The Effect of a Microencapsulated Iron Supplement, Hydrogen Peroxide Superior and Professional Dental Prophylaxis on the Color and Whiteness of Teeth

Kerem Yılmaz; Fehmi Gönüldaş; Zeynep Bilen

doi:10.52037/eads.2025.0003

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The Effect of a Microencapsulated Iron Supplement, Hydrogen Peroxide Superior and Professional Dental Prophylaxis on the Color and Whiteness of Teeth

Year 2025, Volume: 52 Issue: 1, 17 - 25, 30.04.2025

Kerem Yılmaz , Fehmi Gönüldaş , Zeynep Bilen

https://doi.org/10.52037/eads.2025.0003

Abstract

Purpose: To investigate the effect of a microencapsulated liposomal nano-iron supplement, an Fe+2 supplement, black tea, a bleaching agent with a new composition and professional dental prophylaxis (PDP) on tooth color and whiteness change.
Materials and Methods: 84 extracted teeth were immersed in liposomal iron, Fe+2 and black tea solutions by special apparatus. Then different applications were applied: (1) no treatment, (2) water polishing, (3) PDP, (4) bleaching with 25% hydrogen peroxide superior (HPS). Measurements were taken at baseline, 2nd, 4th, 8th week and after applications. Statistical analysis of color and whiteness changes was performed by ANOVA and Bonferroni tests (α=0.05).
Results: The effects of time, application, beverage and their interactions on color and whiteness were statistically significant (p<0.05). At week 8 and at after application, the highest color change was for black tea-HPS pair (∆E00=3.38, ∆E00=2.21, respectively) (p<0.001). At week 8, the highest darkening (∆WID=-4.67) and at after application, the highest whitening (∆WID=3.01) was caused by the black tea-HPS pair (p<0.001).
Conclusions: Black tea, Fe+2 and liposomal iron supplements increased the color change of the teeth towards black over time. Black tea caused the highest darkening of the teeth. The order of magnitude was black tea>Fe+2>liposomal iron (p<0.001). Hydrogen peroxide superior and PDP provided an effect above the clinical perceptibility threshold selected in this study in terms of color recovery of darkened teeth. The order of magnitude was hydrogen peroxide superior>PDP.

Keywords

Iron supplements, Color, Whiteness, Hydrogen peroxide superior, Professional dental prophylaxis

