening toothpaste containing blue covarine was signicantly more effective than the negative control toothpaste ( p < 0.05), and made teeth measurably less yellow, less red and overall whiter immediately after brushing. Conclusion: A statistically signicant reduction in tooth yellowness and improvement in tooth whiteness was measured immediately after brushing with a novel whitening toothpaste containing blue covarine. # 2008 Elsevier Ltd. All rights reserved.

1.

Introduction

The desire for whiter teeth is responsible for the rapid growth of the tooth whitening market segment over the last decade. Many mass-market tooth whitening products are available which claim to whiten teeth either by tooth bleaching or through the removal/control of extrinsic stain. Mass-market tooth bleaching products usually contain peroxide at levels ranging from 3% to 6% and are supplied as strips, paints-on gels or in trays. Products are applied either once or twice daily for up to 14 days, depending on dose and exposure time.1 In contrast, products that remove/control extrinsic stain are more usually toothpastes with special abrasive particles that through regular use (e.g. twice daily) lead to whiter teeth after 24 weeks.2 Thus, the whitening effects of mass-market bleaching products can be observed quickly after 47 days. Whereas the changes in tooth white-

ness from toothpastes that remove/control stain are observed over longer periods of time (24 weeks). In order to observe an instant whitening effect from toothpaste a silica whitening toothpaste has been developed to deliver blue covarine to pellicle-coated tooth surfaces. The delivery of the blue covarine to these surfaces causes a shift in the yellow-blue colour axis (CIE b*) which has been shown to aid whiteness perception.3 Joiner et al. have demonstrated through a series of in vitro experiments that blue covarine is deposited and retained on pellicle-coated tooth surfaces causing a colour shift that ultimately gives rise to an increase in the measurement and perception of tooth whiteness.4 The aim of the in vivo study reported here was to measure the instant whitening effect delivered immediately after brushing with a novel silica whitening toothpaste containing blue covarine.

* Corresponding author. Tel.: +44 151 6413980; fax: +44 151 641 1833. E-mail address: [email protected] (L.Z. Collins). 0300-5712/$ see front matter # 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.jdent.2008.02.006

S22 2. Materials and methods

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Eighty-three subjects were recruited to participate in this controlled, single blind (with respect to the camera operator), cross-over study. The objective of the study was to measure the change in tooth colour and tooth whiteness, using a mobile non-contact camera-based digital imaging system (DIS), immediately after brushing with a novel silica whitening toothpaste containing blue covarine versus a clear gel negative control toothpaste. A full description of the mobile noncontact camera-based DIS and validation of this system is given by Smith et al.5 The protocol, information sheet and informed consent for this study were reviewed and approved by Unilever Research and Development Research Ethics Committee. All subjects were aged 18 years or older, male or female and recruited from the Wirral area, UK. (Subject selection was not balanced for gender). Subjects were in good general health; without signicant pathologies of the oral soft/hard hard tissues and had two normally aligned, natural upper central incisors, free from restorations visible from the labial surface. Recruited subjects who had extrinsic stain on their upper central incisors had their upper central incisors professionally cleaned by the study dentist prior to the rst test session. Women who were pregnant or nursing were not included. The whitening toothpaste containing blue covarine was formulated with a silica abrasive system. The clear gel negative control toothpaste was of the same formulation without the addition of blue covarine. Both pastes were manufactured by Unilever Oral Care, Italy, and contained 1450 ppm uoride. The toothpastes were supplied to the study site in identical white 75 ml tubes labelled with different product codes. The identity of the product codes was only revealed after the statistical analysis had been completed. All subjects attended two test sessions, which were scheduled on separate days within the same week; the minimum washout period was 24 h. From recruitment until the end of the study, all subjects were requested to continue using their own toothpaste and toothbrush at home. They were asked not to renew their toothbrush until after the test had completed and not to change the brand or type of toothpaste they were using. Subjects were requested to refrain from eating, drinking or brushing their teeth for 1 h prior to each test session. At each test session, a set of baseline images were collected using the DIS. Subjects wore sterile plastic cheek retractors and protective eye goggles during the imaging procedure. Subjects positioned themselves with their chin on the DIS chin rest and forehead against the forehead rest. The DIS operator collected an image of the subjects teeth after the lights had been switched on for a xed time. The image was checked for quality, and saved. If the image was out of focus,

