The effect of mouthrinses containing zinc and triclosan on plaque accumulation, development of gingivitis and formation of calculus in a 28-week clinical test.

Experimental mouthrinses containing 0.4% zinc sulphate and 0.15% triclosan, which differed in base formulations were compared to a commercially available non-active control mouthrinse. Following baseline clinical examinations for plaque, gingival bleeding and calculus, the volunteers were provided with a dental prophylaxis and given oral hygiene instruction, stratified into 3 groups and given 1 of 3 mouthrinses. Further clinical assessments were performed after 4, 16 and 28 weeks. Salivary mutans streptococci were also monitored during the study. At 4 weeks, plaque and calculus scores in all groups were low compared to baseline. During the remainder of the study, these improvements were not maintained and both plaque and calculus levels increased in all groups. Plaque was significantly lower (P < 0.05) than in the control at all time points. Calculus was significantly lower (P < 0.05) than in the control at all time points. Calculus was significantly lower at week 28 for experimental mouthrinse group 2. Gingival bleeding also decreased in the initial 4 weeks but increased thereafter in the control group. In contrast, gingival bleeding was significantly (P < 0.05) lower in the two experimental groups than in the control group. No significant changes in mutans streptococci were observed.

Intra-/inter-examiner reproducibility study of gingival bleeding.

Sulcular bleeding after stimulation with a periodontal probe has been associated with the presence of an inflammatory lesion in the gingiva. The objective of this study was to evaluate the effect of the placement of the probe in relation to the tooth surface, and the effect of standardising the probing pressure on the intra- and inter-examiner reproducibility of the gingival bleeding when using a well-defined bleeding index. Four different variations were defined: parallel bleeding index (ParBI): when the probe is run along the marginal gingiva it is held parallel to the tooth surface. Angulated bleeding index (AngBI): the probe is held at an angle of approximately 60 degrees to the longitudinal axis of the tooth and in contact with the sulcular epithelium. Controlled force parallel bleeding index (CF-ParBI)/controlled force angulated bleeding index (CF-AngBI): the same procedure as described for the ParBI and AngBI is followed, but instead of a conventional (WHO-ASH/Dentsply) probe an adjustable force probe (Brodontic-ASH/dentsply), adjusted to 0.25 N is used. The results show that the agreement both within and between clinicians could hardly be rated as 'fair' on a site basis. Approximately one in every three sites was given a different assessment on the second examination. This might have been the consequence of the repeat examination. Agreement on a quadrant basis was slightly better. Furthermore, the direction of the probing influences the number of provoked bleeding sites. Angulation of the probe produces consistently less bleeding compared with parallel placement of the probe.

The effect of mouthrinses containing zinc and triclosan on plaque accumulation and development of gingivitis in a 3-week clinical test.

Experimental mouthrinses containing 0.4% zinc sulphate and 0.15% triclosan were compared with a chlorhexidine and a negative control mouthrinse in a 3-week clinical trial. The zinc/triclosan mouthrinses 1 and 2 differed in their ethanol and humectant contents used to deliver the triclosan. The experimental protocol employed the partial mouth gingivitis design, whereby participants wear a toothshield during toothbrushing. Gingival health at baseline was established by professional cleaning, oral hygiene instruction and effective toothbrushing 3 x per day during a pre-experimental period of 2 weeks. The mouthrinses were subsequently used 2x daily following normal toothbrushing during 3 weeks. The pre-experimental oral hygiene phase very effectively reduced plaque levels and gingival bleeding. During the rinsing period, in the absence of mechanical removal of plaque from the protected teeth, gingival bleeding rose to above the prestudy level in the negative control group. The increments (change from baseline to 21 days) of plaque and bleeding scores for the zinc/triclosan mouthrinse 1 were significantly lower than those in the negative control group. As expected, plaque and gingivitis scores were lowest in the group that rinsed with chlorhexidine. The results extend previous observations on the efficacy of the zinc/triclosan system to maintain gingival health.

Effect of pre-experimental maintenance care duration on the development of gingivitis in a partial mouth experimental gingivitis model.

