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Original Article

Mouthrinses affect color stability of composite

Arshia Rashid Baig, Deepa Deepak Shori, Pratima Ramakrishna Shenoi, Syed Navid Ali1, Sanjay Shetti2,
Alkesh Godhane3
Department of Conservative Dentistry and Endodontics, VSPMS Dental College and Research Centre, 1Department of Conservative
Dentistry and Endodontics, CSMSS Dental College and Hospital, 2DKTES Textile and Engineering Institute, Ichalkaranji, Maharashtra,
3
Department of Pedodontics, Maitri Dental College and Research Centre, Chattisgarh, India

Abstract
Aim: The aim of this study is to evaluate the effect of alcohol and nonalcohol containing mouth rinses on the color stability of
a nanofilled resin composite restorative material.
Materials and Methods: A total of 120 samples of a nanofilled resin composite material (Tetric NCeram, Ivoclar Vivadent AG,
FL9494 Schaan/Liechtenstein) were prepared and immersed in distilled water for 24 h. Baseline color values were recorded
using Color Spectrophotometer 3600d (Konica Minolta, Japan). Samples were then randomly distributed into six groups:
Group I distilled water (control group), Group II Listerine, Group III Eludril, Group IV Phosflur, Group V Amflor, and
Group VI Rexidin. The postimmersion color values of the samples were then recorded, respectively.
Results: Significant reduction in the mean color value (before and after immersion) was observed in nonalcohol containing
mouth rinses (P < 0.001).
Conclusion: All mouthrinses tested in the present invitro study caused a color shift in the nanofilled resin composite restorative
material, but the color shift was dependent on the material and the mouthrinse used. Group VI (Rexidin) showed maximum
color change.
Keywords: Alcohol and nonalcohol containing mouth rinses; color stability; nanocomposite

INTRODUCTION Discoloration of the resin composites has a multifactorial

A quest for an ideal and esthetically acceptable restorative
material is probably as old as dentistry itself and patients
consciousness of selfaesthetics has been enabled by the
development of composite resins.[1,2]
Mouthrinses being the simple vehicle of such agents serve
as an adjunct to the mechanical means for prevention and
control of caries, periodontal diseases, for the cessation
of plaque, moreover for diminishing oral malodor. Many
varieties such as alcohol and nonalcoholbased mouthrinses
are used popularly as a mean for the maintenance of oral
hygiene by the patients on a regular basis.[3,4]
Address for correspondence:
Dr. Arshia Rashid Baig, IShanti Vihar, Chitnavis Marg, Civil Lines,
Nagpur 440 001, Maharashtra, India.
Email: arshia.baig@yahoo.in
Date of submission : 20.01.2016
Review completed : 06.04.2016
Date of acceptance : 12.06.2016
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etiology, many internal and external features may cause
an alteration in color of these materials, out of which the
proprietary mouthrinses are one of the causative factor for
discoloration. However, studies have revealed that color
stability of restorative materials can be reduced by both
alcoholcontaining and alcoholfree mouth rinses. Based
on such thinking and the literature documentation done
by various studies, the present invitro study was carried
out to assess the effect of alcohol and nonalcoholbased
mouthrinses on the color stability of a nanofilled resin
composite restorative material.[49]
MATERIALS AND METHODS
The description of the commercially available mouthrinses
and the nanofilled resin composite are given in Table 1.
This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which
allows others to remix, tweak, and build upon the work non-commercially,
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For reprints contact: reprints@medknow.com

How to cite this article: Baig AR, Shori DD, Shenoi PR,
DOI: Ali SN, Shetti S, Godhane A. Mouthrinses affect color stability
10.4103/0972-0707.186448
of composite. J Conserv Dent 2016;19:355-9.

