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Effect of Whitening Toothpastes on Dentin Abrasion: An In Vitro Study

Article  in  Oral health & preventive dentistry · June 2016

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 ORIGINAL
Vieira
ARTICLE
et al

Effect of Whitening Toothpastes on Dentin Abrasion:

An In Vitro Study

Gustavo Henrique Apolinario Vieiraa / Marcia Bessa Nogueiraa / Eduardo Jose Gaiob
/ Cassiano Kuchenbecker Rosingc / Sergio Lima Santiagod / Rodrigo Otavio Regoe

Purpose: To compare the effect of toothbrushing abrasion with hydrated silica-based whitening and regular tooth-
pastes on root dentin using contact profilometry.

Materials and Methods: Ninety dentin specimens (4 x 4 x 2 mm) were randomly divided into five experimental groups
(n = 18) according to the toothpaste: three whitening (W1, W2 and W3) and two regular toothpastes (R1 and R2) pro-
duced by two different manufacturers. Using a brushing machine, each specimen was brushed with a constant load of
300 g for 2500 cycles (4.5 cycles/s). The toothpastes were diluted at a ratio of 1:3 w/w (dentifrice:distilled water). The
brush diamond tip of the profilometer moved at a constant speed of 0.05 mm/s with a force of 0.7 mN.

Results: The average value of brushing abrasion in μm (mean ± SD) was obtained from five consecutive measurements
of each specimen: W1 = 8.86 ± 1.58, W2 = 7.59 ± 1.04, W3 = 8.27 ± 2.39, R1 = 2.89 ± 1.05 and R2= 2.94 ± 1.29.
There was a significant difference between groups (ANOVA, p<0.0001). Post-hoc Tukey’s test for multiple comparisons
showed differences between all the whitening and regular toothpastes, but not among the whitening nor among the
regular toothpastes.

Conclusion: The whitening toothpastes tested can cause more dentin abrasion than the regular ones.

Key words: bleaching agents, dentifrice, tooth abrasion, toothbrushing

doi: 10.3290/j.ohpd.a36465 Submitted for publication: 25.09.13; accepted for publication: 26.06.15

O ral hygiene is mainly performed by utilising a

toothbrush and toothpaste to mechanically re-
move the dental biofilm. It has the potential to
a
Dentist, Graduate Programme in Dentistry, Faculty of Pharmacy,
Dentistry and Nursing, Federal University of Ceará, Fortaleza, CE,
Brazil. Peformed the experiments, study concept, data acquisi-
tion, critically revised the manuscript.
b
Adjunct Professor, Faculty of Dentistry, Federal University of Rio
Grande do Sul, Porto Alegre, RS, Brazil. Peformed the experi-
ments, study concept, data acquisition, critically revised the man-
uscript.
c
Associate Professor, Department of Conservative Dentistry, Fed-
eral University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Study design, analysis, interpretation, drafted and critically re-
vised the manuscript.
d
Associate Professor, Department of Restorative Dentistry, Faculty
of Pharmacy, Dentistry and Nursing, Federal University of Ceará,
Fortaleza, CE, Brazil. Study design, analysis, interpretation, draft-
ed and critically revised the manuscript.
e
Adjunct Professor, Department of Dentistry, School of Dentistry
at Sobral, Federal University of Ceará, Sobral, CE, Brazil. Study
design, analysis, interpretation, drafted and critically revised the
manuscript.
Correspondence: Rodrigo Otavio Rego, Curso de Odontologia de
Sobral – Universidade Federal do Ceará, Rua Stanislau Frota, s/n,
Sobral, CE, Brazil, CEP: 62-011-000. Tel: +55-85-9909-5775;
Email: rodrigorego@yahoo.com
achieve gingival health and prevent dental car-
ies.2,20 However, if toothbrushing is performed ex-
cessively or incorrectly, this good habit becomes
harmful for the soft and hard oral tissues. These
problems usually appear as abrasions or erosions
on the gums and teeth.7 Epidemiological data
showed that abrasion can be observed at a rela-
tively young age; the percentage of adults with se-
vere loss of dental tissue increases from 3% at age
20 to 17% at age 70.28
The damage to enamel and dentin can be relat-
ed to the type of toothpaste used. It is known that
abrasion not only depends on tooth structure but
also on the abrasiveness of the toothpaste.20,27
Several abrasives such as hydrated silica, calcium
carbonate, dicalcium phosphate dehydrate, calci-
um pyrophosphate, alumina and sodium carbonate
are used at different concentrations in toothpastes.
Although these abrasives allow better plaque and
stain removal, they are also related to increased
dental wear. Therefore, toothpaste abrasiveness
should be moderate to avoid excessive enamel and
dentin wear.1 Several studies have investigated

