A proof of principle investigation of a novel enzyme formulation on dental calculus deposition: a 4-week randomized human clinical trial.

BACKGROUND: The dissolution of dental calculus, safely and at home, is among the more challenging issues facing the over-the-counter healthcare industry. Pontis Biologics, Inc. has developed novel model of calculus development and structure and has formulated a dentifrice (Tartarase™) using digestive enzymes as active ingredients that is shown to dissolve dental calculus in this Proof of Principle clinical trial. METHODS: This investigation was designed to evaluate the safety and efficacy of a novel enzyme formulation to remove existing calculus deposits in 4 weeks, measured using the Volpe-Manhold Index (V-MI) on lingual surfaces of 6 lower anterior teeth. The test formulation was compared to Crest Cavity Protection, as a control dentifrice. A total of 40 randomized test subjects began the study with 20 assigned to the control dentifrice and 20 assigned to the Tartarase groups (ten each, one brushing with Tartarase twice daily and one brushed with Tartarase and wore a dental tray filled with Tartarase for 30 min then brushed again with Tartarase, once daily). RESULTS: The Crest group experienced a 12% increase in calculus, in contrast to the results of both Tartarase groups that experienced a 40% reduction in calculus in 4 weeks of unsupervised at home use of the Tartarase toothpaste formulation. CONCLUSIONS: This proof of principle study demonstrates that a dentifrice, formulated along the lines of the Tartarase material, is capable of combating calculus accumulation using the same oral hygiene habits that are common worldwide. TRIAL REGISTRATION: This trial was registered retrospectively at clinicaltrials.gov and has the Unique Identification Number: NCT06139835, 14/11/2023.

Anti-calculus efficacy of Periogen® oral rinse in gingivitis patients.

Dental biofilm is a complex, organized microbial community that is the primary etiologic factor for plaque, the most frequently occurring oral contamination for gingivitis, dental caries and periodontal diseases. In dentistry, calculus is a form of hardened dental plaque, caused by precipitation of calcium (Ca) and phosphorous (P) ions deposited from saliva and gingival crevicular fluid. Although the dental biofilm cannot be eliminated, it can be controlled with comprehensive mechanical and chemotherapeutic oral hygiene practices. Chemotherapeutic agents have difficulty penetrating the polysaccharide matrix to reach and affect the microorganisms. The purpose of the present study was to evaluate the anti-calculus efficiency of a mouthwash containing an association of sodium tripolyphosphate, tetrapotassium pyrophosphate, sodium bicarbonate and citric acid in patients affected with gingivitis.

The effect of chlorhexidine on dental calculus formation: an in vitro study.

BACKGROUND: Chlorhexidine gluconate (CHG) has been proven to be effective in preventing and controlling biofilm formation. At the same time, an increase in calculus formation is known as one of considerable side effects. The purpose of this study was to investigate whether mineral deposition preceding a calculus formation would occur at an early stage after the use of CHG using an in vitro saliva-related biofilm model. METHODS: Biofilms were developed on the MBEC™ device in brain heart infusion (BHI) broth containing 0.5% sucrose at 37 °C for 3 days under anaerobic conditions. Biofilms were periodically exposed to 1 min applications of 0.12% CHG every 12 h and incubated for up to 2 days in BHI containing a calcifying solution. Calcium and phosphate in the biofilm were measured using atomic absorption spectrophotometry and a phosphate assay kit, respectively. Morphological structure was observed using a scanning electron microscope (SEM), and chemical composition was analyzed with an electron probe microanalyzer (EPMA). RESULTS: The concentrations of Ca and Pi following a single exposure to CHG increased significantly compared with the control. Repeatedly exposing biofilms to CHG dose-dependently increased Ca deposition, and the amount of Ca was five times as much as that of the control. Pi levels in CHG-treated biofilms were significantly higher than those from the control group (p < 0.05); however, the influence of the number of exposures was limited. Analyses using an SEM and EPMA showed many clusters containing calcium and phosphate complexes in CHG-treated biofilms. Upon composition analysis of the clusters, calcium was detected at a greater concentration than phosphate. CONCLUSIONS: Findings suggested that CHG may promote mineral uptake into the biofilm soon after its use. It is necessary to disrupt the biofilm prior to the start of a CHG mouthwash in order to reduce the side effects associated with this procedure. The management of patients is also important.