2016 Journal of Conservative Dentistry|Published by Wolters KluwerMedknow 355

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Baig, et al.: Mouthrinses affect color stability of composite

Table1: Product profile of the nanofilled resin composite restorative material and composition of the mouth rinses used
in the present invitro study
Material Resin Fillers Filler Manufacture
size(nm)
Tetric NCeram(Shade: Dimethacrylates(19-20 weight Barium glass, ytterbium Between Ivoclar vivadent AG
A2) %) trifluoride, mixed oxide 40 and FL9494 Schaan/Liechtenstein
and copolymers(80-81 3000 nm Imported and marketed by Ivoclar Vivadent
weight %) marketing (India) Pvt. Ltd., Gurgaon, Haryana
Groups Detailed description
Mouth rinse Composition Manufacturer
I Distilled water
II Listerine(alcoholbased) Purified water, sorbitol, alcohol, poloxamer 407, benzoic acid, Imported and Marketed by Johnson and
sodium saccharin, mouthwash flavor, eucalyptol, methyl salicylate, Johnson Ltd., Mumbai, India
thymol, sodium benzoate, menthol, CI 47005, CI 42053 Batch No. F031543E
III Eludril(alcoholbased) Chlorhexidine gluconate solution IP equivalent to chlorhexidine Marketed by WinMedicare
gluconate 0.1% w/v WINMEDICARE Pvt Ltd., NewDelhi,
Absolute alcohol content 42.7% w/v India
Purified water IP q.s Batch No. GB0304
Color: Ponceau 4R
IV Phosflur(nonalcoholbased) Sodium fluoride IP 4.4 mg Manufactured by: Colgate Oral
Color: Brilliant blue FCF Pharmaceuticals. Incorporation, Texas, USA
(CI 42090) Imported and Marketed in India by
ColgatePalmolive(India) Ltd., Mumbai,
India
Batch No. P9888072
V Amflor(nonalcoholbased) Purified water, sorbitol, propylene glycol, amine fluoride, Manufactured in India by Group
poloxamer, polyoxyl 40 hydrogenated castor oil, sodium benzoate, Pharmaceuticals Ltd., Malur, India
sodium saccharin, flavors Batch No. B.AW301
Color: Ponceau 4R
Available fluoride content 480 ppm when packed
VI Rexidin(nonalcoholbased) Chlorhexidine gluconate solution IP diluted to chlorhexidine Manufactured in India by INDOCO
gluconate 0.2% w/v in pleasantly flavored aqueous base REMEDIES Ltd., Aurangabad, India
Color: Fast green FCF Batch No. RAQ3F43

Specimen preparation Color stability

A total of 120 samples of nanofilled resin composite
restorative material of size 10 mm in diameter and 2 mm
in height were prepared using a customized teflon mold.
The mold was placed on a glass slab (Neelkanth Health
Care (P) Ltd., Jodhpur, India) and filled with composite
using composite filling instrument (Rotex, Germany). It
was then covered with a clean matrix strip (Samit Matrix
Strips, India), another glass slab was placed on top and
gently pressed for 30 seconds to extrude the excess
material for achieving a smooth surface. Each specimen
was then cured for 40 seconds from the top and another
40 seconds from the bottom using LED light cure unit
(Guilin Woodpecker Medical Instrument Co., Ltd, China)
(having not <450 mW/cm2).
All the prepared samples were immersed in 20 ml of
distilled water followed by incubation at 37C for 24 hours.
After 24 hours, baseline color value of each sample was
recorded using Color Spectrophotometer 3600d (Konica
Minolta, Japan).
Samples were then randomly divided into six groups as
following: Group I Control group (distilled water), Group II
Listerine (alcoholbased), Group III Eludril (alcoholbased,
alcoholchlorhexidine containing), Group IV Phosflur (non
alcoholbased, sodium fluoride containing), Group V Amflor
(non alcoholbased, amine fluoride containing), and Group
VI Rexidin (non alcoholbased, chlorhexidinecontaining).
Each group comprised 20 sample each (n = 20).

pH evaluation The samples of each group were then immersed in 20 ml of

The pH of distilled water and the five commercial mouth
rinses was evaluated using a digital pH meter (Systronics.
Naroda, Ahmedabad, India). The values are:
The pH for Group I Control group (distilled water) was
found to be 7.14, for Group II Listerine: 4.14, for Group III
Eludril: 4.5, for Group IV Phosflur: 4.39, for Group V Amflor:
4.7, and for Group VI Rexidin: 5.6.
their respective mouth rinse followed by incubation at 37C for
24 hours. The after immersion color value of each sample was
evaluated using the same color spectrophotometer. The data
were collected, tabulated, and subjected to statistical analysis.
Statistical tests
The intragroup (pre and postimmersion values)
comparison of the mean color value of the samples was