doi: 10.3290/j.ohpd.a36465 1
Vieira et al
enamel wear, but only a few studies investigating
dentin wear are available.19,24,27,29 Because radicu-
lar dentin is mineralised to a lesser extent and is
softer than enamel, it is more susceptible to abra-
sive wear due to toothbrushing.10
The wear from toothbrushing and toothpastes
may also contribute to gingival recession; a trau-
matic toothbrushing technique can expose radicular
dentin and dentin tubules.1 Exposure of dentin tu-
bules can result in dentin sensitivity, and if this con-
dition is present in patients with gingival recessions,
hypersensitivity may increase. Dentin hypersensitiv-
ity is a condition which causes pain and discomfort
in approximately up to 60% of the population.31
The great demand for aesthetics today is responsi-
ble for an increase in investments in whitening tooth-
pastes by oral hygiene companies. The so-called
whitening toothpastes do not have active whitening
ingredients. Their mechanism of action is related to a
greater concentration of abrasives, which are respon-
sible for removing extrinsic stains from the dental
surfaces.16 Therefore, abrasives can lead to greater
tooth wear, which is directly associated with the
amount and kind of abrasives present in the tooth-
pastes.13,23 All abrasive substances have the poten-
tial to promote dentin wear, and they are influenced
by the type of detergent used in the toothpaste for-
mulation. The potential to promote dentin wear is
based on the shape, size and the concentration of
abrasive particles in the toothpaste, as well as their
capacity to adhere to the toothbrush bristles.10,20
It can be speculated that the greater abrasivity
of whitening toothpastes may contribute to dental
wear. The continual appearance of new whitening
toothpastes on the market requires further studies
to evaluate their safety regarding abrasiveness and
other potential deleterious effects on dental tis-
sues. Thus, the purpose of this in vitro study was
to compare, using a contact profilometer, the su-
perficial wear of radicular dentin brushed with regu-
lar and whitening toothpastes. The null hypothesis
tested was that there would be no difference in
dentin abrasion after brushing with regular or whit-
ening toothpastes.
MATERIALS AND METHODS
Sample Size
The sample size calculation was based on a pilot
study with two toothpastes (W3 and R2), in which a
difference of 2.5 μm for dentin wear between the
2 Oral Health & Preventive Dentistry
groups was observed. Considering _ and ` errors
of 0.05 and 0.2, respectively, 15 specimens per
group would be necessary to detect such a differ-
ence. Calculations were performed using the t-test
for independent samples (BioEstat 5.0 Software,
BioEstat; Belem, PA, Brazil).
For precautionary reasons, taking into consider-
ation possible loss during the study and correcting
possible errors inherent to the method used, the
sample was set at 20 specimens per group. It was
determined that the highest and lowest profilomet-
ric measurements of each group would be rejected,
which led to a total of 18 specimens per group in
the present study.
Toothpastes
Three hydrated silica-based whitening (W) and two
regular toothpastes (R) manufactured by two differ-
ent companies were tested in this study. The de-
tails of the toothpastes are presented in Table 1.
Specimen preparation
One hundred human premolars and canines previ-
ously collected with ethical approval were stored in
0.01% thymol at 4°C. Excluded were teeth with root
caries or cervical lesions deeper than 1 mm. Each
tooth was sectioned 2 mm below the cementoe-
namel junction using a low-speed water-cooled dia-
mond saw (Extec; Enfield, CT, USA). One hundred
dentin slabs measuring 4 x 4 x 2 mm were obtained,
one from each tooth.13 They were embedded in
acrylic resin, forming blocks measuring 2 x 2 X 1 cm.
The slabs were then flattened and serially polished
with 320-, 600- and 1200-grit aluminum oxide and
a 1-μm diamond paste polishing cloth (Buehler; Lake
Bluff, IL, USA).19 Half of the specimen surface was
covered with nail varnish (Colorama, CEIL; São Pau-
lo, Brazil) to obtain a reference surface.
Toothbrushing
The specimens were randomly distributed into five
different groups, each containing 20 specimens.
Toothbrushing abrasion was performed with an au-
tomatic toothbrushing machine (MSEt, Marcelo
Nucci ME; São Carlos, Brazil) under a controlled
temperature of 37°C to simulate the oral condition.
Heads of a soft-bristle toothbrush (Colgate Profes-
 Vieira et al

