Interntionl Journl of Clinicl Preventive Dentistry Volume 9, Number 4, December 2013 The Interdentl Clensing, Stin Removing nd Clculus Deposit Inhibition Effect of Toothpste Contining Tetrsodium Pyrophosphte nd Soft Grnule (Zeolite-M) Won-Ho H 1, Je-Hyun Ahn 1, A-Rm You 1, Ji-Hye Kim 1, Min-Jeong Cho 2, Seung-Chul Shin 3 1 LG Household & Helth Cre Reserch Prk, Dejeon, 2 Deprtment of Dentl Hygiene, Degu Science College University, Degu, 3 Deprtment of Preventive Dentistry, Dnkook University, Cheonn, Kore Objective: The purpose of this study ws to investigte the stin removl, clculus deposit inhibition, nd clening effect for teeth surfce nd interdentl region by using toothpste contining Pyrophosphte nd soft grnule (Zeolite-M). Methods: 1) For the study, generl toothpste ws prepred s control nd 2 kinds of test toothpstes were prepred. Test toothpste-1(t1) contining Pyrophosphte nd test toothpste-2 (T2) contining Pyrophosphte nd soft grnule (Zeolite-M, Ultr White Bll R ). 2) In-vitro study: The stin removl nd interdentl clening effect were mesured using stined Hydroxyptite tblet, nd 20 subjects teeth surfce nd interdentl clening effect by brushing ws evluted with test toothpste. 3) Clinicl study: The study ws performed on 88 subjects. Clculus index nd Stin index were mesured during 8 week. Results: 1) T2 showed the highest stin removl nd clening effect for teeth surfce nd interdentl region. The results of the experiment were sttisticlly significnt (p<0.05). 2) After using toothpstes 4 weeks, subjects using T2 showed less trtr deposit thn using control, nd fter 8 weeks, T2 sttisticlly inhibit trtr formtion thn T1 nd control (p<0.05). 3) Using T2 longer thn 4 weeks could be ccepted s highly effective wy to stin removl. Conclusion: T2 showed significntly effective on plque, stin removl, clculus deposit inhibition nd clening for teeth surfce nd interdentl region thn control toothpstes. Therefore, toothpste contining pyrophosphte nd soft grnule is recommendble to prevent clculus formtion nd teeth stining. The subjects using T 2 cn feel whitening efficcy nd stisfction of clening more thn plcebo nd T1. Keywords: clculus deposit inhibition, interdentl clening, stin removl, tetrsodium pyrophosphte, Zeolite-M Introduction Dentifrice, commonly clled toothpste is used s n uxiliry mteril for the clenliness of the teeth with toothbrush. The primry purpose of using toothpste is removing plque Corresponding uthor Won-Ho H LG Household & Helth Cre Reserch Prk, Jng-dong 84, Yuseong-gu, Dejeon 305-343, Kore, Tel: +82-42-860-8828, Fx: +82-42-863-2073, E-mil: whh@lgcre.com Received My, 22, 2013, Revised December, 22, 2013, Accepted December, 23, 2013 nd cquired pellicle ttched to the teeth surfce effectively by physicl wshing, but recently the purpose of using toothpste hs been extended to the prevention of dentl cries by fluoride, gingivitis prevention, hyper-sensitivity-teeth mitigtion nd suppression of hrmful bcteri (1-3). Especilly lot of reserch bout extrinsic stin prevention nd removl, nd emotionl effects such s bd breth control hve been going on for toothpste contining hydrogen peroxide, pyrophosphte, hydroxyptite (4-6). Dentl clculus is formed by clcifiction of dentl plque remined for long period of time on the teeth surfce. Gingivitis nd periodontitis is induced by dentl clculus nd trtr my only be removed by orl prophylxis. Therefore, trying to in- 199
