Dental Materials Journal 2022; 41(5): 731–740

Is whitening toothpaste safe for dental health?: RDA-PE method

Jae-Heon KIM1, Soyeon KIM1, Van Mai TRUONG1, Joo Won LEE1 and Young-Seok PARK1,2

1
Department of Oral Anatomy and Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea
2
Center future of Dentistry, School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea
Corresponding author, Young-Seok PARK; E-mail: ayoayo7@snu.ac.kr

The relative dentin abrasivity-profilometry equivalent values were compared using non-contact profilometry with three subtypes
of regular toothpaste and two subtypes of whitening toothpaste containing sodium bicarbonate and 35% hydrogen peroxide. Bovine
dentin specimens were assigned to six groups: regular toothpaste (R): R1 (BAMBOO SALT GUM OINTMENT); R2 (MEDIAN
TARTAR ORIGINAL); R3 (PERIOE Alpha), Reference slurry: RS (calcium pyrophosphate), whitening toothpaste (W): W1 (NET.
WT); W2 (Vussen 28 WHITENING). Relative dentin abrasion–profilometry equivalent (RDA-PE) was determined by brushing 10,000
times (n=8). The pH of the toothpaste was measured (n=5) and the abrasive constituents of the toothpaste was analyzed by FE-
SEM and EDS. The RDA-PE values ranged from 26 to 166, and the pH level ranges were 4.928–9.153. The RDA-PE value of the
whitening toothpaste containing hydrogen peroxide was not high compared with that of the regular toothpaste. The RDA-PE values
of whitening toothpaste could vary depending on the mechanism and ingredients of the whitening agents.

Keywords: RDA-PE, Regular toothpaste, Whitening toothpaste, Hydrogen peroxide, Sodium bicarbonate

without the active ingredient of toothpaste abrasive13,14).

INTRODUCTION
Structural loss of teeth is an intraoral phenomenon that
brings about a combination of physical, chemical, and
biological factors on the surface of the teeth1). The physical
factors include attrition, abrasion, and abfraction.
Attrition occurs through mastication (occlusion) and
bruxism. Abrasion is caused by friction when abrasive
material from outside of the mouth comes into contact
with the surface of the teeth. Lastly, abfraction results
from the microfracture of vulnerable parts of the teeth
as the compressive and tensile stresses of the bite force
act as stress on the teeth. A chemical factor is an erosion,
which causes strong acidic substances (food, beverage,
gastric juice, etc.) to demineralize enamel and exposed
dentin, thereby softening and dissolving the surface of
the teeth2-4). The biological factors include the pH level of
individual saliva and the amount of saliva5).
In particular, abrasion of teeth is mainly caused by
toothbrushing in the oral cavity6,7). Toothbrushing is a
relatively inexpensive and efficient means of maintaining
oral health. It should have sufficient cleaning power
to remove food residue and plaque in the mouth8,9).
Factors that lead to tooth abrasion due to tooth brushing
include the types of toothpaste and toothbrush used and
brushing habits4,7,10). Toothpaste consists of between 0
and 50% abrasives and the rest of the ingredients are
humectants, purified water, detergents, bonding agent,
and so on11). Abrasives are used as active ingredients
of toothpaste such as calcium carbonate, silica, sodium
bicarbonate, and alumina12). Studies have reported that
the amount of tooth abrasion was negligible, with less
than 0.1 μm of loss when brushing with only water
These results indicate that the active ingredient of
toothpaste plays an important role in tooth abrasion15).
Although toothbrush and brushing habits might be less
damaging to the teeth than toothpaste16), factors that
lead to tooth abrasion include the shape, thickness, and
stiffness of the bristles, as well as the strength, and
method of brushing17-19).
Tooth abrasion is often more likely to occur in older
people than in younger people due to the aging processes.
Moreover, dentin shows more abrasion than enamel
owing to the difference in their surface hardness4,20). In
particular, highly abrasive toothpaste incurs a structural
loss of teeth in the area of the cervical region with the
thinnest enamel, causing non-caries cervical lesion
(NCCL) and exposure to a dentinal tubule. As a result,
it causes dentin hypersensitivity and toothache21,22). The
NCCL causes C or V-shaped lesions on the tooth surface,
resulting in unfavorable aesthetic changes and increase
risk of tooth fracture23-25). Therefore, it is important
for the consumer or patient to select the appropriate
toothpaste for their oral condition.
Indicators that consumers can refer to when
choosing a toothpaste are the relative dentin abrasivity
(RDA) and relative enamel abrasivity (REA) which
uses a radioactivity detector. Also there are relative
dentin abrasion–profilometry equivalent (RDA-PE) and
relative enamel abrasion–profilometry equivalent (REA-
PE) which are determined by profilometry26). Both the
indicators represent relative values after measurement
according to the International Organization for
Standardization (ISO) 11609 by comparing the amount
of abrasion through the reference material (calcium
pyrophosphate, silica or chalk) and each toothpaste. The
values of REA and RDA of reference materials are 10

