1472-6831-12-13.pdf - Whelton et al. BMC Oral Health 2012 ...

RESEARCH ARTICLE Open Access
Randomized controlled trial to evaluate tooth
stain reduction with nicotine replacement gum
during a smoking cessation program
Helen Whelton
1*
, Rose Kingston
1
, Denis O ’ Mullane
1
and Frederick Nilsson
2
Abstract
Background: In addition to its general and periodontal health effects smoking causes tooth staining. Smoking
cessation support interventions with an added stain removal or tooth whitening effect may increase motivation to
quit smoking. Oral health professionals are well placed to provide smoking cessation advice and support to
patients. The objective of the present study was to evaluate the effect of Nicorette
W
Freshmint Gum used in a
smoking cessation programme administered in a dental setting, on extrinsic stain and tooth shade among smokers.
Methods: An evaluator-blinded, randomized, 12-week parallel-group controlled trial was conducted among 200
daily smokers motivated to quit smoking. Participants were randomised to use either the Nicorette
W
Freshmint
Gum or Nicorette
W
Microtab (tablet). Tooth staining and shade were rated using the modified Lobene Stain Index
and the Vita
W
Shade Guide at baseline, weeks 2, 6 and 12. To maintain consistency with other whitening studies,
the primary end-point was the mean change in stain index between baseline and week 6. Secondary variables
included changes in stain measurements and tooth shade at the other time points the number of gums or tablets
used per day and throughout the trial period; and the number of cigarettes smoked per day. Treatments were
compared using analysis of covariance (ANCOVA), using treatment and nicotine dependence as factors and the
corresponding baseline measurement as a covariate. Each comparison (modified intention-to-treat) was tested at
the 0.05 level, two-sided. Within-treatment changes from baseline were compared using a paired t -test.
Results: At week 6, the gum-group experienced a reduction in mean stain scores whilst the tablet-group
experienced an increase with mean changes of -0.14 and +0.12 respectively, (p = 0.005, ANCOVA). The change in
mean tooth shade scores was statistically significantly greater in the gum-group than in the tablet group at 2
(p = 0.015), 6 (p = 0.011) and 12 weeks (p = 0.003) with greater lightening in the gum-group at each examination
period.
Conclusion: These results support the efficacy of the tested nicotine replacement gum in stain reduction and
shade lightening. These findings may help dentists to motivate those wishing to quit smoking using a nicotine
replacement gum.
Trial registration: NCT01440985
* Correspondence: [email protected]
1
Oral Health Services Research Centre, University College Cork, Ireland
Full list of author information is available at the end of the article
© 2012 Whelton et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.