The effectiveness of a toothpaste containing Triclosan and polyvinyl-methyl ether maleic acid copolymer in improving plaque control and gingival health. A systematic review

Effects of oral administration of Bifidobacterium animalis subsp. lactis HN019 on the treatment of plaque-induced generalized gingivitis

OBJECTIVES

This double-blind, randomized, placebo-controlled clinical trial evaluated the adjuvant effects of Bifidobacterium lactis HN019 on the treatment of plaque-induced generalized gingivitis.

MATERIALS AND METHODS

Sixty patients were submitted to professional supragingival scaling and prophylaxis. They were randomly assigned to test (probiotic lozenges containing B. lactis HN019, n = 30) or control (placebo lozenges, n = 30) groups. Lozenges were consumed twice a day for 8 weeks. Bleeding on probing (BoP), Gingival Index (GI), Plaque Index (PI), probing depth (PD), and clinical attachment level (CAL) were evaluated at baseline and after 2 and 8 weeks. Gingival crevicular fluid (GCF) was collected at baseline and at 8 weeks for analysis of the inflammatory mediators IL-1β, IL-1α, IL-8, MCP-1, and MIP-1β. Data were statistically analyzed (p < 0.05).

RESULTS

After 8 weeks, both groups showed reduction in the percentage of PI, with no significant difference between groups (p = 0.7423). The test group presented a lower percentage of BoP and a higher percentage of sites with GI ≤ 1 when compared with the control group at the end of the study (p < 0.0001). At 8 weeks, the test group had a greater number of patients without generalized gingivitis than the control group (20 and 11 patients, respectively; p < 0.05). The test group presented significantly lower levels of IL-1α, IL-1β, and MCP-1 in GCF than the control group at the end of the study (p < 0.05).

CONCLUSION

The adjunct use of B. lactis HN019 promotes additional clinical and immunological benefits in the treatment of generalized gingivitis.

CLINICAL RELEVANCE

B. lactis HN019 can be an efficient and side-effect-free adjunct strategy in the treatment of generalized gingivitis.

Effectiveness of Smart Applications of Oral Hygiene Instructions on Periodontal Health Compared to Oral Information: A Prospective Study

Nowadays, smartphone applications are widely used in different areas of life, including medical science. The present study aimed to assess the effectiveness of a smartphone application of oral hygiene instructions (OHI) on periodontal health compared to the traditional chairside OHI. All the participants (n = 39) were divided into two groups: control group and test group. Participants of the control group were given verbal OHI and participants of the test group were asked to use a smartphone application to upkeep their oral habits. The gingival index (GI) and Quigley-Hein Turesky modification index (QHTMI) were used for scoring the plaque accumulation at baseline and after one month of the periodontal treatment. A paired t-test and an independent t-test were performed to compare the mean of GI and QHTMI between intra-group and inter-group, respectively. The paired t-test showed significant differences in GI and QHTMI improvement after one month in both groups. Moreover, the independent t-test showed no significant differences between the two groups. However, the test group showed a lower mean score in GI and QHTMI assessments compared to the control group. Smartphone applications in oral health applications did not exhibit any superiority in periodontal health over the traditional OHI method in the current study.

Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

Halitosis, or bad breath, is an oral health problem characterized by an unpleasant malodor emanating from the oral cavity. This condition can have different origins and causes a negative burden in social interactions, communication and quality of life, and can in uncommon cases be indicative of underlying non-oral non-communicable diseases. Most cases of halitosis are due to inadequate oral hygiene, periodontitis and tongue coating, yet the remaining proportion of cases are due to ear-nose-throat-associated (10%) or gastrointestinal/endocrine (5%) disorders. For this reason, the diagnosis, treatment and clinical management of halitosis often require a multidisciplinary team approach. This comprehensive review revisits the etiology of halitosis as well as standard and novel treatment that may contribute to higher clinical success.

Antibacterial, remineralising and matrix metalloproteinase inhibiting scandium-doped phosphate glasses for treatment of dental caries

OBJECTIVES

Antibiotic resistance is increasingly a growing global threat. This study aimed to investigate the potential use of newly developed scandium-doped phosphate-based glasses (Sc-PBGs) as an antibacterial and anticariogenic agent through controlled release of Sc³⁺ ions.

METHODS

Sc-PBGs with various calcium and sodium oxide contents were produced and characterised using thermal and spectroscopic analysis. Degradation behaviour, ion release, antibacterial action against Streptococcus mutans, anti-matrix metalloproteinase-2 (MMP-2) activity, remineralisation potential and in vivo biocompatibility were also investigated.

RESULTS

The developed glass system showed linear Sc³⁺ ions release over time. The released Sc³⁺ shows statistically significant inhibition of S. mutans biofilm (1.2 log₁₀ CFU reduction at 6 h) and matrix metalloproteinase-2 (MMP-2) activity, compared with Sc-free glass and positive control. When Sc-PBGs were mounted alongside enamel sections, subjected to acidic challenges, alternating hyper- and hypomineralisation layers consistent with periods of re- and demineralisation were observed demonstrating their potential remineralising action. Furthermore, Sc-PBGs produced a non-toxic response when implanted subcutaneously for 2 weeks in Sprague Dawley rats.

SIGNIFICANCE

Since Sc³⁺ ions might act on various enzymes essential to the biological mechanisms underlying caries, Sc-PBGs could be a promising therapeutic agent against cariogenic bacteria.

Efficacy of adjunctive therapies in patients with gingival inflammation: A systematic review and meta-analysis

AIM

To evaluate the efficacy of adjunctive therapies in reducing gingivitis and plaque by means of a systematic review of randomized clinical trials (RCTs).

MATERIAL AND METHODS

A search protocol was designed to identify 6-month RCTs that investigated the efficacy of adjuncts to mechanical plaque control on gingivitis and plaque. Following screening, relevant information was extracted, and quality and potential risk of bias were estimated. Mean treatment differences were calculated to obtain standardized mean differences and weighted mean differences (SMD and WMD) as appropriate.

RESULTS

Meta-analyses included 70 studies of adjunctive antiseptics. Compared with mechanical plaque control alone, adjuncts yielded statistically significant reductions in gingival index (n = 72; SMD = -1.268; 95% CI [-1.489; -1.047]; p < .001; I²  = 96.2%), bleeding (%) (n = 26, WMD=-14.62%; 95% CI [-18.01%; -11.23%]; p < .001; I²  = 95.1%), plaque index (n = 93, SMD = -1.017; 95% CI [-1.194; -0.840]; p < .001; I²  = 95.3%) and plaque (%) (n = 23; WMD = -18.20%; 95% CI [-24.00%; -12.50%]; p < .001; I²  = 96.9%). Mouthrinses resulted in greater reductions in per cent plaque compared with dentifrices (meta-regression, coefficient = 13.80%; 95% CI [2.40%; 25.10%]; p = .020). The antiseptic agents were similarly effective in reducing gingivitis and plaque in patients with dental plaque-induced gingivitis (intact periodontium) or previously treated periodontitis with gingival inflammation.

CONCLUSION

Adjunctive antiseptics in mouthrinses and dentifrices provide statistically significant reductions in gingival, bleeding and plaque indices.