References

Pani SC, Alenazi FM, Alotain AM, Alanazi HD, Alasmari AS. Ex- trinsic tooth staining potential of high dose and sustained re- lease iron syrups on primary teeth. BMC Oral Health. 2015;15:90. doi:10.1186/s12903-015-0072-0.
2. Percy L, Mansour D, Fraser I. Iron deficiency and iron defi- ciency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017;40:55–67. doi:10.1016/j.bpobgyn.2016.09.007.
3. Mesonjesi I. Are extrinsic black stains of teeth iron- saturated bovine lactoferrin and a sign of iron deficient ane- mia or iron overload? Med Hypotheses. 2012;79(2):219–21. doi:10.1016/j.mehy.2012.04.044.
4. Abbasi M, Mazhari F, Jaafari MR, Afshari E, Bagheri H, Parisay I. Color change of primary teeth following ex- posure to an experimentally synthesized liposomal nano- encapsulated ferrous sulfate drop versus the commercially available iron drops. Pediatr Dent J. 2021;31(3):256–267. doi:https://doi.org/10.1016/j.pdj.2021.07.003.
5. Kaya E. The effect of surface sealants on discoloration of primary teeth related to iron syrups. Yeditepe J Dent. 2021;17(3):171–176. doi:10.5505/yeditepe.2021.64426.
6. Tinastepe N, Malkondu O, Iscan I, Kazazoglu E. Effect of home and over the contour bleaching on stainability of CAD/CAM esthetic restorative materials. J Esthet Restor Dent. 2021;33(2):303–313. doi:10.1111/jerd.12604.
7. Cavex. What makes "hydrogen peroxide superior" superior? [Web Page]; 2024. Available from: https://www.cavex.nl/ hydrogen-peroxide-superior/?lang=en.
8. Kanat-Ertürk B. Color Stability of CAD/CAM Ceramics Prepared with Different Surface Finishing Procedures. J Prosthodont. 2020;29(2):166–172. doi:10.1111/jopr.13019.
9. Tejada-Casado M, Ghinea R, Perez MM, Lübbe H, Pop-Ciutrila IS, Ruiz-López J, et al. Reflectance and color prediction of dental material monolithic samples with varying thickness. Dent Mater. 2022;38(4):622–631. doi:10.1016/j.dental.2021.12.140.
10. Babaier R, Alhotan A, Haider J, Silikas N, Watts DC. Effects of two dentifrices on the surface properties and staining sus- ceptibility of polymer-based materials. J Prosthodont. 2024. doi:10.1111/jopr.13927.
11. Peña RC, Ramos AC, Dos Santos Nunes Reis JM, Dovigo LN, Salomon JGO, Del Mar Pérez M, et al. Effect of polishing and bleaching on color, whiteness, and translucency of CAD/CAM monolithic materials. J Esthet Restor Dent. 2025;37(2):440– 455. doi:10.1111/jerd.13288.
12. Choi J, Kim HE. In vitro evaluation of the tooth bleaching ef- ficacy and safety of high-concentration hydrogen peroxide with cold atmospheric plasma. Photodiagnosis Photodyn Ther. 2024;47:104101. doi:10.1016/j.pdpdt.2024.104101.
13. Farawati FAL, Hsu SM, O’Neill E, Neal D, Clark A, Esquivel- Upshaw J. Effect of carbamide peroxide bleaching on enamel characteristics and susceptibility to further discoloration. J Prosthet Dent. 2019;121(2):340–346. doi:10.1016/j.prosdent.2018.03.006.
14. Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol. 2020;104(3):153– 161. doi:10.1111/ejh.13345.
15. Tüzüner T, Turgut S, Baygin O, Yilmaz N, Tuna EB, Ozen B. Effects of Different Pediatric Drugs on the Color Stability of Various Restorative Materials Applicable in Pediatric Dentistry. Biomed Res Int. 2017;2017:9684193. doi:10.1155/2017/9684193.
16. Amaechi BT, Higham SM, Edgar WM. Factors influencing the development of dental erosion in vitro: enamel type, temper- ature and exposure time. J Oral Rehabil. 1999;26(8):624–630. doi:10.1046/j.1365-2842.1999.00433.x.
17. Korać S, Ajanović M, Džanković A, Konjhodžić A, Hasić- Branković L, Gavranović-Glamoč A, et al. Color Stability of Den- tal Composites after Immersion in Beverages and Performed Whitening Procedures. Acta Stomatol Croat. 2022;56(1):22–32. doi:10.15644/asc56/1/3.
18. Miyashita-Kobayashi A, Haruyama A, Nakamura K, Wu CY, Kuroiwa A, Yoshinari N, et al. Changes in Gloss Alteration, Surface Roughness, and Color of Direct Dental Restorative Ma- terials after Professional Dental Prophylaxis. J Funct Biomater. 2023;15(1):8. doi:10.3390/jfb15010008.
