Effect of tooth bleaching and application of different dentifrices on enamel properties under normal and hyposalivation conditions: an in situ study

Abstract

Objective: The purpose of this in situ study was to evaluate different dentifrices on enamel after bleaching under normal and hyposalivatory conditions.

Materials and methods: Twenty-four participants were assigned of which 12 had normal and 12 had low salivary flow. The study was conducted in 6 in situ experimental phases of 24 h duration: placebo, NaF, SnF₂, F/Sn/Chitosan, F/Arginine, and F/Bioactive Glass. The specimens were previously bleached in vitro. Microhardness (SMH), roughness (Ra), and color analyses (CIELAB and ΔE₀₀) were performed at baseline (T1), after bleaching (T2) and after in situ phase (T3). Scanning electron microscopy (SEM) and the elemental levels (wt%) of Ca, P, and Na and the proportion between Ca and P were determined using an energy-dispersive X-ray spectrometer (EDS) in T3. The SMH and Ra were analyzed by mixed models for repeated measures and Tukey Kramer. The color and Na% were analyzed by split-plot ANOVA and Tukey test. The EDS were analyzed by Mann's Whitney nonparametric, Friedman, and Nemenyi tests (p<0.05).

Results: The dentifrices placebo and NaF in the low flow presented lower SMH and higher Ra in T3 and lower Ca% compared to the same dentifrices in normal flow. For normal flow, SnF₂ resulted in greater SMH. For low flow, SnF₂, F/Sn/Chitosan, and F/Bioactive Glass resulted in higher SMH in T3 and did not differ from T1. F/Bioactive Glass showed lower Ra among the dentifrices evaluated for both salivary flows, whereas SnF₂ showed the highest. F/Bioactive Glass showed a statistically significant difference from placebo for Ca%, P%, Na%. For ΔE^*_ab and ΔE₀₀ (T1×T3), no differences were found for the dentifrices and salivary flows.

Conclusion: The low salivary flow had less capacity for remineralization of bleached enamel compared to normal flow. Overall, the dentifrice with bioactive glass had the best performance in bleached enamel under low and normal salivary flow condition.

Clinical relevance: It is recommended to use a bioactive glass-based dentifrice after bleaching to promote tooth enamel recovery for patients with or without impaired salivary flow.

Keywords: Dentifrices; Salivar flow; Tooth bleaching.