Toothpastes with Enzymes Support Gum Health and Reduce Plaque Formation

Enzymes in toothpastes can support host immune responses, and thus maintain oral health. This study aimed to investigate gingival health and the plaque-reducing effects of enzyme-containing toothpastes. A laboratory study tested the antimicrobial potential of different enzyme-containing toothpaste formulations. Two promising formulations (enzyme-containing toothpastes with glucose oxidase and D-glucose with (C+) and without Citrox (C-) Citrox) were investigated in a clinical crossover trial (two slurries: sodium lauryl sulfate-containing (SLS), a toothpaste without SLS (reference), and water). Subjects (n = 20) abstained from toothbrushing for four days and rinsed with a toothpaste slurry. Bleeding on probing (BOP) and plaque indices (PI) were measured. A mixed linear model was used to statistically compare the slurries with respect to BOP and PI change. The in vitro bacterial growth-inhibiting evaluation showed the best results for SLS, followed by C+ and C-. The change in BOP and PI exhibited statistically significant differences to water rinsing (BOP; PI changes in % points (difference of the baseline and post-rinse values: water = 8.8%; 90.0%; C+ = -1.4%; 80.4%; SLS = 1.5%; 72.1%; reference = 0.8%; 77.5%; C- = -1.8%; 75.1%). All slurries exhibited anti-gingivitis and anti-plaque effects, resulting in a prophylactic benefit for limited-access regions during brushing.

Comparative evaluation of efficacy of enzymatic toothpaste over standard fluoridated toothpaste in reduction of plaque and gingivitis

OBJECTIVES

To compare and evaluate the efficacy of enzymatic toothpaste v/s standard fluoridated toothpaste in reduction of plaque and gingivitis during maintenance phase after non-surgical periodontal therapy (NSPT).

MATERIALS AND METHODS

A total of 52 participants belonging to age 20-50 years eligible for inclusion were randomly chosen from the outpatient department. Computer-generated randomization was followed to recruit the subjects into two groups. 26 subjects were assigned to control group who were given with control toothpaste (standard fluoridated toothpaste), while 26 subjects were assigned to test group (enzymatic toothpaste) and given with test toothpaste. The amount of dental plaque and gingivitis were assessed baseline visit and at 6-week follow-up visit using Turesky-Gilmore-Glickman modification of the Quigley-Hein plaque index (TQHPI) 1970, Gingival Index (GI) - (Löe and Sillness 1963) and Full Mouth Bleeding Score (FMBS), respectively. Data analysis was done using IBM SPSS^® version 22.

RESULTS

Intergroup comparison of TQHPI, GI and FMBS among test and control group has shown that test group had statistically significant lower values than the control group at the follow-up visit. (p = 0.006*, p = 0.001*, p = 0.001*, respectively).

CONCLUSIONS

Within the limitations of our study, it can be concluded that test toothpaste has shown to be efficient than the previously set standard control fluoridated toothpaste in terms of reduction of plaque and gingivitis during maintenance phase after non-surgical periodontal therapy (NSPT).

Comparative Evaluation of Efficacy of 4% Tulsi Extract (Ocimum sanctum), Fluoridated and Placebo Dentifrices against Gingivitis and Plaque among 14-15 years School Children in Davangere City, India - A Triple Blinded Randomized Clinical Trial

Context:

Gingivitis is the most prevalent periodontal disease among adolescents. The most important factor associated with gingivitis is plaque accumulation. Mechanical plaque control through tooth brushing and mouth rinsing are the most commonly used preventive methods.

Aims:

This study aims to assess and compare the antiplaque and antigingivitis effect of 4% Tulsi leaf extract dentifrice, fluoridated and placebo dentifrice (PD) among 14–15-year-old school children in Davangere city.

Materials and Methods:

A triple blinded concurrent parallel trial. A sample of 84 participants with a baseline mean gingival index score of at least 1.0 and mean plaque index score of at least 1.5 were randomly selected. Participants were divided into three groups by block randomization and concealed random allocation method was used to distribute dentifrices. Postassessment of plaque and gingivitis was done on the 21^st day.

Statistical Analysis Used:

Wilcoxon signed rank test for within group comparison and Kruskal–Wallis ANOVA for intergroup comparison was used.

Results:

Significant reduction in the plaque and gingival scores between the groups was observed on the 21^st day (P = 0.001). Maximum reduction in gingivitis (P = 0.001) and dental plaque (P = 0.01) was seen in 4% tulsi dentifrice group compared to PD.

Conclusion:

Antiplaque and antigingivitis efficacy of 4% tulsi and commercially available fluoridated dentifrice remained the same after 21 days.

Effect of pH Cycling Followed by Simulated Toothbrushing on the Surface Roughness and Bacterial Adhesion of Bulk-fill Composite Resins

The aim was to evaluate, in vitro, quantitatively and qualitatively, the effect of pH cycling and simulated toothbrushing on surface roughness (Ra) and bacterial adhesion (Cn) of bulk-fill composite resins. Thirty specimens of each composite resin, 5 mm wide and 4 mm high, were obtained: group 1 (control): Filtek Z250 (Z250); group 2: Filtek Bulk-Fill (FTK); group 3: Tetric N-Ceram Bulk-Fill (TTC); and group 4: Aura Bulk-Fill (AUR). After 24 hours, the specimens were polished and then alternated with demineralization/remineralization solutions for 15 cycles of 24 hours each at 37°C. Then the specimens were submitted to simulated toothbrushing. The Ra and Cn measurements were quantitatively analyzed in three stages: after polishing (Ra0 and Cn0), after pH cycling (Ra1 and Cn1), and after simulated toothbrushing (Ra2 and Cn2). The Ra values were submitted to two-way analysis of variance, followed by the Tukey test (α=0.05). The Kruskal-Wallis test, followed by multiple comparisons, was applied for Cn analysis. Surface topography and bacterial adhesion were observed by scanning electron microscopy (SEM). Z250, FTK, and TTC showed no significant change in Ra regardless of the treatment performed; AUR obtained increased Ra at Ra2 (p&lt;0.05). FTK differed from the others at Cn0 and Cn1 (p&lt;0.05). At Cn2, there was no difference among the composite resins. SEM images showed the exposure of fillers and microcavities at Ra1 and Ra2. There was greater bacterial adhesion at Cn1 for Z250 and FTK. It was concluded that the pH cycling caused surface degradation of all composite resins, which was potentiated by simulated toothbrushing. However, only AUR presented an increased Ra. Bacterial adhesion occurred on all composite resins after pH cycling; however, after simulated toothbrushing, adhesion of dispersed bacteria was similar for all the composite resin groups.

What is the effect of active ingredients in dentifrice on inhibiting the regrowth of overnight plaque? A systematic review

Objectives

The aim of this systematic review was to establish the adjuvant clinical effect of brushing with a dentifrice containing purported active ingredients as compared to a regular sodium fluoride dentifrice with respect to the inhibition of overnight dental plaque regrowth from studies with human participants.

Methods

MEDLINE‐PubMed, EMBASE and Cochrane CENTRAL were searched, up to June 2019. The inclusion criteria were controlled clinical trials with participants aged ≥ 18 years in good general health. Studies were included that evaluated the effect of toothbrushing with a dentifrice on the inhibition of overnight dental plaque regrowth when an active ingredient was added to the dentifrice as compared to a common sodium fluoride product. Data were extracted from the eligible studies, the risk of bias was assessed, and a meta‐analysis was performed where feasible.