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done by paired ttest. Color change between the groups was
compared by performing oneway nonparametric ANOVA,
i.e., KruskalWallis ANOVA test. Multiple comparisons
were made by Wilcoxon Rank Sum test. The effect of
mouthrinses on the color stability of the nanofilled resin
composite restorative material was compared by post hoc
Wilcoxon Rank Sum test (MannWhitney test). The data
were analyzed using STATA version 13.1 (StataCorp LP,
Texas, USA) and the level of significance was set at P = 0.05.
RESULTS
Significant change in the color stability was shown by the
non alcoholbased mouthrinses.
Mean change in the color, i.e., (before and after immersion)
for distilled water (Group I) was 2.74%, for Listerine
(Group II) 3.08%, for Eludril (Group III) 3.15%, Phosflur
(Group IV) 3.29%, Amflor (Group V) 4.86%, and Rexidin
(Group IV) 5.49% [Table 2].
The E value of the samples, when immersed in Distilled
water, was found to be 1.65.
For alcoholbased mouthrinses
Samples when immersed in Listerine, E was 1.85
The E was found to be 1.82 when samples were
immersed in Eludril. These values are less than the
clinically tolerable value for color changes in dental
materials (assumed to be E*ab 3.3) [Table 2].
For non alcoholbased mouthrinses
The E value of the samples when immersed in Phosflur
(Group IV) was 2.00
For Amflor (Group V), E was found to be 2.92
Whereas the maximum color change was shown by
Rexidin (Group VI) which was E = 3.22 [Table 2].
By applying the post hoc comparison by Wilcoxon Rank
Sum Test (MannWhitney test) when non alcoholbased
mouthrinses were compared with the alcoholbased
mouthrinses, there was highly significant difference
(P < 0.001). This indicated that the nonalcoholbased
Table2: Comparison of mean color change(before
and after immersion) in six groups
Group Mean change SD
I 1.65 0.54
II 1.85 0.44
III 1.82 0.81
IV 2.00 0.33
V 2.94 0.82
VI 3.22 0.62
2 60.55
P <0.0001, HS
Kruskal-Wallis oneway ANOVA test was applied(P<0.000, HS). HS: High
significant, SD: Standard deviation
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Baig, et al.: Mouthrinses affect color stability of composite
mouthrinses affected the color stability of the nanofilled
resin composite restorative material.
When KruskalWallis oneway ANOVA test was applied
to compare the mean values of color stability (before and
after immersion) of six different groups, the difference was
highly significant, i.e., (P < 0.0001) and the KruskalWallis
statistics was 60.55 [Table 2]. When KruskalWallis oneway
ANOVA test was applied to compare the mean values
of color stability (before and after immersion) of three
different groups (control group, alcoholbased group,
and nonalcoholbased group), the difference was highly
significant, i.e., (P < 0.0001) and the KruskalWallis
statistics was 45.29.
DISCUSSION
Composite resins were introduced in the field of aesthetic,
restorative dentistry, in view of reducing the shortcomings of
the acrylic resins. Till date, the most substantial contribution
of Nanotechnology to dentistry has been the restoration of
tooth structure with the newly developed nanocomposites.
The unique nature of the filler particles of nanocomposite
provides it with increased hardness, abrasion resistance,
fracture resistance, polishability, reduced polymerization
shrinkage (1.41.6% by volume), and shrinkage stress.[9]
Discoloration of toothcolored, resinbased materials may
be affected by numerous intrinsic and extrinsic factors.
Intrinsic factors involve the staining of the resin material
itself, such as variation of the resin matrix and changes in
the interface of matrix and fillers. The resin matrix has been
described as critical to color stability, and staining may be
linked to a high resin content and water absorption.[10]
Discoloration can be estimated with different instruments
and techniques. In evaluating chromatic differences, the
Commission Internationale de lEclairage (CIE L*, a*, b*)
system was chosen for this study. According to this system,
L* signifies the lightness of the sample, a* defines greenred
axis (a = green; +a = red) and b* describes blueyellow
axis (b = blue; +b = yellow). It is also possible to
calculate the total color change (E*ab), which cogitates
the changes of L*, a*, and b*. Various studies have different
inceptions of color difference values which are appreciable
to the human eye. However, the clinically tolerable value
% change for color changes in dental materials is presumed to be
2.74 E*ab 3.3.[10,11]
3.08
3.15
3.29 In this study, samples of Group I (control group) when
4.86 immersed in distilled water, showed color change, i.e. E
5.49 as 1.65. This change in color of the tested nanofilled resin
composite restorative material was not perceptible. These
results are in accordance with Lee et al. (2000), Grdal et al.
(2002), and Diab et al.[3,13,14]
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Baig, et al.: Mouthrinses affect color stability of composite
Samples of Group II, when immersed in Listerine
mouthrinse (alcoholcontaining), showed color change E
as 1.85. Although Listerine has low pH (4.14) with high
alcohol content, in this study the color stability of the
