ORIGINAL RESEARCH

https://doi.org/10.5005/jp-journals-10077-3283
Journal of South Asian Association of Pediatric Dentistry
Volume 6 | Issue 3 | Year 2023

Comparative Evaluation of Abrasive Effect of Three Commercially Available Children’s Toothpastes in India on Glass Ionomer Cement: An In Vitro Study

Poonacha KS¹ https://orcid.org/0000-0002-5367-3685, Saylee Deshmukh² https://orcid.org/0000-0002-6832-6942, Seema Bargale³ https://orcid.org/0000-0003-4110-7990, Anshula N Deshpande⁴ https://orcid.org/0000-0003-3467-2123, Sejal Jain⁵ https://orcid.org/0000-0002-0859-9834, Riddhika Shah⁶

^1–6Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India

Corresponding Author: Poonacha KS, Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India, Phone: +91 9725036673, e-mail: poochi2263@gmail.com

Received: 23 May 2023; Accepted: 08 August 2023; Published on: 30 December 2023

ABSTRACT

Background: The roughness of the surfaces of restorations increases after brushing of teeth, leading to an increase in the accumulation of plaque and stains, thus increasing the risk of dental caries formation.

Aim: To compare and evaluate the abrasive effect of three different commercially available children’s toothpastes on the surface properties of conventional restorative glass ionomer cement (GIC).

Materials and methods: Around 40 samples were prepared using conventional GIC, which were divided equally into four groups containing 10 samples each which were subjected to toothbrushing using the test apparatus and different toothpastes for each group for a duration of 2 minutes twice daily for 15 days—group I—Colgate Anticavity toothpaste for kids; group II—Chicco Dentifrico Toothpaste; group III—Cheerio Fluoride Medicated Gel; and group IV—water. Intergroup and intragroup comparisons were made using one-way analysis of variance (ANOVA) and paired sample t-tests, with p < 0.05.

Results: After applying a procedure corresponding to about 1 year of toothbrushing in the mouth, positive results were obtained in terms of the abrasive effect caused by children’s toothpastes on the surface of GIC restorations. The mean surface abrasion of GIC samples varied significantly between all groups at baseline and after brushing (p < 0.001). Among the toothpastes used, group II showed maximum increase in surface abrasion (31.76%), whereas group I showed the least (12.94%).

Conclusion: Toothpaste-containing hydrated silica caused the most abrasion on surface of GIC. Children’s toothpastes with low relative dentin abrasivity (RDA) value should be recommended in terms of causing low surface abrasion of the GIC restorations, thus reducing the plaque accumulation on the surface of the restoration.

How to cite this article: KS P, Deshmukh S, Bargale S, et al. Comparative Evaluation of Abrasive Effect of Three Commercially Available Children’s Toothpastes in India on Glass Ionomer Cement: An In Vitro Study. J South Asian Assoc Pediatr Dent 2023;6(3):118–123.

Source of support: Nil

Conflict of interest: None

Keywords: Abrasion, Children, Glass ionomer cement, Profilometer, Toothpastes

INTRODUCTION

One of the major etiologic factors that contribute to periodontal diseases and are subsequently related to formation of dental caries is “plaque.” Thus, the long-term success of periodontal or dental depends on the effective and daily removal of plaque by gaining patient cooperation for the same.¹ The most reliable strategy for all patients to achieve oral health advantages is to use a toothbrush and other oral hygiene products daily.² The toothbrush, along with a toothpaste, help in removal of and in mechanical control of plaque.³

Dentifrices, used mostly in the form of toothpastes, gels, and toothpowders, are designed to clean and polish tooth surfaces.¹ Toothpastes contain foamers, preservatives, humectants, water, fragrances, flavors, gelling and binding agents, as well as abrasives.⁴ Nowadays, silica derivatives are the most widely used abrasives. In addition to the amount of abrasive used, toothpaste’s abrasiveness also depends on the shape, size, and chemical composition of the particles.⁵ The main difference between tooth gel and toothpaste is the consistency of the formula itself.⁶