Color figures can be viewed in the online issue, which is avail-

able at J-STAGE.
Received Nov 16, 2021: Accepted Apr 5, 2022
doi:10.4012/dmj.2021-303 JOI JST.JSTAGE/dmj/2021-303
732 Dent Mater J 2022; 41(5): 731–740
and 100 respectively, with their limits corresponding
to 40 and 2506,15,27-29). RDA is more commonly used than
REA because the hardness of the abrasive contained in
toothpaste is lower or higher than the surface hardness
of dentin and dentin is more susceptible to abrasion
than enamel5,27).
Recently, whitening toothpaste containing various
ingredients has become increasingly popular. It reflects
the increased consumer’s interest in teeth whitening
or hygiene. It is easy and convenient to improve the
aesthetics of teeth at home. However, there is some
concern that whitening toothpaste may adversely affect
the surface of dental hard tissue in previous studies5,30).
In using whitening toothpaste, the composition of
toothpaste differs depending on the manufacturer.
RDA and REA values of each toothpaste also vary.
Furthermore, there is scant information on the effect of
whitening toothpaste on dental hard tissue. Therefore,
it is necessary to further investigate its effect on teeth.
The purpose of this study is to compare the RDA-PE
values of regular and whitening toothpaste using non-
contact profilometry.
MATERIALS AND METHODS
Specimen preparation
A total of 48 bovine dentin specimens were prepared.
A flawless bovine incisor was extracted from the
bovine mandibular arch to prepare dentin specimens.
Caries, fractured, and microdont teeth were excluded
from extraction. After tooth extraction, the remaining
soft tissues of the tooth were removed with a scalpel,
immersed in 0.1% thymol solution, and stored in a
refrigerator (4°C). The extracted teeth were penetrated
to a diameter of 8 mm using a bench drilling machine
(YDM-13mm, Yongsoo Precision, Daegu, Korea) with
a cylindrical diamond core drill bit (outer diameter
10 Ø×inner diameter 8 Ø) while supplying water30).
Donut-shaped acrylic molds (outer diameter 30 Ø×inner
diameter 12 Ø×thickness 4 mm), which have three
grooves to distinguish the positions were attached to the
OHP film and double-sided tape. The teeth were placed
in the center of the acrylic mold with the labial side of the
enamel facing the floor. A self-curing resin (Vertex Self-
Curing, Vertex, Zeist, The Netherlands) was injected
into an acrylic mold to fix the teeth, and sufficiently
polymerized for 24 h. Specimens were polished using
a polishing machine (LaboPol-5, Struers, Copenhagen,
Denmark) with Silicon carbide paper (#220, 600, and
1200 SiC paper, R&B, Daejeon, Korea) for the removal
of lingual enamel and flattening. The thickness of the
specimens was polished in parallel by adjusting using
a custom polishing jig (Insert holder 30 mm, R&B). The
thickness of the specimens was measured with a digital
vernier calliper (CD67-S15PM, Mitutoyo, Kawasaki,
Japan), and was set to 3.0±0.1 mm (Fig. 1A). The final
specimens were magnified at 5× with a stereoscopic
microscope (KS-200, Korealabtech, Seongnam-si, Korea)
to confirm the state of the specimens31). Defective or
dented specimens were excluded from the study.
Fig. 1 Specimens and toothbrush used in the study.
(A) Completely prepared specimen (until final
polishing). Also shown is position discrimination by
three grooves. (B) Three-row flat-bristle toothbrush
(material, nylon; bristle diameter, 178 μm).
A Vickers hardness tester (HMV-2, Shimadzu,
Kyoto, Japan) was used to verify the Vickers hardness
of the specimens. Tester diamond tip was loaded with a
force of 300 g (2.942 N) and indented on each specimen
for 15 s. After measuring 5 points per specimen at 40×
magnification, the average value was determined as the
Vickers hardness. Specimens with Vickers hardness
values outside the range of 30 to 70 (dentin range) were
excluded. Finally, 48 specimens with a Vickers hardness
range of 40 to 50, which is the middle range among
the Vickers hardness ranges of dentin were adopted.
Specimens were refrigerated at 100% relative humidity
before the test.
Preparation of reference and toothpaste slurries
The five kinds of toothpaste used in this study were
selected as easily available toothpaste in the market.
Three subtypes of regular toothpaste (R1, R2, and
R3) were chosen with calcium carbonate and silica-
based abrasives, respectively (control group), where R
means regular toothpaste. In addition, two subtypes
of whitening toothpaste were selected as toothpaste
containing sodium bicarbonate (W1) and hydrogen
peroxide (W2) as well as silica as a basic abrasive (test
group), where W means whitening toothpaste. Sodium
bicarbonate and hydrogen peroxide are known as
whitening or plaque removal effects. The details of the
toothpaste are described in Table 1. The 48 specimens
were randomly assigned to reference slurry (RS) and
five-toothpaste (n=8).
To prepare a 400 mL reference dilution, 20 mL
of glycerin (99.5%, Shanghai Aladdin Biochemical
Technology, Shanghai, China) and 2 g of carboxymethyl
cellulose (CMC, Sigma-Aldrich, St, Louis, USA) were
stirred using a magnetic stirrer (MS300HS, Coretech
Korean, Hwaseong-si, Korea) at 60°C until homogeneous.
20 mL of 60°C glycerin was added and stirred for 1 h.
Three hundred-sixty milliliters distilled water added
after transferring the solution to a 500 mL lab bottle
(0.5% CMC and 10% glycerine solution). The solution
was stirred slowly for 12 h. It was used after 12 h for
viscosity stabilization. The reference abrasive was used
 Dent Mater J 2022; 41(5): 731–740 733

