“…81 More recently, a toothpaste containing a mixture of the protease enzyme papain, alumina and sodium citrate has been described in the literature. Although an early clinical study showed no significant effect of this toothpaste on removing established extrinsic stain versus a placebo toothpaste, 82 further clinical studies have demonstrated the combination toothpaste to be effective at removing established stains, 83 more effective at removing established extrinsic stain than a tartar control toothpaste, 84 and more effective at removing chlorhexidine induced stain than a control toothpaste. 85 Phosphate materials, such as pyrophosphate, tripolyphosphate and hexametaphosphate, tend to have a strong binding affinity for enamel, dentine and tartar, and during adsorption they have been shown to desorb stain components.…”