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The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

Surface changes of enamel after brushing with charcoal

toothpaste

U I Pertiwi, Y K Eriwati and B Irawan*

Department of Dental Materials, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
*
E-mail: [email protected]

Abstract. The aim of this study was to determine the surface roughness changes of tooth
enamel after brushing with charcoal toothpaste. Thirty specimens were brushed using distilled
water (the first group), Strong® Formula toothpaste (the second group), and Charcoal®
Formula toothpaste for four minutes and 40 seconds (equivalent to one month) and for 14
minutes (equivalent to three months) using a soft fleece toothbrush with a mass of 150 gr. The
roughness was measured using a surface roughness tester, and the results were tested with
repeated ANOVA test and one-way ANOVA. The value of the surface roughness of tooth
enamel was significantly different (p<0.05) after brushing for an equivalent of one month and
an equivalent of three months. Using toothpaste containing charcoal can increase the surface
roughness of tooth enamel.

1. Introduction
Dental caries is a pathologic process of tooth tissue damage caused by microorganisms. Caries is a
multifactorial disease that involves four fundamental factors: the host, who consists of dental tissues
and saliva; the agent, which is microflora; the environment or substrate; and time. Caries is also
defined as the progressive demineralization of the hard tissue of the tooth surface by organic acids
from food. Dental caries occurs in people in Indonesia with a high prevalence and severity. Based on
Indonesia Basic Health Research in 2013, the index of DMF-T in Indonesia is 4.6 with D-T = 1.6, M-
T = 2.9, and F-T = 0.08. This means that there are 460 damaged teeth in 100 people of the Indonesian
population [1]. Most microorganisms in the oral cavity can survive and form colonies when
microorganisms attach to rough surfaces, enamel, or cementum [2]. A study that entailed observing
the changes in the surface roughness of tooth enamel by examining the surface topography suggested
that changes in enamel surface roughness could increase the proliferation of bacteria and biofilm
formation, as well as increase the resistance of bacteria [2]. Several factors influencing changes in
enamel surface roughness are exposure to acid that dissolves the hydroxyapatite on the surface of the
enamel, as well as exposure to the abrasive agents contained in a variety of dental materials [3-4].
Nowadays, various types of toothpaste have been created and circulated in the market, ranging
from toothpastes designed to protect teeth from calculus, gum disease, bad breath, plaque, and caries,
as well as whitening toothpaste [5]. The selection of the right kind of toothpaste is possible through
knowing the content and the function of the content in each toothpaste. Almost all available
toothpastes in the market contain more than one active ingredient, which is promoted as having some
advantages for the user. Generally toothpastes in the market today are a combination of abrasive
materials, detergents, and one or more therapeutic agents.

Content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence. Any further distribution
of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
Published under licence by IOP Publishing Ltd 1
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

Charcoal or activated carbon is one of the materials contained in some toothpaste products. Micro
charcoal in toothpaste is known to have the ability to absorb dirt and to clean the teeth as well as the
gaps between the teeth, which are difficult to reach. However, charcoal’s shape and composition,
along with the sizes of its particles could make it abrasive, so it is suspected to increase the surface
roughness of tooth enamel [6]. Toothpastes that are considered ideal are those with the ability to
maximally clean teeth with a minimum degree of abrasiveness, however.