Natural history of periodontitis: Disease progression and tooth loss over 40 years.

OBJECTIVES: To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years. MATERIAL AND METHODS: Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. RESULTS: PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age. CONCLUSIONS: These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

In Vitro and In Vivo Evaluations of the Anticalculus Effect of a Novel Stabilized Stannous Fluoride Dentifrice.

OBJECTIVES: To evaluate the effect of a novel stannous fluoride dentifrice with zinc citrate on calculus inhibition using both in vitro and clinical models. METHODS: Each investigation tested a novel stabilized 0.454% stannous fluoride dentifrice with zinc citrate as an anticalculus agent (Crest® Pro-Health™ smooth formula) compared to a negative control fluoride dentifrice. The in vitro study used the modified Plaque Growth and Mineralization Model (mPGM). Plaque biofilms were prepared and mineralized by alternate immersion of glass rods in human saliva and artificial mineralization solution. Treatments of 25% w/w dentifrice/water slurries were carried out for 60 seconds daily for 6 days, between saliva and mineralization solution immersions. Plaque calcium levels were determined by digestion and inductively coupled plasma optical emission spectroscopy. Student's t-test (p < 0.05) was used for statistical analysis. The clinical study was a parallel group, double-blind, randomized, and controlled trial. Following a dental prophylaxis, subjects entered a two-month run-in phase. At the end, they received a Volpe-Manhold Index (V-MI) calculus examination. Eighty (80) qualified subjects who had formed at least 9 mm of calculus on the linguals of the mandibular anterior teeth were re-prophied and randomly assigned to either the stannous fluoride dentifrice or the negative control. Subjects brushed twice daily, unsupervised, during the three-month test period, returning at Weeks 6 and 12 for safety and V-MI examinations. Statistical analyses were via ANCOVA. RESULTS: In vitro mPGM: The stabilized stannous fluoride dentifrice showed 20% less in vitro tartar formation, measured as calcium accumulation normalized by biofilm mass, versus the negative control (106.95 versus 133.04 µg Ca/mg biofilm, respectively, p < 0.05). Clinical Trial: Seventy-eight (78) subjects completed with fully evaluable data. The stannous fluoride dentifrice group had 15.1% less adjusted mean calculus at Week 6 compared to the negative control group (p = 0.05) and 21.7% less calculus at Week 12 (p < 0.01). Both dentifrices were well-tolerated. CONCLUSIONS: The stannous fluoride dentifrice produced significant anticalculus benefits in vitro and in a clinical trial compared to a negative control.

Zinc: A precious trace element for oral health care?

This review will discuss the importance of Zinc in the maintenance of oral health. Zinc (Zn) is a trace element of valuable importance. In the oral cavity, it is naturally present at various sites such as dental plaque, dental hard tissues and saliva. It is proven to be effective against common prevalent oral health problems such as dental caries, gingivitis, periodontitis and malodour. It is being used in various oral health care products to control the formation of dental plaque and inhibiting the formation of dental calculus. It has the potential to sustain and maintain its elevated concentrations for a longer time particularly in the dental plaque and saliva on delivery from the mouth rinses and toothpastes. It has been reported that low concentrations of zinc have the capability to reduce dissolution and promote remineralization under caries simulating conditions. Most importantly low Zn2+ levels in the serum are useful as a tumour marker. Thus taking a note of its potentials, it can be concluded that zinc is a precious element for the maintenance of oral health.

