Volume 9, Issue 6, June – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24JUN1754

Potency of Strawberry Extract (Fragaria X

Annanassa) as Stain Removal Strips Against Extrinsic
Stain on the Surface of the Teeth of Adolescents
Aged 18-25 Years
Elmalia Fitri1* Ari Suwondo2*
1 2
Oral Health Therapist, Postgraduate Program, Oral Health Therapist, Postgraduate Program,
Health Polytechnic of Semarang Ministry of Health, Health Polytechnic of Semarang Ministry of Health,
Indonesia Indonesia

Supriyana3* Emma Kamelia4*

3 4
Oral Health Therapist, Postgraduate Program, Oral Health Therapist,
Health Polytechnic of Semarang Ministry of Health, Health Polytechnic of Tasikmalaya Ministry of Health,
Indonesia Indonesia

Abstract:- Extrinsic stain is a staining of teeth that is moderate extrinsic stains and 32% were known to have a
attached directly to the surface of the tooth. Disorders smoking habit [3].
caused by stains are causing aesthetic problems that can
have a considerable psychological impact, especially if Extrinsic stains are dental stains that adhere directly to
they occur in the anterior tooth. Stains are difficult to the tooth surface [4]. The problem caused by stains is
clean just by brushing your teeth. Utilizing natural aesthetic problems. Stains on teeth can cause aesthetic
strawberry ingredients as Stain Removel Strips for an problems that can have a considerable psychological impact,
alternative to cleaning extrinsic stains on the surface of especially if they occur on the anterior teeth [5].
teeth. Objective: Proven administration of Stain Removal
Strips strawberry extract (Fragaria x Ananassa) Products for cleaning or removing extrinsic dental stains
effectively cleans extrinsic stains on the surface of teeth. include: available in the form of solutions, gels, sheets or
Method: This study used the Quasy experimental method strips, and toothpastes containing chemicals. The more
with a pretest posttest design with control group. commonly used chemical is hydrogen peroxide. The adverse
Research sampling was carried out by purposive side effects of these materials on teeth are teeth become
sampling. The sample consisted of 20 people divided into sensitive to stimuli, inflammation of the gums, sore throat,
2 groups. The control group with 6% hydrogen peroxide stinging of the mucosa, changes in the morphology and
strips and the intervention group with 40% strawberry texture of the enamel surface such as increasing the porosity
extract stain removal strips twice a day with a duration of of the tooth enamel surface, demineralization and decreasing
30 minutes for 7 days. Results: The results showed that the concentration of protein, organic matrix, calcium, and
giving strawberry extract Stain Removal Strips was 40% phosphate, and even loss of calcium in the teeth [6,7,8].
effective in cleaning extrinsic stains on day 3 and day 7
against extrinsic stains on the tooth surface with values of Reducing the negative effects caused by chemicals
p = 0.009 and p = 0.002 (p < 0.05) compared to the control requires natural ingredients that do not cause harmful negative
group. Conclusion: Stain Removal Strips 40% strawberry effects on teeth and oral cavity. One of them is by utilizing
extract has potential as an alternative to cleaning strawberries, when compared to other fruits such as tomatoes
extrinsic stains on tooth surfaces. and lemons, strawberries have superior teeth cleaning
properties [9].
Keywords:- Strawberry Extract; Extrinsic Stain; Stain
Removal Strips. Strawberry fruit (Fragaria X annanassa) is a natural
material that contains elegic acid and malic acid compounds
I. INTRODUCTION which are equivalent to 35% carbamide peroxide in removing
extraneous staining on the tooth surface. So it has the potential
Riskesdas data in 2018 stated that the percentage of daily as an alternative material to remove stains on the tooth surface
smokers aged 20-24 years was 27.3% with an average of 12 [10]. Based on the description of the problem, a study was
cigarettes per day [1]. Smoking habits can affect the formation conducted on the utilization of strawberry extract as stain
of dental stains (tooth stains) [2]. A study showed 47 removal strips with the aim of knowing its effectiveness in
respondents aged 25 years and over as many as 62% had