The present study was designed to evaluate if different periods of supervised oral hygiene prior to the experimental gingivitis trial have an effect on the amount of inflammation which develops in the 'toothshield' model. Two groups were compared. One group (Group A) was supervised over a 5-month period before experimental gingivitis. Six months later Group A participated in a second trial, this time receiving only a 1-month pretrial. A second group (Group B) which served as a control was supervised over a pre-trial period of 1-month prior to the start of the experimental gingivitis phase. During the pre-trial period all subjects undertook a regime of vigorous oral hygiene which included polishing of the test quadrant in the upper jaw and supervised subgingival brushing, interdental taping or the use of toothpicks. The presence of plaque and bleeding were assessed. Following the pre-trial period all plaque control measures in the experimental area were prevented during oral hygiene periods by the temporary placement of soft, loosely fitting vinyl toothshield guard. During this period they accumulated plaque rapidly and developed a generalized gingivitis. The results of this study indicate that, irrespective of the length of the pretrial period, subjects by group develop a comparable mean level of plaque and gingival bleeding. However, the extent to which gingivitis develops differs among individuals and was for a number of subjects not consistent. Therefore, in designing an experimental gingivitis trial care should be taken to include a sufficient number of subjects to account for individual variation.

The effect of dentifrices containing Triclosan on the development of gingivitis in a 21-day experimental gingivitis study.

The aim of this study was to investigate the ability of Triclosan dentifrices to delay the development of gingivitis during a 21-day period without toothbrushing. Test pastes contained 0.3 per cent Triclosan; seven also contained 0.75 per cent zinc citrate; one other contained 2 per cent Gantrez. Plaque and gingivitis increased significantly (p < 0.001) between day 0 and day 21 in the control group. there was no evidence to reject the assumption of similar efficacy across the seven Triclosan/zinc citrate variants. For the combined Triclosan/zinc citrate groups, statistically significant reductions in plaque formation and in gingivitis relative to the control were recorded. Reductions in plaque and gingival bleeding compared to control for the Triclosan/Gantrez group were not statistically significant, although reductions in gingival indices were. The greater reduction in the Gingival Index of the Triclosan/zinc citrate group was also statistically significantly different from that of the Triclosan/Gantrez group, suggesting that a dentifrice containing the former would have a greater antigingivitis potential than a dentifrice containing the latter.

The effects of a silica dentifrice containing Triclosan and zinc citrate on supragingival plaque and calculus formation and the control of gingivitis.

A double blind, 7-month parallel clinical study was conducted to determine the effect of a dentifrice containing 0.3 per cent Triclosan and 0.75 per cent zinc citrate in a 0.8 per cent sodium monofluorophosphate/silica base on supragingival plaque, gingivitis and supragingival calculus formation, compared to a 0.8 per cent monofluorophosphate/silica control dentifrice. The results of this clinical study demonstrate that the use of the Triclosan/zinc citrate dentifrice over a 7-month period provided a statistically significant and clinically relevant benefit in controlling gingivitis, compared to a control dentifrice. Supragingival plaque and calculus levels were also significantly reduced in comparison to the effects of a control dentifrice.

Validation of a 21-day, partial-mouth gingivitis model for evaluating chemotherapeutic dentifrices.

The experimental gingivitis model has long been used to evaluate chemotherapeutic agents in mouthrinses. Only recently however has the model been modified to test undiluted dentifrices by using a toothshield both to apply dentifrice and to protect selected teeth from toothbrushing. This also enables participants to brush the rest of the mouth and avoid the unpleasantness of 3 weeks without oral hygiene. Because of its well-documented efficacy, chlorhexidine was used in a toothpaste formulation to investigate the validity of the partial-mouth, experimental gingivitis model for evaluating therapeutic dentifrices. Optimal gingival health was established in 88 adults, who then were randomly assigned to two equal groups. A toothshield was constructed for each subject to fit the teeth of one mandibular quadrant. During the trial chlorhexidine or placebo dentifrice was applied undiluted to the test teeth via the toothshield, which also prevented plaque removal during brushing of the remaining dentition. After 21 days, plaque and gingivitis had developed in both groups. However, the chlorhexidine group had significantly less plaque and gingivitis than the placebo group. No adverse soft tissue effects were observed. This study demonstrated that the partial-mouth, experimental gingivitis model allowed unhindered development of plaque and gingivitis that was comparable to whole-mouth studies in which oral hygiene was suspended for 3 weeks. By corroborating with chlorhexidine, it is concluded that this short-term clinical model is valid for evaluating the chemotherapeutic effects of dentifrices.

Concentration of antimicrobial proteins in human saliva. The effect of six months use of an antiplaque dentifrice on levels of antimicrobial proteins in unstimulated saliva from 102 adults.