[Evaluation of the efficacy of powered and manual toothbrushes in preventing oral diseases (Systematic review with meta-analysis)]. / Elektromos és kézi fogkefék hatékonyságának összehasonlítása az orális prevencióban. Irodalmi áttekintés, systematic review, meta-analízis.

BACKGROUND: The removal of dental plaque plays an essential role in the maintenance of oral health. Numerous powered and manual toothbrushes were manufactured to achieve this goal, but even up to this day different opinions and research results have been revealed to assess the priority of the mentioned devices. AIM: Comparison of powered and manual toothbrushes on the basis of periodontal parameters and safety. MATERIALS AND METHODS: Electronic search of the databases of MEDLINE and EMBASE (until May 2014) was carried out with the help of keywords in order to find relevant trials. The inclusion criteria were as follows: randomised controlled clinical trials, adult population, the presence of at least 15 permanent teeth. Split-mouth trials and interventions carried out by dental professionals, were excluded. Primary outcomes were the changes of plaque and gingival indices, while secondary outcomes were probing pocket depth (PPD), safety and quality assessment. The effect-size of the interventions was expressed by the standardised mean difference (SMD) with 95% confidence interval (CI). Random-effects models were performed. RESULTS: Electronic search resulted in 173 hits. 21 trials with the total number of 1500 subjects were then eligible for the meta-analysis. Both toothbrushes were safe, without considerable side effects on soft or hard tissues. Powered toothbrushes seemed to be generally more effective in removing plaque (-9%), reducing gingivitis (-6%) and preventing calculus formation. The SMDs for plaque and gingival indices were -0,40 (95% Cl: -0,95 to -0,16) and -0,29 (95% Cl: -0,56 to -0,03) respectively, in favour of the powered devices. There was no significant difference in changes of PPD. By further dividing the powered toothbrushes according to their mode of action, the plaque removal effect of the rotation oscillation (plus three dimensional), side to side sonic and ultrasonic toothbrushes seemed to be significantly better, than their manual ones, while the counter oscillation and the ionic toothbrushes did not perform better. Quality assessment and sensitivity analysis revealed various types of bias up to a certain extent. Consequently, no trial was found to be eligible for the highest quality criteria. CONCLUSIONS: The investigated rotation oscillation and vibrating toothbrushes appeared to be statistically more effective than their manual counterparts, although there is little known about its clinical relevance. The advantage of the electric toothbrushes disappears in case of adequately instructed and motivated patients that highlights the importance of individualised oral hygiene education. The design of the trials shows high heterogeneity, therefore their clinical implications should be handled carefully.

Principles in prevention of periodontal diseases: Consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases.

AIMS: In spite of the remarkable success of current preventive efforts, periodontitis remains one of the most prevalent diseases of mankind. The objective of this workshop was to review critical scientific evidence and develop recommendations to improve: (i) plaque control at the individual and population level (oral hygiene), (ii) control of risk factors, and (iii) delivery of preventive professional interventions. METHODS: Discussions were informed by four systematic reviews covering aspects of professional mechanical plaque control, behavioural change interventions to improve self-performed oral hygiene and to control risk factors, and assessment of the risk profile of the individual patient. Recommendations were developed and graded using a modification of the GRADE system using evidence from the systematic reviews and expert opinion. RESULTS: Key messages included: (i) an appropriate periodontal diagnosis is needed before submission of individuals to professional preventive measures and determines the selection of the type of preventive care; (ii) preventive measures are not sufficient for treatment of periodontitis; (iii) repeated and individualized oral hygiene instruction and professional mechanical plaque (and calculus) removal are important components of preventive programs; (iv) behavioural interventions to improve individual oral hygiene need to set specific Goals, incorporate Planning and Self monitoring (GPS approach); (v) brief interventions for risk factor control are key components of primary and secondary periodontal prevention; (vi) the Ask, Advise, Refer (AAR) approach is the minimum standard to be used in dental settings for all subjects consuming tobacco; (vii) validated periodontal risk assessment tools stratify patients in terms of risk of disease progression and tooth loss. CONCLUSIONS: Consensus was reached on specific recommendations for the public, individual dental patients and oral health care professionals with regard to best action to improve efficacy of primary and secondary preventive measures. Some have implications for public health officials, payers and educators.