The relative dentin abrasivity (RDA) value is a common way to depict the abrasiveness of a dentifrice.⁷ The International Organization for Standardization (ISO) recognizes a maximum of 250 for RDA of adult toothpastes. However, the RDA limit for children’s toothpastes has not been standardized.³

The surface abrasion of dental hard tissue is influenced by several factors, such as brushing frequency, force, and duration, stiffness of the toothbrush bristles, the amount of abrasive particles, and concentration of the toothpaste.⁶ Following tooth restoration, the roughness of the surface of various restorative materials is influenced by both their chemical properties and regular usage of various toothpastes.⁴ A “bacterial plaque adhesion” index value above 0.2 μm increases the amount of plaque accumulation, thus leading to development of caries and periodontal inflammation. The roughness that is created by abrasive components on hard tissues should not exceed this value. The changes that occur on the surface of hard dental tissue or restorative materials in terms of roughness after tooth brushing are inevitable. This abraded surface increases the possibility of accumulation of dental plaque.⁷

The aim of this study is to compare and evaluate the abrasive effect of three children’s toothpastes on the surface properties of conventional restorative glass ionomer cement (GIC) by using a surface profilometer and scanning electron microscope (SEM) analysis.

MATERIALS AND METHODOS

Sample Size Calculation

According to the study design by Yılmaz et al., having four groups having a power of 95% and an α error rate of 5%, the Z-score were calculated as 1.644 and 2.638, respectively. Considering a standard deviation of 0.428 and to assess a clinically relevant difference (d) of 1, a sample size of 7 per group was calculated. Rounding off, a sample size of 10 per group was included in the study.

Sample Preparation

Forty samples were prepared using conventional restorative GIC (GC Gold Posterior Restorative GIC, GC Dental India). The GIC was mixed according to instructions given by the manufacturer. Disks of measurement 10 mm diameter by 0.4 mm thickness were made using a plastic mold of similar dimensions. These samples were not subjected to light curing or application of Vaseline to their surface. These samples were placed in circular acrylic molds (Fig. 1). To mimic the natural aging process, the prepared samples were submerged in distilled water for 50 days.

Fig. 1: Glass ionomer cement (GIC) samples (10 × 0.4 mm) mounted on acrylic block

Division of Samples into Groups

Samples were divided into four groups of 10 samples each. The samples were numbered from 1 to 40 and were divided by random allocation method. Samples in each group were subjected to toothbrushing using the test apparatus and different toothpastes for each group–group I—Colgate Anticavity toothpaste for kids (Strawberry flavored); group II—Chicco Dentifrico Toothpaste; group III—Cheerio Fluoride Medicated Gel (Dr Reddy’s); and group IV—control group (water).

The composition and RDA values of the children’s toothpastes used in the study are shown in Table 1.

**Table 1:** Manufacturer, composition, abrasive agent, and RDA values of toothpaste
Group	Toothpaste	Manufacturer	Composition	Abrasive agent	RDA value
I	Colgate anticavity kids toothpaste strawberry flavor	Colgate-Palmolive	Sorbitol, polyethylene glycol 600, sodium lauryl sulfate, sodium carboxymethyl cellulose, tetrasodium pyrophosphate, flavor, sodium saccharin, sodium fluoride, CI 177200, CI 16035, titanium dioxide coated mica, d-limonene, in aqueous base	Silica	35 (50% lesser than most adult toothpastes. Value obtained after comparing with Colgate Total)
II	Chicco dentifrico	Chicco	Hydrogenated starch hydrolysate, aqua (water), xylitol, glycerin, cellulose gum, sodium lauroyl sarcosinate, aroma (flavor), sucralose, calcium gluconate, CI 16035	Hydrated silica	114 (57% lesser than maximum allowed abrasion limit, that is, 200)
III	Cheerio medicated gel	Dr Reddy’s Laboratories Ltd	Sodium monofluorophosphate USP 0.35% w/w in a flavored gel base	Information not disclosed by manufacturer

Test Apparatus

A test apparatus was made of steel that had a screw design to allow the placement of an electric toothbrush and to provide uniform force. Colgate kids’ electric toothbrush (Colgate-Palmolive, India) was used for the brushing of the samples. A constant load of 2 N was ensured by using metallic weights for equal and constant distribution of load (Fig. 2). To prevent any mixing of the toothpastes, different toothbrush heads were used for brushing samples of different groups.