2. Materials and Methods

This study was an experimental laboratory study whose design category was a randomized pretest-post
test. This study involved three groups, and each group consisted of at least nine samples. Thus, in this
study, each group consisted of 10 samples, so the total number of samples used was 30. The samples
were grouped into group A (brushed with distilled water), group B (brushed using Strong® Formula
toothpaste), and group C (brushed using Charcoal® Formula toothpaste).
The samples for this study were the buccal surfaces of maxillary first premolar teeth that had been
extracted and approved for use by the Ethics Research Committee of Faculty of Dentistry, Universitas
Indonesia (Number: 96/Ethical Approval/FKGUI/XI/2016). The research was conducted at the
Laboratory of the Department of Dental Materials, Faculty of Dentistry, Universitas Indonesia and at
Material Physics Laboratory, Faculty of Mathematics and Natural Sciences, Universitas of Indonesia.
Specimens were made through mounting, grinding, and polishing procedures. Teeth that met the
criteria for the study samples were cut at the boundary of the Cemento Enamel Junction (CEJ) in a
mesiodistal direction using a low-speed micromotor and carborondum disc. Then, a paper sticker was
placed on a mixing slab with the sticker surface facing upward, and the buccal enamel surfaces were
affixed to the paper. A plastic ring was affixed to each paper sticker encircling the specimen. The ring
was pressed to prevent the leakage of resin during filling. After that, the resin liquid and hardener
liquid were mixed until homogeneous, and they were poured into the plastic ring and kept for 24 hours
until the resin hardened. After the resin hardened, the specimens were removed from the plastic ring,
and their thickness was measured using a digital caliper. The specimens were sanded with sandpaper
numbers 800, 1500, and 2000. During sanding, the thickness of each specimen was controlled; any
enamel wasted could not be greater than 100 μm (0.1 mm). After sanding, the specimens were
polished with 1 micron of alumina.
As many as 30 tooth specimens were divided into three groups randomly. The initial surface
roughness (Ra) value of each specimen was measured using a surface roughness tester with a cut-off
length of a 0.25-mm and 1.25-mm evaluation length. In one specimen, three measurements were done
on different surfaces. The results of the three measurements were later counted as an average.
Each specimen group was given a different brushing treatment, which were: using distilled water,
using Strong® Formula toothpaste, and using Charcoal® Formula toothpaste. The toothpastes were
weighed with digital scales that had each been given a base. Initial equalization was done by pressing
the "tare" button until it displayed a number in the form of “0, 00 gr.” Toothpaste was then applied
above each specimen until the scale showed 0.10 gr, then mixed with 0.1 ml of distilled water. The
brush holder was properly set and was given a load of 150 gr [7]. After that, the solution of toothpaste
was applied to the surface specimen. Brushing was done for four minutes and 40 seconds, which was
assumed to be the equivalent of brushing for one month, followed by brushing for nine minutes and 10
seconds, which was assumed to be the equivalent of brushing for two months, so that when totalled,
the brushing time would be equivalent to brushing for three months.
A Ra measurement was taken after brushing for the equivalents of one month and three months. A
contribution procedure as the initial Ra measurement before treatment was done with a surface
roughness tester with a 0.25-mm cut-off length and a 1.25-mm evaluation length. In one specimen,
measurements were carried out three times on different surfaces. The total measurement results were
then averaged.
The results were statistically tested using parametric tests. The significance of the changes in the
initial Ra value, the first-month value, and the third-month value in each group were tested by using

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The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

the ANOVA repeated test. The significance of the differences in the Ra value among the groups was
tested with one-way ANOVA. In this study, particle size analysis was also conducted using a particle
size analyzer (COULTER LS 100, America) in the Laboratory of Material Physics, Faculty of
Mathematics and Natural Sciences, Universitas Indonesia.

3. Results and Discussion

3.1 Results
3.1.1 Surface Roughness Test Results
The measured roughness values were the initial value, the value after brushing for an equivalent of one
month (four minutes and 40 seconds), and the value after brushing for an equivalent of three months
(14 minutes) [8]. The tooth surface roughness value was measured using a surface roughness tester
(Mitutoyo SJ 301, Japan) as seen in Table 1.

Table 1. Tooth surface roughness test results after brushing with toothpaste containing charcoal
Roughness Surface Value [Ra ± SD (µm)]
After Brushing for Equivalent After Brushing for
Group
Initial of 1 Month (4 Minutes and 40 Equivalent of 3 Months
Seconds) (14 Minutes)
Distilled water (A) 0.06±0.01 0.10±0.02 0.12±0.03
Strong® Formula (B) 0.06±0.01 0.10±0.01 0.12±0.02
Charcoal® Formula (C) 0.06±0.01 0.11±0.01 0.22±0.01

After the normality assumptions and homoscedasticity were tested and met, the two-way analysis of
variance (ANOVA) were carried out for the study of surface roughness and hardness of the specimens. A
repeated ANOVA test followed by post-hoc pairwise comparison analysis was used to analyze
changes in the value of roughness in the brushing group using distilled water (group A), Formula
Strong® toothpaste (group B), and Formula Charcoal® toothpaste (group C). Moreover, this analysis
was used to determine the value of the significance of the changes in the value of enamel surface
roughness. Observations of the roughness changes in each group of specimens were performed prior to
brushing; after brushing for four minutes and 40 seconds, which was assumed to be equivalent to
brushing for one month; and after brushing for 14 minutes, which was assumed to be equivalent to
brushing for three months [8].

