A randomised clinical study to determine the effect of a toothpaste containing enzymes and proteins on plaque oral microbiome ecology

The numerous species that make up the oral microbiome are now understood to play a key role in establishment and maintenance of oral health. The ability to taxonomically identify community members at the species level is important to elucidating its diversity and association to health and disease. We report the overall ecological effects of using a toothpaste containing enzymes and proteins compared to a control toothpaste on the plaque microbiome. The results reported here demonstrate that a toothpaste containing enzymes and proteins can augment natural salivary defences to promote an overall community shift resulting in an increase in bacteria associated with gum health and a concomitant decrease in those associated with periodontal disease. Statistical analysis shows significant increases in 12 taxa associated with gum health including Neisseria spp. and a significant decrease in 10 taxa associated with periodontal disease including Treponema spp. The results demonstrate that a toothpaste containing enzymes and proteins can significantly shift the ecology of the oral microbiome (at species level) resulting in a community with a stronger association to health.

Sustained oral health improvement and use of toothbrushes and dentifrice by previous users of traditional materials in a rural population in Andhra Pradesh, India

AIM

To follow-up, one year later, a double-blind, randomised study, which investigated the effect of regular brushing with dentifrices on the oral health of an economically disadvantaged rural population in Andhra Pradesh, India who were primarily users of traditional materials.

SUBJECTS

150 of the original study population.

METHOD

Examination to determine whether the improvements in oral health status and oral health behaviour (use of toothbrush and dentifrice), being unsupported, had been sustained since completion of the original study.

RESULTS

Data analysis showed sustained, statistically significant improvements in gingival health as measured by gingival bleeding and plaque indices (GBI and PI) comparing users and non-users of toothbrushes and dentifrice in the original study (PI: p = 0.04; GBI: p = 0.03) and sustained use of toothbrushes and dentifrice by 60% of the subjects at follow-up one year later.

CONCLUSIONS

This study shows a beneficial effect on oral hygiene indices following the introduction of toothbrushes and dentifrices to a community using traditional oral hygiene materials and sustainability of use of these materials with motivation and support. It may therefore be concluded that it is feasible to achieve significant use of conventional toothbrushes and toothpastes, with consequent major and sustained improvements in plaque control and gingival health in a disadvantaged population hitherto often considered as not amenable to conventional oral hygiene for cultural or economic reasons.

The role of Triclosan in dentifrice formulations, with particular reference to a new 0.3% Triclosan calcium carbonate-based system

AIM

To discuss the role of Triclosan in dentifrice systems and demonstrate the enhanced efficacy of Triclosan in calcium carbonate-based systems when the level of the antimicrobial agent is raised from 0.2% to 0.3%. Triclosan is the most commonly used antimicrobial agent in oral care products, being compatible with a wide range of ingredients found in toothpaste formulations, whilst having no negative sensory features (e.g. taste, staining) that are associated with some other antimicrobial/anti-plaque agents. Triclosan is a broad spectrum antimicrobial agent, with additional anti-metabolic and anti-inflammatory properties. When delivered to the mouth in oral care products, Triclosan can selectively inhibit Gram negative anaerobic bacteria implicated in gingivitis and periodontal diseases, while leaving species associated with oral health relatively unaffected. Worldwide, attempts have been made to boost delivery/activity of Triclosan, either by use of copolymers or by combination with other agents such as zinc citrate. However, Triclosan has also been shown to maintain clinical efficacy against plaque and gingivitis when present as the sole antimicrobial in toothpaste formulations.

The oral environment: the challenge for antimicrobials in oral care products

For any antibacterial/ anti-plaque system from an oral care product to be effective, it must firstly be delivered and retained at relevant sites in the oral cavity and secondly, remain active within the chosen formulation to successfully target the biofilm cells within dental plaque. This must include inhibition of the growth and metabolism of relevant organisms associated with disease. This review will concentrate on understanding the environmental conditions in which such oral care products must work and summarise the activity within the oral cavity of the main antibacterial and anti-plaque agents in common oral care products, namely chlorhexidine, essential oils, metal salts and Triclosan. Routes to further enhance the activity of these products, together with the use of relatively novel formats such as confectionery products to provide added consumer oral health benefits will be considered.

Anti-microbial efficacy and mode of action studies on a new zinc/Triclosan formulation

OBJECTIVE

To test in vitro the anti-plaque/ antimicrobial efficacy of a new toothpaste formulation containing a 2% zinc citrate/ 0.3% Triclosan anti-microbial system compared with a 0.75% zinc citrate/ 0.3% Triclosan system and where appropriate, against controls of a standard fluoride paste and a 0.3% Triclosan/ 2% copolymer product.

METHODS

The anti-metabolic activity was assessed using a range of assays measuring the ability of the active systems to inhibit bacterial glycolysis. The antibacterial/ anti-plaque activity was assessed in an in vitro multispecies biofilm assay.

RESULTS

Both zinc formulations were shown to have significantly superior activity at inhibiting glycolysis compared with the 0.3% Triclosan/ 2% copolymer formulation and the standard fluoride paste, particularly in reducing the pH drop after sugar challenge, the new formulation having the greatest activity. Likewise, in the antibacterial assay, both zinc formulations were found to have significantly superior activity over a standard fluoride paste and the 2% zinc citrate/ 0.3% Triclosan formulation was shown to be significantly better than 0.75% zinc citrate/ 0.3% Triclosan formulation.

CONCLUSION

These data provide support for the enhanced performance of the 2% zinc citrate/ 0.3% Triclosan formulation.

The effect of a toothpaste containing 2% zinc citrate and 0.3% Triclosan on bacterial viability and plaque growth in vivo compared to a toothpaste containing 0.3% Triclosan and 2% copolymer

OBJECTIVE

To compare the antimicrobial efficacy and effect on plaque growth of a new silica-based fluoride toothpaste containing 2% zinc citrate/ 0.3% Triclosan with a silica-based fluoride toothpaste containing 0.3% Triclosan/2% copolymer.

METHODS

In Study 1, plaque was collected after one week's use of each toothpaste and assessed for bacterial viability, live/ dead ratio and microbial membrane integrity. In study 2, plaque was measured immediately and 18 hours after a single brushing with the specified toothpastes.

RESULTS

The 2% zinc citrate/0.3% Triclosan formulation significantly reduced the total number of viable aerobic and anaerobic bacteria (p = 0.0223 and p = 0.0443 respectively) compared to the 0.3% Triclosan/2% copolymer formulation. Both toothpastes increased the bacterial membrane permeability significantly. However, the proportion of live bacteria for the 2% zinc citrate/0.3% Triclosan product was significantly reduced (p < 0.05). Study 2 showed significantly less plaque growth 18 hours after using the 2% zinc citrate/0.3% Triclosan toothpaste compared to the 0.3% Triclosan/2% copolymer toothpaste (p < 0.01).

CONCLUSION

Regular use of a fluoride toothpaste containing 2% zinc citrate and 0.3% Triclosan, significantly reduced the viability of plaque bacteria compared to a fluoride toothpaste containing 0.3% Triclosan/ 2% copolymer 12 hours after brushing. In addition, a clinical plaque growth study confirmed that this anti-microbial efficacy leads to a significant reduction in plaque growth.