Fig. 2: Toothbrushing apparatus

Test Procedure

The three toothpastes for groups I, II, and III were dispensed on the toothbrush head before brushing the samples. A pea-sized amount of toothpaste was meticulously applied each time. Different toothbrush heads were used for each group to avoid mixing of any residual toothpaste. The control group was brushed using only water. The samples were cleaned thoroughly with distilled water postbrushing. Tap water was used to wash the toothbrush heads after brushing each sample. All the samples were subjected to brushing for a duration of 2 minutes twice daily at an interval of 12 hours between each brushing cycle for 15 days. Artificial saliva [Wet Mouth liquid, International Cosmetic Products Association (ICPA) Health Products, Ltd], which is the storage medium for the GIC samples, was changed daily between brushing cycles.

Measurement of Surface Roughness (Ra)

A surface profilometer (SURFCOM TOUCH 50, Zeiss, Germany) evaluated the Ra values of all the samples. Ra values were measured from three different areas of the samples at baseline and after completing the brushing cycle (on day 15) (Fig. 3). Average value of each sample was included in the result.

Fig. 3: Directions in which Ra was measured

Scanning electron microscope (SEM) analysis was performed on one sample selected at random from the four groups after the completion of the brushing procedure. The surfaces of selected samples were viewed at 5000× magnification and 5.00 kV with a SEM (Zeiss Evo LS10; CarlZeiss, Germany).

Statistical Analysis

Descriptive and inferential types of statistical analyses were performed. Intergroup comparisons and intragroup comparisons were calculated using one-way analysis of variance (ANOVA) and paired sample t-tests, respectively. p < 0.05 was considered statistically significant. The IBM Statistical Package for the Social Sciences (SPSS) statistics 20.0 software (IBM Corporation, Armonk, New York, United States of America) was used for the analyses of the data.

RESULTS

Surface Roughness (Ra) Analysis

On intragroup comparison, difference between the Ra values at baseline and 15 days postbrushing was observed among all the four groups, which was significant statistically. The maximum increase in roughness was seen in group II, that is, Chicco Dentifrico toothpaste (31.76%), followed by group III, that is, Cheerio Fluoride Medicated Gel (24.21%). The least increase in Ra in terms of brushing with a toothpaste was seen in group I, that is, Colgate Anticavity toothpaste for kids (12.94%). However, the samples which were subjected to brushing with only water showed an increase of 9%, which was very low compared to the samples which were brushed using different commercially available children’s toothpastes (Table 2).

**Table 2:** Surface roughness (Ra) values at baseline and 15 days postbrushing and increase (%) in Ra among the four groups
Group	Ra—baseline (average ± standard deviation in μm)	Ra—15 days postbrushing (average ± standard deviation in μm)	p*	% increase in roughness
Group I: Colgate Anticavity toothpaste for kids (strawberry flavored)	1.808 ± 0.356	2.042 ± 0.360	0.002*	12.94%
Group II: Chicco Dentifrico Toothpaste	1.807 ± 0.506	2.381 ± 0.601	<0.001**	31.76%
Group III: Cheerio Fluoride Medicated Gel (Dr Reddy’s)	2.004 ± 1.016	2.489 ± 0.751	<0.001**	24.21%
Group IV: Water (control group)	1.607 ± 0.339	1.755 ± 0.383	<0.001**	9%

** Highly significant difference in intragroup comparison

Scanning Electron Microscope (SEM) Analysis

On examination at 5000× magnification, SEM images of surfaces of the prepared GIC samples after tooth brushing procedure, cracked areas were observed on the surface of samples from each group. The cracks seen were more pronounced in groups II and III. More irregularity was seen on the surface of samples belonging to group II (Fig. 4).

