| Abstract | Ovo istraživanje provedeno je u kliničkim uvjetima s ciljem analize citotoksičnog i genotoksičnog djelovanja komercijalno dostupnih izbjeljujućih zubnih pasti na stanice bukalne mukoze te njihov optički učinak izbjeljivanja na zubima. Objedinjena je evaluacija subjektivnog i objektivnog učinka te potencijalno toksičnog učinka izbjeljujućih zubnih pasti dostupnih na tržištu. U istraživanju je ispitivano deset zubnih pasti (devet izbjeljujućih: Colgate Max Expert White [CMEW], Signal Daily White [SDW], Himalaya Sparkly White Herbalis [HSWH], Signal White System [SWS], Rembrandt Deeply White + Peroxide [RDWP], Splat
Extreme White [SEW], Splat White Plus [SWP], Biobaza Deep White [BDW], Dontodent Black Shine [DBS], i jedna neizbjeljujuća – Kalodont Multi Repair [kontrola]). Evaluirao se optički učinak izbjeljivanja testiranih pasti (promjena boje zuba – ΔE*ab, ΔE00 i promjena indeksa bjeline – ΔWID) i njihov toksični učinak uz pomoć bukalnog mikronukleus testa u četiri vremenske točke: T0 – inicijalna vrijednost, T1 – 30 dana od početka tretmana, T2 – 60 dana od početka tretmana i T3 – 30 dana nakon prestanka tretmana, te zadovoljstvo ispitanika tretmanom i korištenom zubnom pastom. Rezultirajuća promjena za boju zuba i promjene
indeksa bjeline ukazuju na klinički značajnu promjenu boje zuba i povećanu bjelinu za sve testirane izbjeljujuće zubne paste u svim vremenskim razdobljima korištenja u usporedbi s osnovnim vrijednostima, pri čemu su izbjeljujuće zubne paste koje su u svom sastavu imale kombinaciju abraziva i kemijskih sastojaka pokazale najveći izbjeljujući učinak – HSWH, SEW, RDWP i CMEW. Genotoksični parametri nisu pokazali biološki značajne promjene u nijednom testiranom razdoblju za korištene zubne paste, dok su citotoksični parametri (broj stanica s karioreksijom i kondenziranim kromatinom) pokazali statistički značajno povećanje broja stanica zahvaćenih toksičnim djelovanjem u T1 i T2 periodu u usporedbi s inicijalnom vrijednosti za tri izbjeljujuće zubne paste koje su u svom sastavu imale peroksid – CMEW, RDWP i SEW. Međutim, u T3 nije postojala razlika između udjela stanica zahvaćenih toksičnim djelovanjem u odnosu na T0. Ispitanici koji su koristili izbjeljujuću zubnu pastu SEW
za vrijeme trajanja studije u konačnici su bili najzadovoljniji dobivenom bojom zubi. Rezultati istraživanja ukazuju da postoji pozitivna korelacija između izbjeljujućih zubnih pasti koje u svom sastavu imaju perokside s povećanjem citotoksičnosti tijekom razdoblja korištenja. |
| Abstract (english) | In the last decade, there has been an increasing trend in the use of oral hygiene products that contain bleaching substances. Whitening toothpastes, rinses, paint-on gels, chewing gums, trays with gel activated by light and whitening strips represent an alternative method of removing and controlling tooth discolorations. Unlike professional teeth whitening which takes place under the supervision of doctors in controlled conditions, these products are available in over the counter drugstores. Irrational use of these products can cause a potential risk for human health. In order to investigate the effectiveness and potential harm of commonly available whitening toothpastes, this research conducted in in vivo conditions represent a detail analysis of potentially toxic effects on buccal mucosa cells and whitening performances on teeth surfaces of commercially available whitening toothpastes with different substances. In this prospective, randomized controlled study with parallel groups, 199 healthy individuals participated and divided into 10 test groups depending on used toothpaste (Colgate Max Expert White [CMEW], n=20; Signal Daily White [SDW], n=20; Himalaya Sparkly White Herbalis [HSWH], n=20; Signal White System [SWS], n= 20; Rembrandt Deeply White + Peroxide [RDWP], n=20; Splat Extreme White [SEW], n=20; Splat White Plus [SWP], n=21, Biobaza Deep White [BDW], n=18; Dontodent Black Shine [DBS], n= 20; and Kalodont Multi Repair [control], n=20). The optical whitening effect of the tested pastes, their toxic effect was evaluated using the buccal micronuleus cytome assay (BMCyt assay) at four times at different time intervals: T0- initial value; T1, 30 days after the beginning of using whitening toothpaste; T2, 60 days after the beginnig of using whitening toothpaste; and T3, 90 days from the start of treatment (30 days after completing the treatment)- the follow-up period, and the respondents'