Result

Independent screening of 213 unique papers resulted in 10 eligible publications that provided 14 comparisons. Stannous fluoride and triclosan dentifrices were found as the active ingredients. The descriptive analysis indicated that all, but two comparisons demonstrated an additional effect on the active‐ingredient dentifrice. The meta‐analysis supported and strengthened these findings. It showed that when plaque was scored digitally, a DiffM was −3.15(95% CI [−4.61:‐1.69], P < .001, prediction interval [−5.07;‐1.24]). When plaque was scored clinically, the difference of means (DiffM) was −0.33(95% CI [−0.49:‐0.16], P < .001, prediction interval [−0.87; 0.21]).

Conclusion

The results of this review demonstrate moderate‐quality evidence that brushing with an active‐ingredient dentifrice with stannous fluoride or triclosan does provide an added clinically relevant effect concerning plaque inhibition capabilities that surpass the effect of a regular sodium fluoride dentifrice.

Plaque control and reduction of gingivitis: The evidence for dentifrices

This paper focuses on plaque control and the management of gingivitis in adults and summarizes the evidence of commercially available dentifrices as gathered from existing systematic reviews. Three internet sources were used to search for appropriate papers (up to and including February 2017). The search strategy was designed to include any systematic review published on dentifrices that also included an evaluation of plaque and gingivitis scores. Characteristics of the individual reviews, such as methodological aspects, quantitative data and conclusions, were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Independent screening of 205 unique reviews resulted in 10 published and eligible systematic reviews. One publication evaluated the mechanical contribution of dentifrice to plaque removal. Eight papers were identified that evaluated the efficacy of a proposed single active ingredients, of which two reviewed more than one potentially active ingredient. One study compared two active ingredients. This meta‐review appraised the current state of evidence and found that toothbrushing with a standard fluoride dentifrice does not provide an added effect for the mechanical removal of dental plaque. Evidence suggests that compared with a standard dentifrice, those containing triclosan or stannous fluoride have benefits with respect to gingival health and control of dental plaque.

Effects of a toothpaste containing 0.3% triclosan on periodontal parameters of subjects enrolled in a regular maintenance program: A secondary analysis of a 2-year randomized clinical trial

BACKGROUND

The triclosan-containing dentifrices are effective in controlling biofilm formation and maintaining gingival health; however, there is limited information on their effects during the periodontal maintenance phase. Therefore, the aim of this study was to evaluate the clinical effects of a toothpaste containing 0.3% triclosan on the periodontal parameters of subjects that have been treated for peri-implantitis and were enrolled in a regular maintenance program.

METHODS

Subjects presenting at least one implant with peri-implantitis and received surgical anti-infective therapy were selected. Sixty days post-surgery (baseline), subjects were randomized into two groups: (1) toothpaste containing 0.3% triclosan + 2.0% PVM/MA copolymer + 1450 ppm fluoride (test) or (2) toothpaste containing 1450 ppm fluoride (control), and were instructed to brush with the assigned toothpaste twice/day for 2 years. They received clinical monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months.

RESULTS

Eighty-eight subjects with natural teeth were enrolled in the study (Test, n = 39; Control, n = 49). The test group showed a greater reduction in the percentage of sites exhibiting bleeding on probing (primary outcome) and lower levels of plaque in comparison with the control group after 24 months (P < 0.05). The mean percentage of sites with probing depth ≥5 mm was reduced over the course of the study only in the test group (P < 0.05).

CONCLUSION

A toothpaste containing 0.3% triclosan was more effective than a regular fluoride toothpaste in improving the periodontal clinical condition around natural teeth of periodontally healthy subjects enrolled in a regular maintenance program for 2 years.

Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: A systematic review and network meta-analyses

AIM

The aim of this network meta-analysis (NMA) was to compare the efficacy of different oral hygiene products for chemical biofilm control, in 6-month home-use, randomized clinical trials (RCTs), in terms of changes in gingival index (GI).

MATERIAL AND METHODS

Six-month RCTs assessing GI were identified and screened for inclusion. Relevant information was extracted, and quality and potential risk of bias were estimated. Mean differences between baseline and end were calculated to obtain standardized mean differences (SMDs). NMA protocols were applied to assess direct and indirect comparisons among products using Löe & Silness GI, modified GI and gingival severity index.

RESULTS

Fifty-three papers were included, 19 studies for mouth rinses, 32 for dentifrices, comprising data from 5,775 and 2,682 subjects, respectively. When ranking treatments, similar results were observed for all tested dentifrices, with the lowest effect observed for sanguinarine and baking soda. For mouth rinses, essential oils, triclosan-copolymer, chlorhexidine (at concentrations ≥ 0.10%) and cetylpyridinium chloride (>0.05%) demonstrated the greatest effect.

CONCLUSION

Although NMA revealed significant differences when comparing placebo versus some active agents, when comparing among active agents, no differences were found for dentifrices, while mouth rinses containing essential oils showed the greatest effect on GI scores.

The efficacy of baking soda dentifrice in controlling plaque and gingivitis: A systematic review

OBJECTIVE

To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis.

MATERIALS AND METHODS

MEDLINE-PubMed and Cochrane-CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a meta-analysis was performed.

RESULTS

The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single-use design and 20 being evaluations with a follow-up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta-analysis of plaque scores from the single-brushing experiments showed that BS dentifrice (BS-DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM -0.20; P < 0.0001; 95% CI: [-0.27; -0.12]) or the positive control dentifrices (DiffM -0.18; P < 0.0001; 95% CI: [-0.24; -0.12]). This finding was only confirmed in studies that used a follow-up design as compared to a negative control (DiffM -0.19; P = 0.01; 95% CI: [-0.34; -0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (DiffM -0.08; P = 0.02; 95% CI: [-0.16; -0.01] and (DiffM -0.13; P < 0.001; 95% CI: [-0.18; -0.08]. However, for the gingival index scores, the meta-analysis did not reveal any significant differences.

CONCLUSION

BS-DF showed promising results with respect to plaque removal in single-use studies. However, the finding was partially substantiated in follow-up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product.

Nylon Bristles and Elastomers Retain Centigram Levels of Triclosan and Other Chemicals from Toothpastes: Accumulation and Uncontrolled Release

Triclosan (TCS), a broad-spectrum antimicrobial, is used in commercial toothpastes with reported dental benefits. Our studies on 22 popular manual toothbrushes in the U.S. showed that common toothbrush head components can accumulate substantial amounts of TCS after brushing with TCS-formulated toothpastes (TCS-TPs). After simulated 3-month brushing with a commercial best-selling TCS-TP, over one third of the adults' toothbrushes showed a cumulative TCS uptake of 21-37.5 mg, equivalent to 7-12.5 doses of the TCS used per brushing. Similar results were observed on children's toothbrushes with small pea-size heads. Elastomer components were found to be the main contributor while both nylon bristles and elastomers could act as absorptive sinks for TCS during brushing. Studies on six different TCS-TPs containing 0.3 wt% TCS showed similar profiles of TCS accumulation. The absorbed TCS was gradually released into toothpaste slurries after switching to TCS-free alternatives. Release of TCS, which typically measured at a fraction (<75%) of the standard dose using the TCS-TPs, continued for over 2 weeks and occurred most rapidly in peroxide-containing "whitening" toothpastes, followed by alkaline and surfactant-rich toothpastes. The accumulating effect was not exclusive to TCS but was commonly observed on several chemicals identified in TCS-TPs and a range of regular toothpastes.