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Volume 9, Issue 6, June – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24JUN1754

removing extrinsic stains on the surface of the teeth of the chemical and biological analysis laboratory of Cendikia
adolescents aged 18-25 years. Nanotech Hutama Semarang. then the extract is processed
into stain removal strips by requiring analytical scales, film
II. METHODS molds, magnetic stirrers, hot plates, digital micrometers,
micropipettes, ovens, weighing bottles, incubators, cutters,
This study is a type of quasi experiment (pretest-posttest scissors, rulers, pH meters. at this stage the materials needed
with control group design) with the target of adolescents 18- are: Strawberry extract (Fragaria x Ananassa), Glycerin,
25 years old and considering the smoking history factor as a Polyvinypyrrolidone (PVP), Hydroxypropyl Methyl Cellulose
confounding variable. This study was conducted after (HPMC), Aquadest with the following formula:
obtaining a research permit and the issuance of Ethical
Clearance from the Poltekkes Kemenkes Semarang with No. Table 1. Formula of Strawberry Extract Stain Removal Strips
0959/EA/KEPK/2023. This study was conducted in August Material Usability Formula
2023 in West Kandangan Village, Kandangan City, Hulu Strawberry extract Active substance 4 grams
Sungai Selatan Regency, South Kalimantan Province. HPMC Polymers 2.1 grams
Glycerin Plasticizer 1.5 grams
This study was conducted in 2 groups, namely the PVP Polymers 0.9 grams
intervention group giving 40% strawberry extract Stain
Aquadest Solvent 30.0 grams
Removal Strips and the control group giving 6% Hydrogen
Peroxide Strips. Research observations were made on day
seven and day three of extrinsic stains on 8 teeth, namely III. RESULTS AND DISCUSSION
maxillary front teeth 1.2, 1.1, 2.1, 2.2, and mandibular 4.2,
4.1, 3.1, 3.2 which were seen on the labial surface. Before testing the effectiveness of the stain removal potential
Measurement of extrinsic stains was carried out using the LSI of strawberry strips, organoleptic tests and pH tests were
(Lobene Stain Index) method. The total number of carried out to determine the physical assessment and acidity
respondents was 20. During the study, there were no dropouts. of the strawberry strips developed. Based on this study, the
In the manufacture of strawberry extract with a concentration color produced is golden brown, with a distinctive aroma of
of 40%, the ingredients needed are strawberries as much as 1 strawberry, and a sticky chewy texture (table 2). This is due to
kg, 70% ethanol and water. as for the tools needed are the content of PVP, where PVP is hygroscopic, which can
blenders, ovens, scales, sieving materials, maceration bind water, so that the resulting 40% strawberry extract Stain
containers and stirrers in the process of making extracts, Removal Strips are slightly moist and sticky [11].
filters, funnels, rotating vacuum evaporators, sterile Organoleptic results show that strawberry extract Stain
containers, and aluminum foil which are all tools obtained at Removal Strips are physically stable.

Table 2: Organoleptic Test Results of Strawberry Extract Stain Removal Strips.

Variables Color Aroma Texture Taste
Stain Removal Strips 40% strawberry
extract Golden brown Typical (strawberry aroma) Chewy (sticky) Acid

pH measurement is an important physicochemical indicator, and the pH of the 40% strawberry extract Stain
parameter in topical preparations because pH is related to the Removal Strips in this study was 4 (Table 3). The critical pH
effectiveness of the active substance, the stability of the active limit of tooth enamel is between 5.2 and 5.5 [12]. Tooth
substance and preparation, and comfort during use. Surface enamel will erode when it reaches a critical pH of 5.5 This pH
pH is measured to determine the amount of pH that will be is a pH that is considered critical to cause enamel solubility so
exposed to the teeth when Stain Removal Strips 40% that erosion occurs [13]. Thus, the pH resulting from this
strawberry extract is applied, so that potential side effects can study is still below the critical pH so it is necessary to control
be estimated. The surface pH of the 40% strawberry extract the pH within the critical pH range.
Stain Removal Strips was measured using a universal pH