additional images were collected until an in-focus image had been captured. After collecting the baseline image, subjects brushed with one of the study toothpastes using their normal brushing technique for 90 s followed by a 5 s 5 ml water rinse. Immediately after brushing, subjects had their teeth reimaged (post image). The study toothpastes were tested in a randomised order. The randomisation was computer generated and comprised of a list, which varied between the two product codes. Subjects were assigned their randomisation codes based on the order in which they attended their rst test session. The operator of the DIS was blinded with respect to the toothpaste randomisation. All images were analysed in Adobe Photoshop CS2 version 9 (Adobe System Inc., Seattle, WA, USA). The upper central incisors were highlighted using the magnetic lasso tool to obtain values for red, green and blue (RGB) from within the highlighted region. These values were transcribed into an Excel spreadsheet algorithm which calculated the CIELAB colour space values and WIO whiteness index.6 All measurements collected within a test session were standardised against the whiteness values taken from imaging a ceramic white tile colour standard (Ceram, Staffordshire, UK) at the start of each test session. The calculated CIELAB values and WIO whiteness index were submitted for statistical analysis. Using the CIELAB denition, colour is dened through three axes: L* represents a measure of the lightness of the object (a positive L* value indicates lightness, whereas a negative L* value is darker); a* is a measure of the colour on the red to green axis (positive a* is nearer red and negative a* is closer to green); b* represents the colour on the yellow-blue axis (positive b* is closer to yellow and negative b* value is nearer blue).7 Paired t-tests were used to test for signicant differences between the baseline and post images for each of the toothpastes tested. The post values for the test and negative control groups were compared by analysis of covariance (ANCOVA) using the baseline values as covariate. For all analyses, the level of statistical signicance was p < 0.05.

3.

Results

Seventy-eight subjects completed the two product cross-over study to measure the optical effect of blue covarine delivered from a novel silica whitening toothpaste. One subject was excluded for medical reasons unrelated to the study test toothpastes and four subjects failed to complete the study for personal reasons. Subject demographics are shown in Table 1. The DWIO whiteness index for the test toothpaste showed that teeth became signicantly whiter ( p < 0.05) immediately after brushing with the silica whitening toothpaste containing

Table 1 Subject demographics Groups

n
78 7 71

Mean age (S.E.)

Minimum age
20 28 20

Maximum age
69 57 69

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Table 2 Mean CIELAB and WIO whiteness index baseline and post brushing (standard error) Treatment
Negative control

Colour index
L* a* b* WIO index L* a* b* WIO index

Baseline
68.39 6.99 28.85 55.03 68.51 7.06 29.01 55.28 (0.40) (0.11) (0.30) (1.71) (0.40) (0.12) (0.30) (1.70)

Post
68.60 7.21 28.86 54.95 68.51 6.97 28.65 54.14 (0.42) (0.12) (0.31) (1.79) (0.42) (0.12) (0.30) (1.70)

Difference (post-base)
0.20 0.21 0.01 0.08 (0.11) (0.03) (0.05) (0.31)

Signicance (paired comparisons)

Whitening toothpaste containing blue covarine

0.001 (0.12) 0.09 (0.03) 0.36 (0.06) 1.14 (0.30)

blue covarine. A statistically signicant shift in WIO whiteness index was not observed for the negative control toothpaste (Table 2). Paired comparisons between the baseline and post values showed that the test toothpaste containing blue covarine caused a statistically signicant reduction in tooth yellowness ( p < 0.05), whereas the negative control did not signicantly effect the measurement of b* (Fig. 1). ANCOVA analysis showed that the whitening toothpaste containing blue covarine was signicantly more effective than the negative control toothpaste ( p < 0.05), and made teeth appear less yellow, less red and overall whiter immediately after brushing.

4.

Discussion

The mobile non-contact camera-based DIS used in this study has been shown to be a reproducible and reliable means of measuring tooth colour and tooth whiteness.5 This type of instrumental analysis of tooth colour provides an objective measure that helps to eliminate the introduction of bias within studies.8 The sensitivity of this method of colour analysis can be exploited to measure small colour differences9 which may otherwise be lost in the noise when using less discriminatory methods such as subjective assessment using the Vita shade guide. The baseline L*, a* and b* values recorded during this study ranged from 52.98 to 75.50, 5.14 to 10.58, and 21.58 to 35.23, respectively. Although direct comparison of the results obtained using this system with those published by other authors is not recommended as each system is designed differently; these values are similar to those recorded within the literature for other non-contact camera-based digital imaging systems.1012

Fig. 1 Effect of test toothpastes on Db* (S.E.).

A statistically signicant reduction in tooth yellowness was measured immediately after brushing with the silica whitening toothpaste containing blue covarine. The mean difference in Db* was 0.36 (standard error [S.E.] = 0.06). A similar shift in Db* of 0.24 (S.E. = 0.11) was observed by Farrell et al.13 after two, 30 min applications of an 18% carbamide peroxide gel, covered by a polythene strip barrier. This change in b* was a statistically signicant reduction in tooth yellowness compared to the baseline value ( p < 0.05). In three separate studies, where the same 18% carbamide peroxide gel was used twice daily, over a greater number of days, the shift in b* was 0.34 (S.E. = 0.06) after 7 days,14 0.27 (S.E. = 0.23) after 14 days15 and 0.21 (S.E. = 0.11) after 21 days.16 In each of these studies, the positive controls (which were 19% sodium percarbonate lm, 6% hydrogen peroxide bleaching strips or 5% carbamide peroxide gel trays, respectively) produced changes in b* ranging from 0.84 to 2.53 units. A number of studies have been published using non-contact camera-based digital imaging methods to measure changes in tooth colour resulting from regular brushing with a variety of toothpastes. The Db* values are displayed in Table 3. As summarised, Yudhira et al.11 observed that a whitening toothpaste with an alumina abrasive system delivered a signicant shift in b* after 2 weeks of twice daily brushing, but this was not maintained when measured again after 12 weeks of use. The magnitude of shift in b* after 2 weeks of twice daily brushing was the same as observed for the blue covarine toothpaste after just one brushing event. Luo et al.12 observed a much larger shift in b* after 1 and 2 weeks of brushing with a regular non-whitening toothpaste; however, they also recorded a much larger Db* for their positive control group using 6% hydrogen peroxide whitening strips, 3.53 (S.E. = 0.29) and 4.49 (S.E. = 0.36) after 1 and 2 weeks, respectively. This difference in measurement is most likely due to different instrument design. The non-contact camera-based DIS used in the study reported here generates data with similar values to the imaging system used by Gerlach et al.3,8,10,11,1317 The age of subjects who completed the study ranged from 20 to 69 years. The magnitude of Db* measured immediately after brushing with the blue covarine toothpaste was found to be independent of b* value recorded at baseline (correlation coefcient = 0.020) and subjects age (correlation coefcient = 0.022). Although subjects were not selected to specically represent a range of ages or baseline b* values the absence of correlations suggests that the signicant reduction in tooth yellowness measured immediately after brushing was not dependant on subject age or starting tooth colour.