Table 2. Statistical test result for repeated ANOVA with value of p<0.05 in three experiment groups
Mean Mean p-value among
Variable p-value Test Group Difference (%)
Difference Groups
A1 with A2 -0.031 51.6 0.016*
Distilled Water
0.001* A1 with A3 -0.057 95 0.010*
Group (A)
A2 with A3 -0.026 26 0.187
Strong® B1 with B2 -0.038 63.3 0.000*
Formula Group 0.000* B1 with B3 -0.060 60 0.000*
(B) B2 with B3 -0.022 22 0.006*
®
Charcoal C1 with C2 -0.053 88.3 0.000*
Formula Group 0.000* C1 with C3 -0.158 143.6 0.000*
(C) C2 with C3 -0.105 95.5 0.000*
Note: A,B,C=brushing group with distilled water (A), Strong® Formula toothpaste (B),
Charcoal® Formula toothpaste (C); 1,2,3=initial (1), brushing time equivalent to 1 month (2),
brushing time equivalent to 3 months (3); p˂0.05*statistically significantly different

3
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

The repeated ANOVA test results for the negative control group with distilled water (A) in Table 2
show a change in the value of surface roughness (Ra), which is statistically significantly different
overall (p˂0.05). These test results indicate that at least two different measurements were significantly
different. Therefore, the post-hoc pairwise comparison test was conducted to determine the
significance among the groups. The results of this analysis show that there was a statistically
significant difference (p˂0.05) between the initial Ra (A1) and the Ra after brushing for the equivalent
of one month (A2). Significant differences were also found between the initial Ra (A1) and the Ra
after brushing for three months (A3). Meanwhile, the values of Ra between brushing for the equivalent
of one month (A2) and brushing for the equivalent of three months (A3) were not significantly
different (p˃0.05).
The repeated ANOVA test results for the positive control group with Strong® Formula toothpaste
(B) in Table 2 show a change in the value of surface roughness (Ra), which is statistically significantly
different overall (p˂0.05). The results of the post-hoc pairwise comparison test show statistically
significant differences (p˂0.05) in the surface roughness values for all surfaces, including for the
initial group (B1) and the group after brushing for the equivalent of one month (B2), for the initial
group (B1) and the group after brushing for the equivalent of three months (B3), and the group after
brushing for the equivalent of one month (B2) and the group after brushing for the equivalent of three
months (B3).
The repeated ANOVA test results for the positive control group with Charcoal® Formula
toothpaste (C) in Table 2 show a change in the value of surface roughness (Ra), which is statistically
significantly different overall (p˂0.05). The results of the post-hoc pairwise comparison test show
statistically significant differences (p˂0.05) in the surface roughness values for all surfaces, including
for the initial group (C1) and the group after brushing for the equivalent of one month (C2), for the
initial group (C1) and the group after brushing for the equivalent of three months (C3), and for the
group after brushing for the equivalent of one month (C2) and the group after brushing for the
equivalent of three months (C3).
The one-way ANOVA hypothesis test was also used to analyze the results of this study.
Specifically, it was used to determine the significance of the differences in the average values of
enamel surface roughness among the three groups of A, B, and C before treatment, after brushing for
the equivalent of one month, and after brushing for the equivalent of three months. This was followed
by Tukey post-hoc analysis to see which treatment groups had significant differences.

Table 3. Statistical test result for one-way ANOVA with value of p<0.05 in three experiment
groups
Mean Difference p-value
Treatment p-value Test Group Mean Difference
(%) among groups
A1 and B1 -0.00500 8 0.473
Initial (1) 0.501 A1 and C1 -0.00300 5 0.760
B1 and C1 -0.00200 3 0.884
Brushing A2 and B2 -0.00200 2 0.955
Equivalent to 1 0.020* A2 and C2 -0.01900 19 0.028*
Month (2) B2 and C2 -0.01700 17 0.052
Brushing A3 and B3 -0.00900 7.5 0.597
Equivalent to 3 0.006* A3 and C3 -0.08700 72.5 0.000*
Months (3) B3 and C3 -0.09600 80 0.000*
Note: A,B,C= Brushing group with distilled water (A), Strong® Formula toothpaste (B), Charcoal®
Formula toothpaste (C); 1,2,3= initial (1), brushing time equivalent to 1 month (2), brushing time
equivalent to 3 months (3); p˂0.05* statistically significantly different

