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CC BY 4.0 · Eur J Dent 2022; 16(04): 911-918
DOI: 10.1055/s-0041-1742123
Original Article

The Impact on Dental Staining Caused by Beverages in Combination with Chlorhexidine Digluconate

Sandra Sarembe
1   Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Halle, Germany
,
Andreas Kiesow
1   Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Halle, Germany
,
Jonathan Pratten
2   GSK Consumer Healthcare, Weybridge, United Kingdom
,
Corinne Webster
2   GSK Consumer Healthcare, Weybridge, United Kingdom
› Author Affiliations Funding This study was funded by GSK Consumer Healthcare, Weybridge.
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Abstract

Objectives There are several hypotheses regarding how chlorhexidine (CHX) digluconate causes staining with the role of beverages, specifically the precipitation of anionic dietary chromogens onto adsorbed cations, the most probable cause. The aim of this study was to investigate and compare the staining potential of common beverages using an in vitro staining and brushing model to better understand the interactions between chromogens from different beverage categories and the teeth.

Materials and Methods Human enamel samples were exposed to a cyclic treatment of artificial saliva and 0.2% CHX mouthwash combined with a range of beverages, with and without brushing, simulating a period equivalent to 2 weeks. Eleven beverages were tested: diet coke, diet lemonade, white wine, red wine, lager beer, black tea, coffee, black tea with milk, coffee with milk, ginger and lemon infusion, and water. Toothbrushing was performed in a brushing simulator with toothpaste and also with water. Colorimetric differences were determined by ΔE using a VITA Easyshade dental spectrophotometer. Statistical analyses were performed by one-way analysis of variance with post hoc Tukey's honestly significant difference test and Levene's test.

Results Black tea and red wine produced highest staining, which agrees with the literature. Significant staining was also observed for a ginger and lemon infusion, coffee, coffee with milk, tea with milk, and lager beer compared with water (p < 0.05). The staining potential of diet coke in combination with brushing appeared to be connected to its low pH. Both white wine and diet lemonade produced stain comparable to the water control. After treatment with high staining beverages, scanning electron microscope evaluation confirmed the formation of a surface layer. The mechanical resistance of the stain differed depending on the beverage, black tea stain was the most resistant. The addition of milk to tea and coffee considerably modified the stain layer and the adhesion to the tooth surface.

Conclusion The data may help demonstrate that appropriate user guidance can avoid stain and in turn help improve user compliance during short-term use of this gold standard antimicrobial treatment.

Keywords

chlorhexidine - dental staining - beverages - color measurements - SEM

Authors' Contributions

S.S., A.K., J.P., and C.W. prepared the study protocol; S.S. performed the experimental approach; S.S. and A.K. performed the analysis/interpretation of the data; S.S., C.W., J.P., and A.K. took part in the preparation for the publication of the manuscript.


