Crest ProHealth and Brown Staining: Fact or Fiction?

Published on 8 June 2023 at 21:05

When Crest introduced the Pro-Health line of products in August 2006, Proctor & Gamble advertised it as triclosan-free products with antimicrobial properties.  Pro-Health products began to gain popularity with both dental professionals and the general public through P&G's advertising.  Oral-B started selling trial-sized Pro-Health toothpaste and mint to dental professionals for patient care, and Pro-Health is now a well-established and widely used dentifrice.  

My office began sending home Pro-Health toothpaste samples, and I received full-size product samples directly from the manufacturer.  I noticed a different type of 'tingle', as opposed to the sting I usually feel with alcohol-containing rinses, and the toothpaste seemed to be a decent toothpaste. After about a month, however, I noticed brown stains appearing.  They began very slowly, but after 3 months I broke down and asked my colleague Sena to polish my teeth.  I went home, continued to sport my pearly whites, and after a month I began to see the stain returning!!! Disgusted with myself and feeling undeserving of a hygiene license, I switched back to my Arm & Hammer toothpaste.  The stains were gone in a week.

The Fiction:

I started to share my experience with other hygienists, and quickly found I was not the only one who had drawn this (not very scientific) conclusion.  I began to warn parents about Pro-Health when I would notice brown stains in my pedo patients.  I read an article or two about the staining online, and that solidified it in my mind: Pro-Health causes tooth discoloration. Period. The End.

My beliefs continued, unchallenged, until a few months ago. One of the docs at our practice, Dr. Gupta, was asking about brown staining in a patient she had seen recently.  Of course, I boldly told her about the evils of Pro-Health products.  She listened, and then said, "I would love to read more about this...can you please show me the articles you read that support this?"  Of course, I told her I would find them so she could see for herself. 

Now, I would really like to bend the truth and tell you I got back to her the following business day.  I really want to keep my site credible, however, so the truth is she had to ask me several times over the course of a month.  Her reminders finally broke through my mental fog and I researched my scientifically, peer-reviewed "facts".  I am hanging my head in shame as I tell you now: The only evidence I could find online was from websites with no peer review or credible citations.  Wow, that stung! I could hear my Master's professors in my head "always check the reliability and credibility of the literature you use.  The research must be peer-reviewed, and multiple corroborating sources should be referenced."  I sure hope none of them read this!!! What, then, are the facts about Crest Pro-Health and brown staining?

The Facts:

After the Pro-Health line debut in 2006, patients and professionals began to notice an increase in brown staining.  The stain was presumed to be from the use of Pro-Health products. After numerous reports to P&G about the staining, the company conceded one of the ingredients,  cetylpyridinium chloride (CPC), was found to cause staining in about 3% of its users during clinical trials. The staining, according to P&G, was a result of bacterial death in biofilm.  Unfortunately, the internet took off with the brown staining and it became nearly scandalous! It went as far as a class-action suit against P&G, which the filing law firm, Parker Waichman, reports was ultimately dismissed.

I was able to find several peer-reviewed studies and reports which corroborate P&G's claims that CPC is safe, and brown staining was observed in less than 5% of patients with a p value of 0.05 or less (that's good). I was unable to find any credible studies or reports linking any of the ingredients in Pro-Health products to brown staining in a significant percentage of patients. That does not mean there is no such research, but I was unable to find any Pub-Med, Scopus, or Google Scholar.  These are a few resources I found for you (and Dr.Gupta!) to check out for yourself:

https://www.nature.com/articles/4809913

https://onlinelibrary.wiley.com/doi/abs/10.1111/idh.12413

https://onlinelibrary.wiley.com/doi/abs/10.1034/j.1600-051x.2003.00342.x

https://onlinelibrary.wiley.com/doi/abs/10.1111/idh.12371 

The Take-Away:

Crest Pro-Health products may be responsible for brown staining in a small percentage of patients.  As for the care I provide, I am making a change.  When brown stain is present, I will remind parents that staining is not harmful to dental health.  I will ask about other possible causes of brown staining, such as excess iron, tea or coffee consumption, and medication use. If the mystery remains and the patient uses Pro-Health, I will advise the parents it may cause brown staining and I will gladly polish the stain off. 

What about you? What have you encountered as possible causes of brown staining? What do you think about Pro-Health? Let me know your experiences and give me your opinions and suggestions...it's a great way to learn and grow! ~ Janel

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