Interntionl Journl of Clinicl Preventive Dentistry hibit the formtion of the initil clculus by using toothpste is required. In prticulr, removing of plque formed in inter-dentl region is not esy by toothbrushing, nd interdentl plque cn be esily chnged to dentl clculus. Since the mngement of interdentl plque is even more importnt. In ddition, vrious studies bout toothpste development of removing extrinsic stin ttched to the tooth surfce nd inhibition the dhesion to the tooth surfce tht cn give esthetic stisfction re being done in vrious wys. Until now, there re mny studies bsed on high brsive toothpste with high clening effect (7). However, in cse of hypersensitive teeth, or if dentin hs been exposed by gingivl recession, high brsivity toothpste cn hve side effects such s cervicl brsion. Interntionl Stndrd Orgniztion (ISO), British Stndrds nd Americn Dentl Assocition (ADA) present the limit specifiction for brsivity compre to reference toothpste mesured by rdio trce method which ws proposed by Hefferen (8) nd surfce profile method which ws introduced Ashmore, etc. (9). Interntionl stndrd (ISO 11609) recommends for the upper limit of 2 nd 2.5 times thn reference toothpste ccording to mesuring method nd 2 nd 4 times for dentin nd enmel respectively (10). British Stndrd (BS 5136) suggests less thn two nd four times compre to reference toothpste for dentin nd enmel respectively (11). Therefore, in the design of toothpste, the sfety for teeth lso be considered, nd toothpste tht cn efficiently remove nd inhibit extrinsic stin nd dentl plque without high degree of brsivity will hve to be developed. Recently, new toothpste ws developed tht contins tetrsodium pyrophosphte nd soft grnule (Zeolite-M). The efficcy of clculus deposit inhibition of tetrsodium pyrophosphte is well known. Soft grnules cn remove effectively the dentl plque ttched to the interdentl-region. In ddition, soft grnule (Zeolite-M, Ultr White Bll), which contin sodium metphosphte, sodium metphosphte inhibit the formtion of dentl clculus nd prevention of extrinsic stin ttchment function is known. Zeolite-M is contining sodium luminosilicte (N 2O Al 2O 3 2.53SiO 2) nd condensed sodium metphosphte. It cn be esily broken by the brushing pressure nd effectively remove dentl plque between teeth. Sodium metphosphte in Zeolite-M cn chelte metllic ions. Tetrsodium pyrophosphte is expected to inhibit dentl clculus deposition nd teeth surfce stining by removing the divlent ctions like C 2+. In this study, effect of removing stins, interdentl clening power nd dentin brsivity of toothpste contining Zeolite-M nd tetrsodium pyrophosphte were evluted. Some clinicl trils were performed bout the decontmintion effectiveness for teeth surfces nd interdentl region, inhibition of teeth stining nd prevention of dentl clculus deposit. The purpose of this study is to determine the usefulness of toothpste contining Zeolite-M nd sodium pyrophosphte s orl helth promotion product. Mteril nd Methods 1. Preprtion of toothpstes All of the toothpstes were mde by the sme formul except the dentl clculus deposit inhibition nd nti-stin components (Tble 1). Vcuum mixer (Combimixer Woo-won, Kore) ws used for preprtion of toothpstes. 2. Mesurement of stin clening effect Stin clening effect ws mesured by modified Stookey method (). Artificilly stined hydroxyptite (HAP) specimens were prepred nd initil lightness vlues were mesured with colorimeter (Minolt CR-321 Jpn). Hydroxyptite (HAP) specimens were distributed to ech experimentl toothpste group without sttisticl significnce nd brushed for 1 hour (5,400 double strokes) under 250 g lod t the rte of 90 double strokes per minute in 2:1 mixture slurries of rtificil sliv solution nd ech toothpste. Lightness vlues fter brushing were mesured nd the differences of before nd fter light- Tble 1. Composition of experimentl toothpstes Ingredients Hydrted silic (NF)* Sodium monofluorophosphte (USP) Tocopherol cette (KP) Tetrsodium pyrophosphte (KQC) Zeolite-M** Sorbitol, cellulose gum, purified wter etc. 18.00% 0.76% 0.05% - - 18.00% 0.76% 0.05% 3.40% - Proper dose 18.00% 0.76% 0.05% 3.40% 2.00% *Hydrted silic: Dentl type silic, **Zeolite M: Soft grnule contining Sodium luminosilicte (N 2O Al 2O 3 2.53SiO 2), Titnium dioxide nd Sodium metphosphte (Ultr Phosphte). 200 Vol. 9, No. 4, December 2013
