HERBAL DENTAL MASK : APPLE VINEGAR, TAMARIND ,

AND LEMONADE EXTRACTS FOR TOOTH WHITENING

Archadian Nuryanti1*, Rizky Septiano2, Muzzammal Alfath3, Natalia

Kristanti4, Nurzahra Sekar Ningrum2, Qushayvi Harienda Agung2
1
Department of Biomedic, Faculty of Dentistry, Universitas Gadjah Mada, Sleman, D.I.Yogyakarta,
Indonesia
2
Faculty of Dentistry, Universitas Gadjah Mada, Sleman, D.I.Yogyakarta, Indonesia
3
Faculty of Medicine, Universitas Gadjah Mada, Sleman, D.I.Yogyakarta, Indonesia
4
Faculty of Pharmacy, Universitas Gadjah Mada, Sleman, D.I.Yogyakarta, Indonesia
*
Corresponding author: archadiannur_fkg@yahoo.com

Abstract
Introduction : Tooth whitening is the process when any substance such as peroxide diffuse through
enamel to cause oxidation and hence lightening of discoloured tooth . However there are some recent
research that reveal some adverse effects and safety issues of peroxide as bleaching agent. Apple
vinegar (Malus domestica), tamarind (Tamarindus indica), and lemonade (Rhus integrifolia) were
used as herbal medicine properties. Their chemical composition like malic acid and citric acid are
having potential effect for tooth whitening.
Objective ; This study will find about the role of Apple vinegar, tamarind, and lemonade extract as
agent of staining removal of tooth by investigating using colorimeter before and after extracts
application
Methods : Teeth were divided into 2 groups. Apple vinegar, tamarind, and lemonade were applied to
each of the experimental group in concentrations of 5%,10%, and 15%. One control group was given
hydrogen peroxide in concentrations of 5% .
Result : All groups after application of HDM showing the significant results (p<0.05) compared to the
groups before application of HDM. HDM groups showed little significant results compared to the
control group.
Conclusion : These results suggest that Application of HDM are useful for tooth whitening.

Keywords : apple vinegar, lemonade, tamarind, tooth whitening.