Table 1 Toothpaste brand names, ingredients and manufacturers

Tooth- Abrasive Active Other
paste Commercial brand* system ingredients relevant ingredients Manufacturer
Hydrated Tetrasodium pyrophosphate, Colgate-Palmolive; São
W1 Colgate Luminous Sodium fluoride
silica pentasodium triphosphate Paulo, SP, Brazil
Oral B Pró Saúde Hydrated Stannous Sodium hexametaphos- Procter and Gamble Brasil;
W2
Whitening# silica fluoride phate, trisodium phosphate São Paulo, SP, Brazil
Sodium fluoride,
Colgate Total 12 Hydrated
W3 triclosan – PVM/ – Colgate-Palmolive
Professional Whitening silica
MA copolymer
Hydrated Stannous Sodium hexametaphos-
R1 Oral B Pró Saúde# Procter and Gamble Brasil
silica fluoride phate, trisodium phosphate
Sodium fluoride,
Colgate Total 12 Clean Hydrated
R2 triclosan – PVM/ – Colgate-Palmolive
Mint silica
MA copolymer,
* In Brazil; #Oral B Pró Saúde Whitening and Oral B Pró Saúde are marketed in most of countries as Crest Pro Health Whitening and Crest Pro
Health, respectively. PVM/MA: copolymer of methyl vinyl ether and maleic anhydride or maleic acid.

Table 2 Dentin abrasion (mean ± standard deviation in μm) after brushing with whitening and regular toothpastes
Toothpaste W1 W2 W3 R1 R2
a a a b
Dentin abrasion 8.86 ± 1.58 7.59 ± 1.04 8.27 ± 2.39 2.89 ± 1.05 2.94 ± 1.29b
p < 0.0001 (ANOVA). Different superscript letters indicate statistically significant differences (p < 0.05) according to Tukey’s test.

sional Extra Clean, Colgate-Palmolive; São Paulo,
SP, Brazil) were mounted on the machine and used
for only one specimen each. It was applied with a
300-g load and submitted to linear movements
with an amplitude of 20 mm at a speed of 4.5
strokes/s.19 The slurry was prepared by mixing one
of the toothpastes with artificial saliva (1.45 mM
Ca, 5.4 mM PO4, 0.1 M Tris, 2,2 g/l porcine gastric
mucine [Sigma-Aldrich; St Louis, MO, USA], pH 7.0)
at a ratio of 1:3 by weight.13 Specimens were sub-
jected to 2500 brushing strokes using the different
toothpastes. In each cycle, 5 ml of the slurry was
used to brush each specimen.
Profilometry
with a force of 0.7 mN. On each specimen, five
readings were carried out from the reference area
to the treated area. The average of these measure-
ments was used as the roughness of each sample.
Statistical analysis
Abrasion data obtained by profilometry was tested
for normality using the Kolmogorov- Smirnov test.
Groups were compared using one-way ANOVA, fol-
lowed by Tukey’s test for multiple comparisons. A
difference of p < 0.05 was considered statistically
significant. The data analysis was performed using
GraphPad Prism 5 (GraphPad Software; San Diego,
CA, USA).

The abrasion-generated roughness was analysed

by contact profilometry (Hommel Tester T1000,
Hommelwerke; Schwenningen, Germany). As previ-
ously described, the specimens were allowed to
dry for 10 min before analysis in order to reduce
the possible interference caused by the shrinkage
of dentin organic content.22 The nail varnish was
removed from the specimens to expose the refer-
ence area. In order to evaluate roughness, the dia-
mond tip moved at a constant speed of 0.05 mm/s
RESULTS
As planned, the highest and lowest values for each
group were excluded. Thus, the averages of profilo-
metric measurements were obtained from 18 spec-
imens per group. All specimens were assessable
and no specimen loss was registered.
The mean dentin wear values after brushing with
different toothpastes are presented in Table 2. The