Table 3. pH test of Strawberry Extract Stain Removal Strips

Variables Results
Stain Removal Strips 40% strawberry extract 4

Stains are a problem often experienced by smokers and persistent and become a habit that is considered normal as you
caffeine addicts. Stains can damage the aesthetic value of grow older in adulthood. So that from the smoking habit, a
teeth. Stain can unite with plaque and tartar. In this study, the stain will form on the surface of the teeth. Reinforced from
characteristics of the majority of respondents were 25 years previous research says the average age of respondents 25
old with a smoking frequency of ≤6 cigarettes per day (Table years and over as many as 62% have extrinsic stains in the
4), this is because at that age the formation of smoking habits moderate category and known smoking frequency in the mild
was initiated by the influence of socialization in the category [3].
community. Continuous repetition will make this behavior

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Volume 9, Issue 6, June – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24JUN1754

Table 4. Distribution of Respondents by Frequency of Smoking in a Day

Frequency of Smoking in a Day (cigarettes) Group
Intervention Control
n % n %
≤6 5 50 7 70
7-12 3 30 1 10
>12 2 20 2 20

From the use of 6% hydrogen peroxide strips in the treatment has a mean of 1.104 and after day 3 has a mean of
control group and the use of 40% strawberry stain removal 0.625 and day 7 with a mean of 0.199. In the control group,
strips developed, the average value of changes in the value of the decrease in extrinsic stains before treatment had a mean of
stains on respondents was obtained. In the intervention group, 0.321 and after day 3 had a mean of 0.158 and day 7 with a
namely the use of 40% strawberry extract Stain Removal mean of 0.068 (Figure 1).
Strips, which means a decrease in extrinsic stains before

Fig 1. Mean Reduction of Extrinsic Stains in Control and Intervention Groups.

Based on these data, the effectiveness of giving 40% variables on the teeth in the control group on day 3 and day 7
strawberry extract Stain Removal Strips and 6% Hydrogen with a P- Value of 0.002 and 0.002 (P <0.05) means that 6%
Peroxide Strips on extrinsic dental stains was tested. It is Hydrogen Peroxide Strips effectively remove extrinsic stains
known from the results (table 5), that the results of the paired on the surface of the teeth on day 3 and day 7. It can be
data test of the extrinsic stain variable of the intervention concluded that the administration of the two strips above are
group on day 3 and day 7 with a P-Value of 0.001 and 0.005 equally effective in removing extrinsic stains on the tooth
(P <0.05) mean that 40% strawberry extract Stain Removal surface because the paired data test for each group shows a
Strips are effective in removing extrinsic stains on the tooth significant difference due to (p <0.05).
surface on day 3 and day 7. Paired data test of extrinsic stain

Table 5. Effectiveness Test of 40% Strawberry Extract Stain Removal Strips and 6% Hydrogen Peroxide Strips against Dental
Extrinsic Stains
Group Mean ± SD P-Value
Before 1,104 ± 0,715
0,001**
Day 3 0,625 ± 0,507
Intervension
Before 1,104 ± 0,715
Day7 0,199 ± 0,268 0,005*
Group Mean ± SD P-Value
Before 0,312 ± 0,209
0,002**
Day 3 0,158 ± 0,138
Control
Before 0,312 ± 0,209
0,002**
Day 7 0,068 ± 0,065
* Uji Statistik: Wilcoxon
** Uji Statistik: Paired Sample Test

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Volume 9, Issue 6, June – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24JUN1754