19. Cavex. Cavex Bite&White In-Office, Instructions for use [Web Page]; 2023. Available from: https://www.cavex. nl/producten/whitening-and-oral-care-en/whitening-en/ cavex-bitewhite-in-office-systeem/?lang=en.
20. Sampaio CS, Belfus J, Avila A, Cordero C, Freitte M, Ferrari V, et al. Effect of different fabrication steps on color and translu- cency of a CAD-CAM feldspathic ceramic. J Esthet Restor Dent. 2021;33(7):1038–1044. doi:10.1111/jerd.12789.
21. Posavec I, Prpić V, Zlatarić DK. Influence of Light Condi- tions and Light Sources on Clinical Measurement of Natural Teeth Color using VITA Easyshade Advance 4,0(®) Spectropho- tometer. Pilot Study. Acta Stomatol Croat. 2016;50(4):337–347. doi:10.15644/asc50/4/7.
22. Koçak EF, Ekren O, Johnston WM, Uçar Y. Analysis of color differences in stained contemporary esthetic den- tal materials. J Prosthet Dent. 2021;126(3):438–445. doi:10.1016/j.prosdent.2020.08.006.
23. Farma R. Newvit Iron Drops: Instructions for use [Web Page]; 2024. Available from: https://www.rcfarma.com/en/urunler/ newvit-iron-drops-2x50-ml/.
24. Valens. Bestiron Plus: Instructions for use [Web Page]; 2024. Available from: https://www.instagram.com/valensilac/p/ C9hekbWA-xy/?img_index=1.
25. Lokhande RS, Nagarathna PJ, Deoghare A, Chhatani N, Busi S, Malladi S. Effect of Different Iron Supplements on Color Stability of Nanocomposite Restorative Materials. Int J Clin Pediatr Dent. 2024;17(3):274–278. doi:10.5005/jp-journals- 10005-2790.
26. Nazemisalman B, Mohseni M, Darvish S, Farsadeghi M, Luchian I. Effects of Iron Salts on Demineralization and Dis- coloration of Primary Incisor Enamel Subjected to Artificial Cariogenic Challenge versus Saline Immersion. Healthcare (Basel). 2023;11(4):569. doi:10.3390/healthcare11040569.
27. Dos Santos DM, da Silva EVF, Watanabe D, Bitencourt SB, Guiotti AM, Goiato MC. Effect of different acidic solutions on the optical behavior of lithium disilicate ceramics. J Prosthet Dent. 2017;118(3):430–436. doi:10.1016/j.prosdent.2016.10.023.
28. Chen YH, Yang S, Hong DW, Attin T, Yu H. Short-term ef- fects of stain-causing beverages on tooth bleaching: A ran- domized controlled clinical trial. J Dent. 2020;95:103318. doi:10.1016/j.jdent.2020.103318.
29. Doğu Kaya B, Yılmaz Atalı P, Özmen S, Öztürk S, Tarçın B. Effect of an Effervescent Multivitamin on Color and Surface Effect of Iron Supplement and Bleaching on Tooth Whiteness | 25 Roughness of Micro-Hybrid Dental Resin Composites. Materi- als (Basel). 2024;17(5):1040. doi:10.3390/ma17051040.
30. Carneiro TS, Favoreto MW, Mena-Serrano A, Wendlinger M, Forville H, Reis A, et al. In vitro evaluation of the effect of different bleaching varnishes: Hydrogen peroxide penetration into the pulp chamber and color change. J Esthet Restor Dent. 2024;36(2):402–409. doi:10.1111/jerd.13133.
31. Panahandeh N, Mohammadkhani S, Sedighi S, Nejadkarimi S, Ghasemi A. Comparative Effects of Three Bleaching Techniques on Tooth Discoloration Caused by Tea. Front Dent. 2023;20:25. doi:10.18502/fid.v20i25.13343.
32. Tartari T, Bachmann L, Maliza AG, Andrade FB, Duarte MA, Bramante CM. Tissue dissolution and modifications in dentin composition by different sodium hypochlorite concen- trations. J Appl Oral Sci. 2016;24(3):291–298. doi:10.1590/1678- 775720150524.
33. Bazzi JZ, Bindo MJ, Rached RN, Mazur RF, Vieira S, de Souza EM. The effect of at-home bleaching and toothbrushing on removal of coffee and cigarette smoke stains and color stability of enamel. J Am Dent Assoc. 2012;143(5):e1–7. doi:10.14219/jada.archive.2012.0188.
34. Rodrigues FT, Serro AP, Polido M, Ramalho A, Figueiredo- Pina CG. Effect of bleaching teeth with hydrogen peroxide on the morphology, hydrophilicity, and mechanical and tribo- logical properties of the enamel. Wear. 2017;374-375:21–28. doi:https://doi.org/10.1016/j.wear.2016.11.001.