Four-level evaluation of health promotion intervention for preventing early childhood caries: a randomized controlled trial

Background

Early childhood caries (ECC) is the most common dental disease among children, which can affect children’s primary teeth during their teething. This study evaluates an intervention for preventing early childhood caries in a pediatric population in Ahvaz, Iran.

Method

The population of this study (IRCT2017070210804N10) consists of 104 women with 12 to 36 months of age without dental caries referred to a health care center in Ahvaz, Iran. The children were randomly assigned to either an experimental or control group in equal numbers. First, the demographic information of participants was collected through a questionnaire containing components of perceived threat, health literacy, and oral health behaviors using a valid and reliable questionnaire. The ECC status of the children was established by a dentist. Control group received “standard well baby care”. The experimental group received standard well baby care in addition to educational interventions, including lecture and group discussion. After 6 months, the participant completed the questionnaire for the second time, and the children’s teeth were reexamined. Data were analyzed using SPSS version 15 at a significance level of p < 0.05.

Results

The mean ages of women and children were 31 ± 6.68 years and 18 ± 7.21 months, respectively. Before the intervention, no significant difference was documented between the groups for the study variables, p > 0.05. However, after the intervention, a significant difference was observed between the perceived threats (41.15 ± 4.46 in the experimental group and 38.26 ± 4.21 in the control group, p = 0.001), health literacy (20.98 ± 2.15 in the experimental group and 19.76 ± 2.70 in the control group, p = 0.01), oral health behaviors (7.75 ± 2.30 in the experimental group and 6.15 ± 2.65 in the control group, p = 0.01), and the incidence of ECC (13% in the experimental group and 35% in the control group,p = 0.001).

Conclusion

This intervention had positive effects on the perceived threat, health literacy, and health behaviors; and the intervention could reduce the incidence of ECC. The finding of this study provided a suggestion for evidence-based decision-making processes regarding ECCs prevention programs.

Trial registration

IRCT2017070210804N10 (retrospectively registered)

The effect of triclosan on posttranslational modification of proteins through citrullination and carbamylation

OBJECTIVES

The aim of this study was evaluate the effect of triclosan on citrullination and carbamylation, two important protein posttranslational modifications associated with inflammatory conditions such as periodontitis and rheumatoid arthritis.

MATERIALS AND METHODS

A range of triclosan concentrations were incubated in the presence of appropriate substrates used for the generation of either citrullinated or carbamylated proteins. The effect of triclosan on protein citrullination and carbamylation in macrophages was also assessed.

RESULTS

Citrullination and carbamylation were both significantly decreased by triclosan at concentrations six times lower than the 0.3% triclosan approved by the FDA to use in mouthwash and toothpaste. When macrophages were exposed to triclosan, carbamylation was significantly deceased (p = 0.01), and while citrullination also decreased, this reduction was not statistically significant (p = 0.06).

CONCLUSION

Triclosan reduced the generation of protein citrullination and carbamylation in vitro.

CLINICAL RELEVANCE

Triclosan may be useful as an adjunct therapy in the management of inflammatory periodontal diseases and help to reduce posttranslational protein modification citrullination and carbamylation) in these tissues.

Plaque Removal and Gingival Health after Use of a Novel Dental Gel: A Clinical Study

Background

Goal of this in vivo prospective, randomized, controlled, double-blinded, cross over study was to compare the level of plaque control and gingivitis after use of a novel dental gel (test) vs. A Triclosan/copolymer dentifrice (control).

Methods

After coronal polishing, 22 subjects with moderate gingivitis were randomly assigned to brush twice daily with test or control dentifrice for the first study Arm. Plaque, gingival and sulcus bleeding indices were recorded at baseline, week 2 and week 4. Professional coronal polishing was repeated, and then subjects brushed with the second dentifrice for 4 weeks. Clinical indices were again recorded at Baseline, week 2 and week 4. The effects of each dentifrice on clinical indices were compared using Student’s t-test.

Results

Brushing with the test gel produced significantly greater levels of plaque reduction versus the Triclosan/copolymer control dentifrice at each time point. 45% less plaque was measured after 4 weeks of test agent use than after control agent use (p<0.000000005). A significant reduction in gingival inflammation from test vs control agent over w\4 weeks was also observed (p=0.000342).

Conclusions

An activated edathamil dental gel formulation provides effective plaque control and reduced gingival inflammation compared to a Triclosan/Co-polymer dental gel. Practical Implications: A novel dental gel formulation that does not contain abrasives, detergents or antimicrobials may provide effective plaque control and support gingival health.

Efficacy of adjunctive anti-plaque chemical agents: a systematic review and network meta-analyses of the Turesky modification of the Quigley and Hein plaque index

AIM

The aim of this systematic review and network meta-analysis (NMA) was to compare the efficacy of different anti-plaque chemical agents, in 6-month, home-use, randomized clinical trials (RCTs), in terms of plaque index (PlI) changes.

MATERIAL AND METHODS

RCTs assessing PlI were identified, screened, and evaluated for inclusion. Relevant information was extracted, and quality and risk of bias were assessed. Mean differences between baseline-end were calculated to obtain weighted mean differences and 95% confidence intervals. NMA protocols were applied to assess direct and indirect comparisons among products using Turesky PlI.

RESULTS

Eighty-three papers were included: 49 examined dentifrices, 32 mouthrinses and 2 both. The NMA analysed 51 studies including data from 4242 and 4180 subjects for dentifrices and mouthrinses respectively. For dentifrices, triclosan-copolymer and chlorhexidine showed the greatest effect, with significant differences when compared with stannous fluoride. For mouthrinses, essential oils and chlorhexidine showed the greatest effect, with significant differences when compared with delmopinol, alexidine and cetylpyridinium chloride.

CONCLUSION

Within the limitations of this study (including the severe imbalance in the amount of evidence), dentifrices containing triclosan-copolymer or chlorhexidine and mouthrinses containing essential oils or chlorhexidine showed the greatest effect on PlI scores as assessed with NMA.

