950 Bali Medical Journal 2022; 11(2): 950-952 | doi: 10.15562/bmj.v11i2.3511 ORIGINAL ARTICLE ABSTRACT Whitening Efect of Manalagi Apple (Malus sylvestris) Extract on Tea-Induced Tooth Discoloration Nadia Hardini 1 , Rahmania Alikhlash 1 , Dwi Retnoningrum 2 , Edward Kurnia Setiawan Limijadi 2* Introduction: Tooth discoloration is a change in color that occurs on the enamel and dentin surfaces of a tooth due to the habit of drinking tea. Some fruits are used as natural teeth whitening ingredients, such as Manalagi Apple (Malus sylvestris), which contains malic acid. Method: This study was an experimental study with a pre-and post-test control group design involving 27 samples divided into three groups, Control (K), P1, and P2. We immersed tooth samples from three groups in tea solution for two weeks. After that, the P1 group was immersed with 50% Manalagi Apple extract three times a day for one week and the P2 group three times a day for two weeks, while the Control group (K) did not get any treatment. We analyzed the tooth discoloration before and after immersing 50% of Manalagi Apple extracts utilizing a Colorimeter, with hunter L, a, and b color scales. The color diference value was obtained using the formula of ⧍E(Lab) = [(L) 2 +(a) 2 +(b) 2 ] 1/2 ]. Results: The ANOVA test results showed signifcant diferences between the three sample groups (p = 0.00). Besides, the Post-hoc test revealed a signifcant diference between the K group and the P1 group with a p-value of 0.00 (p <0.05). It also indicated a signifcant diference between the K group and the P2 group with a p-value of 0.00 (p <0.05). Conclusions: Color changes occurred after immersing the teeth in Manalagi Apple extract for one and two weeks. Immersing the teeth for two weeks caused whiter teeth compared to immersing the teeth for one week. Keywords: Manalagi Apple, Malic Acid, Discoloration, Tooth Whitening. Cite This Article: Hardini, N., Alikhlash, R., Retnoningrum, D., Limijadi, E.K.S. 2022. Whitening Efect of Manalagi Apple (Malus sylvestris) Extract on Tea-Induced Tooth Discoloration. Bali Medical Journal 11(2): 950-952. DOI: 10.15562/bmj. v11i2.3511 1 Department of Dentistry, Faculty of Medicine, Diponegoro University, Prof. Soedarto Semarang, 50275, Indonesia; 2 Department of Clinical Pathology, Faculty of Medicine, Diponegoro University, Prof. Soedarto Semarang, 50275, Indonesia; *Corresponding author: Edward Kurnia Setiawan Limijadi; Department of Clinical Pathology, Faculty of Medicine, Diponegoro University, Prof. Soedarto Semarang, 50275, Indonesia; edwardksl@fk.undip.ac.id Received: 2022-05-28 Accepted: 2022-07-04 Published: 2022-08-22 950 Bali Medical Journal (Bali MedJ) 2022, Volume 11, Number 2: 950-952 P-ISSN.2089-1180, E-ISSN: 2302-2914 Open access: www.balimedicaljournal.org INTRODUCTION Te change in color of the teeth is commonly referred to as tooth discoloration. Tooth discoloration in enamel or dentin anterior teeth may cause discomfort. 1 Several factors can cause tooth discoloration, one of which is the continued consumption of drinks that can change teeth’ color, like tea. Tis habit will eventually cause an aesthetic disorder for the patients. 2 Tea is enriched with bioactive substances and has a chromogenic efect that contributes to tooth discoloration. 3 Tannin compounds found in tea can lead to the deposition of brown stains on the teeth’ surface. Te stain level that tea provides on the teeth surface is more than cofee’s stain level due to the lower acidity (pH). 4 Te low acidity (pH) causes changes in the external teeth’ color, unlike the neutral and high acidity. Te degree of acidity (pH) can also induce surface roughness on the teeth surface, allowing food stains to penetrate the tooth surface and cause signifcant extrinsic discoloration. 5 Natural ingredients such as fruit can be used as an alternative treatment to overcome tooth discoloration because it does not cause side efects and is more afordable. Apples are a fruit that grows in many subtropical regions, especially in Indonesia. Various kinds of apples frequently found in Indonesia include Rome Beauty Apples, Anna Apples, and Manalagi Apples (Malus sylvestris), which are economical and enriched with high nutritional substances. Apples also contain malic acid, which is vital in producing mitochondrial ATP. Tis substance is also an efective chelating agent, capable of binding and deactivating some toxic metals. Malic acid is a carboxylic acid group that can whiten the teeth by oxidizing the enamel to become neutral and has a whitening efect. 6,7,8 A similar study was previously carried out by Nuzulya Puspasari in 2012 using apple juice as a tooth whitening agent afer immersing the tooth sample in cofee solution. 9 No study has analyzed Manalagi Apple extract as an alternative tooth whitening agent in tea-induced tooth discoloration. Tea is one of Indonesian people’s most frequently consumed drinks that can cause teeth to stain more than cofee. Terefore, the authors were interested in researching this matter. METHOD Tis study was an experimental study with a pre-and post-test control group design. We conducted this study in the Integrated Laboratory of the University of Diponegoro, Semarang, from January