Student nurses (aged 20-26 years) were assigned to two groups that were matched for plaque levels and gingival health. For six months, one group used a standard fluoride dentifrice while the other used an identical dentifrice to which zinc citrate (1%, w/w) and Triclosan (0.2%, w/w) had been added. Levels of natural antimicrobial proteins (lysozyme, lactoferrin, salivary peroxidase and Immunoglobulin A) in whole, unstimulated saliva taken from the students at the start and on completion of the six months were measured. No statistically significant differences were found in the levels of antimicrobial proteins in saliva between the test and placebo groups.

Antibacterial dentifrices. Clinical data and relevance with emphasis on zinc/triclosan.

The present review concerns the effect on plaque and gingivitis of some antibacterial dentifrices. The difficulties of including cationic agents in conventional dentifrice formulations are briefly discussed. The focus is on 2 recently introduced dentifrices with triclosan as the active ingredient. One aims at providing a slow release reservoir of triclosan in the oral cavity by delivering the substance dissolved in a lipophilic copolymer. 3-month results indicate a modestly improved effect on plaque and gingivitis compared to that of triclosan alone. Long-term studies are needed before conclusions on the clinical relevance can be drawn. The other dentifrice on the market utilises the principle of additive effects by combining triclosan and zinc citrate in the formulation. The combination appears to be more effective against plaque and gingivitis than either compound alone. Studies of up to 1 year duration indicate that the level of oral hygiene and gingival health obtained through an initial period of motivation and oral hygiene instruction can be maintained by regular use of the test dentifrice, while most subjects in the control group returned to pre-experimental levels. Microbiological monitoring indicates no major shifts in plaque ecology nor any development of resistant bacteria, and adverse side-effects have not been observed. It is concluded that the new approaches to chemical plaque control may be beneficial to the population at large, and thus of great clinical relevance.

Control of gingivitis and calculus by a dentifrice containing a zinc salt and triclosan.

The effect of unsupervised brushing with a dentifrice containing two antiplaque agents, 0.5% zinc citrate and 0.2% triclosan, on gingival health, plaque, supragingival calculus, and the oral flora was compared to brushing with a non-active control dentifrice. Volunteers were given oral hygiene instruction and their teeth were professionally cleaned. They then used a placebo dentifrice for a pre-experimental phase of 1 month, before being stratified into two groups on the basis of their initial plaque, gingival bleeding, and calculus levels, sex, and age. Over the following 6 months, one group used the control while the other used the test dentifrice. Plaque levels, gingival bleeding, and calculus were assessed at baseline and at 3 and 6 months. Supragingival plaque was sampled for microbiological analysis at the initial examination, at 3 and 6 months (conclusion of study period) and 3 months after the study. Representative oral bacteria and the development of bacterial resistance to triclosan were monitored. Results showed that plaque was reduced and gingival health significantly improved during the 1-month pre-experimental period. During the experimental period, this improvement was not maintained by the control group as gingival bleeding and calculus increased. In contrast, gingival bleeding and calculus levels of the test group were maintained significantly below those of the placebo group. Plaque levels were lower in the test group after 3 and 6 months, but the groups were not significantly (P = 0.05) different. No shifts in oral flora or development of bacterial resistance to triclosan were detected.

Microbiological and clinical effects of a dentifrice containing zinc citrate and Triclosan in the human experimental gingivitis model.

A partial mouth experimental gingivitis model was employed to establish the effect of a dentifrice containing 0.2% Triclosan and 0.5% zinc citrate on the development of chronic gingivitis. In addition, changes in the plaque flora associated with the developing gingivitis have been monitored. Following a period of stringent oral hygiene, volunteers were allocated to 1 of 2 treatment groups. A toothshield was constructed to fit 4 posterior mandibular teeth. During the 21-day experimental period test or placebo dentifrice was applied to the experimental teeth via the tooth shield. The toothshield also prevented plaque removal from those teeth during habitual brushing of the remaining dentition. Supragingival plaque was collected at baseline and day 21 for analysis of the total bacterial flora. At the end of the experimental period, plaque and gingivitis had developed in both groups. However, the test group had significantly less plaque and gingivitis than the placebo group. The microbiological data demonstrated that plaque from the test group contained significantly lower numbers of anaerobes compared to plaque from the placebo group. This was considered particularly significant as these bacteria are generally associated with chronic inflammatory periodontal disease. There was also a trend for the numbers of actinomyces to decrease in plaque from the test group but not in the placebo group.

