Quality Resource Guide

Dentifrices and Mouthrinses to Reduce Plaque and Gingivitis 3rd Edition

www.metdental.com

Dentifrices

The systematic review

reported that seventeen

studies support the antiplaque and antigingivitis

effects of dentifrices containing 0.30 percent

triclosan/2.0

percent

Gantrez

copolymer.

Dentifrices with stannous fluoride had statistically

significant, but marginally clinically significant

evidence of an antiplaque effect; however, they

demonstrated both a statistically and clinically

significant antigingivitis effect. The review focused

on triclosan and stannous fluoride since these

are the two antiseptics that are most often sold in

dentifrices in the United States for the reduction of

plaque and gingivitis.

Triclosan

Triclosan is a broad-spectrum antimicrobial agent

that is marketed for use in oral products. In the

early 1990s, a new dentifrice containing 0.3%

triclosan, 2.0% polyvinylmethyl ether maleic acid

(PVM/MA) copolymer, and 0.243% sodium fluoride

in a silica base was introduced. The addition of the

copolymer to the dentifrice formulation allowed a

greater uptake and retention of triclosan to the

enamel and buccal epithelial cells than when

triclosan was formulated alone. This retention

provided a long-lasting effect that has been well

documented.

The product carries the ADA seal

and is approved by the FDA for the reduction of

plaque and gingivitis.

Triclosan/copolymer dentifrice, when

compared

to the placebo dentifrice, demonstrated plaque

reduction of up to 58.9% and gingivitis reduction

of up to 41.9%. No significant adverse effects

(including absence of development of bacterial

resistance) were noted in studies of up to

5 years duration.

Triclosan/copolymer dentifrice

also shows

the ability to significantly reduce

supragingival

calculus

formation

(23-57%),

with an average reduction of 37%).

Laboratory

studies suggest that, in addition to its antibacterial

activity, this product may also have an anti-

inflammatory effect.

Long-term studies suggest

that use of a triclosan/copolymer dentifrice may

be of benefit in stabilizing patients following

periodontal therapy.

8,11,12,13

Studies in humans do not support data from

studies in animals suggesting adverse effects of

triclosan on thyroid and reproductive functions.

It should be noted that doses used in the animal

studies were 10,000-1,000,000 times higher than

those levels found in humans. Further, no clinical

signs of toxicity or changes of various clinical

and biochemical parameters were found in a

study in which subjects brushed twice daily with

a triclosan containing dentifrice. Also, recently,

FDA reaffirmed the inclusion of triclosan in a

toothpaste.

A recent 6-months clinical trial

demonstrated the significant reduction of gingival

inflammation when using Colgate Total dentifrice

(triclosan/copolymer/fluoride).

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 anti-caries

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.

A more recent

formulation

reported

the

literature

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.

The product carries the ADA Seal

of Acceptance. Studies of this dentifrice have

demonstrated reductions in plaque accumulation

ranging up to 8.5% and reductions in gingivitis

ranging up to 26%. Evaluation of use of this

dentifrice by patients following periodontal therapy

suggests that gingivitis is reduced better than by

a sodium fluoride dentifrice. 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

Triclosan/co-polymer/

fluoride dentifrice and also reduced dentinal

hypersensitivity.

18,19

In their systematic review,

et al.

found that 0.454% stannous fluoride

provided relief from dentin hypersensitivity. The

authors evaluated studies from 2005-2015 that

were 2 to 8 weeks in duration.

Most recently

a new form of stannous fluoride stabilized with

zinc phosphate has been introduced into the

U.S. market and has also been found to be

effective in relief of dentin hypersentitivity.

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 stannous fluoride dentifrice to a

triclosan/copolymer dentifrice and found the

reduction in Gingival Index to be better with

the stannous fluoride product.

Another study

compared the two dentifrices for effects on

periodontitis in patients with xerostomia and

found similar beneficial effects.

Most recently,

a stannous fluoride dentifrice that is stabilized

with zinc phosphate has been introduced.

This

new formulation has been rigorously tested

vitro and

through randomized clinical trials for

efficacy pertaining to reduction of oral microbial

flora,

control of dental biofilm and gingivitis,

26,27

stain reduction

and dentin hypersensitivity.

In view of its effect on micro-organisms not only

on biofilm on teeth and gingival tissue, it has also

been demonstrated to be effective against micro-

organisms on other oral surfaces. Therefore it has

been described as a dentifrice for maintenance of

whole mouth health.

Table 1

provides information on studies that have

been conducted with triclosan, and with stannous

fluoride.