doi: 10.3290/j.ohpd.a36465 3
Vieira et al
15
10
μm
5 ed with toothpastes are evaluated.23 The load ap-
0
W1 W2 W3 R1 R2
Toothpastes
Fig 1  Dispersion values of abrasion on dentin in μm.
mean values of dentin abrasion for the whitening
toothpastes tested ranged between 7.59 ± 1.04
and 8.86 ±1.58 μm, while the dentin abrasion val-
ues of the regular toothpastes ranged between
2.89 ± 1.05 and 2.94 ± 1.29 μm. Clearly, the nu-
merical values obtained for the whitening tooth-
paste groups are higher than those of regular tooth-
pastes. The distribution of this data is presented in
Fig 1.
There was a statistically significant difference
between groups (ANOVA, p < 0.0001). The post-
hoc Tukey’s test for multiple comparisons showed
differences between all whitening (W1, W2 and W3)
and all regular (R1 and R2) toothpastes (p < 0.05).
However, as shown in Table 2, the within-group
analyses of whitening or regular toothpastes did
not show statistically significant differences among
the toothpastes of the respective groups (p > 0.05).
DISCUSSION
The present study evaluated the effects of tooth-
brushing on dentin in vitro. The null hypothesis
tested was rejected, since whitening toothpastes
produced greater dentin abrasion than did regular
toothpastes. The scope of this in vitro study was to
understand the potential risks of toothbrushing to
the dentin surface. Since this is an in vitro study,
the results cannot be directly transferred to clinical
practice. However, understanding how tooth struc-
ture is lost can indicate an approach to dealing with
it under clinical conditions.
The toothbrushing conditions chosen for this
study were similar to those in real life. In trying to
4 Oral Health & Preventive Dentistry
simulate real clinical conditions, canines and pre-
molars were chosen for this study, since the cervi-
cal areas on their buccal surfaces are those most
strongly affected by abrasion.1,31 In addition, the
motion produced by the toothbrushing machine in
vitro has shown to have a good correlation with
clinical conditions when abrasive lesions associat-
plied to the toothbrushes (300 g) was similar to the
that observed in in vivo conditions.33 Thus, the pre-
sent study can provide clinically relevant results,
since the same load has been observed in clinical
studies, taking a 1-min daily toothbrushing session
into consideration, which suggests 5 s of brushing
per tooth.8 In clinical conditions, toothpaste is di-
luted by saliva and water. Thus, the present study
follows other previously established protocols,9,14
in which one part toothpaste was diluted in 3 parts
of artificial saliva by weight.
The main indications of the active ingredients in
toothpastes are for caries (fluorides) and periodon-
tal diseases (stannous fluoride or triclosan with
PVM/MA). However, its whitening effect was specu-
lated to be from the mechanical action of abrasives
along with chemically active compounds that pro-
mote extrinsic stain control (pyrophosphates and
polyphosphates), or peroxides to promote tooth
bleaching.5,26 As shown in Table 1, all the tooth-
pastes tested in this study contained hydrated sili-
ca as their main abrasive substance. None of them
contained peroxide. W1 toothpaste included both
pyrophosphate and pentasodium triphosphate. W2
and R1 contained trisodium phosphate and sodium
hexametaphosphate. These agents have a binding
affinity to calcium phosphate in enamel and dentin,
desorbing biofilms and contributing to their ability
to remove existing surface discoloration and inhibit
new chromogens from being adsorbed.5
However, Alshara et al3 developed two models to
evaluate the whitening toothpastes, attempting to
distinguish between chemical and mechanical ac-
tions. Despite the fact that some whitening effect
could be observed for chemical agents, it was sub-
stantially lower than the mechanical effect. Thus,
as suggested previously,9,16 Alshara et al3 conclud-
ed that the whitening effect is mostly related to the
abrasive’s mechanical removal of stains, rather
than to the chemical ingredients. Abrasive sub-
stances such as hydrated silica, which all of the
tested toothpastes contain, are used to reduce or
prevent extrinsic stains. This abrasiveness must
be moderate in order to avoid enamel and dentin
removal.12,15 The results of the current study