4
The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

Table 4. Differences in the average tooth surface roughness values among groups before
treatment (A1, B1, C1)
∆Ra Distilled ∆Ra Strong® Formula ∆Ra Charcoal® Formula
Water Group Group Group
∆Ra Distilled Water Group
(µm) - 0.00500 0.00300
∆Ra Strong® Formula
Group (µm) -0.00500 - -0.00200

∆Ra Charcoal® Formula

-0.00300 0.00200 -
Group (µm)
Initial roughness before brushing in the three groups did not differ significantly

In Table 4, we can see the differences in the mean values of enamel surface roughness among the
groups before treatment (A1, B1, and C1). Based on the results of the post-hoc Tukey HSD in Table 3,
the roughness values of the three groups were not statistically significant at 0.501 (p>0.05). This was
consistent with the previous assumption that every sample was in the same state before the study.

Table 5. Differences in the average tooth surface roughness values among groups after brushing
(A2, B2, C2)
∆Ra Distilled ∆Ra Formula Strong® ∆Ra Formula Charcoal®
Water Group Group Group
∆Ra Distilled Water
Group (µm) - -0.00200 -0.01900*

∆Ra Strong® Formula

Group (µm) 0.00200 - -0.01700

∆Ra Charcoal® Formula

0.01900* 0.01700 -
Group (µm)
(*)Value statistically differs significantly. Result from one-way ANOVA test (p˂0.05)

We can see the mean value of surface roughness among the groups that brushed for the equivalent
of one month (A2, B2 and C2). Based on the ANOVA test, the significance value was 0.020 (p˂0.05),
which means that there were significant differences in the data group. Based on the post-hoc Tukey
HSD test’s significance value in Table 3, there were statistically significantly different average
roughness values—between the distilled water group (A2) and Charcoal® Formula toothpaste group
(C2)—with a significance value of 0.028 (p<0.05). Meanwhile, the average value of the distilled water
(A2) with Strong® Formula toothpaste group (B2) and the average values of roughness between the
Strong® Formula toothpaste group (B2) and the Charcoal® Formula toothpaste group (C2) were not
significantly different. This is seen from the significant values between the respective groups, which
were 0.955 and 0.052 (p˃0.05).

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The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

Table 6. Differences in the Average Tooth Surface Roughness Value among Groups after
Brushing (A3, B3, C3)
∆Ra Distilled Water ∆Ra Strong® Formula ∆Ra Charcoal® Formula
Group (µm) Group (µm) Group (µm)
∆Ra Distilled Water
- 0.00900 -0.08700*
Group (µm)
∆Ra Strong Formula
®
-0.00900 - -0.09600*
Group (µm)
∆Ra Charcoal® Formula
0.08700* 0.09600* -
Group (µm)
(*)Value statistically differs significantly. Result from one-way ANOVA test (p<0.05)

In Table 6, there are differences in the mean surface roughness values among the groups after
brushing for the equivalent of three months (A3, B3 and C3). Based on the ANOVA test, the
significance value was 0.000 (p˂0.05), which means that there were significant differences in the data
group. Based on the post-hoc Tukey HSD test’s significance value in Table 3, there were statistically
significantly different average roughness values between the distilled water group (A3) and the
Charcoal® Formula toothpaste group (C3), with the significance value being 0.000 (p<0.05). The average
surface roughness value of the Strong® Formula toothpaste group (B3) and the Charcoal® Formula
toothpaste group (C3) was also significantly different. Mean-while, the average surface roughness value
of the distilled water group (A3) and the Strong® Formula (B3) was not statistically significantly
different with a p value of 0.597 (p˃0.05).