Won-Ho H, et l:the Effect of Toothpste Contining Tetrsodium Pyrophosphte nd Soft Grnule ness vlues were clculted. 3. Mesurement of interdentl clening Interdentl clening power ws indirectly evluted by mesuring of rtificil color removl t curved portion of the teeth-form model. First, curved teeth model mde by stinless steel ws stined by rtificil contminnts. Color Spry (Lucky industry, Kore, Seoul) ws used s rtificil contminnts, it is spryed ll-round on teeth model nd dried. Stined teeth model ws mounted t brushing mchine (LG House & Helth Cre, Kore, Dejeon) nd brushed with diluted toothpste slurry (toothpste : distilled wter = 2:1) for 500 times by 500 g force nd 60 stroke/min. After brushing, teeth model ws wshed by wter nd dried. Scores of residul contminnt were mesured for 9 prts of interdentl regions on teeth model by using evlution stndrds (Tble 2). Interdentl region clening rte ws clculted by sum of the scores (13). 4. Reltive dentin brsivity mesuring 1) Preprtion of teeth specimen The specimens used in this experiment were recently extrcted cries-free humn molr permnent teeth nd soft tissue ws removed. They were wshed with distilled wter, dipped in 0.1% Thymol solution, nd kept in the refrigertor. The cervicl prts of teeth were cut in cross-sectionl nd longitudinl direction with dimond wheel disk. After the shpe of specimen ws mde, the surfces were ground by using the 2 2 cm brss mould nd epoxy resin, they were ground nd polished below 1.0 µm of surfce smoothness (Surfce Profile Meter: Mitutoyo SV-3000, Jpn) by using lpping mchine (Grinder Metserv 2000) nd silicon crbmide ppers (# 200, # 400, # 600, # 800, # 00). 2) Method for reltive dentin brsivity mesurement The method used in this experiment ws bsed on the surfce profile method (BS 5136) (11) to quntify the degree of surfce wer. Dentin specimens were stirred for 30 minutes with shker in 2:1 mixture slurries of rtificil sliv solution nd ech of toothpste. They were wshed with distilled wter then, dried Tble 2. Evlution stndrds for residul contminnts Score 0 1 2 3 Evlution stndrds No contminnts on interdentl region Contminnts exist s spots Contminnts exist s liner form under 1 mm Contminnts exist s liner form bove 1 mm t room temperture nd covered with PVC tpe except for the centrl region of 2 mm wide. Dentin specimens were brushed on 1,000 times round-trip t the speed of 90 rpm under the 250 g lod using sme toothpste slurry (). 20 ml of rtificil sliv ws dded for every 200 times of brushing. After brushing, specimens were dried t room temperture nd surfce roughness ws mesured with surfce profile meter (Mitutoyo SV-3000, Jpn). Dentin brsion re s cross-sectionl re of dentin ws mesured. After the sme procedure on the stndrd toothpste ws conducted, Reltive dentin brsivities on the ech experimentl toothpste were clculted compred with the re of the stndrd toothpste. Reltive dentin brsivity = brsion re of experimentl toothpste 100 brsion re of stndrd toothpste 5. Institutionl review bord (IRB) pprovl To clinicl trils, IRB pprovl ws received from Dnkook University Dentl Hospitl Ethics Committee (H-1111/009/ 005). 6. Teeth clensing efficcy evlution by clinicl tril Clinicl test ws performed with helthy 20 dults by cross-over design. Artificil contminnt consisting of rosin, shellc nd red color etc., ws pplied on teeth surfce for test. All subjects brushed for 20 second by using test or plcebo toothpste nd wshed out with tb wter. After brushing, residul contminnt ws scored by criteri of Turesky Plque Index (14) - Turesky Plque Index (Modifiction of Quigley nd Hein Plque Index, 1970) <Criteri references> 0: No plque 1: Seprte flecks of plque t the cervicl mrgin of the tooth 2: A thin continuous bnd of plque (up to 1 mm) t the cervicl mrgin of the tooth 3: A bnd of plque wider thn 1 mm covering less thn one third of the crown of the tooth 4: Plque covering t lest one-third but less thn two thirds of the crown of the tooth 5: Plque covering two-thirds or more of the crown of the tooth 7. Evlution of dentl clculus deposit inhibition nd nti-stining effect by clinicl test 1) Subjects Helthy mle nd femle dult volunteers were recruited for this study nd divided to 3 groups of plcebo, test toothpste 1 IJCPD 201