Fig. 4A to D: Scanning electron microscope (SEM) images showing surface crack formations on surface of GIC samples after brushing cycle. (A) Colgate Kids Anticavity toothpaste; (B) Cheerio Fluoride Medicated Gel; (C) Chicco Dentifrico; (D) Water

DISCUSSION

The removal of plaque and stained pellicle is achieved using a toothbrush along with the abrasive ingredients in the toothpaste formulation.⁸^-¹⁰ Alumina, calcium carbonate, and silica are the common abrasive ingredients used in a toothpaste. Toothpastes that are developed especially for children should have a formulation and abrasivity that are balanced to provide cleansing benefits while reducing any damage to the surfaces of the developing.¹¹ Thus, the concentration of abrasive material in children’s dentifrices must be less. However, abrasives increase the Ra in an inevitable fact.¹¹^,¹² “Enamel surface wear increases with the use of toothpaste” was reported by Kumar et al. Following tooth brushing, there is an increase in Ra, promoting the formation of caries, pigment-based stains, and dental plaque.¹³ Relative enamel abrasivity (REA) and RDA are two parameters frequently used to evaluate the abrasiveness of any toothpaste formulation. These parameters are normally evaluated following the method outlined by Hefferren and advised by the American Dental Association and ISO 11609.²^,¹⁴ A REA value of 40 or an RDA value of ≤250 for a toothpaste formulation is considered a safety limit in adults for everyday use. However, no such limit has been stated for children’s dentifrices.²

Relative dentin abrasivity (RDA) values for toothpastes are given as 0–70 (low abrasive), 70–100 (medium abrasive), 100–150 (highly abrasive), and 150–250 (harmful limit).³

A variety of toothpastes are available commercially. Studies have been performed using toothpastes with a variety of ingredients, pH levels, and abrasives and their influence on the surface properties of dental hard tissues.³^,⁴ Commercially available dentifrices can be categorized into (1) toothpastes, (2) gel-based dentifrices, and (3) tooth powders.¹

Since a variety of materials have been employed in pediatric dentistry for restorative procedures, GICs, resin-containing glass ionomer, and compomer are among the most chosen.¹⁵^,¹⁶ High viscosity glass ionomers are used frequently in atraumatic restorative treatment (ART) technique.¹⁷^,¹⁸ Studies by Dudás et al. and Demirel et al. have shown an increased Ra of GIC-based restorative materials post toothbrushing.⁸^,¹⁹ Hence, samples made from posterior restorative GIC were made for this in vitro study.

For in vitro studies, glass ionomers can be stored in various storage media such as water, fruit juice, saline, or saliva. Doing so can enhance the materials’ physical characteristics.²⁰^,²¹ Soaking of the dental restorative material has been proposed as one of the methods to simulate oral conditions and to imitate the natural aging process of the material in an in vitro setting. The samples were immersed in liquid at 37°C.⁴ Glass ionomer-type restorative materials stored in distilled water should wait minimum 1 week for complete maturation.²²^,²³ In a study by Abdalla et. al. to complete the GIC maturation phase and simulate the aging process, prepared samples were kept in distilled water for 50 days at 37°C in the present study.²⁴ Similar methodology was followed in the present study.

For in vivo studies, brushing force of 203–1533 g and a load of 0.5–2.5 N is recommended to determine the changes in terms of surface abrasion of the materials as per ISO standards.²⁵ According to Kumar et al., brushing technique, force, duration, and frequency must be kept constant.¹³ In a similar study conducted by Yılmaz et al., the GIC samples were brushed two times/day for 2 minutes for a period of 1 week, which corresponded to 6 months of brushing in the mouth.⁴ The present study aimed to increase the amount of time for which the GIC samples would be subjected to brushing. Hence, the samples underwent brushing of the surfaces for 2 minutes twice a day for 15 days which by calculation corresponds to brushing for approximately 1 year in the mouth.