satisfaction with the treatment and toothpaste used. The obtained data were analyzed by Kolmogorov-Smirnov test, Levene's test, two-way analysis of variance (ANOVA) for repeated measures (two-way ANOVA), one-way analysis of variance (one way ANOVA), Tukey's test and multiple regression analysis. A statistically significant value difference was observed in the ΔL* coordinate for all tested whitening toothpastes compared to the control toothpaste (classified as conventional toothpaste) after 30 and 60 days of use (P < 0.05), for Δb* values after 30 and 60 days of use (P < 0.05), and for Δa* values after 30 days of continuous use (P < 0.05). The resulting change in tooth color (ΔE*ab, ΔE00) and whiteness index change (ΔWID) reveal a clinically significant tooth color change and increased whiteness for all tested whitening toothpastes for evaluated time points in comparison to baseline values. The only exception was Signal white system (SWS) which showed that tooth color change is below the perceptible limit (PT) for T3 vs.T0 (ΔE*ab = 1.14, ΔWID = 0.44, ΔE00 = 0.71). Genotoxic parameters didn't show biologically significant changes in any tested time period for the used toothpastes, while cytotoxic parameters (number of cells with karyorexia and condensed chromatin) showed a statistically significant increase (P < 0.05) at T1 and T2 compared to baseline for three peroxide containing toothpaste Colgate Max Expert White
(CMEW), Rembrandt Deeply White + Peroxide (RDWP) and Splat Extreme White (SEW). Statistically significant difference neither for genotoxic parameters nor for cytotoxic parameters between groups for the same sampling time. The same applies for the genotoxic parameters for all the ten groups between sampling times. The statistically significant difference (P < 0.05) was observed only for cytotoxic parameters (cells with condensed chromatin and cells with karyorrhexis) between sampling times for the following whitening toothpastes: CMEW - karyorrhexis (increase: T1 vs. T0; T2 vs. T0;), CMEW - condensed chromatin (increase: T1 vs.T0; T2 vs.T0; decrease: T3 vs.T1; T3 vs. T2;), RDWP - karyorrhexis (increase: T1 vs.T0; T2 vs.T0; decrease: T3 vs.T1; T3 vs. T2;), RDWP - condensed chromatin (increase: T1 vs. T0; T2 vs. T0; T2 vs. T1; T3 vs. T0; decrease: T3 vs. T1; T3 vs. T2;), SEW - karyorrhexis (increase: T1 vs.T0; T2 vs.T0; decrease: T3 vs.T1; T3 vs. T2;) and SEW - condensed chromatin (increase: T1 vs. T0; T2 vs. T0; T2 vs. T1; T3 vs. T0; decrease: T3 vs. T1; T3 vs. T2).
Participants who used Splat Extreme White whitening toothpaste (SEW) for the duration of the research were ultimately the most satisfied with the color of their teeth. The research results proved that whitening toothpastes with abrasives, enzymes, peroxides, activated charcoal and their combinations can achieve a perceptible whitening effect, whitening toothpastes that had a combination of abrasives and chemical ingredients (peroxide and/or enzymes) showed the highest whitening effect- HSWH, SEW, RDWP and CMEW, toothpastes with peroxide in their composition- CMEW, RDWP and SEW showed a significant increase in cytotoxic parameters (number of cells with condensed chromatin and karyorexia) only during the period of their use, none of the tested whitening toothpaste showed a genotoxic effect on the oral mucosa cells, there is positive correlation between whitening toothpastes that have peroxides in their composition with an increase in cytotoxicity during the period of use- toothpastes with peroxides had the most significant whitening effect and showed increase in cytotoxicity during their use only. |