3.1.2 Particle Size Analyzer Analysis Results

The result of the particle size test using the particle size analyzer showed that the particle size of the
Charcoal® Formula toothpaste was greater than that of the Strong® Formula toothpaste. The Charcoal®
Formula toothpaste had an average particle size of 7.853 μm, while the Strong® Formula toothpaste had
an average size of 4.625 µm. This was presumably because there were charcoal particles in large
quantities in the toothpaste. Several previous studies mentioned that large particle size in toothpaste
can affect the value of the tooth surface roughness (Ra).

(a)

(b)

Figure 1. (a) Particle Size Analysis Result for Charcoal® Formula, (b) Particle Size Analysis
Result for Strong® Formula
3.2 Discussion

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The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

The goal of this study was to observe changes in enamel surface roughness after brushing with
toothpaste containing charcoal, then evaluated after brushing for the equivalent of one month and three
months. This study used parameters adapted to the clinical recommendation, such as the volume of
toothpaste, given load, and brushing time for each specimen. In this study, the toothpaste was diluted
using distilled water at a ratio of 1:1. Loading was at 150 gr [7]. Also, in this study, brushing teeth
simulation was done according to tooth brushing recommendations for 120 seconds (two minutes) for
the entire surface of the tooth, with each quadrant brushed for 30 seconds [9]. A study involving the
use of an electric toothbrush on a subject who had an average of six teeth in each quadrant explained
that the size of the head of the electric toothbrush was capable of reaching at least more than one tooth
surface, buccal/labial or lingual/palatal, so as to brush two tooth surfaces simultaneously. This took an
estimated five seconds, the same amount of time estimated for brushing one tooth surface [7]. Some
studies also used five seconds on each tooth surface in their research methods [9]. Thus, if brushing
one tooth surface is assumed to take five seconds, with the recommendations stating that the teeth
should be brushed twice a day, brushing a tooth in one day was assumed to take 10 seconds, brushing
for one week was assumed to take 70 seconds, brushing for one month was assumed to take 280
seconds (four minutes and 40 seconds), and brushing for three months was assumed to take 840
seconds (14 minutes). In this study, brushing was conducted for 280 seconds (equivalent to one
month), followed by brushing for 560 seconds (equivalent to two months) for each treatment, so the
total time would become 840 seconds (equivalent to three months).
The results showed that the values of surface roughness of all three groups after brushing for the
equivalent of one and three months were significantly different. The increased Ra value was caused by
the action mechanism of the toothbrush bristles, the applied load while brushing, and the content of
abrasive material contained in the toothpaste. In this study, the type of toothbrush bristle and brushing
load were controlled accordingly and were the same for the three groups—a soft bristle brush with a
load of 150 gr.
The smallest increase in Ra was found in the brushing group using distilled water (group A), which
was a negative control. Based on the results of the study, an increase in Ra was significantly different
between before brushing and brushing time equivalent to one month, but it was not significantly
different between brushing time equivalent to one month and brushing time equivalent to three
months. This showed that the brushing load and soft bristle brush affected the release of minerals and
the increase of the roughness of tooth enamel. A toothbrush with a soft bristle brush has a greater
contact surface area with the surface of the tooth, thus increasing surface roughness [8]. In addition,
the level of abrasiveness of the tooth surface is also influenced by the length of the brushing time [8].
Increased Ra also occurred in the group involving brushing using Strong® Formula toothpaste
(group B), which was a positive control, with there being similarities in the types of abrasive material
content found in Strong® Formula and Charcoal® Formula toothpaste, which are silica and hydrated
silica. Strong® Formula toothpaste did not claim to contain charcoal to clean the teeth and to remove
stains found on the surface of a tooth; thus, it was assumed that the increasing Ra value in this group
was due to the content of the abrasive material contained in toothpaste. When the process of abrasion
occurred, abrasive materials contained in toothpaste would cause scratches in the enamel surface and
cause the loss of some minerals in the enamel surface. The loss of tooth minerals would lead to an
increase in the value of Ra. Some of the factors influencing the improvement of the abrasion of the
material include abrasive material hardness. On the Mohs hardness scale, silica and hydrated silica
have a value of 5-7, whereas the tooth enamel has a value of 5. We should beware if tooth enamel
contacts materials with greater Mohs hardness values, as this could create scratches on the surface of
the tooth enamel and increase the Ra value. In addition, the shape, size, and number of particles also
determine the abrasive properties of a material. Based on the results of the particle size analyzer test,
the average size of the particles in Strong® Formula toothpaste is 4.625 µm.
The highest increase in the Ra value occurred in Charcoal® Formula toothpaste. This was thought
to result from the content of the abrasive material contained in toothpaste. In addition to having silica
and hydrated silica as abrasive materials, Charcoal® Formula toothpaste also contains activated