Table 1 Detail of the toothpaste used in the study, with their compositions and manufacturers

Product name/ Fluoride

Code* Composition Lot
Manufacturer (ppm)

Centella Titrated Extract, Bamboo Salt, Sodium fluoride,

Dipotassium glycyrrhizate, Dental type silica, Sodium copper
BAMBOO SALT
chlorophyllin, Sodium lauryl sulfate, Amorphous sorbitol
R1 GUM 1,000 G101E
solution 70%, Saccharin sodium hydrate, Titanium dioxide,
OINTMENTa
Xanthan gum, Purified water, Carboxymethylcellulose sodium
salt, Polyethylene glycol 300, Flavor

Green tea extract, Sodium monofluorophosphate,

MEDIAN Sodium pyrophosphate, Dental type silica, Methylcyclohexanol,
R2 TARTAR Saccharin sodium hydrate, Titanium dioxide, Cellulose gum, 1,000 DGN057F
ORIGINALb Sodium lauryl sulfate, Sorbitol, Sucralose, Purified water,
Zeolite silica, Ground calcium carbonate, Flavor

Sodium monofluorophosphate, Calcium carbonate, Glycerin,

Sodium lauryl sulfate, Polyoxyethylene sorbitan monooleate,
Amorphous sorbitol solution 70%, Saccharin sodium hydrate,
R3 PERIOE Alphaa 1,000 F061D
Disodium dihydrogen pyrophosphate, Zinc Acetate dihydrate,
Xylitol, Purified water, Carboxymethylcellulose sodium salt,
Silicic acid (TIXOSIL 43K), Flavor