Interntionl Journl of Clinicl Preventive Dentistry nd 2. Every group ws composed of 30 subjects, but 2 subjects dropped while clinicl test ws performed. 2) Clinicl test method (1) Orl exmintion: All the subjects, PHP index, Clculus index (CI) nd Stin index (SI) were exmined nd reported t Orl exmintion chrt. 1 PHP index Subjects were divided to 3 groups fter PHP index check. PHP index of every group ws not different significntly (Tble 3). For PHP index mesurement, 5 region of tooth surfce ws checked whether dentl plque ws dhered or not. If divided nd PHP index ws determined by sum of 5 region of teeth surfce. 2 Clculus index (CI) Clculus index ws rted by the following criteri. 0: No dentl clculus 1: Dentl clculus deposited less thn one third of cervicl re 2: Dentl clculus deposited t lest one-third but less thn two thirds 3: Dentl clculus deposited two-thirds or more, or round form subgingivl clculus 3 Stin index (SI) Stin index ws rted by the following criteri. 0: No Stin 1: Stin covered less thn one third of teeth surfce 2: Stin covered t lest one-third but less thn two thirds 3: Stin covered two-thirds or more (2) Toothbrushing method trining: All subjects were trined to the rotting toothbrushing method. (3) Orl prophylxis: Orl prophylxis ws performed to ll subjects before clinicl test. (4) CI nd SI mesurement: Plcebo nd test toothpstes were distributed nd used by double-blind test. All subjects were reclled t 2, 4 nd 8 weeks fter using toothpste. Eight weeks fter using, clinicl exmintion by interview ws done. 8. Sttisticl nlysis All experimentl dt were nlyzed by sttisticl progrm SPSS.0 (SPSS Inc. USA) t the significnce level of α= 0.05. Anlysis of vrince (One-wy ANOVA) nd Scheffe's multiple-comprison method were conducted to see the sttisticl significnce mong the effects of the ech toothpste. Results 1. Evlution of stin removing effect The effect of stin removing on HAP specimen (ΔL) were 5.28±2.13, 11.70±3.64 nd 17.98±2.32 for the control group, test toothpste 1 group nd test toothpste 2 group, respectively. Test toothpste 1 nd 2 contining sodium pyrophosphte showed significntly higher stin removl efficiency compred to plcebo toothpste (p<0.05). Stin removl efficiency of Zeolite-M contined test toothpste 2 ws higher thn tht of test toothpste 1, significntly (p<0.05) (Tble 4). 2. Evlution of interdentl clening efficiency Results of interdentl clening power evlution of rtificil contmintion were in the control group 20.20±0.85, test toothpste 1 group 20.00±3.49 nd 13.50±2.61 for test toothpste 2 group. Zeolite-M contined test toothpste 2 showed the most higher interdentl clening power nd the difference between control group or test toothpste 1 group ws sttisticlly significnt (p<0.05). Tetrsodium pyrophosphte contined test toothpste 1 group couldn t show significnt differences compred to control group (p>0.05, Tble 5). 