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The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

carbon or charcoal. Based on visual observation, the color of Charcoal® Formula is identical to the
color of charcoal, which is black. Charcoal particles are star shaped or so-called fractal shaped. A
study once explained that the irregularity of particle shape could affect the value of surface roughness
on a tooth [6]. In addition, based on the test results of the particle size analyzer, the average size of the
particles in Charcoal® Formula toothpaste was greater than that of Strong® Formula, which was
7.853 µm. Larger particle size was expected to increase the value of Ra on the enamel surface after
brushing with Charcoal® Formula toothpaste. After statistical tests, it was shown that the values of Ra
after brushing for the equivalent of one month and three months among distilled water, Strong®
Formula toothpaste, and Charcoal® Formula toothpaste were significantly different. This indicates
that the materials contained in toothpaste affect changes in the roughness of tooth enamel. The
statistical testing of Strong® Formula toothpaste (positive control) and Charcoal® Formula toothpaste,
which had similar types of abrasive materials, also showed significantly different Ra value changes
after brushing for the equivalent of three months. This indicates that the charcoal allegedly played a
role in the change of surface roughness of tooth enamel.
The duration of toothpaste application could also affect tooth enamel, which is divided into good
influences, such as the effect of the removal of food debris and stains attached to the surface of the
teeth, and bad influences in the form of the side effects of the use of toothpaste. Charcoal® Formula
toothpaste claims that the content of charcoal or activated carbon contained in the toothpaste was able
to clean teeth and remove dirt on the surface of the tooth, so more time is needed to see the long-term
effects. Therefore, in this study, the brushing times were the equivalent of one month and three months
to see their effect on Ra.
The results showed increasing Ra values for all treatment groups after brushing for the equivalent
of one month and three months. A tooth’s rough enamel would be a strategic place for bacteria to
adhere to the tooth’s surface. The presence of bacteria in the oral cavity is one of the causes of high
caries and periodontal disease risk [8]. The threshold value for Ra that might cause the retention of
bacteria is 0.2 μm [8]. An Ra value above the threshold would be a strategic place for bacterial growth
and the accumulation of plaque causing a high risk of caries and periodontitis [8].
Based on the research that has been done, after brushing for the equivalent of one month, the Ra
values of the three groups were still below the threshold. However, after brushing for the equivalent of
three months, the Ra value of Charcoal® Formula toothpaste crossed the threshold of bacterial
retention. The increased Ra value nearly doubled from the initial roughness. Therefore, people need to
reconsider the use of toothpastes containing charcoal for the long term (more than three months).
This research study had some limitations. First, the teeth were randomly selected, so researchers
did not know the previous conditions of the teeth, such as dental age and interventions that had been
conducted on the teeth. This caused the initial Ra values to vary. However, after being statistically
tested, the initial Ra values of the three treatment groups did not differ significantly; the average values
were similar. Second, there were differences between the research conditions and the natural
atmosphere of the oral cavity. In the natural condition of the oral cavity, the demineralization-
remineralization process occurs continuously, and there are also many other interventions. In in vitro
studies, it is difficult to recreate such conditions [10].
Further research is needed to investigate each toothpaste composition and surface topography
analysis can be further analysed with Scanning Electron Microscope. For the community, it is
suggested to compensate for the long-term use of toothpastes containing charcoal, considering the
increased risk of tooth surface roughness, through supporting enamel remineralization, such as the use
of topical fluoride [10].

4. Conclusion
The research concluded that there were increasing surface roughness values of tooth surfaces after the
use of toothpaste containing charcoal, and the increased surface roughness was statistically significant
after brushing for four minutes and 40 seconds (equivalent to one month of brushing) and 14 minutes
(equivalent to three months of brushing) using toothpaste containing charcoal.

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The 1st Physics and Technologies in Medicine and Dentistry Symposium IOP Publishing
IOP Conf. Series: Journal of Physics: Conf. Series 1234567890
884 (2017) 012002 doi:10.1088/1742-6596/884/1/012002

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