Sodium fluoride, Sodium pyrophosphate, Sodium bicarbonate,

Hydrated silicon dioxide, Glycerin, Sodium lauryl sulfate,
Saccharin sodium hydrate, Titanium dioxide, Sodium lauroyl
W1 NET. WT.c 995 LL8137
sarcosinate 30%, Sorbitol solution 70%, Purified water,
Carboxymethylcellulose sodium salt, Flavor (containing
eugenol)

Hydrogen peroxide 35% (containing 2.8 wt%), Colloidal

silicon dioxide, Glycerin, Sodium lauryl sulfate, Sodium
Vussen 28
W2 metaphosphate, Saccharin sodium hydrate, Citric acid, — 19H005
WHITENINGd
l-Menthol, Purified water, Poloxamer 407, Polyethylene glycol
1500, Flavor, Hydroxyethylcellulose

*R=regular toothpaste, W=whitening toothpaste

a
LG Household & Health Care, Cheongju-si, Korea
b
AMOREPACIFIC, Daejeon, Korea
c
Church & Dwigh, Ewing, NJ, USA
d
Vussen, Ansan-si, Korea

as a calcium pyrophosphate (99.95%, Strem Chemicals,
Newburyport, MA, USA). The reference slurries (RS)
were mixed with 10 g of calcium pyrophosphate with 50
mL of reference dilution.
The toothpaste slurries were prepared by stirring a
mixture of 40 mL distilled water and 25 g of toothpaste.
Reference and toothpaste slurries were each prepared
in 100 mL lab bottles for ease of mixing and to prevent
precipitation. All slurries were stirred again before use.
Toothbrushing process
Before toothbrushing, specimens were masked with a 25
μm polyester tape (162.H421.25B, HaeSung Tape Ind.,
Daejeon, Korea) for creating a window measuring 5×20
mm (width×height) to obtain an unbrushed reference
surface. A three-row flat-bristle toothbrush (Name Brush
T21, Guardian Angel, Suwon-si, Korea) was used with a
bristle’s diameter of 178 μm and bristles were made of
nylon material (Fig. 1B). The toothbrush was soaked in
distilled water for 24 h before the toothbrushing. A new
toothbrush was used for each test. The toothbrushing
was performed in an automatic toothbrush machine
(RB118, R&B) with six slots. Specimens, which assigned
by the table of random numbers were fixed in six
toothpaste baths. The toothbrush heads were in contact
with the center of the specimens, and a load of 150 g was
applied. Each slurry was poured into a toothpaste bath
and brushed 10,000 strokes. The toothbrushing rate was
170 strokes/min. It was re-checked 8 times during the
toothbrushing process and was stirred with a brush to
prevent precipitation of the slurry (per 1,250 strokes).
After completion of toothbrushing, the tape was removed
734 Dent Mater J 2022; 41(5): 731–740
and the specimen was washed with tap water.
Profilometry measurement and determination of RDA-
PE
After brushing, each specimen was magnified at 5× using
white-light scanning interferometry (WSI)-based non-
contact 3D surface profiler (NV-E1000, NanoSystem,
Daejeon, Korea) and NanoView software (ver. 2.1). At
the center of the specimens, a total of 6 mm, which
included 0.5 mm of the left reference zone, 5 mm of the
abrasion zone, and 0.5 mm of the right reference zone
was continuously scanned in the range of 1.28×0.96
mm (width×height) by the stitching mode. The overall
average depth of abrasion was analyzed by the algorithm
of the image analysis program (NanoMap ver. 2.5.17.3).
The value of RDA-PE was determined for each
toothpaste/reference ×100 as the relative value of the
abrasion amount of the reference and toothpaste. The
reference toothpaste brushed with 10,000 strokes was
considered to have an RDA-PE value of 100.
pH measurement
Five slurries were prepared at the ratio of the toothpaste
slurry described above, respectively (n=5). One mixed
solution was measured three times, and the average
was determined as the measured value. The RS was
made at an RS ratio. The pH was measured using a pH
electrode (9615S-10D, HORIBA, Kyoto, Japan) and a
pH meter (F-71, HORIBA) calibrated with a pH buffer
kit of 4.0, 7.0, and 10.0 (502-S, HORIBA, Singapore)
before measurement. The measurement temperature