3. Dentin brsivity The results of dentin brsivity were 53.57±1.67, 65.07±1.41, 65.77±2.22 for control toothpste, test toothpste 1 nd 2, respectively. Control toothpste which does not contin tetrsodium pyrophosphte showed lower dentin brsivity thn test toothpste 1 nd 2, significntly (p<0.05). However, there ws no sttisticlly significnt difference between test toothpste 1 nd 2 (p>0.05, Tble 6). Tble 3. Rndom distribution of subjects PHP index Test group n PHP index p 30 3.15±0.42 3.03±0.41 3.08±0.41 Totl 88 Rndom distribution Vlues re mens±stndrd devition. PHP index ws determined by one wy ANOVA nlysis mong groups. The sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. Tble 4. Chnge of lightness (L) of HAP tblet Toothpste Plcebo N Lightness (L) of HAP tblet Before brushing 36.23±5.94 37.04±6.83 35.47±6.87 After brushing 41.51±5.47 48.75±6.71 53.45±6.30 ΔL 5.28±2.13 11.70±3.64 b 17.98±2.32 c Vlues re mens±stndrd devition. ΔL ws determined by one wy ANOVA nlysis mong groups.,b,c The sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. 202 Vol. 9, No. 4, December 2013
Won-Ho H, et l:the Effect of Toothpste Contining Tetrsodium Pyrophosphte nd Soft Grnule 4. Clinicl test of teeth surfce clening 1) Chnge of clening index for entire teeth surfce Experiments with rtificil contminnts clening indices for entire teeth surfce were 2.61±0.67 of control group, 2.±0.64 of tetrsodium pyrophosphte contined test toothpste 1 group nd 1.68±0.70 of tetrsodium pyrophosphte nd Zeolite-M formulted test toothpste 2 group, respectively (Tble 7). Clening effect level of test toothpste 2 group ws significntly superior to those of test toothpste 1 group nd control group (p<0.05). Test toothpste 1 group showed higher clening effect tendency compred to the control group, but it did not show significnt difference (p>0.05) (Tble 7 nd Figure 1). 2) Chnge of clening index for interdentl teeth surfce Experiments with rtificil contminnts clening indices for Tble 5. Are of rtificil contminnts removl Toothpste N Are of rtificil contminnts removl Tble 6. Dentin brsivity of experimentl toothpstes Toothpste N Dentin brsivity 20.20±3.49 20.00±0.85 13.50±2.61 b Vlues re mens±stndrd devition. Are of rtificil contminnts removl ws determined by one wy ANOVA nlysis mong groups.,b The sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. 53.57±1.67 65.07±1.41 b 65.77±2.22 b Vlues re mens±stndrd devition. Dentin Abrsivityws determined by one wy ANOVA nlysis mong groups.,b The sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. interdentl teeth surfce were 2.70±0.69, 2.37±0.62 nd 1.76± 0.65 for control group, test toothpste 1 group nd test toothpste 2 group, respectively (Tble 7). Test toothpste contining Zeolite-M nd tetrsodium pyrophosphte showed 64.80% of rtificil contminnt removl efficcy, nd this rtio ws higher thn the other experimentl group nd control group. These dt were sttisticlly significnt (p<0.05). Test toothpste 1 group showed slightly higher clening index chnge compred to the control group with no sttisticlly significnt difference (p>0.05) (Tble 7 nd Figure 1). 5. Clinicl test of clculus deposit inhibition Before the strt of the clinicl tril, orl prophylxis ws performed to ll subjects. So t the beginning of the experiment nd 2 weeks fter, clculus nerly did not be mde nd there is ny difference for ech group. Four weeks fter use, Zeolite-M contined test toothpste 2 group showed suppressed level of clculus formtion compred with the control group, significntly (p<0.05). However, there ws no difference between test toothpste 1 group (p>0.05). The results fter eight weeks, test toothpste 2 showed it cn inhibit clculus deposit more effectively thn control nd test toothpste 1, significntly (p<0.05)(tble 8). 6. Clinicl test of teeth stining inhibition Before the strt of the clinicl tril, orl prophylxis ws performed to ll subjects. So t the beginning of the experiment nd 2 weeks fter, clculus nerly did not be mde nd there is not ny difference for ech group. Four weeks fter, Zeolite-M contined test 2 toothpste showed lower Stin Index thn the control nd test 1 toothpste, significntly (p<0.05). However, there ws no difference between tetrsodium pyrophosphte contined test 1 toothpste using group nd the control group (p>0.05). The result fter using 8 weeks, the sme s 4 weeks using result, test toothpste 2 hd superior suppressing effect for teeth stining thn test 1 nd control toothpste (p<0.05) (Tble 9). Tble 7. Chnge of clening index for whole teeth surfce nd interdentl surfce Toothpste Whole teeth surfce Interdentl surfce Before brushing After brushing Before brushing After brushing 2.61±0.67 2.