Eugenia uniflora Dentifrice for Treating Gingivitis in Children: Antibacterial Assay and Randomized Clinical Trial

Abstract School-age children are frequently at high risk for the onset of biofilm-dependent conditions, including dental caries and periodontal diseases. The objective of this study was to evaluate the clinical efficacy of a dentifrice containing Eugenia uniflora Linn. (Surinam cherry) extract versus a triclosan-based comparator in treating gingivitis in children aged 10-12 years. The in vitro antibacterial potential of the dentifrice was tested against oral pathogens (Streptococcus mutans, Streptococcus oralis and Lactobacillus casei). Then a phase-II clinical trial was conducted with 50 subjects aged 10-12 years, with clinical signs of gingivitis. The subjects were randomly assigned to the experimental group (n=25) and control group (n=25), in which participants used the experimental dentifrice and a triclosan-based fluoridated dentifrice (Colgate Total 12(r)), respectively. Clinical examinations assessed the presence of gingivitis (primary outcome) and biofilm accumulation (secondary outcome) using the Gingival-Bleeding Index (GBI) and Simplified Oral Hygiene Index (OHI-S), respectively, at baseline and after seven days of tooth brushing 3x/day. The data were analyzed using paired and unpaired t-test (GBI) and Wilcoxon and Mann-Whitney (OHI-S), with p≤0.05. The experimental dentifrice showed efficient antibacterial activity in vitro. In the clinical trial, a significant reduction in gingival bleeding was observed in both experimental and control groups (p<0.0001), with no statistical difference between them (p=0.178), although a small size effect was observed. Biofilm accumulation was only reduced in the control group (p=0.0039). In conclusion, E. uniflora dentifrice showed anti-gingivitis properties in children aged 10-12 years. Thus, it may be a potentially efficient and safe product to be used alternatively in preventive dental practice

Efficacy of adjunctive anti-plaque chemical agents in managing gingivitis: a systematic review and meta-analysis

AIM

The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials (RCTs).

MATERIAL AND METHODS

A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences (WMD) and 95% confidence intervals.

RESULTS

After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD -0.217), modified gingival index (n = 23, -0.415), gingivitis severity index (n = 26, -14.939%) or bleeding index (n = 23, -7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD -0.475), Silness & Löe (n = 26, -0.109), and plaque severity (n = 12, -23.4%) indices, with significant heterogeneity.

CONCLUSION

Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices.

Consumer products as sources of chemical exposures to children: case study of triclosan

PURPOSE OF REVIEW

Consumer products are often overlooked as sources of children's exposures to toxic chemicals. Various regulatory bodies have developed lists of chemicals of concern that can be found in products contacted by children. However, this information has not been summarized for health practitioners. This review organizes such chemicals and products into four categories, with the antibacterial agent triclosan used to illustrate the potential risks to children from a common ingredient in consumer products.

RECENT FINDINGS

Biomonitoring, house dust, indoor air, and product testing document children's exposures to a wide variety of chemicals. An increasing number of epidemiology studies have shown associations between these exposures and health effects in children. Triclosan is an example of a chemical contained in high contact products (e.g., soaps, lotions, and toothpaste) not necessarily designed for children. Triclosan exposure in children has been associated with increased responsiveness to airway allergens, with it also capable of endocrine disruption. However, the utility and necessity of this chemical in consumer products has not been demonstrated in most cases.

SUMMARY

Triclosan and the other examples provided show that a changing marketplace with little regulatory oversight of chemical uses can lead to unanticipated exposures and potential health risks to children.

Halitosis: Current concepts on etiology, diagnosis and management

Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view.

Triclosan antimicrobial polymers

Triclosan antimicrobial molecular fluctuating energies of nonbonding electron pairs for the oxygen atom by ether bond rotations are reviewed with conformational computational chemistry analyses. Subsequent understanding of triclosan alternating ether bond rotations is able to help explain several material properties in Polymer Science. Unique bond rotation entanglements between triclosan and the polymer chains increase both the mechanical properties of polymer toughness and strength that are enhanced even better through secondary bonding relationships. Further, polymer blend compatibilization is considered due to similar molecular relationships and polarities. With compatibilization of triclosan in polymers a more uniform stability for nonpolar triclosan in the polymer solid state is retained by the antimicrobial for extremely low release with minimum solubility into aqueous solution. As a result, triclosan is projected for long extended lifetimes as an antimicrobial polymer additive. Further, triclosan rapid alternating ether bond rotations disrupt secondary bonding between chain monomers in the resin state to reduce viscosity and enhance polymer blending. Thus, triclosan is considered for a polymer additive with multiple properties to be an antimicrobial with additional benefits as a nonpolar toughening agent and a hydrophobic wetting agent. The triclosan material relationships with alternating ether bond rotations are described through a complete different form of medium by comparisons with known antimicrobial properties that upset bacterial cell membranes through rapid fluctuating mechanomolecular energies. Also, triclosan bond entanglements with secondary bonding can produce structural defects in weak bacterial lipid membranes requiring pliability that can then interfere with cell division. Regarding applications with polymers, triclosan can be incorporated by mixing into a resin system before cure, melt mixed with thermoplastic polymers that set on cooling into a solid or alternatively applied as a coating through several different methods with dissolving into an organic solvent and dried on by evaporation as a common means.

Antibacterial activity of fluoride compounds and herbal toothpastes on Streptococcus mutans: an in vitro study

BACKGROUND

Streptococcus mutans is an important bacterial species implicated in dental caries. This laboratory study compared the antimicrobial activity of a number of fluoride containing and herbal dentifrices and their components against S. mutans.

METHODS

An agar diffusion method was used with Mueller-Hinton agar. Wells were filled with either 10 commercial fluoride or 6 herbal dentifrices, or with solutions of various fluoride compounds, sodium lauryl sulphate, sodium benzoate, chlorhexidine digluconate or triclosan. Diameters of zones of bacterial growth inhibition surrounding the wells were measured using a micrometer.

RESULTS

Significant differences were found for growth inhibition between the 10 fluoridated dentifrices (p < 0.0001), with Colgate Total having the greatest effect. There was not a direct correlation with fluoride type or fluoride concentration. The antibacterial activities of the 6 herbal toothpastes varied, with Herbal Fresh being the strongest. Sodium lauryl sulphate showed strong antimicrobial activity against S. mutans at the levels used in dentifrices.

CONCLUSIONS

Antimicrobial activity of commercial dentifrices against S. mutans may be exerted by components other than fluoride. Ingredients such as triclosan and sodium lauryl sulphate have larger antimicrobial effects than fluorides in this model.

Comparison of Antimicrobial Efficacy of Triclosan- Containing, Herbal and Homeopathy Toothpastes- An Invitro Study

BACKGROUND

Use of antimicrobial agents is one of the important strategies to prevent oral diseases. These agents vary in their abilities to deliver preventive and therapeutic benefits.

OBJECTIVES

This invitro study was conducted to assess antimicrobial efficacy of different toothpastes against various oral pathogens.

MATERIALS AND METHODS

A total of nine toothpastes in three groups were tested for their antimicrobial activity against Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923), Streptococcus mutans (ATCC 0266P) and Candida albicans (Laboratory Strain) by modified agar well diffusion method. Statistical Analysis was performed using Minitab Software. A p-value of less than 0.05 was considered significant.

RESULTS

Triclosan-based dental formulation with combination of fluoride (1000ppm) exhibited higher antimicrobial activity against test organisms than the combination of lower fluoride-concentration or sodium monofluorophosphate. Among herbal dentifrices, formulation containing Neem, Pudina, Long, Babool, Turmeric and Vajradanti showed significant antimicrobial activity against all the four tested microorganisms (p<0.05). However, against Streptococcus mutans, all three herbal products showed significant antimicrobial activity. Homeo products showed least antimicrobial activity on the tested strains. Formulation with kreosotum, Plantago major and calendula was significantly effective only against Streptococcus mutans.