was 25±0.5°C.
Field emission scanning electron microscopy (FE-SEM)
and energy-dispersive X-ray spectroscopy (EDS)
For visual observation of the toothpaste abrasives,
1 g of toothpaste and 50 mL of distilled water were
thoroughly stirred until completely dissolved. The solid
was centrifuged at 10,000 RPM for 15 min using a
High-Speed Centrifuge (Avanti J-E, Beckman Coulter,
Fullerton, CA, USA). The supernatant was discarded.
The process was repeated five times by adding fresh
Table 2 Mean and standard deviation of Vickers hardness in used specimens
Toothpaste*
R3
W1
R1
RS
R2
W2
Code*: R1 (BAMBOO SALT GUM OINTMENT); R2 (MEDIAN TARTAR ORIGINAL); R3 (PERIOE Alpha); RS (Reference
Slurry); W1 (NET WT.); W2 (Vussen 28 WHITENING).
Different letters imply significant difference between groups (p<0.05, n=8).
distilled water. Finally, the solids were washed out with
ethanol to remove residual components. The remaining
solid was dried for 3 days in a dryer heated to 37°C. The
RS was used as calcium pyrophosphate powder without
washing process. The powders were attached to the stub
with copper tape and coated with platinum particles. The
image and composition of the powders were investigated
using FE-SEM (AURIGA, Carl Zeiss, Jena, Germany)
and EDS (QUANTAX 800, Bruker, Berlin, Germany)
with analysis software (ESPRIT, ver. 2.1.2.17832,
Bruker). All groups were operated and magnified at 11
kV and 1,000×. Additionally, R2 was magnified at 500×.
Statistics
A statistics software (IBM SPSS Statistics v26.0, IBM,
Armonk, NY, USA) was used to perform all statistical
analyses. Normal distribution test was performed by
Shapiro-Wilk test. Statistical analysis was performed
with a one-way analysis of variance (ANOVA) with the
Tukey honest significant differences (HSD) test as a post
hoc test. All statistical analyses were performed with a
95% confidence interval.
RESULTS
Vickers hardness of the specimens
The means and standard deviations of Vickers hardness
in used specimens are shown in Table 2. There was
no significant difference in Vickers hardness between
groups (p=0.440)
RDA-PE value and average depth of abrasion
The images of dentin abrasion are shown in Fig. 2
according to the type of toothpaste and brushing 10,000
strokes. The means and standard deviations of the RDA-
PE values, the average depth of abrasion is shown in
Table 3. There was a significant difference in RDA-PE
values and the average depth of abrasion among groups
(p<0.001). R3 showed the highest RDA-PE value. The
W1 containing sodium bicarbonate demonstrated the
second-highest value. No statistical difference was
found between R3 and W1 by post-hoc test (p>0.05).
Vickers Hardness (HV)
46.4 (2.3)a
46.1 (3.0)a
44.5 (3.0)a
44.2 (3.1)a
45.9 (3.1)a
46.5 (3.0)a
 Dent Mater J 2022; 41(5): 731–740 735

Fig. 2 Dentin abrasivity of three subtypes of regular toothpaste and two subtypes of
whitening toothpaste as determined by noncontact profilometry. The 0 on the
Y-axis represents the reference line.
The average depth of abrasion was calculated using a software program
after 10,000 strokes of brushing under flat conditions, where the left and
right reference surfaces are within 10 μm. Code: R1 (BAMBOO SALT GUM
OINTMENT); R2 (MEDIAN TARTAR ORIGINAL); R3 (PERIOE Alpha); RS
(Reference Slurry); W1 (NET WT.); W2 (Vussen 28 WHITENING)

Table 3 Means and standard deviation of RDA-PE value and average depth of abrasion

Toothpaste* RDA-PE value Average depth of abrasion (µm)

R3 166 (57)a 54.31 (18.77)a

W1 124 (21)ab 40.62 (6.97)ab

R1 102 (14)bc 33.38 (4.53)bc

RS 100 (33)bc 32.72 (10.69)bc

R2 66 (20)cd 21.72 (6.40)cd

W2 26 (2)d 8.62 (0.72)d

Code*: R1 (BAMBOO SALT GUM OINTMENT); R2 (MEDIAN TARTAR ORIGINAL); R3 (PERIOE Alpha); RS (Reference
Slurry); W1 (NET WT.); W2 (Vussen 28 WHITENING).
Different letters imply significant difference between groups (p<0.05, n=8).