Six-month study of the effect of a dentifrice containing zinc citrate and triclosan on plaque, gingival health, and calculus.

In two previous studies gingival health was maintained for at least 12 months by a dentifrice containing zinc citrate and triclosan. The aims of the present study were to determine if a zinc/triclosan dentifrice would stabilize gingival health if a lower concentration of zinc was used and to investigate its effect on the formation of calculus. 101 men and women were given oral hygiene instruction and their teeth were professionally cleaned. Two balanced groups were then formed, based on the prestudy levels of gingival bleeding and calculus. One group used the zinc/triclosan dentifrice for 6 months, while the other used a control. Results were assessed after 3 months and 6 months. Following the oral hygiene instruction, plaque and gingival bleeding were assessed at the end of the 4-wk period preceding the experimental phase, and both had been reduced. This improvement was not maintained by the control group, whereas the test group exhibited significantly lower plaque levels and a higher standard of gingival health throughout the 6 months. After 3 months, levels of calculus in the control group had returned to prestudy levels. At both the 3- and 6-month assessments, significantly less calculus was observed in the test group. The improved plaque control, stabilized gingival health, and reduced calculus formation support the conclusion that a dentifrice containing 0.5% zinc citrate and 0.2% triclosan can contribute to oral care.

One-year study of the efficacy of a dentifrice containing zinc citrate and triclosan to maintain gingival health.

In a previous study we demonstrated that gingival health could be maintained in a group of highly motivated nurses using a dentifrice containing a zinc salt and triclosan. We have now investigated the effect of the experimental dentifrice on a group of less motivated men. One hundred and three male students were given oral hygiene instruction (OHI) and their teeth were professionally cleaned. For each individual, both the instruction and cleaning were completed in a single 15-min period. Two balanced groups were formed, based on the prestudy plaque levels and gingival bleeding. One group used the experimental dentifrice for 12 months, while the other used a control. Results were assessed after 6 months, and after 12 months. As a result of the OHI, plaque and gingival bleeding were reduced at the end of the prestudy period. This improvement was not maintained by the control group even for 6 months. In contrast, the test group exhibited significantly lower plaque levels and higher standard of gingival health throughout the 12 months. Reassessment of available participants 6 months after the study showed that gingival health in both groups had returned to its prestudy condition. The lower observed standard of gingival health in the test group after ceasing to use the experimental dentifrice further supports the conclusion that this dentifrice can contribute to an oral care program.

A 1-year study on the maintenance of gingival health by a dentifrice containing a zinc salt and non-anionic antimicrobial agent.

An experimental dentifrice containing zinc citrate and Triclosan was used by student nurses for 12 months without supervision, while a corresponding group used a control dentifrice. Dental flossing was not permitted during the first 6 months. Gingival health achieved in a pre-experimental period, during which oral hygiene instruction was given, was maintained by users of the experimental dentifrice for 12 months but not by users of the control dentifrice. About 1/3 of the control group used floss daily during the 2nd 6 months and significantly improved their gingival health to a level comparable to that of the experimental group. Flossing brought no extra benefit for the latter group. In the control group, approximal regions were less healthy than buccal or lingual sites. The gingival health of these sites improved significantly with daily flossing. The experimental dentifrice maintained gingival health in all sites irrespective of the use of floss. The study has confirmed that oral health can be maintained by the use of the experimental dentifrice for at least 12 months in a habitual toothbrushing regime, and that the dentifrice would be as effective and simpler than relying on the combination of brushing and regular flossing.

The effect of a dentifrice containing zinc citrate and Triclosan on developing gingivitis.

A partial mouth experimental gingivitis model was employed to establish the potential efficacy of a dentifrice containing a zinc salt and the antimicrobial agent Triclosan to prevent or delay the development of gingivitis over a period of 28 days. Initially, gingival health was established in 34 subjects following a 6-week period of professional tooth cleaning and oral hygiene instruction. A toothshield was constructed to fit 4 posterior mandibular teeth. Undiluted test or placebo dentifrice was applied to the experimental teeth via the toothshield, which also prevented plaque removal from these teeth during habitual brushing of the remainder of the dentition. The presence of plaque, bleeding after probing and visual signs of inflammation were independently assessed. Plaque accumulated rapidly and gingivitis developed in both groups. At the 2-wk assessments, lower mean plaque scores were recorded for the group using the test dentifrice. At the 4-wk assessment a significantly lower level of gingivitis was recorded for the test group. It is concluded that (a) the model can be used to establish the potential efficacy of a dentifrice to maintain gingival health, (b) the dentifrice containing zinc citrate and Triclosan was efficacious and (c) the Gingival Index possibly overestimates the proportion of healthy gingival sites.