tested composite was not affected. These results are in
accordance with Diab et al. (2007) and ElEmbaby AelS et al.
(2014). Accordance with Festuccia et al. (2012) who reported
that significant color change was found by Listerine.
Samples of Group III when immersed in Eludril mouthrinse
(alcoholchlorhexidine containing), the change in color,
i.e. E as 1.82. Although the alcohol content of Eludril
is high with low pH (4.5), the change in color was not
perceptible.[3,4] These results are in accordance with Diab
et al (2007), Celik et al (2008).
When samples of Group IV were immersed in Phosflur
mouthrinse (sodium fluoride containing), color change
E was 2.00. These results are in accordance with Lee
et al. (2000). These results are in disagreement with Diab
et al. (2007), who reported that sodium fluoride containing
mouthrinse showed the highest change in color of the
tested resin composite restorative materials. This may be
due to the percentage of sodium fluoride in Flucal (0.2%)
which is higher than that of Phosflur (0.044%). Hence,
no significant color change was found in samples when
immersed in Phosflur in the present invitro study.[12,13]
Samples of Group V, when immersed in Amflor mouthrinse
(aminefluoride containing), showed change in color E
as 2.94, which is less than the clinically acceptable value
(assumed to be E*ab 3.3) for color change in dental
materials. Hence, the color change shown by Amflor was
not visually perceptible. These results are in agreement
with Lee et al. (2000), Grdal et al. (2002), and Diab et al.
(2007).
When samples of Group VI were immersed in Rexidin
mouthrinse (chlorhexidinecontaining), the color change
E was 3.22, which is very close to the clinically standard
value for color variations in dental materials (assumed to
be E*ab 3.3).[13,14]
Among the three non alcoholbased mouthrinses
(Phosflur, Amflor, Rexidin) used in the present study,
Rexidin showed maximum color change E as 3.22 in the
nanofilled resin composite restorative material because
chlorhexidinecontaining mouthrinses having 0.2%
chlorhexidine gluconate, affect the color stability of resin
composites. These results are in accordance with Celik
et al. (2008),[4] Bagis et al. (2011)[19], and Poggio et al.[1519]
Intergroup comparison revealed that non alcoholbased
mouthrinses (Group IV Phosflur, Group V Amflor,
and Group VI Rexidin) when were compared with the
alcoholbased mouthrinses (Group II Listerine and
358 Journal of Conservative Dentistry | Jul-Aug 2016|Vol 19 | Issue 4
Group III Eludril) there was highly significant difference
(P < 0.001). This indicated that the nonalcoholbased
mouthrinses affected the color stability of the nanofilled
resin composite restorative material.
CONCLUSION
Within the limitations of the present experimental study
and the parameters used, it can be concluded that:
1. Mouthrinses with low pH are more detrimental to the
hardness rather than to color stability
2. The present study appears to support the hypothesis
that chlorhexidinecontaining mouthrinse having 0.2%
of chlorhexidine gluconate cause perceptible color
change of the nanofilled resin composite restorative
material
3. All mouthrinses tested in this invitro study caused a
color shift in the tested nanofilled resin composite
restorative material, but the color shift was dependent
on the material and the mouthrinse used.
Clinical recommendations
1. Patients having resin composite restorations in the
esthetic zone should avoid using mouthrinses which
contain high concentration of chlorhexidine gluconate
2. In addition, there is variety of commercially available
nanocomposites in the market; it would be pertinent to
include other types of composite resins in future studies
3. Any new mouthrinse, introduced into the market
should be tested for its effect on the properties of
toothcolored restorative materials.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Rawls HR, Josephine FE. Restorative resins. In: Anusavice KJ, editor.
Phillips Science of Dental Materials. 11th ed. Philadelphia: WB Saunders
Co.; 2010. p. 399437.
2. Theodore MR, Harald OH, Edward JS. Sturdevantss Art and Science of
Operative Dentistry. 4th ed. Mosby; 2002.
3. Diab M, Zaazou MH, Mubarak EH, Olaa MI. Effect of five commercial
mouthrinses on the microhardness and color stability of two resin
composite restorative materials. Aust J Basic Appl Sci 2007;1:66774.
4. Celik C, Yuzugullu B, Erkut S, Yamanel K. Effects of mouth rinses on
color stability of resin composites. Eur J Dent 2008;2:24753.
5. George R. Nanocomposites A review. J Dent Oral Biol 2011;2:3840.
6. Swift EJ. Nanocomposites. J Esthet Restor Dent 2005;17:34.
7. Chandki R, Kala M, Kumar KN, Brigit B, Banthia P, Banthia R.
Nanodentistry: Exploring the beauty of miniature. J Clin Exp Dent
2012;4:e11924.
8. Ferracane JL. Current trends in dental composites. Crit Rev Oral Biol
Med 1995;6:30218.
9. Terry DA. Direct applications of a nanocomposite resin system:
Part 1 The evolution of contemporary composite materials. Pract
Proced Aesthet Dent 2004;16:41722.
10. ElEmbaby AelS. The effects of mouth rinses on the color stability
[Downloaded free from http://www.jcd.org.in on Tuesday, August 15, 2017, IP: 183.82.179.52]