However, the other four toothpaste has a lower RDA- peroxide showed the lowest value. There was a
PE value compared with those of R3 according to the statistically significant difference from other groups
post-hoc comparison (p<0.05). W2 containing hydrogen except for R2 (p<0.05). The comparisons of the average
736 Dent Mater J 2022; 41(5): 731–740
Table 4 Mean and standard deviation of pH value
Toothpaste*
R2
R3
W1
RS
R1
W2
Code*: R1 (BAMBOO SALT GUM OINTMENT); R2 (MEDIAN TARTAR ORIGINAL); R3 (PERIOE Alpha); RS (Reference
Slurry); W1 (NET WT.); W2 (Vussen 28 WHITENING).
depth of abrasion showed a similar trend with the RDA-
PE value.
pH measurement
The mean and standard deviation of the pH
measurements are shown in Table 4. The pH ranges
were from 4.928 to 9.153.
FE-SEM and EDS
The abrasive particles contained in the toothpaste had
irregular shapes such as round, oval, rectangular, and
polygonal shapes in the FE-SEM image (Fig. 3). In all
groups except R2, large and small abrasives within 50
μm were observed. The zeolite silica contained in R2 was
observed to be several hundred micrometers in size.
EDS analysis indicated the elements contained in the
abrasives of each toothpaste (Fig. 3), and the elements
of the main abrasives were matched by color (mapping).
RS and W2 showed a single abrasive element, and the
remaining groups showed results that included abrasive
and other elements. All groups except RS contained
silica (green color). R2, R3, and RS contained calcium
(purple color). R2 containing zeolite included sodium
(red color), barium (yellow color), strontium (brown
color), and aluminum (blue color) as well as silica and
calcium. The large bead-shaped zeolite (Fig. 3, green
arrow) contained all six elements. W1 was observed as
silica and some agglomerated sodium (Fig. 3, yellow
arrows). Trace amounts of titanium concentration were
present in R1, R2, and W1.
DISCUSSION
In the present study, the RDA-PE value and average
depth of abrasion were determined using non-contact
profilometry after brushing 10,000 strokes each of
regular toothpaste and whitening toothpaste on the
dentin surface. Our results showed RDA-PE value in the
range of 26–166 and an average depth of abrasion dentin
in the range of 8.62–54.31 μm (Table 3). Interestingly,
the W2 with hydrogen peroxide had the lowest value for
both measurements. It is also noteworthy that there is
a difference between the two subtypes (i.e. W1 and W2)
pH
9.153 (0.010)
8.850 (0.026)
8.116 (0.018)
7.098 (0.025)
6.748 (0.022)
4.928 (0.016)
of whitening toothpaste according to the result of the
post-hoc comparison. In addition, the values of W2 were
lower than those of R1 and R3 (p<0.05). On the other
hand, the value of W1 is the second-highest but we could
not find any statistical significance when comparing the
values of R3, R1, and RS.
Studies have reported that whitening toothpaste
was evaluated based on RDA or abrasion values
(µm) of human or bovine teeth compared to regular
toothpaste32-37). The abrasion values of whitening
toothpaste were not higher than that of regular
toothpaste in some studies32,35,36). On the other hand,
other studies have demonstrated that whitening
toothpaste has higher abrasion values than regular
toothpaste33,34,37). These similarities or discrepancies
in outcomes indicate that abrasion value may vary
depending on the difference in the abrasive and
whitening ingredients included in toothpaste. The RDA-
PE value of all toothpaste did not exceed the 250 which
is defined as the limit value in ISO 11609. This finding
indicates that regular and whitening toothpaste can be
safe to use on the hard tissues of the teeth.
The radioactivity measurement method was used
as the ‘gold standard’ for the evaluation of abrasivity.
The profilometry measurement method was developed
due to errors in weighing, color change of specimens,
variability of values, and regulation of radioactive
equipment5,15). It is currently used as an alternative to
radioactivity measurement. In a previous study, there
was no statistical difference when comparing the RDA
and RDA-PE values between the two methods29), and it
showed a strong correlation (R2=0.71)38). Profilometry
measurement methods are divided into contact and
non-contact methods. Both methods can quantify the
amount of abrasion through the reference and the
abrasion surface. The contact profilometry method may
damage the surface of the specimen because it measures
the surface of the specimen by scraping it using stylus
tips. Moreover, there is a limitation that the abrasion
area smaller than the diameter of the stylus tips cannot
be measured. However, the non-contact profilometry
method does not damage the surface of the specimen
and can observe the surface information more effectively
 Dent Mater J 2022; 41(5): 731–740 737

