Short Communication

Comparison between the effect of commercially available

chemical teeth whitening paste and teeth whitening paste
containing ingredients of herbal origin on human enamel
Chacko Kalliath, Archana Mukunda, Meera Pynadath, Vidya Venugopal, Jithin Prethweeraj
Department of Oral and Maxillofacial Pathology, Royal Dental College, KUHS, Palakkad, Kerala, India

Abstract
Background: Dentistry plays a crucial role in shaping the esthetics of a person and thus boosts the self‑esteem of an individual. Whitening of
the teeth is the most popular procedure where surface and deep stain removal whitens the teeth. Teeth whitening is achieved by professional
application of chemicals and can also be self‑administered by numerous products available. The most popular product is teeth whitening paste
which is simple in application and easily available. Recently, teeth whitening tooth paste is commercially available where natural ingredients
or their derivatives are used instead of chemicals for teeth whitening. Aims: To investigate and compare the effect of commercially available
chemical teeth whitening toothpaste and teeth whitening toothpaste containing ingredients of herbal origin on human enamel (at the Department
of Oral and Maxillofacial Pathology, Royal Dental College, Kerala, India). Materials and Methods: An in vitro study with a duration of
14 days was conducted. Settings and Design: An in vitro study was conducted twenty samples were taken and assembled in to two groups of
10 each. Group A for teeth treated with conventional chemical toothpaste and group B for teeth treated with toothpaste containing ingredients
of herbal origin. Premolars extracted for orthodontic purpose were checked for shade with Vita 3D shade guide and were observed under a
stereomicroscope for surface morphology before the procedure. Each section was cleansed twice daily for 1 min with specified toothpaste and
soft bristle toothbrush according to their groups and then cleansed with tap water and stored again in the same solution. After 14 days, the teeth
were tested for the shade using vita 3D shade guide and surface morphology using stereomicroscope. Statistical Analysis Used: Student’s
unpaired t‑test. Results and Conclusion: In this 14‑day in vitro study, the chemical whitening toothpaste showed better whitening of teeth than
toothpaste containing ingredient of herbal origin, whereas the surface irregularities was increased on the surface of the enamel with chemical
whitening toothpaste when compared with toothpaste containing ingrtedients of herbal origin.

Keywords: Chemical whitening paste, herbal whitening paste, teeth whitening

Introduction most popular technique. Basically, conventional whitening

toothpaste contains abrasives and bleaching agents such as
The simplest and most common oral hygiene measure is
silica, pyrophosphates, hydrogen peroxide or carbamide
cleansing of the teeth using toothpaste and toothbrush.[1,2] It offers peroxide, which remove the extrinsic stains, thereby lightening
basic protection from plaque and dental caries.[3] Dentifrices the teeth color.[1,2,7,8] The chemical ingredients in whitening
carries the active therapeutic agent for basic protection from toothpaste cause undesired harmful effects not only on the
dental plaque and caries.[4] In addition to this, whitening enamel but also on the soft tissues, resulting in mucosal
pastes have formulations with enhanced physical and irritation, ulceration and circumoral dermatitis. It has been
chemical cleaning ability to remove as well as prevent
extrinsic stains.[5,6] Teeth whitening can be achieved either by Address for correspondence: Dr. Archana Mukunda,
professional application or can be self‑administered by the Department of Oral and Maxillofacial Pathology, Royal Dental College,
use of commercially available products such as toothpaste, Iron Hills, Chalissery, Palakkad- 679536, Kerala, India.
E‑mail: [email protected]
mouthwashes, whitening pens, whitening strips and whitening
trays; among these, use of whitening toothpaste is the
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How to cite this article: Kalliath C, Mukunda A, Pynadath M, Venugopal V,

DOI: Prethweeraj J. Comparison between the effect of commercially available
10.4103/ayu.AYU_82_18 chemical teeth whitening paste and teeth whitening paste containing
ingredients of herbal origin on human enamel. Ayu 2018;39:113-7.

© 2019 AYU (An International Quarterly Journal of Research in Ayurveda) | 113

Official publication of Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar | Published by Wolters Kluwer ‑ Medknow
 Kalliath, et al.: Comparative effect of tooth paste containing chemical and herbal ingredient on human enamel

noted that recently, the general population is leaning more surface morphology than group B, i.e., 4/10 in group A and
toward herbal products as they propagate to be chemical free; 2/10 in group B. Unpaired “t”‑test was run and the P value
hence, free of harmful side effects and their efficacy is due to was 0.3544 and results were not statistically significant as
their anti‑inflammatory, antimicrobial, astringent, antidiabetic, shown in Table 2. Table 3 shows pre and post‑procedure
antifungal, analgesics and antiseptic properties.[9] This has
resulted in a steep increase in various herbal products in the
market including whitening toothpaste. Whitening ingredient
in toothpaste containing ingredients of herbal origin is papaya
(papain enzyme), menthol, meswak, clove, salt, citrus fruits
etc. Thus, the study focused to investigate the effect of
commercially available chemical teeth whitening toothpaste
and teeth whitening toothpaste containing ingredients of herbal
origin on the shade of human enamel as well as its surface
morphology.