showed that regular and whitening toothpastes
from the same manufacturer have different abra-
sive potentials despite having the same ingredi-
ents (Table 1). This could be explained by a greater
concentration of abrasive substances in the whit-
ening toothpastes.12,26
Several methods have been utilised to evaluate
dentinal surface wear caused by toothpastes. Mi-
crohardness, weight loss analysis, profile projec-
tions, optical and scanning electron microscopy
(SEM), histometry, optical or surface profilometry
and, as in this study, contact profilome-
try.12,17,21,23,29,30 Although not as accurate as sur-
face profilometry, contact profilometry allows
measuring the depth of dentin loss and evaluating
the texture of the worn surface.19
Relative dentin abrasivity (RDA) is a method
used to compare toothpaste abrasivity to standard
abrasive materials. This comparison generates
abrasive values for the dentifrices that would be
safe for daily use.2 In vitro dental wear studies
showed a positive correlation between the highest
RDAs and greater dentin wear.3,18,23 In an in vivo
study, Gilles et al11 found similar results and sug-
gested that patients with noncarious cervical le-
sions, or who may later present these lesions,
should use less-abrasive toothpastes. Macdonald
et al18 also observed differences between tooth-
pastes with higher and lower RDAs. These results
agree with the ones from the present study. The
differences observed in dentin wear were compati-
ble with the toothpastes’ RDAs. The greater the
RDA of the whitening toothpastes, the greater the
dentin wear.12 Hence, the difference between regu-
lar and whitening toothpastes lies in the concentra-
tion of the abrasive substances. The RDAs of the
toothpastes in this study were determined previ-
ously: W1 = 240, W2 = 220, W3 = 200, R1 = 120,
R2 = 70.3,6,18,32
This study evaluated a toothpaste with one of
the highest reported RDAs – W1, RDA=24018 –
which is extremely abrasive. However, when this
toothpaste was compared to the other whitening
toothpastes, W2, RDA=2203 or W3, RDA=200,6 no
differences were found for dentin wear (Table 2). A
cutoff point of RDA=150 has been suggested to
distinguish between high and moderate abrasive-
ness of the toothpastes.11 This is consistent with
the results of this study. The highest RDA did not
produce a wear pattern that was significantly differ-
ent from that of the other whitening toothpastes
evaluated, which also had RDAs above this sug-
gested value.
doi: 10.3290/j.ohpd.a36465
Vieira et al
Pickles et al24 found dentin wear values from
9.47 to 11.6 μm in three of the whitening tooth-
pastes with hydrated silica or calcium carbonate
and perlite as the abrasive ingredients in their for-
mulas. Their results agreed with those of our study,
where no differences were found between the three
whitening toothpastes. Turssi et al,27 in an in situ
study evaluating regular and whitening toothpastes,
showed that whitening toothpastes have a greater
potential to abrade both healthy and already erod-
ed dentin. These findings are in agreement with our
results as well as those of Menezes et al,19 who
observed that whitening toothpastes are more
abrasive than regular toothpastes, but the whiten-
ing toothpastes were not different than anti-calcu-
lus toothpastes. In an in vitro study comparing the
abrasiveness of nine toothpastes on bovine dentin,
Vicentini et al29 observed that whitening tooth-
pastes promoted greater dentin wear than did regu-
lar toothpastes. Joiner et al,17 on the other hand,
did not find any differences between whitening and
regular toothpastes which had hydrated silica as
the abrasive substance. These differences can be
a result of different evaluation methods and differ-
ent factors such as abrasiveness, brushing load
and time.
The effect of abrasion on the diameter of the
dentinal tubules is another important aspect of
dental wear, since there is a relationship between
wear and the onset of dentin sensitivity. Although
not analysed in this study, it has been demonstrat-
ed that abrasion from hydrated silica promotes
greater opening of dentin tubules. However, it can
also obliterate them.4,30 Because this obliteration
can prevent sensitivity, the use of abrasive denti-
frices may not have a major clinical impact on sen-
sitivity. Due to the specific characteristics of the
abrasive components, different methodologies,
e.g. SEM, evaluation of dentin permeability or clini-
cal interventional studies, can be useful in explain-
ing the real role of these abrasive substances in
the increase or prevention of dentin sensitivity. It
must always be borne in mind that the method of
analysis can influence the results and in many situ-
ations lead to misleading conclusions, especially in
clinical situations.25
The differences between the present and other
studies can be explained by differences in their
methodologies, but the clinical impact of theses
differences is still unclear. However, because the
number of older people is increasing and they are
keeping their teeth longer, dentin exposure has in-
creased and processes once restricted to enamel
5
Vieira et al
are now affecting dentin. As dentin is considerably
more susceptible to abrasion than enamel, it has
become the main parameter for determining the
relative abrasive level of the toothpastes and
should be the focus of future investigations.12
CONCLUSION
The silica-based whitening toothpastes tested here
have the potential to cause greater dentin wear
than do regular dentifrices. However, caution must
be exercised when extrapolating in vitro results to
the clinical situation. Although in vitro studies at-
tempt to simulate clinical conditions, clinical stud-
ies are necessary to investigate the amount of den-
tin wear caused by these toothpastes as well as
their impact on dentin sensitivity.
ACKNOWLEDGEMENTS
This study was supported by CAPES – Ministry of Education, Brazil:
Grants PROCAD NF 2313/2008 and PROCAD NF 2341/2008.
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