Quality Resource Guide –
Dentifrices and Mouthrinses to Reduce Plaque and Gingivities 2nd Ed.
www.metdental.com
Page 3
which subjects brushed twice daily with a triclosan
containing dentifrice. Also, recently, FDA reaffirmed
the inclusion
of triclosan in a toothpaste.
14
Further,
the American Dental Association on August 15,
2014 continued its approval of Colgate Total with its
Acceptance Seal.
15
Stannous Fluoride
Stannous fluoride was first introduced into the U.S.
market in the 1950s as an additive to dentifrices
aimed at reducing carious lesions. Later, due to
staining and taste issues, it was removed from
dentifrices and replaced by sodium fluoride or
sodium monofluorophosphate as an anticaries
agent. Stannous fluoride was reformulated in
1997 into a dentifrice additive to reduce plaque
and gingivitis as well as caries activity. However,
the formulation was not successful in the U.S.
marketplace possibly because of problems with
tooth staining.
16
The newest formulation reported
in the literature is a dentifrice containing 0.45%
stannous fluoride and sodium hexametaphosphate.
Sodium hexametaphosphate has been incorporated
into the formulation to aid in the control of calculus
and extrinsic tooth staining via inhibition of pellicle
formation and mineralization.
17
The product carries
the ADA Seal. Studies of this dentifrice have
demonstrated reductions in plaque accumulation
ranging up to 8.5% and reductions in gingivitis
ranging up to 26%. Tooth staining was not reported
in the most recent studies of this formulation. Two
studies showed that a stannous fluoride dentifrice
inhibited calculus formation 56% better than a
Triclosan/co-polymer/fluoride dentifrice and also
reduced dentinal hypersensitivity.
18,19
Evaluation of
use of this dentifrice by patients following periodontal
therapy suggests that gingivitis is reduced better
than by a sodium fluoride dentifrice.
Aside from tooth staining (when stannous fluoride is
used without sodium hexametaphosphate) reported
in some studies, no serious adverse events have
been reported following the use of a stannous
fluoride dentifrice. One study compared a stabilized
stannous fluoride dentifrice to a triclosan/copolymer
dentifrice and found the reduction in Gingival Index
to be better with the stannous fluoride product.
20
Another study compared the two dentifrices for
effects on periodontitis in patients with xerostomia
and found similar beneficial effects.
21
Table 1
provides information on studies that have been
conducted with triclosan, and with stannous fluoride.
Mouthrinses
T
hree systematic reviews and one meta-
analysis were found that evaluated the
efFcacy of anti-plaque,
anti-gingivitis
mouthrinses.
The systematic reviews concluded
that there is
strong evidence supporting the
efFcacy of
chlorhexidine and essential oils
as anti-
plaque, anti-gingivitis mouthrinses. The evidence
for
cetylpyridinium chloride (CPC) was weaker due
to few clinical trials testing the same formulations
of CPC. There was one meta-analysis of studies
from a manufacture of Delmopinol, but it was not a
systematic review of
the literature. The report based
on the meta-analysis concluded that Delmopinol was
an effective anti-plaque, anti- gingivitis agent.
6,22
Evaluation of clinical relevance by estimating percent
reduction due to the active agents and changes over
time in the placebo groups, demonstrated that the
clinical effect of both chlorhexidine and essential oil
containing mouthrinses met or exceeded reductions
over time for placebo groups. Again the results
for CPC were less consistent, but were similar to
reductions over time in
the placebo groups. The
author concluded that these results suggest that
the
clinical beneFts of
anti-plaque, anti- gingivitis
mouthrinses are similar to the beneFts of oral
prophylaxis and oral hygiene instructions at six
month recall appointments.
A more extensive review was conducted in 2015
by Serrano,
et al
.
23
Their analysis
differed
from previous ones in that they did not specify
which agents
were better than others evaluated.
They stated “No specific recommendations can be
made based on the results of the present review,
as no direct comparisons among products were
performed”. They further stated that “the clinician
should take into account when prescribing or
recommending these products, the results of the
described meta-analysis, in terms of magnitude of
the effect, number of available studies, consistency
of the results and heterogeneity. In addition, adverse
effects, economical costs and the clinical indication
should also be taken into account.”
The first systematic analysis by Gunsolley of
mouthrinses
6
concluded that the largest body of
studies
supported the efficacy of mouthrinses
containing essential oils. A smaller body of studies
supported
a
strong
antiplaque,
antigingivitis
effect from mouthrinses containing 0.12 percent
chlorhexidine. Results for mouthrinses containing
cetylpyridinium chloride varied and depended on the
product’s formula. Few of the studies evaluated the
relative efficacy of the different agents. The studies
compared mouthrinses containing active agents with
control mouthrinses, as well as, in some cases, with
mouthrinses containing other active agents. Four
studies compared mouthrinses containing essential
oils with chlorhexidine mouthrinses. In all cases,
0.12% chlorhexidine exhibited a greater antiplaque
effect than did mouthrinses containing essential
Table 1 - Comparison of Dentifrices for Plaque and Gingivitis Reduction
§
Product
# Studies
# Patients
% Plaque
% Gingivitis
Tooth
Staining
ADA
Seal of Acceptance
Triclosan/Copolymer/Fluoride
13
2000
12-59
19-42
No
Yes
Stannous Fluoride
3
612
0-9
17-26
No
§§
Yes
§
Randomized, placebo controlled clinical studies of at least 6-month duration, following ADA Seal of Acceptance Guidelines
§§
Although tooth staining has occurred with stannous fluoride products, clinical studies of this product reported no staining