Materials and Methods

The current in vitro non randomized open labeled pilot study
was carried out for 14 days. Ethical clearance was obtained
from the institutional ethics committee. Premolars extracted
for orthodontic purpose without any crack or decay were
Figure 1: Surface of enamel morphology in Group A before the procedure
selected for this study. Whereas carious teeth, teeth extracted
other than for orthodontic purpose and teeth other than
premolars were excluded. Twenty samples were taken and
grouped into two groups of 10 each. Teeth in group A were
treated with conventional chemical toothpaste and teeth in
group B (the ingredients of these paste are given in annexure
1 and 2 respectively) were treated with toothpaste containing
ingredients of herbal origin. All the selected premolars in
this study were checked for shade using Vita 3D shade guide
and were observed under a stereomicroscope for surface
morphology before the procedure. The preprocedure records
obtained were tabulated. The teeth were stored in distilled
water throughout the study. Each section was cleansed twice
daily for 1 min with the specified toothpaste for both the
groups with the help of soft bristle toothbrush, then cleansed
with tap water and stored again in the same solution. This
procedure was continued daily till the end of the study. After
14 days, the teeth were again examined for the shade and Figure 2: Surface of enamel morphology in Group A after the procedure
surface morphology using Vita 3D shade guide and stereo
microscope and were tabulated [Figures 1-4]. Change in the
tooth shade was scored on a scale from 0 to 1. Similarly,
change in surface morphology was also scored on a scale from
0 to 1. The scores of each group were tabulated and compared.

Results
The changes in the surface morphology and shade of enamel in
group A and group B were noted as ‘yes’ for the presence and
‘no’ for the absence and were scored numerically as 1 = yes
and 0 = no. The scores obtained were entered into excel sheets
and subjected for statistical analysis using student t‑test SPSS
package 18 (SPSS Inc. Released 2009, PASW statistics for
windows, version 18.0. Chicago: SPSS Inc.).
Table 1 depicts the surface morphology of the 20 teeth in
group A and group B. Group A showed more changes in Figure 3: Shade of enamel surface in Group B before the procedure

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 Kalliath, et al.: Comparative effect of tooth paste containing chemical and herbal ingredient on human enamel

Table 1: Surface morphology of enamel in group A and

group B (pre‑ and post‑procedure) score yes=1; no=0
Tooth number Group A Score Group B Score
1 Yes 1 No 0
2 Yes 1 No 0
3 No 0 No 0
4 Yes 1 Yes 1
5 No 0 No 0
6 No 0 Yes 1
7 No 0 No 0
8 No 0 No 0
9 Yes 1 No 0
10 No 0 No 0

Figure 4: Shade of enamel surface in group B after the procedure Table 2: Unpaired student t‑test for surface morphology
of enamel
shades of each tooth. Of the 10 teeth, six teeth showed
Group Group A Group B
lightening of tooth in group A and only 4/10 in group B
Mean 0.4000 0.2000
showed lightening. The P value was found as 0.1923,
SD 0.5160 0.4200
which was not statistically significant as shown in table 4.
SEM 0.1631 0.1328
Conventional chemical whitening toothpaste showed better
Sample size (n) 10 10
whitening of teeth than the toothpaste containing ingredients
P=0.3544 (statistically not significant). SD: Standard deviation,
of herbal origin, whereas the surface irregularities increased SEM: Standard error of mean
on the surface of the enamel with chemical whitening
toothpaste when compared with toothpaste containing
ingredients of herbal origin. Table 3: The shade of enamel in group A and group B
(pre‑ and post‑procedure) score yes=1; no=0
Discussion Tooth Group A Score Group B Score
number
The universal method of cleansing teeth till date is achieved Pre Post Pre Post
with the efficient use of dentifrice and toothbrush. Dentifrice 1 2M‑3 2M‑2 1 0M‑2 0M‑2 0
contains various therapeutic agents and thus is the most 2 3L‑2.5 3L‑1.5 1 2R‑2.5 2R‑1.5 1
common and simple method to maintain oral hygiene.[8] 3 3L‑2.5 3L‑1.5 1 0M‑2 0M‑2 0
The ingredients in dentifrice act on dental plaque thereby 4 3L‑2.5 3L‑1.5 1 2M‑3 2M‑2 1
preventing dental caries and gingivitis.[9] In addition to 5 2M‑2 2M‑2 0 1M‑1 1M‑1 0
mechanical cleansing, whitening toothpaste offers removal of 6 2R‑1.5 2R‑1.5 0 2R‑2.5 2R‑1.5 1
7 0M‑1 0M‑1 0 2R‑2.5 2R‑1.5 1
stain and discolorations. Its use in general population is gaining
8 2M‑2 2M‑1 1 0M‑2 0M‑2 0
popularity as it can be self‑administered and cost‑effective,
9 0M‑3 0M‑2 1 2R‑2.5 2R‑2.5 0
consumes less time and reduces visits to a dental clinic.
10 3M‑3 3M‑2 1 2M‑3 2M‑3 0
Hence, there are varieties of commercially available whitening
toothpaste available in the market. In 2005, Joiner et al. showed
that whitening toothpaste makes no significant wear on the Table 4: Unpaired student t‑test for comparison shade of
enamel and dentin.[1] However, Zimmerman et al. reported that enamel
whitening treatments could change the mechanical properties
of the enamel.[1] Literature of Joiner and Terezhalmy shows Group Group A Group B
conflicting results on the efficiency of whitening toothpaste. Mean 0.7000 0.4000
However, in 2007, Terezhalmy et al. concluded that there is SD 0.4800 0.5100
no significant difference between the efficacies of different SEM 0.1518 0.1613
whitening toothpastes in terms of removal of extrinsic stain.[1] Sample size (n) 10 10
P=0.1923 (statistically not significant). SD: Standard deviation,
However, the chemicals used in the commercial pastes have SEM: Standard error of mean
known to cause undesirable side effects such as irritation,
allergies and mucosal ulceration.
minimized or prevented totally when natural ingredients in
Recently, there is an upsurge of herbal products for the herbal toothpaste are used in place of synthetic chemicals. This
treatment and prevention of various diseases including oral has resulted in increased preference for toothpaste containing
diseases. There is public perception that side effects are herbal ingredients by general population leading to a variety of