Fig. 3 Image visualization and compositional analysis of abrasives by FE-SEM and EDS.
The white scale bar of 50 μm represents a magnification of 1,000×, whereas the
white scale bar of 100 μm represents a magnification of 500×. EDS and mapping
detected the components of each abrasive and matched the main components.
Elements and colors at the bottom left of the mapping image of EDS indicate the
corresponding element in the FE-SEM image. The green arrow indicates zeolite
silica in the R2 group, which contains six elements. The yellow arrow indicates
some residual agglomerated sodium in the W1 group. Code: R1 (BAMBOO SALT
GUM OINTMENT); R2 (MEDIAN TARTAR ORIGINAL); R3 (PERIOE Alpha); RS
(Reference Slurry); W1 (NET WT.); W2 (Vussen 28 WHITENING)
738 Dent Mater J 2022; 41(5): 731–740
than other methods39).
In this study, dentin from bovine incisors was used
to determine the RDA-PE value of toothpaste. Bovine
teeth do not pose ethical problems, have fewer defects,
easy to obtain a flat surface, and have the advantages
of relatively large size compared to human teeth40).
However, due to differences in the biological properties
(physical/chemical) of dentin, there has been controversy
when using it as an alternative material29,41,42). In a
previous study, there was no significant difference in
RDA values when comparing four types of laboratory
toothpaste with different RDA values in human and
bovine dentin, respectively43). In addition, studies
showed similar properties when compared by physical/
chemical methods between human teeth and bovine
teeth40,41,43). These data suggest that bovine teeth can be
used as a substitute for human teeth in determining the
RDA-PE value of toothpaste. Dentin has wide biological
variability and is less homogeneous than enamel, so
the experimental results show high deviation39). In our
study, we tried to minimize the error in the results
by controlling the hardness of the specimen to be the
median value of the dentin range (Table 2).
The frequency and time of brushing are some
other factors that affect dentin abrasion along with
toothpaste23). In general, RDA-PE value after 4,000
strokes using RS is defined that of 100 in as indicated by
ISO 1160926). However, the RDA-PE value after 10,000
strokes using RS was considered that of 100 in this
study. Ten thousand strokes correspond to the number
of strokes completed in 12 months, assuming that you
brush your teeth ten times per tooth and three times
a day44,45). We decided to evaluate the effects of 10,000
strokes rather than 4,000 strokes, which corresponds
to about five months, to determine long-term real
effects. In addition, a higher number of strokes is more
advantageous in evaluating abrasion in the case of
toothpaste exhibiting significantly low abrasivity. RDA-
PE value depends on the performance of non-contact
profilometry and inaccurate values were obtained in the
pilot study when measuring the case of toothpaste with
significantly low abrasivity.
Whitening toothpaste is known to make the inside or
outside of the tooth visually brighter46). Currently, it has
a complex composition with various whitening agents as
well as abrasives added for efficacy such as brightening
and tartar removal (anti-plaque)46,47). The ingredient
list in the toothpaste packaging often does not contain
information about the exact ingredient content, RDA or
RDA-PE.
Consumers primarily choose toothpaste based on
the product’s name, manufacturer’s advertisement,
and the efficacy indicated on the packaging. However,
the choice can potentially increase the abrasion of hard
dental tissue and worsen the condition especially in
patients suffering from non-carious cervical lesion. In
addition, the scanty information can make difficult for
dental professionals to recommend a suitable toothpaste
for a patient’s oral condition. ISO 11609 provides only
the limit (250) for safe toothpaste of RDA-PE, and there
is no detailed classification standard. Authors suggest
different classification ranges, and often it can be
suggested that the range of low-abrasive toothpaste is
less than 70, medium abrasive toothpaste is 70 to 150,