±0.64 1.68±0.70 b 2.70±0.69 2.37±0.62 1.76±0.65 b Vlues re mens±stndrd devition. Clening indexes fter brushing were determined by one wy ANOVA nlysis mong groups.,b The sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. IJCPD 203
Interntionl Journl of Clinicl Preventive Dentistry Figure 1. Comprison of teeth clening efficcy by experimentl toothpstes. (A) toothpste. (B) Before brushing. (C) toothpste. (D) toothpste. Tble 8. Chnge of clculus index by experimentl toothpstes Toothpste n 30 0 2 weeks 0.05±0.10 0.07±0.11 0.07±0.11 4 weeks 0.33±0.20 0.30±0.21 0.35±0.19 8 weeks b 0.86±0.19 0.76±0.28,b 0.68±0.25 1.25±0.17 1.24±0.17 1.±0.17b Vlues re mens±stndrd devition. Clculus indexes were determined by one wy ANOVA nlysis mong groups.,bthe sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. 7. Clinicl exmintion by interview Discussion The rtes of subjects who feel whitening effect by using test or plcebo toothpste were 6.7%, 62.1% nd 93.1% for control group, test toothpste 1 group nd test toothpste 2 group, respectively. Results of stisfied rtios for well-clening by clinicl survey, 13.3%, 68.9% nd 89.6% of subjects were stisfied by using plcebo, test 1 nd test 2 toothpste, respectively. The results from clinicl interview, the subjects using test toothpste 2 cn feel whitening effect nd stisfction of clening more thn control nd test toothpste 1, significntly (p 0.05). The bsic purpose of toothpste is effective dentl plque removl on the surfce of the teeth. However, the purposes of using toothpste re expnded to pthologicl intends such s prevention of gingivitis, inhibition of dentl clculus formtion, relief of hypersensitivity nd removl of mlodor nd esthetic intends such s teeth whitening, removl of teeth stining nd teeth surfce shining. Mny reserches bout development of toothpste which hs extended nd improved efficcy, re being done. Especilly studies bout clculus deposit inhibition by 204 Vol. 9, No. 4, December 2013
Won-Ho H, et l:the Effect of Toothpste Contining Tetrsodium Pyrophosphte nd Soft Grnule Tble 9. Chnge of stin index by experimentl toothpstes Toothpste n 0 2 weeks 4 weeks 8 weeks 30 0.16±0.17 0.18±0.21 0.11±0.13 0.59±0.21 0.53±0.20 0.50±0.22 0.92±0.25 0.96±0.30 0.75±0.26 b 1.25±0.17 1.09±0.40 0.77±0.35 b Vlues re mens±stndrd devition. Stin indexes weredetermined by one wy ANOVA nlysis mong groups.,b The sme chrcters re not sttisticlly significnt by Scheffe multiple comprison t α=0.05. dentl plque removl (15) nd tooth stin removl (16) hve been performed in vrious wys. The purpose of this study is elucidtion of efficcy of toothpste contining Zeolite-M grnule nd tetrsodium pyrophosphte for removing dentl plque, interdentl clening effect, inhibition of trtr formtion nd nti-stining effect through in-vitro experiments nd clinicl trils. Zeolite-M, the min component of test toothpste ws expected two functions. One is removing inter-dentl plque by breking with brushing nd the other is inhibiting dentl clculus deposit by condensed sodium metphosphte, component of Zeolite-M. Kwon etc. confirmed grnule zeolite cn be esily broken by brushing pressure, 200-300 g/cm 2 nd hs the effect of plque dsorption (13). Also, condensed sodium metphosphte tht is contined in Zeolite-M is kind of polymeric phosphte, N X H Y (PO 3 ) X+Y. It cn chelte nd remove metllic ctions like C 2+ tht be involved on dentl clculus