Year 2025, Volume: 52 Issue: 1, 17 - 25, 30.04.2025

Kerem Yılmaz , Fehmi Gönüldaş , Zeynep Bilen

https://doi.org/10.52037/eads.2025.0003

Abstract

References

Pani SC, Alenazi FM, Alotain AM, Alanazi HD, Alasmari AS. Ex- trinsic tooth staining potential of high dose and sustained re- lease iron syrups on primary teeth. BMC Oral Health. 2015;15:90. doi:10.1186/s12903-015-0072-0.
2. Percy L, Mansour D, Fraser I. Iron deficiency and iron defi- ciency anaemia in women. Best Pract Res Clin Obstet Gynaecol. 2017;40:55–67. doi:10.1016/j.bpobgyn.2016.09.007.
3. Mesonjesi I. Are extrinsic black stains of teeth iron- saturated bovine lactoferrin and a sign of iron deficient ane- mia or iron overload? Med Hypotheses. 2012;79(2):219–21. doi:10.1016/j.mehy.2012.04.044.
4. Abbasi M, Mazhari F, Jaafari MR, Afshari E, Bagheri H, Parisay I. Color change of primary teeth following ex- posure to an experimentally synthesized liposomal nano- encapsulated ferrous sulfate drop versus the commercially available iron drops. Pediatr Dent J. 2021;31(3):256–267. doi:https://doi.org/10.1016/j.pdj.2021.07.003.
5. Kaya E. The effect of surface sealants on discoloration of primary teeth related to iron syrups. Yeditepe J Dent. 2021;17(3):171–176. doi:10.5505/yeditepe.2021.64426.
6. Tinastepe N, Malkondu O, Iscan I, Kazazoglu E. Effect of home and over the contour bleaching on stainability of CAD/CAM esthetic restorative materials. J Esthet Restor Dent. 2021;33(2):303–313. doi:10.1111/jerd.12604.
7. Cavex. What makes "hydrogen peroxide superior" superior? [Web Page]; 2024. Available from: https://www.cavex.nl/ hydrogen-peroxide-superior/?lang=en.
8. Kanat-Ertürk B. Color Stability of CAD/CAM Ceramics Prepared with Different Surface Finishing Procedures. J Prosthodont. 2020;29(2):166–172. doi:10.1111/jopr.13019.
9. Tejada-Casado M, Ghinea R, Perez MM, Lübbe H, Pop-Ciutrila IS, Ruiz-López J, et al. Reflectance and color prediction of dental material monolithic samples with varying thickness. Dent Mater. 2022;38(4):622–631. doi:10.1016/j.dental.2021.12.140.
10. Babaier R, Alhotan A, Haider J, Silikas N, Watts DC. Effects of two dentifrices on the surface properties and staining sus- ceptibility of polymer-based materials. J Prosthodont. 2024. doi:10.1111/jopr.13927.
11. Peña RC, Ramos AC, Dos Santos Nunes Reis JM, Dovigo LN, Salomon JGO, Del Mar Pérez M, et al. Effect of polishing and bleaching on color, whiteness, and translucency of CAD/CAM monolithic materials. J Esthet Restor Dent. 2025;37(2):440– 455. doi:10.1111/jerd.13288.
12. Choi J, Kim HE. In vitro evaluation of the tooth bleaching ef- ficacy and safety of high-concentration hydrogen peroxide with cold atmospheric plasma. Photodiagnosis Photodyn Ther. 2024;47:104101. doi:10.1016/j.pdpdt.2024.104101.
13. Farawati FAL, Hsu SM, O’Neill E, Neal D, Clark A, Esquivel- Upshaw J. Effect of carbamide peroxide bleaching on enamel characteristics and susceptibility to further discoloration. J Prosthet Dent. 2019;121(2):340–346. doi:10.1016/j.prosdent.2018.03.006.
14. Elstrott B, Khan L, Olson S, Raghunathan V, DeLoughery T, Shatzel JJ. The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol. 2020;104(3):153– 161. doi:10.1111/ejh.13345.
15. Tüzüner T, Turgut S, Baygin O, Yilmaz N, Tuna EB, Ozen B. Effects of Different Pediatric Drugs on the Color Stability of Various Restorative Materials Applicable in Pediatric Dentistry. Biomed Res Int. 2017;2017:9684193. doi:10.1155/2017/9684193.
16. Amaechi BT, Higham SM, Edgar WM. Factors influencing the development of dental erosion in vitro: enamel type, temper- ature and exposure time. J Oral Rehabil. 1999;26(8):624–630. doi:10.1046/j.1365-2842.1999.00433.x.
17. Korać S, Ajanović M, Džanković A, Konjhodžić A, Hasić- Branković L, Gavranović-Glamoč A, et al. Color Stability of Den- tal Composites after Immersion in Beverages and Performed Whitening Procedures. Acta Stomatol Croat. 2022;56(1):22–32. doi:10.15644/asc56/1/3.
18. Miyashita-Kobayashi A, Haruyama A, Nakamura K, Wu CY, Kuroiwa A, Yoshinari N, et al. Changes in Gloss Alteration, Surface Roughness, and Color of Direct Dental Restorative Ma- terials after Professional Dental Prophylaxis. J Funct Biomater. 2023;15(1):8. doi:10.3390/jfb15010008.
19. Cavex. Cavex Bite&White In-Office, Instructions for use [Web Page]; 2023. Available from: https://www.cavex. nl/producten/whitening-and-oral-care-en/whitening-en/ cavex-bitewhite-in-office-systeem/?lang=en.