CONCLUSION

In the present study, antimicrobial activity of the toothpaste containing both triclosan and fluoride (1000ppm) as active ingredients showed a significant difference (p< 0.05) against all four tested microflora compared to that of with lower fluoride-concentration or sodium monofluorophosphate. Of herbal groups, the only dentifrice containing several phytochemicals was found to be significantly effective and comparable to triclosan-fluoride (1000ppm) formulation. Thus, this herbal toothpaste can be used as alternative to triclosan-based formulations. However, these results might not be clinically useful unless tested invivo.

Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism

BACKGROUND

Conventional periodontal therapy aims at controlling supra- and subgingival biofilms. Although periodontal therapy was shown to improve periodontal health, it does not completely arrest the disease. Almost all subjects compliant with periodontal maintenance continue to experience progressive clinical attachment loss and a fraction of them loses teeth. An oral microbial transplant may be a new alternative for treating periodontitis (inspired by fecal transplant). First, it must be established that microbiomes of oral health and periodontitis are distinct. In that case, the health-associated microbiome could be introduced into the oral cavity of periodontitis patients. This relates to the goals of our study: (i) to assess if microbial communities of the entire oral cavity of subjects with periodontitis were different from or oral health contrasted by microbiotas of caries and edentulism patients; (ii) to test in vitro if safe concentration of sodium hypochlorite could be used for initial eradication of the original oral microbiota followed by a safe neutralization of the hypochlorite prior transplantation.

METHODS

Sixteen systemically healthy white adults with clinical signs of one of the following oral conditions were enrolled: periodontitis, established caries, edentulism, and oral health. Oral biofilm samples were collected from sub- and supra-gingival sites, and oral mucosae. DNA was extracted and 16S rRNA genes were amplified. Amplicons from the same patient were pooled, sequenced and quantified. Volunteer's oral plaque was treated with saline, 16 mM NaOCl and NaOCl neutralized by ascorbate buffer followed by plating on blood agar.

RESULTS

Ordination plots of rRNA gene abundances revealed distinct groupings for the oral microbiomes of subjects with periodontitis, edentulism, or oral health. The oral microbiome in subjects with periodontitis showed the greatest diversity harboring 29 bacterial species at significantly higher abundance compared to subjects with the other assessed conditions. Healthy subjects had significantly higher abundance in 10 microbial species compared to the other conditions. NaOCl showed strong antimicrobial properties; nontoxic ascorbate was capable of neutralizing the hypochlorite.

CONCLUSIONS

Distinct oral microbial signatures were found in subjects with periodontitis, edentulism, or oral health. This finding opens up a potential for a new therapy, whereby a health-related entire oral microbial community would be transplanted to the diseased patient.

Triclosan produces statistically significant reduction in plaque, gingivitis and caries but not clinically important benefit

DATA SOURCES

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and the US National Institutes of Health Trials Register.

STUDY SELECTION

Randomised controlled trials (RCTs) of parallel or crossover design, (with a sufficient wash-out period) of at least six months duration, and irrespective of language or publication status.

DATA EXTRACTION AND SYNTHESIS

Study assessment and data extraction were carried out independently by at least two reviewers. Meta-analysis was conducted using random-effects models when there were at least four studies (fixed-effect models when fewer than four studies), reporting mean differences (MD) for continuous data and risk ratios (RR) for dichotomous data.

RESULTS

Thirty studies involving 14,835 patients were included. Ten studies were considered to be a low risk of bias, nine at high risk and the remaining 11 were assessed as at unclear risk. After six to seven months use of triclosan/copolymer toothpaste there was a statistically significant reduction in plaque in favour of triclosan/copolymer of 22% (20 studies, 2675 patients, moderate-quality evidence).There was also a statistically significant reduction in plaque severity of 41% (13 studies, 1850 patients, moderate-quality evidence). Triclosan/copolymer toothpaste also reduced gingival inflammation statistically significantly by 22% after six to nine months of use (20 studies, 2743 patients, moderate-quality evidence). After 36 months of use there was no evidence of a difference between triclosan/copolymer toothpaste and control in the development of periodontitis (attachment loss) (RR 0.92, 95% CI 0.67 to 1.27, one study, 480 patients, low-quality evidence). After 24 to 36 months of use, triclosan/copolymer toothpaste slightly reduced coronal caries by about 5% (four studies, 9692 patients, high-quality evidence). One study (1357 patients, moderate-quality evidence) suggested that after 36 months of use triclosan/copolymer toothpaste probably reduced root caries.After six months of use triclosan/copolymer toothpaste may have reduced the mean total calculus by about 15%. There were no data available for meta-analysis regarding adverse effects, but 22 studies (73%) reported that there were no adverse effects caused by either the experimental or control toothpaste.There was considerable heterogeneity present in the meta-analyses for plaque, gingivitis and calculus. Plaque and gingivitis showed such consistent results that it did not affect our conclusions, but the reader may wish to interpret the results with more caution.

CONCLUSIONS

There was moderate-quality evidence showing that toothpastes containing triclosan/copolymer, in addition to fluoride, reduced plaque, gingival inflammation and gingival bleeding when compared with fluoride toothpastes without triclosan/copolymer. These reductions may or may not be clinically important, and are evident regardless of initial plaque and gingivitis levels, or whether a baseline oral prophylaxis had taken place or not.High-quality evidence showed that triclosan/copolymer toothpastes led to a small reduction in coronal caries. There was weaker evidence to show that triclosan/copolymer toothpastes may have reduced root caries and calculus, but insufficient evidence to show whether or not they prevented periodontitis. There do not appear to be any serious safety concerns regarding the use of triclosan/copolymer toothpastes in studies up to three years in duration.

Community-level assessment of dental plaque bacteria susceptibility to triclosan over 19 years

Background

Triclosan is a broad-spectrum antimicrobial agent used in toothpaste to reduce dental plaque, gingivitis and oral malodor. This community-level assessment evaluated the susceptibility of dental plaque bacteria to triclosan in samples collected over 19 years.

Methods

A total of 155 dental plaque samples were collected at eleven different times over 19 years from 58 adults using 0.3% triclosan, 2% copolymer, 0.243% sodium fluoride toothpaste and from 97 adults using toothpaste without triclosan. These included samples from 21 subjects who used triclosan toothpaste for at least five years and samples from 20 control subjects. The samples were cultured on media containing 0, 7.5 or 25 μg/ml triclosan. Descriptive statistics and p values were computed and a linear regression model and the runs test were used to examine susceptibility over time.

Results

Growth inhibition averaged 99.451% (91.209 - 99.830%) on media containing 7.5 μg/ml triclosan and 99.989% (99.670 - 100%) on media containing 25 μg/ml triclosan. There was no change in microbial susceptibility to triclosan over time discernible by regression analysis or the runs test in plaque samples taken over 19 years including samples from subjects using a triclosan-containing dentifrice for at least five years.

Conclusions

This community-level assessment of microbial susceptibility to triclosan among supragingival plaque bacteria is consistent with the long-term safety of a 0.3% triclosan, 2% copolymer, 0.243% sodium fluoride dentifrice.