Baig, et al.: Mouthrinses affect color stability of composite

of resinbased restorative materials. J Esthet Restor Dent
2014;26:26471.
11. Dietschi D, Campanile G, Holz J, Meyer JM. Comparison of the color
stability of ten newgeneration composites: An in vitro study. Dent Mater
1994;10:35362.
12. Festuccia MS, Garcia Lda F, Cruvinel DR, PiresDeSouza Fde C. Color
stability, surface roughness and microhardness of composites submitted
to mouthrinsing action. J Appl Oral Sci 2012;20:2005.
13. Lee SY, Huang HM, Lin CY, Shih YH. Leached components from dental
composites in oral simulating fluids and the resultant composite
strengths. J Oral Rehabil 1998;25:57588.
14. Grdal P, Akdeniz BG, Hakan Sen B. The effects of mouthrinses on
microhardness and colour stability of aesthetic restorative materials. J
Oral Rehabil 2002;29:895901.
15. Khokhar ZA, Razzoog ME, Yaman P. Color stability of restorative resins.
Quintessence Int 1991;22:7337.
16. Uchida H, Vaidyanathan J, Viswanadhan T, Vaidyanathan TK. Color
stability of dental composites as a function of shade. J Prosthet Dent
1998;79:3727.
17. Poggio P, Dagna A, Lombardini M, Chiesa M, Bianchi S. Staining of
dental composite resins with chlorhexidine mouthwashes. Ann di
Stomat 2009;LVIII(3):62-7.
18. Lehmann KM, Devigus A, Igiel C, Weyhrauch M, Schmidtmann I,
Wentaschek S, et al. Are dental color measuring devices CIE compliant?
Eur J Esthet Dent 2012;7:32433.
19. Bagis B, Baltacioglu E, Ozcan M, Ustaomer S. Evaluation of chlorhexidine
gluconate mouthrinse-induced staining using a digital colorimeter: An in
vivo study. Quint Int 2011;42:213-23.

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