Introduction

Tooth discolouration is a biological process
that changed the colour of tooth appearance.
The cause of discoloured tooth are usually
classified into extrinsic, intrinsic, and
internalized discolouration.5,7 In this research,
we are focusing on the extrinsic discolouration
that very common among healthy people. Tea
and coffee are substance that leading extrinsic
discolouration process which is containing
tannic acid that adsorped onto pellicle layer9.
As a result the aesthetic of tooth will be
decrease and made low self-esteem.
Application of hydrogen peroxide as tooth
bleaching agent was investigated for some
adverse effects and safety issues. Research
from British Dental Journal revealed that
hydrogen peroxide induces genotoxic effect in
bacteria and cultured epithelial cells.4 In
addition hydrogen peroxide might possibly act
as promoter of carcinogenesis if it used
without gingival protection or applied into
damaged or diseased soft tissue.4
Apple (Malus domestica), tamarind
(Tamarindus indica), and lemonade (Rhus
integrifolia) are tropical plants which is quite
common in Indonesia. Historically, their fruit
consumed as food or processed as cuisines.
But, recently there are many research showing
that their components are very useful for displaced in hot water and 50 ml of ethanol
medical properties. Their chemical then mixed with gelatin until homogenized
compositions such as malic acid and citric acid using homogenizer. PEG 4000 were dissolved
hypothetically are having some mechanism to into PEG 400 then added in a mixture of
removed the stain for tooth whitening.1-3 HPMC and gelatin. Glycerin, the extractions,
menthol, methyl paraben, ethanol 70% 100ml,
Research by Puspasari revealed that apple aquades 300ml were added respectively. This
juice has the ability to whiten the tooth enamel method was repeated for 3 different
surface.3 Another research by Wulandari to extractions.
investigated Tamarindus Indica showing that
extracts of this plant could remove root canal The HDM gels were tested for quality control.
wall smear layer of tooth.1 Effect of lemonade The tests include pH, viscosity, and
tooth paste for tooth whitening and antiseptic organoleptic tests. The taste, color, and odor
investigated by Nurdianti and showed positive of HDM were tested with organoleptic test.
effect.2 This study aims to compare between Viscosity were measured by RION
Apple (Malus domestica), tamarind viscosimeter using rotor number 1 and ph
(Tamarindus indica), and lemonade (Rhus measurement were done by using pH meter.
integrifolia) which one of this fruit is having
the best result and expected as tooth whitening Table 1. Mean Values of Teeth Colour (RGB
colour model)
agent that has minimal side effects.
Group Mean
Methods After Teeth After
Staining Application
Research was carried out between April and of HDM
June 2017 at the Technology Pharmacies 10% Tamarind 102.67 153.67
10% Lemonade 107 147
Laboratory of the Pharmacy Faculty, Physics
10% Apple Vinegar 113 143.33
Laboratory of Sciences Faculty, Universitas 5% H2O2 114.67 140.67
Gadjah Mada, Yogyakarta, Indonesia.
Table 2. Mean Difference between before-after
The HDM gels formulation were conducted at application of HDM and the significance of tooth
Pharmacy Technology Laboratory Unit III whitening effect with Paired t test
Department of Pharmacetics, Faculty of Group Mean p value
Pharmacy Gadjah Mada University. Juice of Difference
lemon and tamarind processed by extraction. Tamarind 51 0.00*
The extractions were performed by maceration Lemonade 40 0.00*
method using ethanol and water (70:30), with Apple vinegar 30.33 0.00*
weight ratio of ethanol compared lemonade
*statistically significant (p<0.05)
(5:1) and ethanol compared tamarind (7:1).
This maseration is carried out for 24 hours on
There were 27 tooth which treated in this
the maseration pan. Then these mixture were
research, divided into 2 groups. The first group
filtered using a cloth filter in order to separate
as a control group with hydrogen peroxide 5%
the waste and filtrate. The filtrate then housed
application. The second group was given
in a porcelain dish and heated in water bath at
HDM with concentration of 5%, 10%, and
70 ° C while stirring constantly until the pure
15% Tamarind , lemonade, and apple vinegar
lemon and tamarind extracts were obtained.
extracts. There were three subgroups in the
After extractions process were finished, the observations of the tooth surface: before
extracts were combinated with HPMC 10g; immersion in the tea solution (Ia), after
gelatin 5g; PEG 4000 2g; PEG 400 10g; immersion in the tea solution(Ib), and after
glycerin 10g; menthol 1g; methyl paraben HDM formula applied(Ic). Samples of teeth
0.01%; ethanol 70% 150 ml; and aquades 300 element were immersed in the tea solution
ml. All materials were weighed using about 1 weeks until the teeth were stained. All
analytical balance and then gelatin were heated of group then measured with Colorimetric test
approximately about 5 minutes. HPMC were using RGB colour model (Figure 1).
Figure 1. Teeth Colour (RGB) were measured using colorimeter after tooth staining (1-3), after application of HDM
: tamarind, lemonade, and apple vinegar (4-6 respectively)
Figure 2. Comparison of mean values of teeth colour
(RGB) after application of H2O2, tamarind,lemonade,
and apple vinegar extracts. Analysis conducted using
one-way ANOVA (F=0.895, df=3 and 8, p=0.485)
This data was used as pre-experimental
research to determine the sample which later
used in the statistical analysis. The sample
were applied with extracts of Tamarind,
lemonade, and apple vinegar with
concentration of 10% during 15 minutes .The
results were statistically analyzed using SPSS
program with a significance level of 0.05 (p=
0.05) using Paired T-test and one-way
ANOVA.
Result and Discussion
The result showed that the mean colour of the
teeth were higher after application of HDM
(Table 1). High mean indicated that the colour
of the teeth were becoming more white than
the lower mean. Tamarind showed the highest
mean compared the other substance(Figure 2).
Application of H2O2 as positive control
showing higher result compared before their
application(Table 1).
Statistical analysis Paired T-test were
performed and showing significant difference
between before-after application of HDM
(p<0.05). Anova test were performed and the
result were having no significant difference
between application of HDM compared to the
control group(Figure 2).
Research by Ingle and Wulandari revealed that
tamarind chemical substance especially citric
acid dissolved saline mineral such as
hydroxyapatite and it is chelating agent
therefore it can remove smear layer .1,8,10
Study by Puspasari and Hughes and Nurdianti
suggested the chemical substance of apple and
lemonade such as malic acid has shown that
this substance could erode enamel for tooth
whitening purpose.2,3,6
Although application of HDM not showing
significant result than the application H2O2,
 however the result of all HDM application 4. Tredwin CJ, Naik S, Lewis NJ, Scully C.
showing the higher mean than the control Hydrogen peroxide tooth-whitening
group(Figure 2). (bleaching) products: Review of adverse
effects and safety issues. British Dental
Conclusion Journal. 2006;200(7):371–6.
5. Watts A, Addy M. Tooth discolouration and
HDM has ability for tooth whitening with the
staining: a review of the literature. British
best result is from the tamarind extract in
Dental Journal. 2001;190(6):309–3016.
concentration of 10%.
6. Hughes JA, West NX, Parker DM, van den
Acknowledgment Braak MH, Addy M. Effects of pH and
concentration of citric, malic and lactic acids
We would like to thank DIKTI for their on enamel, in vitro. Journal of Dentistry.
funding support. 2000;28(2):147–52.
7. Sulieman M. An overview of tooth
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