A randomized controlled clinical study of the effect of daily intake of Ascophyllum nodosum alga on calculus, plaque, and gingivitis.

OBJECTIVE: The aim of this study is to evaluate, in a randomized controlled cross-over study, the effect of daily intake of the alga Ascophyllum nodosum on supragingival calculus, plaque formation, and gingival health over a 6-month period. MATERIAL AND METHODS: Sixty-one adults with moderate to heavy calculus formation since their last yearly recall visit participated. In a randomized order over two 6-month periods, they swallowed two capsules daily, comprising a total of 500 mg dried marine alga powder (Ascophyllum nodosum, ProDen PlaqueOff®) or two negative control tablets. During the study, the participants maintained their regular oral habits. Their teeth were professionally cleaned at the start of each period and after the 6-month registrations. A wash out period of 1 month separated the two 6-month periods. Supragingival calculus (Volpe Manhold), gingivitis (Löe and Silness), gingival bleeding (Ainamo and Bay), and plaque (Quigley-Hein) were registered at screening and at the end of the two periods. Differences in oral health between the test and control periods were analyzed using a paired t test and Wilcoxon signed rank test. RESULTS: Fifty-five participants completed the study. After the alga intake, the mean calculus reduction was 52% compared to the control (p < 0.0001). Fifty-two participants showed less calculus formation in the alga group than in the control group. Plaque (p = 0.008) and gingival bleeding (p = 0.02) were also significantly less in the alga group. However, no significant difference was found between the groups for gingivitis (p = 0.13). CONCLUSIONS: The alga intake significantly reduced the formation of supragingival calculus and plaque and occurrence of gingival bleeding. The alga has a systemic effect on oral health. CLINICAL RELEVANCE: Daily intake of the alga Ascophyllum nodosum as an adjunct to customary oral hygiene showed a major reduction of supragingival calculus formation and reduced plaque formation. In addition, the calculus in the alga group was characterized by a more porous and less solid structure and was easier to remove than the calculus in the control group.

Long-Lasting Efficacy of an Experimental 1450 ppm Fluoride/Zinc-Based Dentifrice as Measured by Calcium Buildup Using an In Situ Intra-Oral Device After 12 Hours: A Randomized Clinical Trial.

OBJECTIVE: To assess the efficacy of an experimental 1450 ppm fluoride as sodium monofluorophosphate (SMFP)/zinc-based dentifrice (Test), a clinically proven 1450 ppm fluoride as SMFP/zinc-based dentifrice (Positive Control), and a 1000 ppm fluoride as SMFP and 450 ppm fluoride as sodium fluoride (NaF) dentifrice (Negative Control) in delivering 12-hour anti-tartar benefits as measured by calcium buildup after a single product brushing. METHODS: Fourteen (14) adult subjects completed this single-center, double-blind, randomized, cross-over clinical study conducted in Piscataway, New Jersey. An intra-oral appliance was custom-made for each subject as a surface on which the anti-calculus agents' inhibition of early calculus formation could be analyzed. After brushing with their assigned toothpaste, each subject wore their respective appliance for 12 hours overnight. When the appliance was removed, it was washed, suspended in 0.1 MHCL to release Ca2+ from deposits, and analyzed by Inductively Coupled Plasma (ICP) for deposited calcium. There was a one-week washout period between each product use. Statistical analyses were performed on the mean level of calcium (µg). Comparisons of the treatment groups with respect to 12-hour post-brushing (overnight) calcium levels were performed via a two-way analysis of variance (ANOVA), with subjects and products as factors in the ANOVA model. Post-ANOVA pair-wise comparisons of the study treatments were performed using the Tukey's test for multiple comparisons. All statistical tests of hypothesis were two-sided, and employed a level of significance of α = 0.05. RESULTS: At the 12-hour post-brushing examination, the mean level of calcium buildup was 0.46 µg for subjects assigned to the experimental Test dentifrice, 0.41 µg for subjects assigned to the Positive Control dentifrice, and 2.47 µg for subjects assigned to the Negative Control dentifrice. After 12 hours post-brushing, subjects assigned to the experimental Test dentifrice and Positive Control dentifrice both exhibited statistically significantly (p = 0.005 and p = 0.004, respectively) lower levels of calcium buildup as compared to the subjects assigned to the Negative Control dentifrice. No statistically significant (p = 0.996) difference was observed between the experimental Test dentifrice and Positive Control dentifrice with respect to tartar control efficacy after 12 hours post-brushing. No adverse effects of the hard or soft oral tissue were observed by the clinical investigators or reported by the subjects. CONCLUSION: Both the experimental Test dentifrice (1450 ppm fluoride as SMFP/zinc-based dentifrice) and the Positive Control dentifrice (1450 ppm fluoride as SMFP/zinc-based dentifrice) provided significantly greater 12-hour tartar control as measured by calcium buildup, as compared to the Negative Control dentifrice containing 1000 ppm fluoride as SMFP and 450 ppm fluoride as NaF.

