Methods and Materials

Subjects were screened and accepted based upon meeting the following criteria:  18-65 years of age, visible extrinsic staining indicative of staining propensity, no advanced periodontal disease, no anterior porcelain or composite restorations, and dentition primarily comprised of natural teeth.  Fifty-nine adults began the study.  All subjects received a full-mouth scaling and a polish performed by experienced dental hygienists.  All visible calculus and extrinsic stains were removed and any areas of intrinsic staining were documented.

Sulcular brushing instructions were provided and subjects were asked to brush in the morning and evening.  Half of the subjects were given a manual toothbrush (Crest® Complete, Procter & Gamble, Cincinnati, OH), and the other half were given another brush being piloted.  Half of the subjects were given a whitening dentifrice (Crest® Extra Whitening, Procter & Gamble, Cincinnati, OH) while the other half received regular dentifrice (Crest® Cavity Protection, Procter & Gamble, Cincinnati, OH).  Products were issued in non-branded tubes with investigational labels, blinding both subjects and examiner to treatment groups.  Brush and dentifrice groupings were determined by random assignment.

At baseline, all subjects received a month’s supply of 0.12% chlorhexidine mouthrinse (Peridex®, Zila Pharmaceuticals, Phoenix, AZ).  Instructions were to rinse with 1/2 ounce of chlorhexidine immediately after brushing.  This was to occur in the morning after breakfast and in the evening just prior to bed.  This brushing and rinsing sequence was provided to simulate instruction that would be given to most dental patients being prescribed chlorhexidine to treat gingivitis.  Any other oral hygiene practices already being utilized could be continued.  In order to encourage compliance, calendars were given and subjects asked to document each of their twice-daily brush and rinse sequences.  These were collected at the end of each month.

Subjects returned at 1, 2 and 3 months after baseline.  At each of these visits additional dentifrice and mouthrinse were provided, intraoral photographs were taken and stain accumulation was assessed.  Stain was evaluated in two parameters:  intensity of color and percentage of tooth surface covered with stain.  All natural teeth in the dentition were included.  Intensity was recorded for the distofacial, middle facial, mesiofacial, distolingual, middle lingual, and mesiolingual surfaces.  A five-point color intensity scale, modeled after Lang and Raber39 was used with the following descriptors:

The second parameter, percentage of the buccal and lingual surfaces covered by stain, by Raber and others,40 was estimated to the nearest 10 percent.

All stain evaluations were conducted by one blinded clinician, who was an experienced clinical research examiner calibrated in the stain indices utilized.

After the 3-month evaluation, the teeth of all subjects were re-scaled and polished to remove any accumulated extrinsic stains in order to return to a stain-free baseline.  Subjects received monetary compensation in addition to the two debridements.
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