title: Clinical validation and calibration of in vitro peroxide tooth whitening.
abstract: OBJECTIVE
  The purpose of this study was to validate and calibrate an in vitro test method for screening the performance of peroxide-containing toothpastes against actual clinical whitening performance. An additional objective was to estimate the whitening performance of a new peroxide-additive gel using the in vitro methodology.
  
  
  METHODS
  A one-month longitudinal clinical study was performed to provide a benchmark for the in vivo intrinsic whitening performance of a peroxide-containing fluoride toothpaste. An in vitro study was then conducted, using freshly prepared slurries of the same peroxide-containing toothpaste in artificial saliva, to repeatedly treat extracted human teeth with natural intrinsic stain. The effect of cumulative treatment time on whiteness was determined using objective chromometer whiteness measurements (L*, a*, and b*), and more subjective Vita Shade guide (Vitapan) comparisons, and the results were correlated. A non-peroxide fluoride toothpaste was used as a negative control. The peroxide gel additive, combined in a 1:1 ratio with each of two non-peroxide toothpastes and diluted in artificial saliva, was evaluated using the same instrumental and subjective measures for in vitro whitening efficacy. The previously evaluated peroxide toothpaste and one of the non-peroxide toothpastes were used as positive and negative controls, respectively.
  
  
  RESULTS
  In the clinical study, the peroxide-containing toothpaste produced a linear increase in tooth whiteness with time, achieving an approximately two Vita Shade guide improvement in whiteness at the end of four weeks. The same peroxide toothpaste in vitro produced a curvilinear increase in tooth whiteness versus cumulative treatment time, with a two-shade increase being achieved in 116 minutes. The non-peroxide control toothpaste produced less than half a shade guide increase in whiteness within the first 30 minutes, and none thereafter. Both the clinical and in vitro studies indicated that further whitening can be obtained with longer use of the peroxide-containing toothpaste or peroxide-additive gel.
  
  
  CONCLUSIONS
  Treatment of naturally stained teeth in vitro with the peroxide toothpaste for 116 cumulative minutes produced the same two-shade increase in whiteness as obtained with twice-daily brushing for four weeks in vivo. The peroxide-additive gel, combined with a non-peroxide toothpaste, is projected to provide a similar two-shade increase in whiteness when used twice daily for four weeks. There are indications that greater intrinsic whiteness increase would be achieved with the peroxide toothpaste or with the peroxide-additive gel plus non-peroxide toothpaste with more extended regular twice-daily use in vivo.
authors.affiliation: Health Science Research Center, Indiana University-Purdue University, Fort Wayne, IN, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Putt
authors.forename: Michael H
authors.initials: MH
authors.lastname: Moore
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Milleman
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Milleman
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thong
authors.forename: Linda M
authors.initials: LM
authors.lastname: Vorwerk
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Charig
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Nelson
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Winston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002138:Calibration; D005260:Female; D005782:Gels; D006801:Humans; D006861:Hydrogen Peroxide / Q000737:chemistry*; D066298:In Vitro Techniques; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014073:Tooth Bleaching / Q000592:standards*; D014075:Tooth Discoloration / Q000628:therapy*; D014099:Toothbrushing / Q000295:instrumentation; D014100:Toothpastes / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D005782:Gels; D014100:Toothpastes; D006861:Hydrogen Peroxide