and high-abrasive toothpaste is 151 or more5,15,48). Based
on the classification range, R2 and W2 can be classified
as low-abrasive, R1 and W1 as medium-abrasive, and
R3 as high-abrasive.
Whitening toothpaste with hydrogen peroxide may
also contain abrasives to remove stains and reinforce
the cleaning effect49). The experiments showed that the
RDA-PE value of W2 was 2.5 to 6.4 times lower than the
values of R1, R2, and R3 as well as 4.8 times lower than
the value of W1, which is also a whitening toothpaste
(Fig. 2 and Table 3). These findings suggest that the
combined action of 35% hydrogen peroxide with other
ingredients did not have a detrimental effect on dentin
in terms of the RDA-PE value. One previous study
showed that the amount of dentin loss when brushing
with 35% hydrogen peroxide gel for 30 min did not differ
compared with when brushing with distilled water50).
The result also supports our observation that the use
of 35% hydrogen peroxide alone does not seem to cause
substantial abrasion on dentin surface. However, it is
not prudent to conclude that the 35% hydrogen peroxide
does not have any detrimental effect on the tooth surface,
because the only RDE-PE was evaluated in the present
study. There could be many other factors affecting
the result of dentin loss. For example, the pattern of
abrasion might differ from toothpaste and tooth paste
depending on the whitening mechanism. Furthermore,
exact composition and amount of abrasives were not
specified on the toothpaste package. They may be the
main factors affecting the value of RDE-PE rather
than the hydrogen peroxide. Further studies should be
warranted considering the above factors.
Zeolite silica is widely used in the medical field and
is sometimes called a magic stone50). Structurally, zeolite
silica is a porous solid containing silica and aluminum.
It also includes alkali ions sodium, calcium, barium,
and strontium51). The pH value of R2 containing zeolite
silica was 9.153. However, the current result could not
find an association between RDA-PE and pH value,
which is in line with one previous study52). Zeolite silica
has an adsorption function and ion exchange, so it can
effectively remove calculus and help hemostasis50).
Meanwhile, clinical studies have demonstrated the
plaque removal effects of zeolite53,54). However, the effect
of zeolite silica on the dentin surface is unknown. Here,
zeolite silica was observed as a large particle size of
several hundred micrometers compared to other groups
(Fig. 3). The relatively large particle abrasive could be
related to high abrasivity55), but the present study did
not find a higher RDE-PE value of R2 compared to other
toothpaste without the zeolite silica.
The present study compared the long-term effect of
whitening toothpaste and regular toothpaste through
in vitro experiments. The influence of variables was
minimized compared to in vivo experiments by controlling
factors such as the amount of toothpaste, number of
 Dent Mater J 2022; 41(5): 731–740
brushing, and pressure. Continuous brushing was
performed for about 1 h (10,000 strokes) to determine
the RDA-PE value in this study. There is a limitation
that it may not sufficiently reflect the clinical situation
compared to in vivo experiments. In a further study, it
is necessary to evaluate the additional factors such as
acidity, ingredients, abrasives of type and shape.
CONCLUSION
This study compared the RDA-PE values of two
subtypes of whitening toothpaste and three subtypes of
regular toothpaste. The RDA-PE value of the whitening
toothpaste containing hydrogen peroxide was not high
compared with that of the regular toothpaste. All
toothpaste tested in the present study had an RDA-PE
value that did not pose any hazard to the dentin surface.
Our results suggest that the RDA-PE values of whitening
toothpaste could vary depending on the mechanism of
the whitening agents.
ACKNOWLEDGMENTS
This research was supported by Basic Science Research
Program through the National Research Foundation
of Korea (NRF) funded by the Ministry of Education
(2021R1l1A204851611).
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