Supplementary Material



Publication History

Article published online:
23 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Bernardi F, Pincelli MR, Carloni S, Gatto MR, Montebugnoli L. Chlorhexidine with an anti discoloration system. A comparative study. Int J Dent Hyg 2004; 2 (03) 122-126
    CrossrefPubMedGoogle Scholar
  • 2 Chye RML, Perrotti V, Piattelli A, Iaculli F, Quaranta A. Effectiveness of different commercial chlorhexidine-based mouthwashes after periodontal and implant surgery: a systematic review. Implant Dent 2019; 28 (01) 74-85
    CrossrefPubMedGoogle Scholar
  • 3 Addy M, Prayitno S, Taylor L, Cadogan S. An in vitro study of the role of dietary factors in the aetiology of tooth staining associated with the use of chlorhexidine. J Periodontal Res 1979; 14 (05) 403-410
    CrossrefPubMedGoogle Scholar
  • 4 Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouth rinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol 2012; 39 (11) 1042-1055
    CrossrefPubMedGoogle Scholar
  • 5 Heyden G. Relation between locally high concentration of chlorhexidine and staining as seen in the clinic. J Periodontal Res Suppl 1973; 12: 76-80
    CrossrefPubMedGoogle Scholar
  • 6 Addy M, Mahdavi SA, Loyn T. Dietary staining in vitro by mouth rinses as a comparative measure of antiseptic activity and predictor of staining in vivo . J Dent 1995; 23 (02) 95-99
    CrossrefPubMedGoogle Scholar
  • 7 Addy M, Roberts WR. Comparison of the bisbiguanide antiseptics alexidine and chlorhexidine. II. Clinical and in vitro staining properties. J Clin Periodontol 1981; 8 (03) 220-230
    CrossrefPubMedGoogle Scholar
  • 8 Watts A, Addy M. Tooth discolouration and staining: a review of the literature. Br Dent J 2001; 190 (06) 309-316
    CrossrefPubMedGoogle Scholar
  • 9 Pratten J, Smith AW, Wilson M. Response of single species biofilms and microcosm dental plaques to pulsing with chlorhexidine. J Antimicrob Chemother 1998; 42 (04) 453-459
    CrossrefPubMedGoogle Scholar
  • 10 Addy M, al-Arrayed F, Moran J. The use of an oxidising mouthwash to reduce staining associated with chlorhexidine. Studies in vitro and in vivo . J Clin Periodontol 1991; 18 (04) 267-271
    CrossrefPubMedGoogle Scholar
  • 11 Addy M, Moran J, Newcombe R, Warren P. The comparative tea staining potential of phenolic, chlorhexidine and anti-adhesive mouth rinses. J Clin Periodontol 1995; 22 (12) 923-928
    CrossrefPubMedGoogle Scholar
  • 12 Prayitno S, Addy M. An in vitro study of factors affecting the development of staining associated with the use of chlorhexidine. J Periodontal Res 1979; 14 (05) 397-402
    CrossrefPubMedGoogle Scholar
  • 13 Hanin S. Association between dental erosion and carbonated drinks. Drug Invention Today 2018; 10 (11) 2335-2337
    Google Scholar
  • 14 Lee RJ, Bayne A, Tiangco M, Garen G, Chow AK. Prevention of tea-induced extrinsic tooth stain. Int J Dent Hyg 2014; 12 (04) 267-272
    CrossrefPubMedGoogle Scholar
  • 15 Omata Y, Uno S, Nakaoki Y. et al. Staining of hybrid composites with coffee, oolong tea, or red wine. Dent Mater J 2006; 25 (01) 125-131
    CrossrefPubMedGoogle Scholar
  • 16 Addy M, Goodfield S, Harrison A. The use of acrylic to compare the abrasivitand stain removal properties of toothpastes. Clin Mater 1991; 7 (03) 219-225
    CrossrefGoogle Scholar
  • 17 Addy M, Moran J. Extrinsic tooth discoloration by metals and chlorhexidine. II. Clinical staining produced by chlorhexidine, iron and tea. Br Dent J 1985; 159 (10) 331-334
    CrossrefPubMedGoogle Scholar
  • 18 Kiklis Z. Chemical Dental Plaque Control: Chlorhexidine Tooth Staining and Efficacy of Common Whitening Procedures. Scripps Senior Theses. Paper 336. 2014
    PubMedGoogle Scholar
  • 19 Carpenter GH, Pramanik R, Proctor GB. An in vitro model of chlorhexidine-induced tooth staining. J Periodontal Res 2005; 40 (03) 225-230
    CrossrefPubMedGoogle Scholar
  • 20 Joiner A, Elofsson UM, Arnebrant T. Adsorption of chlorhexidine and black tea onto in vitro salivary pellicles, as studied by ellipsometry. Eur J Oral Sci 2006; 114 (04) 337-342
    CrossrefPubMedGoogle Scholar
  • 21 Leard A, Addy M. The propensity of different brands of tea and coffee to cause staining associated with chlorhexidine. J Clin Periodontol 1997; 24 (02) 115-118
    CrossrefPubMedGoogle Scholar
  • 22 Azer SS, Hague AL, Johnston WM. Effect of pH on tooth discoloration from food colorant in vitro . J Dent 2010; 38 (Suppl. 02) e106-e109
    CrossrefPubMedGoogle Scholar
  • 23 Pratomo A, Triaminingsih S, Indrani DJ. Effect on tooth discoloration from the coffee drink at various smoke disposal during coffee bean roasting. Journal of Physics: Conference Series 2018; 1073 (03) 032031
    Google Scholar
  • 24 Tanthanuch S, Kukiattrakoon B, Peerasukprasert T, Chanmanee N, Chaisomboonphun P, Rodklai A. The effect of red and white wine on color changes of nanofilled and nanohybrid resin composites. Restor Dent Endod 2016; 41 (02) 130-136
    CrossrefPubMedGoogle Scholar