Subinhibitory concentrations of triclosan promote Streptococcus mutans biofilm formation and adherence to oral epithelial cells

Triclosan is a general membrane-active agent with a broad-spectrum antimicrobial activity that is commonly used in oral care products. In this study, we investigated the effect of sub-minimum inhibitory concentrations (MICs) of triclosan on the capacity of the cariogenic bacterium Streptococcus mutans to form biofilm and adhere to oral epithelial cells. As quantified by crystal violet staining, biofilm formation by two reference strains of S. mutans was dose-dependently promoted, in the range of 2.2- to 6.2-fold, by 1/2 and 1/4 MIC of triclosan. Observations by scanning electron microscopy revealed the presence of a dense biofilm attached to the polystyrene surface. Growth of S. mutans in the presence of triclosan at sub-MICs also increased its capacity to adhere to a monolayer of gingival epithelial cells. The expression of several genes involved in adherence and biofilm formation in S. mutans was investigated by quantitative RT-PCR. It was found that sub-MICs of triclosan significantly increased the expression of comD, gtfC, and luxS, and to a lesser extent of gtfB and atlA genes. These findings stress the importance of maintaining effective bactericidal concentrations of therapeutic triclosan since sub-MICs may promote colonization of the oral cavity by S. mutans.

Triclosan/copolymer containing toothpastes for oral health

BACKGROUND

Periodontal disease and dental caries are highly prevalent oral diseases that can lead to pain and discomfort, oral hygiene and aesthetic problems, and eventually tooth loss, all of which can be costly to treat and are a burden to healthcare systems. Triclosan is an antibacterial agent with low toxicity, which, along with a copolymer for aiding retention, can be added to toothpastes to reduce plaque and gingivitis (inflammation of the gums). It is important that these additional ingredients do not interfere with the anticaries effect of the fluoride present in toothpastes, and that they are safe.

OBJECTIVES

To assess the effects of triclosan/copolymer containing fluoride toothpastes, compared with fluoride toothpastes, for the long-term control of caries, plaque and gingivitis in children and adults.

SEARCH METHODS

We searched the Cochrane Oral Health Group's Trials Register (to 19 August 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 7), MEDLINE via OVID (1946 to 19 August 2013), EMBASE via OVID (1980 to 19 August 2013), and the US National Institutes of Health Trials Register (clinicaltrials.gov) (to 19 August 2013). We applied no restrictions regarding language or date of publication in the searches of the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) assessing the effects triclosan/copolymer containing toothpastes on oral health.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the search results against the inclusion criteria for this review, extracted data and carried out risk of bias assessments. We attempted to contact study authors for missing information or clarification when feasible. We combined sufficiently similar studies in meta-analyses using random-effects models when there were at least four studies (fixed-effect models when fewer than four studies), reporting mean differences (MD) for continuous data and risk ratios (RR) for dichotomous data.

MAIN RESULTS

We included 30 studies, analysing 14,835 participants, in this review. We assessed 10 studies (33%) as at low risk of bias, nine (30%) as at high risk of bias and 11 (37%) as unclear. Plaque Compared with control, after six to seven months of use, triclosan/copolymer toothpaste reduced plaque by 0.47 on a 0 to 5 scale (MD -0.47, 95% confidence interval (CI) -0.60 to -0.34, 20 studies, 2675 participants, moderate-quality evidence). The control group mean was 2.17, representing a 22% reduction in plaque. After six to seven months of use, it also reduced the proportion of sites scoring 3 to 5 on a 0 to 5 scale by 0.15 (MD -0.15, 95% CI -0.20 to -0.10, 13 studies, 1850 participants, moderate-quality evidence). The control group mean was 0.37, representing a 41% reduction in plaque severity. Gingivitis After six to nine months of use, triclosan/copolymer toothpaste reduced inflammation by 0.27 on a 0 to 3 scale (MD -0.27, 95% CI -0.33 to -0.21, 20 studies, 2743 participants, moderate-quality evidence). The control group mean was 1.22, representing a 22% reduction in inflammation. After six to seven months of use, it reduced the proportion of bleeding sites (i.e. scoring 2 or 3 on the 0 to 3 scale) by 0.13 (MD -0.13, 95% CI -0.17 to -0.08, 15 studies, 1998 participants, moderate-quality evidence). The control group mean was 0.27, representing a 48% reduction in bleeding. Periodontitis After 36 months of use, there was no evidence of a difference between triclosan/copolymer toothpaste and control in the development of periodontitis (attachment loss) (RR 0.92, 95% CI 0.67 to 1.27, one study, 480 participants, low-quality evidence). Caries After 24 to 36 months of use, triclosan/copolymer toothpaste slightly reduced coronal caries when using the decayed and filled surfaces (DFS) index (MD -0.16, 95% CI -0.31 to -0.02, four studies, 9692 participants, high-quality evidence). The control group mean was 3.44, representing a 5% reduction in coronal caries. After 36 months of use, triclosan/copolymer toothpaste probably reduced root caries (MD -0.31, 95% CI -0.39 to -0.23, one study, 1357 participants, moderate-quality evidence). Calculus After six months of use, triclosan/copolymer toothpaste may have reduced the mean total calculus per participant by 2.12 mm (MD -2.12 mm, 95% CI -3.39 to -0.84, two studies, 415 participants, low-quality evidence). The control group mean was 14.61 mm, representing a 15% reduction in calculus. Adverse effects There were no data available for meta-analysis regarding adverse effects, but 22 studies (73%) reported that there were no adverse effects caused by either the experimental or control toothpaste.There was considerable heterogeneity present in the meta-analyses for plaque, gingivitis and calculus. Plaque and gingivitis showed such consistent results that it did not affect our conclusions, but the reader may wish to interpret the results with more caution.

AUTHORS' CONCLUSIONS

There was moderate-quality evidence showing that toothpastes containing triclosan/copolymer, in addition to fluoride, reduced plaque, gingival inflammation and gingival bleeding when compared with fluoride toothpastes without triclosan/copolymer. These reductions may or may not be clinically important, and are evident regardless of initial plaque and gingivitis levels, or whether a baseline oral prophylaxis had taken place or not. High-quality evidence showed that triclosan/copolymer toothpastes lead to a small reduction in coronal caries. There was weaker evidence to show that triclosan/copolymer toothpastes may have reduced root caries and calculus, but insufficient evidence to show whether or not they prevented periodontitis. There do not appear to be any serious safety concerns regarding the use of triclosan/copolymer toothpastes in studies up to three years in duration.

Aloe vera herbal dentifrices for plaque and gingivitis control: a systematic review

OBJECTIVES

To evaluate the effectiveness of aloe vera containing herbal dentifrices in improving plaque control and gingival health.

METHODS

A manual and electronic literature (MEDLINE and Cochrane Central Register of Controlled Trials) search was performed up to July 2012, for randomized controlled trials presenting clinical, microbiological, immunological, and patient-centered data for the efficacy of aloe vera herbal dentifrices for controlling plaque and gingival inflammation in patients with gingivitis.

RESULTS

From 79 titles and abstracts, eight full-text articles were screened and finally two randomized controlled trials were selected. These randomized controlled trials reported that aloe vera dentifrices were similar in efficacy to control dentifrices in effectively reducing plaque and gingival inflammation in gingivitis patients based on the assessment of clinical, microbiological, and patient-centered treatment outcomes. However, many important details (composition and characteristics of aloe vera and control dentifrices along with appropriate randomization, blinding, and outcomes assessed) were lacking in these trials, and therefore, the quality of reporting and methods was generally flawed with high risk of bias.