The results of the unpaired data test to see the difference research conducted by Farida et al (2023) strawberry extract
between the use of 40% strawberry extract Stain Removal (Fragaria x annanassea) 25% and 45% effective as an
Strips and 6% Hydrogen Peroxide Strips on extrinsic dental alternative material for cleaning extrinsic stains [14].
stains (Table 6). Shows that the use of 40% strawberry extract Similarly, research conducted by Juanita et al (2019), this
Stain Removal Strips compared to 6% Hydrogen Peroxide study shows after treatment with Strawberry gel (Fragaria X
Strips on day 3 and day 7 resulted in a P-Value <0.05. Giving annanassa) 10% on day 3, day 7 to day 12. The observation
Stain Removal Strips 40% strawberry extract is effective in results that Strawberry gel (Fragaria X annanassa) 10% can
removing extrinsic dental stains compared to 6% Hydrogen brighten the color of the teeth even though it cannot restore
Peroxide Strips on day 3 and day 7, this is in line with the brightness of the color to the baseline [15].

Table 6. Analysis of Differences Between the Intervention Group and the Control Group on Changes in Dental Extrinsic Stains
Observation time Intervention Control P- Value
Mean(Δ) ± SD Mean(Δ) ± SD
Before- 3 0,479 ± 0,154 ± 0,009
days (Δ) 0,306 0,117
Before- 7 0,905 ± 0,244 ± 0,002
days (Δ) 0,497 0,172

Strawberries, with their ellagic acid and malic acid extrinsic stain score on the tooth surface by 0.479 within 3
content, have the potential to remove extrinsic stains on teeth. days and 0.905 within 7 days.
The concentration of elagic acid and malic acid in
strawberries is believed to play an important role in whitening IV. SUMMARY
and cleaning teeth, with the oxidation reaction that occurs in
elagic acid damaging the extrinsic staining molecules in teeth. Strawberry extract as Stain Removal Strips proved to be
Malic acid also contributes by oxidizing the tooth surface and effective in removing extrinsic stains on the surface of the
removing stains. In addition, malic acid and elagic acid in teeth as evidenced by Stain Removal Strips 40% strawberry
strawberries work to remove staining by destroying double extract (Fragaria X annanassa) proven to remove extrinsic
bonds in conjugate bonds, oxidizing other chemical stains on the surface of the teeth for 7 days by going through
components, and generating H+ radicals, which can change an oxidation reaction where malic acid and elagic acid will
the color of tooth enamel to a lighter shade. release electrons which will then bind to the extrinsic staining
of the teeth to damage the molecules of the extrinsic staining,
The main ingredients in strawberries that play a role in thus causing the effect of cleaning the extrinsic stain. Stain
cleaning extrinsic stains are malic acid and elagic acid. In Removal Strips 40% strawberry extract (Fragaria X
addition, compounds such as flavonoids, tannins, and annanassa) is feasible to use as an alternative treatment for
catechins also contribute to reducing extrinsic stain formation cleaning extrinsic stains on the tooth surface as evidenced by
on teeth by denaturing bacterial cell proteins, inhibiting the the results of the organoleptic test showing that strawberry
attachment of Streptococcus mutans bacteria, and inhibiting extract Stain Removal Strips are physically stable, namely
dental plaque formation. The pH factor also plays an golden brown in color, with a distinctive aroma of
important role, with strawberry extract having a low pH (pH strawberries, and a chewy texture.
3-4) aiding in the erosion of stains on the tooth enamel
surface, resulting in whiter looking teeth. Research shows that ACKNOWLEDGMENT
strawberry extracts, with high acidity and low pH, are
effective in removing extrinsic stains on teeth without Thank you to all respondents who have participated in
changing the surface characteristics of the teeth. The factors this study. Thank you to the chemical and biological analysis
of material concentration and application time also affect the laboratory of Cendikia Nanotech Hutama Semarang who has
success in removing extrinsic staining of teeth, with high helped in the implementation and smooth running of this
concentration and regular use can provide better results in a research
shorter time.
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