Introducing dental hygienists in general practice to research - an in-practice evaluation programme in the United Kingdom.

AIM: To introduce dental hygienists (DHs) in the UK to the principles of research through a practice-based product evaluation programme. METHODS: The programme consisted of an initial training and orientation day with presentations on evidence-based practice, research methods and the structure of research papers. The programme and its aims were explained in detail, and participants were briefed on the methods to be used. Participants then recruited seven to ten patients from their practices (offices), carried out a baseline assessment of: plaque, gingival health, calculus and staining at anterior teeth, and gave the patients a questionnaire asking about their teeth and then provided a 3-month supply of a test toothpaste. About 10 weeks later, a follow-up assessment of the same variables was performed and the questionnaire was repeated. A second training day followed during which the DHs provided feedback of their experiences and received training in literature searching and critical appraisal of literature including interpretation of results. RESULTS: Sixty-five DHs attended the first training day; 31 were able to recruit sufficient patients and attend the second training day. The DHs recruited 168 patients who received baseline and follow-up assessments. All the variables improved overall. Feedback from the DHs was very positive, and patients expressed delight with the care they had received. CONCLUSIONS: Qualitative feedback for participating DHs suggests the programme met its aim and could be used in the future as a mechanism for helping DHs who want to increase their understanding of research methodology.

Effect of Frequency of Brushing Teeth on Plaque and Calculus Accumulation, and Gingivitis in Dogs.

The efficacy of brushing the teeth of beagle dogs in a randomized, controlled, blinded study design using a clearly-defined brushing technique was evaluated for 4 brushing frequencies: brushing daily, brushing every other day, brushing weekly and brushing every other week, compared with no brushing in a control group of dogs. All dogs were fed a standard dry kibble diet during the study. Standard plaque, calculus, and gingivitis indices were used to score the teeth. A 'clean tooth' model was used. No gingival or non-gingival lacerations or other signs of injury to oral tissues were found at the end of the 28 day trial period. Brushing more frequently had greater effectiveness in retarding accumulation of plaque and calculus, and reducing the severity of pre-existing gingivitis. Brushing daily or every other day produced statistically significant improved results compared with brushing weekly or every other week. Based on the results of this study, daily brushing is recommended.

Dental wax decreases calculus accumulation in small dogs.