formtion (17). And, tetrsodium pyrophosphte, N 4P 2O 7 10H 2O cn chelte metllic ions, too. The effect of stin removing on rtificil teeth showed test toothpste 1 nd 2 contining sodium pyrophosphte hd significntly higher stin removl efficiency compred to plcebo toothpste (p<0.05). Stin removl efficiency of Zeolite-M contined test toothpste 2 ws higher thn tht of test toothpste 1 nd plcebo toothpste (p<0.05). Tetrsodium pyrophosphte, formulted in experimentl toothpste 1 nd 2, mde weken dhesive strength between rtificil colored mteril nd tooth surfce by cheltion. Test toothpste 2 shows the higher effect thn test toothpste 1 cn be explined s follows, Zeolite-M is destroyed by brushing nd ppers dditionl physicl clening power nd sodium metphosphte eluted from Zeolite-M shows chemicl clening ction. The results of in-vitro interdentl clening power mesuring t teeth-form model were up to Zeolite-M too. Even brushing ws done, dentl plque remins on interdentl region which toothbrush cnnot rech nd induces dentl cries nd trtr deposit. The common toothpste cn remove esily the plque on the surfce, but it is hrd to remove on interdentl region. However test toothpste 2 is expected to effectively remove the dentl plque on interdentl region where does not rech by toothbrush. However, if brsivity is overly high, there cn be vrious side effects like cervicl wering nd dentl hypersensitivity (18). It is not preferred method. Kielbss etc. sid by their study using bovine teeth, higher brsivity leds deeper tooth wering (19). It is good to mesure brsivity by clinicl test becuse brsivity cn vry by not only kind of toothpste but lso kind of toothbrush, tooth brushing hbit nd method. However in clinicl test, it is difficult to get stndrdized result. In this study, Interntionl Stndrd (ISO 11609) bsed surfce profile method ws used for mesuring dentin brsivity. Results of brsiivity for tetrsodium pyrophosphte contined toothpstes, 65.77±2.22 nd 65.07±1.41 were higher thn for plcebo toothpste, 53.57±1.67. For ll the brsivities were under 70 nd even lower thn hlf of sfety criteri (200) presented by interntionl stndrd (ISO 11609) nd the Kore Stndrd (KS). All the toothpstes which were used in this study will not show ny side effect by high brsivity. The brsivity of test toothpste 2 ws similr to tht of test toothpste 1, nd this result shows the excellent clening power nd stin removing effect cme from physicl nd chemicl chrcteristics of Zeolite-M, not from high brsivity. Therefore formultion of Zeolite-M cn be recommended s good nd sfe wy to improve the efficcy of clening nd stin removl without brsivity rising. It seemed tht Zeolite-M, contined in test toothpste 2 ws broken during toothbrushing nd showed the effect of interdentl clening. Especilly, cvities esily rise t the interdentl region becuse toothbrush cnnot rech to there, so test toothpste 2 is helpful to control dentl plque t interdentl region. And the inhibition of interdentl clculus formtion by interproximl plque clcifiction cn be expected lso. In the clinicl study, test toothpste 2 showed tht it cn inhibit dentl clculus formtion compred to plcebo toothpste fter 4 weeks using (p<0.05) nd it is more effective thn test toothpste 1 fter 8 weeks using (p<0.05). These results re relted to the effect seen before s result of clening interdentl region by test toothpste 2. Teeth surfce stining inhibition effect showed similr results with dentl clculus deposit inhibition. Subjects who use test IJCPD 205