Toothpastes contain abrasives such as calcium carbonate, sodium bicarbonate, alumina, hydrated silica, calcium pyrophosphate, and dicalcium phosphate dihydrate.²⁶ The major factors that affect cleaning and abrasion of surface of teeth are the size and shape of the particles of these substances.²⁷ The toothpastes used in this study contained silica (in group I) and hydrated silica (in group III) as the abrasives. A high difference between their RDA values was also noted. This difference can be attributed to the difference in particle shape and/or fineness of the abrasive components.²⁷ Dudás et al. have stated that higher abrasive characteristics, which led to significant changes in the surface of GlassFill glass ionomer samples, were demonstrated by toothpastes containing hydrated silica. The roughness that was reported was less after brushing without any toothpaste.¹² Similar results were obtained in the present study, where the samples that were subjected to the toothpaste containing hydrated silica (group III—Chicco Dentifrico) showed the maximum increase in Ra. Least Ra was seen in group IV, where samples were subjected to brushing with only water. In a study by Yılmaz et al. in 2020, which followed a similar study design as the present study, increase in Ra was found which was statistically insignificant. The particle size of silica used in toothpastes is lower (4–12 μm) as opposed to the higher particle size of hydrated silica (14–20 μm).²⁸^,²⁹ The difference in particle size between the two abrasives can thus explain the results of this study.

In this study, toothpastes with a higher RDA value (groups II and III) showed more increase in roughness values. This is in accordance with Hooper et al., who state that high abrasive effects are observed in toothpastes having a higher RDA value.³⁰ Johannsen et al. state that a toothpaste with a higher RDA value produces a lower roughness value compared to the one having a lower RDA value. A possible explanation could be the presence of silicone oil in the paste with a high RDA value. This makes the surface of the material being abraded smoother and lessens its abrasive effect.⁵

The abrasiveness of toothpastes is assessed using a variety of techniques, such as loss of weight and volume. Commonly used methods are a profilometer to measure Ra numerically by using tracer tip devices.³^,³¹ A SEM was also used in a study by Kanik et al. where the surface images were obtained.³² Similar methods of measurements were also adopted in other studies by Gando et al. and Yılmaz et al.⁴^,³³ Similarly, this study also measures the Ra of all the GIC samples at baseline and after the brushing cycle using a surface profilometer. SEM images were obtained under 2000× magnification to visualize any surface crack formation.

The Ra of restorative materials has been attributed to the consequence of restoration wear as well as the cause of antagonistic tooth and restoration wear.³⁴

Limitations

The present study was performed in an in vitro setting. The conditions in the oral cavity cannot be accurately mimicked in such a study. Factors causing surface abrasion of a restorative material other than toothbrushing with dentifrices, such as wear due to antagonist teeth and food/beverages, were not considered.

CONCLUSION

After applying a procedure corresponding to about 1 year of toothbrushing in the mouth, positive results were obtained in terms of the abrasive effect of children’s toothpastes on the surface of GIC restorations.

Children’s toothpastes with lower RDA values should be suggested, which will cause less surface abrasion of the GIC restorations, thus reducing the accumulation of plaque on the surface of the restoration and subsequent risk of caries development.

More comprehensive in vivo studies where surface properties of restorative materials other than GIC are checked are required in the future to correctly gauge the changes post toothbrushing with children’s dentifrices.

Clinical Significance

The use of toothpastes with lower RDA will help to increase the longevity of the restoration in terms of surface abrasion, thus preventing subsequent plaque accumulation. Moreover, pediatric dentists and/or parents will be able to make the correct choice of toothpaste according to the needs of the patient.

ORCID

K S Poonacha https://orcid.org/0000-0002-5367-3685

Saylee Deshmukh https://orcid.org/0000-0002-6832-6942

Seema Bargale https://orcid.org/0000-0003-4110-7990

Anshula N Deshpande https://orcid.org/0000-0003-3467-2123

Sejal Jain https://orcid.org/0000-0002-0859-9834

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