A dental wax was evaluated after unilateral application in 20 client-owned, mixed and purebred small dogs using a clean, split-mouth study model. All dogs had clinical signs of periodontal disease including plaque, calculus, and/or gingivitis. The wax was randomly applied to the teeth of one side of the mouth daily for 30-days while the contralateral side received no treatment. Owner parameters evaluated included compliance and a subjective assessment of ease of wax application. Gingivitis, plaque and calculus accumulation were scored at the end of the study period. Owners considered the wax easy to apply in all dogs. Compliance with no missed application days was achieved in 8 dogs. The number of missed application days had no effect on wax efficacy. There was no significant difference in gingivitis or plaque accumulation scores when comparing treated and untreated sides. Calculus accumulation scores were significantly less (22.1 %) for teeth receiving the dental wax.

Recent advances in the pathogenesis and prevention strategies of dental calculus.

Dental calculus severely affects the oral health of humans and animal pets. Calculus deposition affects the gingival appearance and causes inflammation. Failure to remove dental calculus from the dentition results in oral diseases such as periodontitis. Apart from adversely affecting oral health, some systemic diseases are closely related to dental calculus deposition. Hence, identifying the mechanisms of dental calculus formation helps protect oral and systemic health. A plethora of biological and physicochemical factors contribute to the physiological equilibrium in the oral cavity. Bacteria are an important part of the equation. Calculus formation commences when the bacterial equilibrium is broken. Bacteria accumulate locally and form biofilms on the tooth surface. The bacteria promote increases in local calcium and phosphorus concentrations, which triggers biomineralization and the development of dental calculus. Current treatments only help to relieve the symptoms caused by calculus deposition. These symptoms are prone to relapse if calculus removal is not under control. There is a need for a treatment regime that combines short-term and long-term goals in addressing calculus formation. The present review introduces the mechanisms of dental calculus formation, influencing factors, and the relationship between dental calculus and several systemic diseases. This is followed by the presentation of a conceptual solution for improving existing treatment strategies and minimizing recurrence.

Effect of dental chew on reducing dental plaque, dental calculus and halitosis in beagle dogs.

Periodontosis is the most common clinical disease in adult dogs, which is mainly caused by plaque accumulation and seriously endangers the oral health of dogs and even cause kidney, myocardial, and liver problems in severe cases. The aim of this study was to determine the clinical efficacy of dental chew (Cature Brushing Treats product) with mechanical and chemical properties in beagles. The dogs in the experimental group were fed with a dental chew twice a day after meals; The control group had no treatment. Dental plaque was evaluated on the 14th day and 29th day, respectively. The concentration of volatile sulfur compounds (VSC) in the breath and dental calculus were also evaluated on the 29th day. The results showed that there was no significant difference in the indexes of dental plaque on the 14th day. While they had significantly reduced accumulation of plaque (37.63%), calculus (37.61%), and VSC concentration (81.08%) compared to when receiving no chew on the 29th day.

Effects of full-mouth scaling on the periodontal health of Indigenous Australians: a randomized controlled trial.

BACKGROUND: Simplified periodontal therapy might be a pragmatic strategy for public health programmes targeting Indigenous Australian adults. The objective of this randomized controlled trial was to evaluate oral health effects of single-visit, non-surgical periodontal therapy compared to no treatment. METHODS: This parallel-group, randomized, open label clinical trial enrolled 273 Indigenous Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling and root planing during a single visit while the control group received no treatment. Endpoints were summary variables derived from clinical assessments of probing depth, clinical attachment loss, plaque, calculus and gingival bleeding before treatment and 3 months later. RESULTS: Endpoints could be calculated for 169 participants with follow-up data. Compared to the control group, there were statistically significant reductions in extent of shallow pockets: PD ≥4 mm (mean difference -2.86, [95% CI -5.01 to -0.71], p = 0.009) and gingival bleeding (mean difference -0.25, [95% CI -0.43 to -0.08], p = 0.005) but not deeper pockets PD ≥5 mm (mean difference -0.48, [95% CI -1.78 to 0.82], p = 0.468) or plaque scores. CONCLUSIONS: Periodontal therapy produced improvements in shallow periodontal pockets and measures of gingival bleeding in these Indigenous Australians.

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.

Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial was carried out to assess the effect of comprehensive nonsurgical periodontal treatment and strict plaque control performed during pregnancy on the reduction of preterm and/or low birth weight rates (PTLBW). MATERIAL AND METHODS: Three hundred and three women were randomly allocated to receive periodontal treatment either during pregnancy (n = 147, test group) or after delivery (n = 156, control group). During pregnancy, the control group received only one session of supragingival scaling and oral hygiene instruction. In contrast, the test group received comprehensive periodontal treatment including multiple sessions of scaling and root planing, oral hygiene instructions, and frequent maintenance visits. RESULTS: At baseline, periodontal inflammation was observed in approximately 50% of sites and attachment loss affected <15% of sites. Compared to controls, women in the test group had significant reductions in the percentage of sites with plaque (48.5% vs. 10.3%, p < 0.001), gingival bleeding (23.3% vs. 2.5%, p < 0.001), calculus (21.3% vs. 4.1%, p < 0.001), bleeding on probing (38.1% vs. 2.6%, p < 0.001) and probing depth ≥3 mm (19.97% vs. −2.45%, p < 0.001). No significant differences were observed between the groups in the occurrence of PT (11.7% vs. 9.1%, p = 0.57), LBW (5.6 % vs. 4.1%, p = 0.59), and PTLBW (4.15% vs. 2.60%, p = 0.53). CONCLUSIONS: Comprehensive periodontal treatment and strict plaque control significantly improved periodontal health; however, no reduction of PTLBW rates was observed. Thus, remaining periodontal inflammation posttreatment cannot explain the lack of effect of periodontal treatment on PTLBW. Clinical relevance This study demonstrated that periodontal diseases may be successfully treated during pregnancy. Our results do not support a potential beneficial effect of periodontal treatment on PTLBW.

IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care.

BACKGROUND: Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. METHODS/DESIGN: This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0-3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI.Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases.The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits. DISCUSSION: IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making. TRIAL REGISTRATION: Protocol ID: ISRCTN56465715.

Effectiveness of a mouthrinse containing active ingredients in addition to chlorhexidine and triclosan compared with chlorhexidine and triclosan rinses on plaque, gingivitis, supragingival calculus and extrinsic staining.

OBJECTIVES: To assess the effectiveness of three different mouthrinses--chlorhexidine, triclosan + sodium fluoride and chlorhexidine + triclosan + sodium fluoride + zinc chloride--on plaque, calculus, gingivitis and stains and to evaluate the occurrence of adverse effects with these three treatments. METHODS: Forty-eight healthy subjects participated in a double-blind, randomized, parallel experiment and were randomly allocated to any one of the three experimental mouthrinses: group A (0.2% chlorhexidine (CHX) gluconate), group B (0.03% triclosan + 0.025% sodium fluoride (NaF) + 12% ethyl alcohol) or group C (0.2% CHX + 0.3% triclosan + 0.3% NaF + 0.09% Zn chloride (ZnCl(2)). All the subjects were assessed for gingivitis, plaque, supragingival calculus and extrinsic stains at baseline and at the end of the 21-day experimental period. RESULTS: There was a significant difference (P = 0.046) in the effectiveness for the prevention of gingivitis and plaque, with subjects of group A and group C presenting least and highest gingival and plaque scores, respectively. Significant differences (P = 0.03) were observed for the accumulation of supragingival calculus where the deposition of calculus in group A was nearly double that of the group B, and group B was most effective in the prevention of supragingival calculus. Highest deposition of extrinsic stains was in the group A followed by group C and group B. There was no significant difference between the three treatments for adverse events' occurrence. CONCLUSIONS: CHX mouthrinse was most effective in controlling plaque and gingivitis but caused greatest deposition of extrinsic stains. Supragingival calculus deposition was least in triclosan + NaF group followed by CHX + triclosan + NaF + ZnCl(2) and CHX. More than half of the subjects reported adverse events during the experimental phase.