20. Sampaio CS, Belfus J, Avila A, Cordero C, Freitte M, Ferrari V, et al. Effect of different fabrication steps on color and translu- cency of a CAD-CAM feldspathic ceramic. J Esthet Restor Dent. 2021;33(7):1038–1044. doi:10.1111/jerd.12789.
21. Posavec I, Prpić V, Zlatarić DK. Influence of Light Condi- tions and Light Sources on Clinical Measurement of Natural Teeth Color using VITA Easyshade Advance 4,0(®) Spectropho- tometer. Pilot Study. Acta Stomatol Croat. 2016;50(4):337–347. doi:10.15644/asc50/4/7.
22. Koçak EF, Ekren O, Johnston WM, Uçar Y. Analysis of color differences in stained contemporary esthetic den- tal materials. J Prosthet Dent. 2021;126(3):438–445. doi:10.1016/j.prosdent.2020.08.006.
23. Farma R. Newvit Iron Drops: Instructions for use [Web Page]; 2024. Available from: https://www.rcfarma.com/en/urunler/ newvit-iron-drops-2x50-ml/.
24. Valens. Bestiron Plus: Instructions for use [Web Page]; 2024. Available from: https://www.instagram.com/valensilac/p/ C9hekbWA-xy/?img_index=1.
25. Lokhande RS, Nagarathna PJ, Deoghare A, Chhatani N, Busi S, Malladi S. Effect of Different Iron Supplements on Color Stability of Nanocomposite Restorative Materials. Int J Clin Pediatr Dent. 2024;17(3):274–278. doi:10.5005/jp-journals- 10005-2790.
26. Nazemisalman B, Mohseni M, Darvish S, Farsadeghi M, Luchian I. Effects of Iron Salts on Demineralization and Dis- coloration of Primary Incisor Enamel Subjected to Artificial Cariogenic Challenge versus Saline Immersion. Healthcare (Basel). 2023;11(4):569. doi:10.3390/healthcare11040569.
27. Dos Santos DM, da Silva EVF, Watanabe D, Bitencourt SB, Guiotti AM, Goiato MC. Effect of different acidic solutions on the optical behavior of lithium disilicate ceramics. J Prosthet Dent. 2017;118(3):430–436. doi:10.1016/j.prosdent.2016.10.023.
28. Chen YH, Yang S, Hong DW, Attin T, Yu H. Short-term ef- fects of stain-causing beverages on tooth bleaching: A ran- domized controlled clinical trial. J Dent. 2020;95:103318. doi:10.1016/j.jdent.2020.103318.
29. Doğu Kaya B, Yılmaz Atalı P, Özmen S, Öztürk S, Tarçın B. Effect of an Effervescent Multivitamin on Color and Surface Effect of Iron Supplement and Bleaching on Tooth Whiteness | 25 Roughness of Micro-Hybrid Dental Resin Composites. Materi- als (Basel). 2024;17(5):1040. doi:10.3390/ma17051040.
30. Carneiro TS, Favoreto MW, Mena-Serrano A, Wendlinger M, Forville H, Reis A, et al. In vitro evaluation of the effect of different bleaching varnishes: Hydrogen peroxide penetration into the pulp chamber and color change. J Esthet Restor Dent. 2024;36(2):402–409. doi:10.1111/jerd.13133.
31. Panahandeh N, Mohammadkhani S, Sedighi S, Nejadkarimi S, Ghasemi A. Comparative Effects of Three Bleaching Techniques on Tooth Discoloration Caused by Tea. Front Dent. 2023;20:25. doi:10.18502/fid.v20i25.13343.
32. Tartari T, Bachmann L, Maliza AG, Andrade FB, Duarte MA, Bramante CM. Tissue dissolution and modifications in dentin composition by different sodium hypochlorite concen- trations. J Appl Oral Sci. 2016;24(3):291–298. doi:10.1590/1678- 775720150524.
33. Bazzi JZ, Bindo MJ, Rached RN, Mazur RF, Vieira S, de Souza EM. The effect of at-home bleaching and toothbrushing on removal of coffee and cigarette smoke stains and color stability of enamel. J Am Dent Assoc. 2012;143(5):e1–7. doi:10.14219/jada.archive.2012.0188.
34. Rodrigues FT, Serro AP, Polido M, Ramalho A, Figueiredo- Pina CG. Effect of bleaching teeth with hydrogen peroxide on the morphology, hydrophilicity, and mechanical and tribo- logical properties of the enamel. Wear. 2017;374-375:21–28. doi:https://doi.org/10.1016/j.wear.2016.11.001.

There are 34 citations in total.

Details

Primary Language	English
Subjects	Dental Materials and Equipment, Prosthodontics
Journal Section	Original Research Articles
Authors	Kerem Yılmaz 0000-0002-2974-6696 Fehmi Gönüldaş 0000-0002-4009-3972 Zeynep Bilen 0009-0008-2308-8232
Early Pub Date	April 30, 2025
Publication Date	April 30, 2025
Submission Date	September 8, 2024
Acceptance Date	December 1, 2024
Published in Issue	Year 2025 Volume: 52 Issue: 1

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Vancouver	Yılmaz K, Gönüldaş F, Bilen Z. The Effect of a Microencapsulated Iron Supplement, Hydrogen Peroxide Superior and Professional Dental Prophylaxis on the Color and Whiteness of Teeth. EADS. 2025;52(1):17-25.

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