Antiplaque effects and mode of action of a combination of zinc citrate and a nonionic antimicrobial agent.

The effect upon plaque growth of adding a nonionic antimicrobial agent, triclosan, to a dentifrice containing zinc citrate was established in short-term in vivo studies. Plaque regrowth was inhibited by brushing with dentifrices which contained either zinc citrate or triclosan. When both were combined in the same dentifrice, the inhibition of overnight plaque regrowth was significantly greater. In two 4-day non-brushing studies, the dentifrices containing both zinc citrate and triclosan were applied either undiluted by the use of a cap splint or as 23% suspensions in water. Both methods resulted in significant reductions in plaque accumulation, with the greater activity being observed for the undiluted application of the dentifrice. Analysis of results of the overnight plaque studies for individual teeth revealed that the two agents had a complementary inhibitory action on plaque regrowth, zinc citrate being more effective on existing plaque whereas triclosan inhibited plaque formation on clean surfaces. The dentifrice containing both agents was effective against both existing plaque and new plaque formation. It is concluded that the addition of triclosan to a dentifrice containing zinc citrate improves its antiplaque potential.

The influence of a dentifrice containing a zinc salt and a nonionic antimicrobial agent on the maintenance of gingival health.

The purpose of the present investigation was to test the concept that a dentifrice containing zinc citrate and Triclosan could maintain gingival health. The gingival health of 101 young predominately female student nurses in Oslo was brought to a high level by professional cleaning supported by oral hygiene instruction. The criterion of gingival health was less than or equal to 5 elicited bleeding sites from a full mouth assessment. The mean bleeding value attained for the whole group was 3.5. 2 balanced groups were formed, based on the initial number of elicited bleeding sites and plaque values. One group used the test dentifrice and the other group the placebo for 6 months, with an intermediate assessment after 3 months. The placebo group failed to maintain the standard of oral hygiene and gingival health that had been achieved by professional care. In contrast, the group using the test dentifrice for 6 months exhibited similar levels of plaque and gingival health to that observed at baseline following oral hygiene instruction. After 6 months, less than 7% of the subjects in the placebo group possessed healthy gingivae in contrast to 60% of the test group. Thus a dentifrice containing a zinc salt and nonionic germicide had successfully maintained gingival health in a group of young adults.

The effects of a dentifrice containing a zinc salt and a non-cationic antimicrobial agent on plaque and gingivitis.

The antiplaque potential of metal salts in mouthwashes or dentifrices has been previously demonstrated. The purpose of the present investigation was to establish the effects on plaque and gingival health of a dentifrice which contained a combination of the metal salt, zinc citrate, and the anti-microbial agent, Triclosan. Plaque growth was reduced by a dentifrice which contained either zinc citrate or triclosan, but greater inhibition was achieved with dentifrices which contained both agents. A 4-day non-brushing study in which slurries of the dentifrice were used, confirmed that the test dentifrice which contained 1% zinc citrate and 0.5% Triclosan reduced the accumulation of plaque by 50%. In a double-blind crossover study of 28 days duration, a significant reduction in plaque accumulation and an improvement in gingival health was demonstrated for the test dentifrice compared to the placebo. Further analysis of the data indicated that the dentifrice was most efficacious for participants who brushed ineffectively. Also, the greatest benefit was obtained by subjects that used the largest amount of dentifrice.

The effects of a dentifrice containing zinc citrate and 2,4,4' trichloro-2'-hydroxydiphenyl ether.

The effects of a dentifrice which contained 1% zinc citrate and 0.5% of a nonionic antimicrobial agent, 2,4,4' trichloro-2'-hydroxydiphenyl ether on plaque and gingival health have been investigated. In a 4-day nonbrushing study in which dentifrices were used as slurries, this dentifrice inhibited plaque accumulation significantly more than dentifrices which contained either zinc citrate or Triclosan separately. In a 28-day double-blind cross-over study, a significant reduction in plaque accumulation and improvement in gingival health was demonstrated for the test dentifrice compared to the placebo. The effect was demonstrated with a group of well motivated volunteers who had a good standard of oral health. Analysis of the data suggested that the benefit might be extended to a less motivated population.