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 Kalliath, et al.: Comparative effect of tooth paste containing chemical and herbal ingredient on human enamel

toothpastes containing ingredients of herbal origin available in • Celery, carrots and sesame seeds have high fiber content
the market today. A study by George et al. in 2009 has shown and act as mild abrasive which scrubs and removes surface
that the efficacy of the herbal ingredients proprietary toothpaste stains effectively.
is as effective as the conventionally formulated dentifrice in • Pineapple and orange contain an enzyme known as
the control of plaque and gingivitis.[10] bromelain which removes superficial stains and also
reduces plaque buildup.
The chemicals used to achieve bleaching effects in toothpaste
• Papaya contains enzyme papain which is more like
are hydrogen peroxide and carbamide peroxide in varying
bromelain and removes superficial stains and reduces
concentrations. However, their use is associated with
plaque buildup. Papain enzyme is found more in unripe
roughening of enamel surface with cervical root resorption,
papaya than ripe papaya.
leading to sensitivity.[11]
• Dairy products such as milk, cheese and yogurt contain
These adverse effects of chemicals can be minimized or lactic acid which is a natural enamel whitener and also
avoided when substituted with herbal products which offer increases the production of saliva.
teeth whitening without damage to the enamel. • Kiwifruit contains actinidin which removes surface stains
on enamel.
Thus, present pilot study was an attempt to check the efficacy
• Lemon extract and peel contain citric acid which bleaches
of tooth whitening toothpaste containing ingredients of herbal
the stains on enamel. It also has antibacterial properties.
origin as against synthetic chemical whitening toothpaste.
• Banana peel is rich in potassium, magnesium and
Efficacy of the chemical whitening toothpaste and herbal manganese which are absorbed over teeth surface making
whitening toothpaste by assessing the enamel shade using a them appear white.
vita‑D shade guide and surface irregularities were evaluated • Rock salt acts as a mild abrasive and removes superficial
using stereomicroscope before and after completion of stains. They increase the pH of the saliva thereby exerting
the study. antibacterial properties.
In this study lightening of enamel shade was found to be • Activated charcoal is negatively charged and binds to the
increased in teeth which were treated with conventional positively charged plaque on tooth surface and is thus
chemical toothpaste than toothpaste containing ingredients absorbed over tooth surface whitening it.
of herbal origin. However, it was not statistically significant.
Nevertheless the surface irregularities on enamel surface were Conclusion
also found more in teeth which were treated with chemical In this 14‑day in vitro study, the toothpaste containing
toothpaste than toothpaste containing herbal ingredients and ingredients of herbal origin provided similar whitening
there was no statistical significance along both groups. Brinda effects to that of conventional chemical whitening toothpaste
et al., 2015 in the past have compared the efficacy of herbal with less surface changes to the enamel. In spite of surge
based whitening toothpaste against professional prescribed in availability of numerous proprietary herbal whitening
bleaching agent and found the efficacy of the effects on toothpaste, there is dearth of data regarding their efficacy
enamel surface similar in both. They also emphasized that hence it was not possible to further assess and correlate the
in vitro changes may differ from in vivo changes and thus findings of the study. Increase in sample size, duration of
contribute to changes in the micromorphology of enamel.[11] the study and increase time of exposure may help achieve
This is true that as changes in the enamel in vivo is governed statistically significant results.
by the fact that salivary pH plays a major role in determining
the movement of calcium and phosphorus ions in and out Financial support and sponsorship
of the enamel surface. Khairnar et al. in 2017 noticed that Nil.
salivary pH increased immediately after brushing with herbal Conflicts of interest
toothpaste. They correlated the increase in salivary pH to There are no conflicts of interest.
increased salivary stimulation produced by salivary stimulants
such as cinnamon, licorice, Nimba and Pilu etc., in toothpaste
containing ingredients of herbal origin used in their study. It is References
a well‑known fact that decrease in pH favors mineral loss from 1. Khamverdi Z, Kasraie Sh, Rezaei‑Soufi L, Jebeli S. Comparison of the
effects of two whitening toothpastes on microhardness of the enamel
enamel surface leading to surface irregularities.[12] However, in and a microhybride composite resin: An in vitro study. J Dent (Tehran)
this study pH was not evaluated the as it was an in vitro study. 2010;7:139‑45.
2. Nainan MT, Balan AK, Sharma R, Thomas SS, Deveerappa SB. The
A variety of other herbal products offer whitening effect of comparison of the effects of different whitening toothpastes on the
teeth and are enumerated below with their mechanism of micro hardness of a nano hybrid composite resin. J Conserv Dent
action: 2014;17:550‑4.
3. Watanabe MM, Rodrigues JA, Marchi GM, Ambrosano GM.
• Strawberries and apples contain malic acid which is a In vitro cariostatic effect of whitening toothpastes in human dental
natural enamel whitener. It also increases saliva production enamel‑microhardness evaluation. Quintessence Int 2005;36:467‑73.
and thereby exerting the anticariogenic property. 4. Alves KM, Pessan JP, Buzalaf MA, Delbem AC. Short communication:

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In vitro evaluation of the abrasiveness of acidic dentifrices. Eur Arch 9. Khairnar MR, Dodamani AS, Karibasappa GN, Naik RG, Deshmukh MA.
Paediatr Dent 2009;10 Suppl 1:43‑5. Efficacy of herbal toothpastes on salivary pH and salivary glucose – A
5. Ferreira MC, Ramos‑Jorge ML, Delbem AC, Vieirac Rde S. Effect preliminary study. J Ayurveda Integr Med 2017;8:3‑6.
of toothpastes with different abrasives on eroded human enamel: An 10. George J, Hegde S, Rajesh KS, Kumar A. The efficacy of a herbal‑based
in situ/ex vivo study. Open Dent J 2013;7:132‑9. toothpaste in the control of plaque and gingivitis: A clinico‑biochemical
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2017;67S: S3‑10. 11. Brinda B, Madan Kumar PD, Mohammed J. Effect of an indigenously
7. Tao D, Smith RN, Zhang Q, Sun JN, Philpotts CJ, Ricketts SR, et al. available herbal tooth whitening system on human enamel microhardness
Tooth whitening evaluation of blue covarine containing toothpastes. and micromorphology‑an in‑vitro study. Sch J Dent Sci 2015;2:254‑8.
J Dent 2017;67S: S20‑4. 12. Benjakul P, Chuenarrom C. Association of dental enamel loss with the
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Dent 1981;3:101‑13. 6, 129e133.

Annexure 1: Ingredients of commercially available Annexure 2: Ingredients of commercially available teeth

chemical teeth whitening paste (Colgate Visible White whitening paste containing ingredients of herbal origin
Tooth paste) (Himalaya Sparkling white tooth paste)
Silica Aqua
Sorbitol Bromelain (enzyme in pineapple juice)
Glycerine Ceylanicum bark oil (Cinnamon)
Polyethylene glycol Cinnamomum (Cinnamon)
Sodium tripolyphosphate Citric acid
Tetra potassium pyrophosphate Eugenia Caryophyllus bud oil (Clove oil)
Sodium lauryl sulpate Flavor
Flavor Glycerine
Cocamido propyl betadine Hydrated silica
Sodium carboxy methyl cellulose Menthol
Sodium saccharin Meswak
Sodium fluoride Papain (papaya proteinase)
Xanthan Potassium benzoate
Sodium hydroxide Potassium sorbate
Blue poly 50 Prunus Amygdalus Dulcis (almond) shell extract
Titanium dioxide in aqueous base Salvadora Persica stem extract (Meswak)
Silica
Sodium citrate
Sodium lauryl sulphate
Sodium saccharin
Sorbitol
Thymol
Titanium dioxide
Xanthan gum

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