Abstract
Objective Black stain (BS) is an extrinsic dental discoloration particularly difficult to treat.
Although its etiology is not fully clear yet, chromogenic bacteria inside the oral
cavity seem to be involved. In this pilot study, we evaluated whether a toothpaste
containing enzymes and salivary proteins could improve oral health and reduce the
presence of periodontal pathogens in subjects predisposed to BS discoloration.
Materials and Methods Twenty-six subjects were enrolled in the study: 10 subjects without BS; 16 subjects
with BS, randomly assigned in two groups: test (n = 8) and control (n = 8). The test group used a toothpaste containing sodium fluoride, enzymes, and salivary
proteins. The control group used a toothpaste with amine fluoride. At enrollment and
after 14 weeks, participants were subjected to professional oral hygiene, evaluation
of BS (through Shourie index) and oral health status, collection of saliva and dental
plaque samples. The presence of periodontal pathogens in plaque and saliva of all
subjects was investigated by molecular analysis (PCR).
Statistical Analysis The prevalence of investigated microbial species in patients with/without BS was
performed by Chi-squared test. The variation in the prevalence of the investigated
species after treatment in test and control group was analyzed by t-test.
Results Clinical evaluation showed that 86% of participants with BS had a reduction in the
Shourie index, independently from the toothpaste used. In particular, a greater reduction
in the Shourie index was observed in subjects using an electric toothbrush. We did
not observe an effect of the fluoride toothpaste containing enzymes and salivary proteins
on the composition of the oral microbiota of the test subjects in comparison with
controls. When comparing all subjects with BS (n = 16) and without BS (n = 10), P. gingivalis detection was significantly higher in saliva samples collected from subjects with
BS (p = 0.0129).
Conclusion We verified that the use of an enzyme-containing toothpaste alone is not sufficient
to prevent the formation of BS dental pigmentation in subjects predisposed to this
discoloration. Mechanical cleaning, especially using electrical toothbrushes, seems
to be useful to counteract BS formation. Moreover, our results suggest a possible
association between BS and the presence of P. gingivalis at the salivary level.
Keywords
black stain - enzyme-based toothpaste - oral hygiene - periodontal pathogens.