CONCLUSION

Even though there are some promising results, the clinical effectiveness of aloe vera herbal dentifrices is not sufficiently defined at present and warrants further investigations based on reporting guidelines of herbal CONSORT statement.

Extent and quality of systematic review evidence related to minimum intervention in dentistry: essential oils, powered toothbrushes, triclosan, xylitol

OBJECTIVE

To investigate extent and quality of current systematic review evidence regarding: powered toothbrushes, triclosan toothpaste, essential oil mouthwashes, xylitol chewing gum.

METHODS

Five databases were searched for systematic reviews until 13 November 2010.

INCLUSION CRITERIA

relevant to topic, systematic review according to title and/or abstract, published in English. Article exclusion criteria were based on QUOROM recommendations for the reporting of systematic review methods. Systematic review quality was judged using the AMSTAR tool. All trials included by reviews were assessed for selection bias.

RESULTS

119 articles were found, of which 11 systematic reviews were included. Of these, six were excluded and five accepted: one for triclosan toothpaste; one for xylitol chewing gum; two for powered toothbrushes; one for essential oil mouthwashes. AMSTAR scores: triclosan toothpaste 7; powered toothbrushes 9 and 11; xylitol chewing gum 9; essential oil mouthwashes 8. In total, 75 (out of 76) reviewed trials were identified. In-depth assessment showed a high risk of selection bias for all trials.

CONCLUSIONS

The extent of available systematic review evidence is low. Although the few identified systematic reviews could be rated as of medium and high quality, the validity of their conclusions needs to be treated with caution, owing to high risk of selection bias in the reviewed trials. High quality randomised control trials are needed in order to provide convincing evidence regarding true clinical efficacy.

Why should a doctor be interested in oral disease?

Oral health has been implicated in systemic disease throughout the ages; however, the understanding of the relationship between oral disease and systemic diseases such as cardiovascular disease and Type 2 diabetes mellitus is still emerging today. Chronic periodontal disease is widespread in the general population and a significant proportion of adults suffer from the most severe form of the disease. Dental plaque biofilm is necessary for the development of chronic periodontal disease with genetic and environmental factors contributing towards the pathogenesis. The putative biological mechanisms of the association between oral disease and atherogenesis are discussed, although there is insufficient evidence to establish causality at this time. Regardless of a direct causal relationship between oral disease and cardiovascular disease, treatment of oral disease leads to both a reduction in the systemic inflammatory burden as reflected in inflammatory markers and an improvement in endothelial function and hence improved overall health outcomes. A brief overview of periodontal disease including etiology, pathogenesis, screening and therapeutic implications is presented.

Assessment of antimicrobial susceptibility of Enterococcus faecalis isolated from chronic periodontitis in biofilm versus planktonic phase

BACKGROUND

Enterococci are often associated with chronic and recurrent infectious diseases because of their antimicrobial resistance. The aim of this study is to assess antimicrobial susceptibility of Enterococcus faecalis in chronic periodontitis.

METHODS

Antimicrobial susceptibility was determined on 23 E. faecalis strains isolated from patients with chronic periodontitis. Ampicillin, erythromycin, gentamicin, tetracycline, triclosan, and vancomycin were prepared in two-fold serial dilution up to 8,192 μg/mL. Enterococcal biofilm was established by a biofilm device and observed by confocal laser microscopy and scanning electron microscopy. The minimum inhibitory concentration (MIC), minimum biofilm inhibitory concentration, and minimum biofilm eradication concentration were determined by spectrophotometer at optical density(650).

RESULTS

A few patches of monolayer early biofilm were observed on the surfaces of biofilm device pegs. The colony-forming units of biofilm per peg were 1.2 × 10(3) to 1.7 × 10(4) and 0 to 20 post-triclosan treatment. The MIC(50) was higher than the MIC epidemiologic cut-off for tetracycline and the MIC(90) was higher than the cut-off for erythromycin and tetracycline, respectively. In biofilm, minimum biofilm eradication concentrations were extremely high for all of the drugs except triclosan.

CONCLUSIONS

The E. faecalis strains of chronic periodontitis exhibited weak biofilm formation ability at the early stage. Over 50% of the strains were resistant to tetracycline, and a few strains were highly resistant to erythromycin or gentamicin. E. faecalis cells in biofilm were hardly eradicated by most of the agents, even in high concentrations. Triclosan was effective in inhibiting E. faecalis growth in both biofilm and planktonic phase.

Clinical assessment and management of the oral environment in the oncology patient

The dental care of oncology patients is an important component of general dental practice. Oncology patients have additional requirements for their outpatient care in the dental office. Intense involvement of the general dental practitioner in the patient's overall plan of care is essential so that appropriate preventive and therapeutic strategies are followed prior to chemotherapy, radiation and other medical treatments. This paper provides an overview of the role of the dental practitioner in the pre-treatment workup and post-treatment maintenance of oncology patients, and discusses the complications which occur during the intensive and in-hospital phases of care, in the context of approaches that show promise for reducing or preventing these. The role of the general dental practitioner in the maintenance of oral health for the remainder of the patient's life is stressed, with evidence-based recommendations given for optimal use of home care products which support oral health and improve quality-of-life.

Powered toothbrush plus triclosan only as effective as manual brush and fluoride toothpaste for periodontal maintenance patients

DESIGN

This randomised, controlled and single-masked clinical trial was carried out in specialist clinics in Sweden and the US.

INTERVENTION

The test group were instructed to use an rotation-oscillation action (ROA) powered toothbrush (Oral-B; Gillette, Boston, Massachusetts, USA) and a triclosan/ copolymer/ fluoride-containing dentifrice (Total; Colgate, Piscataway, New Jersey, US). The control group were instructed to brush using the modified Bass technique and a conventionally designed, multitufted, soft, manual toothbrush using a standard fluoride-containing dentifrice (Protection Caries; Colgate). Both groups were to brush twice a day and clean interdentally daily with dental floss, toothpicks and/ or interdental brushes.

OUTCOME MEASURE

Measurements were taken at baseline, and 1, 2 and 3 years for the following parameters: number of teeth, plaque, bleeding on probing (BoP), probing pocket depth (PPD) and level of the gingival margin (GM). GM was assessed as the distance between the soft tissue margin and the cemento-enamel junction or the border of a restoration. Relative attachment level (RAL) was calculated as PPD minus GM. Subgingival plaque samples were taken and analysed for their content of 40 bacterial species at each examination interval.

RESULTS

Both groups showed significant reduction in BoP, PPD and in mean total counts of the 40 bacterial species between baseline and 3 years, whereas plaque score and RAL remained almost unchanged. No significant differences between the two prevention programmes were found for any of the clinical outcome variables or in mean counts of the various bacterial species.

CONCLUSIONS

The study failed to demonstrate superior clinical and microbiological effects of powered toothbrush and triclosan dentifrice compared with manual toothbrush and standard fluoride-dentifrice in periodontitis-susceptible subjects undergoing regular maintenance therapy.