Potency of Acid Content in Local and Imported Strawberry Fruit Extract (Fragaria X Ananassa) as Natural Ingredients for Teeth Whitening

Introduction

Tooth bleaching has become one of the most successful and well-accepted aesthetic dental treatments over the past decades and has become an important part of aesthetic dentistry, representing the most conservative method of treatment of dental discoloration. Special interest enjoyed this type of dental treatment, especially among patients and physicians, has led to numerous market profiles for bleaching products and application techniques [1, 2].

The 2015 survey data states that more than 1 million Americans are interested in carrying out teeth whitening treatment at a cost of up to 600 million dollars per year [3].

Tooth discoloration is caused by stains which may be intrinsic, extrinsic or a combination of both in terms of source [4]. Intrinsic factors such as congenital, systemic, hematologic factors, disorders and exposure to phenolic or iodoformic drugs and conditions caused by extrinsic factors, namely pigments in food, beverages such as tea, coffee, tobacco, red wine, and other substances that often come into contact with the hard tissues of the teeth in the oral cavity. The use of tobacco products is also a risk factor for tooth discoloration [5, 6, 7]. The color of the tooth structure results from the interaction of different light phenomena through hard tissues including dispersion, refraction, transmission and absorption. The final observed color is determined by a combination of the optical properties of the enamel and dentine tissue including translucency and chromaticity [8]. Bleaching involves an oxidation process in which the molecules causing the discoloration are chemically modified [9].

Shade guides is the one commonly used and commercially available is Vitapan Classical with 16 shade guides (Vita Zahnfabrik) arranged from lightest to darkest, namely B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3 .5, B4, C3, A4 and C4. Vitapan 3D master with 29 colors including three colors of bleach (Vita Zahnfabrik) which is used as a benchmark for measuring tooth color. Each tab is placed in the inspection box and measured using a spectrophotometer [10, 11].

Color measurement is based on the use of 3 or 4 color discs, each of which has been calibrated using 3 methods, namely chromatic, value and chrome. Chromium is a color intensity that distinguishes strong colors from weak colors which is described as the distance of the circle from the center (Munsell color ball). Value is a color quality associated with lighting and the system’s color measurement for visually matching product colors to Munsell colors using the sense of sight [12].

Indications for bleaching teeth that have undergone discoloration are tooth discoloration caused by pulp chambers, discolored dentin, discolored due to calcification metamorphosis, and discolored due to hypoplasia/ hypomineralization. Hypoplasia and hypomineralization may require additional treatment to completely cover the discoloration [13].

The side effect of using hydrogen peroxide and carbamide peroxide as teeth whitening agents are that they can cause penetration of the pulp chamber, increase sensitivity to temperature making it easier to ache, decrease enamel hardness and changes in enamel layer roughness [14].

The side effects resulting from the use of chemicals as tooth whiteners have made many researchers look for alternative materials to replace chemicals, namely by using natural ingredients that are safer and at affordable prices [14].

Indonesia imports around 150 tons of premium strawberries per year from South Korea, the United States and Australia. Strawberry fruit is a fruit that is widely consumed as fresh or processed food with a distinctive aroma, red color and sweet taste. In 2019 world strawberry production reached 8.9 million tonnes, of which China contributed 35.9%, the United States 11.2% and Mexico 10.11%. Strawberry is a fruit that is valued because of the nutritional content contained in the fruit [15, 16].

Indonesia is one of the fruit-producing countries with diversity and rich in taste when compared to fruit from other countries. Based on data from the Food and Agriculture Organization (FAO). In 2014 Indonesia was ranked in the top 20 as a world-level fruit producing country. Tomatoes and strawberries are types of fruit that are quite popular and are known to have a fairly high water content. Strawberries and tomatoes are considered fruits that are widely consumed in Indonesia, but both have a short shelf life due to their high water content [17].

There are natural ingredients from strawberries as a natural teeth whitener because strawberries (Fragaria x ananassa) contain pectin (natural fiber) which helps clean teeth themselves and strawberries are fruits that are rich in phytochemicals such as ellagic acid (ellagic acid), malic acid (malic acid), anthocyanins, quercetin, catechins and vitamins such as ascorbic acid and folic acid. Ellagic acid has a potential OH group which acts as a strong oxidizer. Stephanie et al noticed that the more ellagic acid, the more OH groups produced and the more effective the bleaching process. OH and H radicals produced from ellagic acid react with organic email molecules, disrupting electron conjugation and changing the absorption of energy in enamel by forming smaller organic molecules with a lighter color [18, 19] (Figure 1).

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Materials and Methods

In this study, 48 single-rooted teeth were used which had been coated with clear nail polish on the roots of the teeth Figure 2.

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Discussion

This study aims to determine the potential of the acid present in local strawberries and imported strawberries. The local strawberries used were Holibert strawberries originating from Garut and Ciwidey Bandung, Indonesia which had been examined for the malic acid content contained in these fruits of 0.15% and the imported strawberries used were strawberries with the Evergood brand originating from South Korea with a malic acid content of 0.0885%. This study used 35% carbamide peroxide bleach.

If you look at the average data in this study for the local strawberry juice group, if you compare the pretest and posttest at 24 hours, there is a difference of 0.78, while at 48 hours there is a difference of 0.22. The imported strawberry juice group when comparing the pretest and posttest at 24 hours there was a difference of 1.32 while at 48 hours of immersion there was difference of 0.33. The 35% carbamide peroxide group when comparing the pretest and posttest at 24 hours there was a difference of 4.03 while at 48 hours of immersion there was a difference of 7.83. If seen from the difference in the average of the data, the immersion group with significant results occurred in the 35% carbamide peroxide group. The group of local strawberries and imported strawberries did not have a significant difference, but when compared through the difference in the average group data, imported strawberries were higher than the local strawberry group.

When compared through data from the average value of these groups, the imported strawberry juice group had a superior effect on teeth whitening results compared to the local strawberry juice group, where the malic acid content in the imported strawberry juice group was lower than the local strawberry juice group with a difference of 0.0615%. This is likely to occur due to the presence of other acids in imported strawberries, thus increasing the potential for teeth whitening, namely the ellagic acid content. Research by Selva Mutkumaran, et al. [20].

In Senthilkumar’s research, et al. in 2021 stated that the average value obtained by using carbamide peroxide was more significant than strawberry extract (p <0.01). In comparison, the carbamide peroxide group was statistically more significant than strawberry extract (p <0.01) [21].

The results of this study are in accordance with the results of research conducted by Senthilkumar, et al. namely “the comparison in the carbamide peroxide group statistically has a significant effect compared to the strawberry fruit extract” but the difference is the soaking time of the samples. Radhakrishnan, et al. namely the use of hydrogen peroxide bleaching agent, while in this study carbamide peroxide was used. Another thing that distinguishes it is the acid content in the strawberries used as research material. It is proven that local strawberries originating from Indonesia, the holibert type, have a malic acid content of 0.15% and imported strawberries originating from South Korea, the evergood brand, have an acid content of 0.15%. 0.0885% while the strawberries used in the study by Radhakrishnan, et al. [21, 22].

Conclusion and Recommendation

Strawberry fruit juice extract with malic acid content in it of 0.15% in local strawberry juice and 0.0885% in imported strawberry fruit juice has the potential to whiten discolored teeth but not significant (p>0.05). Imported strawberries have a higher potential to whiten teeth compared to local strawberries.

Further research is needed to determine the ellagic acid content in local and imported strawberries at the Saraswanti Indo Genetech Laboratory, Bogor, West Java, Indonesia.

Conflicts of Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.