S24

journal of dentistry 36s (2008) s21s25

Table 3 Mean Db* reported after brushing with toothpaste Authors

Product
Anti-cavity toothpaste and placebo gel strip Dual-phase whitening toothpaste 1% hydrogen peroxide toothpaste Anti-cavity toothpaste and placebo gel strip Silica whitening toothpaste and placebo gel strip Alumina whitening toothpaste and placebo gel strip Non-whitening toothpaste

n
29

Treatment time (twice daily)

Adjusted mean Db* (S.E.)

Change from baseline

14 14 18

21 days 14 days 7 days

0.06 (0.13) 0.05 (0.22) 0.26 (0.20)

Not signicant Not signicant Not signicant

Yudhira et al.11

16 15

14 12 14 12

days weeks days weeks

0.03 0.14 0.37 0.20

(0.21) (0.18) (0.21) (0.19)

Not Not Not Not

signicant signicant signicant signicant

Luo et al.12

21

7 days 14 days

1.11 (0.11) 0.85 (0.07)

p < 0.05 p < 0.05

The WIO whiteness index was used by Luo et al.,11 who measured baseline WIO values of 77.88 (S.E. = 1.97) and 76.43 (S.E. = 2.85) for their test and control groups, respectively. These values are approximately 20 units more negative (less white) than the values reported here. This could be due to different populations of subjects or instrument differences. A statistically signicant shift in WIO of 1.14 units (S.E. = 0.30) was measured immediately after brushing with the whitening toothpaste containing blue covarine. This shift was larger than that observed for the negative control, 0.08 (S.E. = 0.31) and larger than that previously reported within the literature for a non-whitening toothpaste.12 The changes in b* and WIO in the current study clearly indicate an objectively measured improvement in tooth whiteness immediately after brushing with a novel silica whitening toothpaste containing blue covarine. Since the b* value is the most important parameter for perceptual changes for users of vital tooth bleaching products,3 the measured changes in b* and WIO in the current study can potentially help drive the perception of whiter teeth immediately after brushing and every time this toothpaste is used. Indeed, in vitro studies have demonstrated that blue covarine deposited on teeth can give both an objective and subjective measure of increase in tooth whiteness.4 The magnitude of the changes in b* and WIO in the current study suggest modest changes in overall tooth colour have been measured, but nonetheless are signicantly greater than the changes recorded for the control product. In terms of consumer relevance, the perception of the colour of objects is known to be a complex phenomenon, with many factors affecting the nal perception of their colour, including lighting conditions, the reection and absorption of light by the object, the adaptation state of the observer and the context in which the object is viewed.18 The perception of tooth colour following toothbrushing is also likely to be equally complex, with many attributes of the product (e.g. avour, foam quality, abrasivity) together with the context of the teeth, gums and lips all potentially inuencing the overall perception. The contribution of these various factors on perception of tooth colour is clearly worthy of further systematic scientic study. Regardless of how it is generated, the subjective perception of the end user is one of the most important measures of consumer relevance.

Current whitening toothpastes improve tooth whiteness by the removal and control of extrinsic stain gradually over a period of weeks.1921 However, in the current study, the tooth whitening effects were demonstrated immediately after a single brushing with the silica whitening toothpaste containing blue covarine. The optical effect from the blue covarine helps the user of the product to get an immediate and perceivable whitening benet from the toothpaste4 every time it is used, in addition to the gradual, longer term whitening benet from the effective silica abrasive system within the toothpaste.22 Thus, the user of the silica whitening toothpaste containing blue covarine will obtain both immediate and long term tooth whitening benets.

5.

Conclusion

A statistically signicant reduction in tooth yellowness and improvement in tooth whiteness was measured immediately after brushing with a novel whitening toothpaste containing blue covarine.

Role of funding source

Conict of interest
Luisa Z. Collins, Mojgan Naeeni and Suzanne Platten are employees of Unilever Plc.

references

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