Interntionl Journl of Clinicl Preventive Dentistry toothpste 2 for 4 weeks hve better stin index thn use test toothpste 1 or plcebo toothpste (p<0.05). Zeolite-M cn mke more effective on inhibition of teeth stining by physicl clening nd chemicl chelting. Conclusion Toothpste contined tetrpyrophophte nd Zeolit-M showed the highest stin removl nd clening effect for whole teeth surfce nd interdentl surfce (p<0.05). After using toothpstes 4 weeks, subjects using test toothpste 2 showed less trtr deposit thn using plcebo group, nd fter 8 weeks, test toothpste 2 sttisticlly inhibit dentl clculus formtion thn other toothpstes (p<0.05). Using test toothpste 2 longer thn 4 weeks could be ccepted s highly effective wy to prevent teeth stining. The subjects using test toothpste 2 cn feel whitening efficcy nd stisfction of clening more thn plcebo nd test toothpste 1, significntly (p<0.05). In conclusion, test toothpste contining pyrophosphte nd Zeolite-M (Ultr white bll) showed significntly effective on plque nd stin removl, clculus deposit inhibition nd clening for teeth surfce nd interdentl region thn control toothpstes. Therefore, toothpste contining pyrophosphte nd soft grnule is recommendble to prevent clculus formtion nd teeth stining. References 1. Hwng SJ, Kim SN, Chng SY, et l. Gingivitis suppression effect of the de novo toothpste contining curcum xnthorrhiz, bmboo slt nd vrious dditives. J Kor Acd Dent Helth 2005; (4):451-62. 2. Son JB, Seong JH, Kim DG. Desensitizing effect of toothpste contining potssium phosphte on dentinl hypersensitivity. J Kor Acd Dent Helth 2003;27(1):97-111. 3. Kim NH, Mun SJ, Kim AH, et l. The ntimicrobil nd nti-plque effect of toothpste contining bking sod nd triclosn. J Kor Acd Dent Helth 2011;35(1):10-7. 4. Kim JH, Chng YS, Shin SC, et l. The effects of toothpste contining sodium bicrbonte nd triclosn on orl mlodor. Int Clin Prev Dent 2011;7(1):41-9. 5. M DS, Prk DY, Jung SH. Effect of the toothpste contining hydroxyptite, sodium pyrophosphte nd crbmide peroxide on the reduction of gingivitis the chnge of microhrdness nd brightness on tooth enmel. J Kor Acd Dent Helth 1998;22(1): 1-11. 6. Kim YS, Mun YH, Kim SH, Cho JW. Correltion co-efficient between dentl plque nd hlitosis. Int Dent J 2009;5(4):241-9. 7. Wiilknitz P. Clening power nd brsivity of Europen toothpste. Adv Dent Res 1997;11(4):576-9. 8. Hefferren JJ. A lbortory method for ssessment of toothpste brsivity. J Dent Res 1976;55(4):563-73. 9. Ashmore H, Vn NJ, Wilson SJ. The mesurement in vitro of dentine brsion by toothpste. Br Dent J 1972;133:60-6. 10. Interntionl stndrd Orgniztion ISO 11609, Interntionl stndrd dentistry-toothpste-requirements, test methods nd mrking ISO Genev Swizerlnd. 1995. 11. British stndrd institution Specifiction for toothpste. BS 5136, 1981.. Stooky TA, Burkhrd TA, Schemehorn BR. In vitro removl of stin with toothpste. J Dent Res 1982;61:36-9. 13. Kwon HJ, Seo HS, Shin SC. A clinicl nd lbortory study of toothpste contining sodium metphosphte nd zeolite on dentl plque nd clculus. J Koren Acd Dent Helth 2001; 25(1):33-49. 14. Turesky S, Gilmore ND, Glickmn I. Reduced plque formtion by the Chloromethyl nlogue of Victmine C. J Periodontl 1970;41:41-3. 15. Sowinski J, Petrone DM, Bttist G, et l. The clinicl nticlculus efficcy of trtr control whitening toothpste for the prevention of suprgingivl clculus in three-month study. J Clin Dent 1999;103(10):107-10. 16. Frid A, Bn D, Aml K. A six-week clinicl efficcy study of new toothpste for the removl of extrinsic tooth stin. J Clin Dent 1999;103(10):1-6. 17. Glonek T, Kleps RA, Vn Wzer JR, Myers TC. Crbodiimideintermedited esterifiction of the inorgnic phosphtes nd the effect of tertiry mine bse. Bioinorg Chem 1976;5(4):283-310. 18. Ahn JH, Kim JH, Shin SC. The brsive effect of toothpstes contining reminerliztion components. Int Clin Prev Dent 20; 8(4):215-. 19. Kielbss AM, Gillmnn L, Zntner C, Meyer L, Hellwig E, Schulte J. Profilometric nd micrordiogrphic studies on the effects of toothpste nd cidic gel brsivity on sound nd deminerlized bovine dentl enmel. Cr Res 2005;39:380-6. 206 Vol. 9, No. 4, December 2013