Comparison of the effect of toothpastes containing enzymes or antimicrobial compounds with a conventional fluoride toothpaste on the development of plaque and gingivitis

Cytotoxic effects of different detergent containing children's toothpastes on human gingival epithelial cells

Background

This study aimed to evaluate possible cytotoxic effects to gingival epithelial cells exposed to children toothpastes containing different detergent.

Methods

Tissues required for the isolation of human gingival epithelial cells were obtained by biopsy during the extraction of the impacted third molar tooth. Toothpaste solutions of different concentrations were prepared from five different children’s toothpastes with different detergent contents. Isolated gingival epithelial cells were stimulated with experimental groups consisting of toothpaste solutions (Colgate, Sensodyne, Splat, Nenedent, Perlodent) at different concentrations and a control group consisting of complete Dulbecco’s modified eagle medium. After the experiments, cell viability was evaluated using flow cytometry. 2 Way ANOVA was used to see the interaction effect of the main effects of toothpaste solution and concentration factors. Pairwise comparisons were made by Tukey post hoc tests. In the study, the significance level was taken as 0.05.

Results

As a result of the analysis, it was seen that the toothpaste solution and concentration factors and the interactions of these 2 factors were effective on the viable, early apoptotic, late apoptotic and necrotic cell rates. The statistically highest live cell ratios were detected in Splat’s toothpaste solutions (90.14% at 0.4% concentration) after the control group (90.82%) and the group with the lowest viability values was determined in Colgate group (75.74% at 0.4% concentration) (p < 0.05).

Conclusions

According to the results of the study, it was observed that toothpastes containing SLS affected the viability of cells more negatively than toothpastes with other detergent contents.

Oral care product formulations, properties and challenges

This review explores the physical, chemical and structural properties of key components of oral care products, whilst looking at the challenges which need to be overcome to continue to improve the efficacy of oral care, and improve dental health. Oral care has been an essential part of all populations and cultures around the world for thousands of years. To maintain good oral health, dental plaque causing bacteria and malodour must be controlled whilst also strengthening and protecting the teeth to prevent dental caries. Advanced modern formulations need to provide controlled and extended release of ingredients vital for dental health. With modern day products such as toothpastes and mouthwashes, it has never been easier to maintain good oral hygiene and health, yet the incidence of dental caries is still on the rise. The complex formulations of modern toothpastes and mouthwashes makes them one of the most sophisticated pharmaceutical products on the market today. The demands of the consumer coupled with the complexity of the oral cavity make it one of the most challenging development processes.

Comparative evaluation of efficacy of enzymatic toothpaste over standard fluoridated toothpaste in reduction of plaque and gingivitis

OBJECTIVES

To compare and evaluate the efficacy of enzymatic toothpaste v/s standard fluoridated toothpaste in reduction of plaque and gingivitis during maintenance phase after non-surgical periodontal therapy (NSPT).

MATERIALS AND METHODS

A total of 52 participants belonging to age 20-50 years eligible for inclusion were randomly chosen from the outpatient department. Computer-generated randomization was followed to recruit the subjects into two groups. 26 subjects were assigned to control group who were given with control toothpaste (standard fluoridated toothpaste), while 26 subjects were assigned to test group (enzymatic toothpaste) and given with test toothpaste. The amount of dental plaque and gingivitis were assessed baseline visit and at 6-week follow-up visit using Turesky-Gilmore-Glickman modification of the Quigley-Hein plaque index (TQHPI) 1970, Gingival Index (GI) - (Löe and Sillness 1963) and Full Mouth Bleeding Score (FMBS), respectively. Data analysis was done using IBM SPSS^® version 22.

RESULTS

Intergroup comparison of TQHPI, GI and FMBS among test and control group has shown that test group had statistically significant lower values than the control group at the follow-up visit. (p = 0.006*, p = 0.001*, p = 0.001*, respectively).

CONCLUSIONS

Within the limitations of our study, it can be concluded that test toothpaste has shown to be efficient than the previously set standard control fluoridated toothpaste in terms of reduction of plaque and gingivitis during maintenance phase after non-surgical periodontal therapy (NSPT).

Effectiveness of Enzyme Dentifrices on Oral Health in Orthodontic Patients: A Randomized Controlled Trial

Plaque accumulation and white spot lesions are common adverse effects of fixed orthodontic appliance use. This study compared the effects between enzyme-containing and conventional dentifrices on orthodontic patients. This double-blind randomized controlled trial included 42 orthodontic patients (25 women and 17 men: 22.7 ± 4.2 years) from Taipei Medical University Hospital between 2017 and 2018. The patients were randomly divided into three groups and assigned to dentifrice use during the first 3 months of the orthodontic treatment: group 1 used dentifrices containing enzymes including amyloglucosidase and glucose oxidase, group 2 used dentifrices containing 1450 ppm fluoride, and group 3 used natural dentifrices containing no chemical agent. White spot lesion index (WSL), gingival bleeding index (GBI), and visible plaque index (VPI) were recorded and analyzed. WSL, GBI, and VPI values exhibited no significant difference among the three groups. WSL increased significantly in group 3, GBI decreased significantly in all groups, and VPI decreased significantly in groups 1 and 2. No significant difference was observed between the use of enzyme-containing and conventional dentifrices after fixed orthodontic appliance placement.

The effectiveness of dentifrices without and with sodium lauryl sulfate on plaque, gingivitis and gingival abrasion--a randomized clinical trial

OBJECTIVES

The aim of this study was to compare the efficacy of a dentifrice without sodium lauryl sulfate (SLS) to a dentifrice with SLS in young adults aged 18-34 years on gingivitis.

MATERIAL AND METHODS

One hundred twenty participants (non-dental students) with a moderate gingival inflammation (bleeding on probing at 40-70 % of test sites) were included in this randomized controlled double blind clinical trial. According to randomization, participants had to brush their teeth either with dentifrice without SLS or with SLS for 8 weeks. The primary outcome was bleeding on marginal probing (BOMP). The secondary outcomes were plaque scores and gingival abrasion scores (GA) as well as a visual analogue scale (VAS) score at exit survey. Baseline and end differences were analysed by univariate analysis of covariance (ANCOVA) test, between group differences by independent t test and within groups by paired sample t test.

RESULTS

BOMP improved within groups from on average 0.80 at baseline to 0.60 in the group without SLS and to 0.56 in the group with SLS. No statistical difference for BOMP, plaque and gingival abrasion was found between both groups. VAS scores for taste, freshness and foaming effect were significantly in favour of the SLS-containing dentifrice.

CONCLUSION

The test dentifrice without SLS was as effective as a regular SLS dentifrice on gingival bleeding scores and plaque scores. There was no significant difference in the incidence of gingival abrasion.

CLINICAL RELEVANCE

In patients diagnosed with gingivitis, a dentifrice without SLS seems to be equally effective compared to a dentifrice with SLS and did not demonstrate any significant difference in gingival abrasion. In patient with recurrent aphthous ulcers, the absence of SLS may even be beneficial. However, participants indicate that they appreciate the foaming effect of a dentifrice with SLS more.

The effectiveness of a dentifrice without sodium lauryl sulphate on dental plaque and gingivitis - a randomized controlled clinical trial

OBJECTIVES

The purpose of the study was to evaluate the effect on dental plaque and gingivitis of a dentifrice without sodium lauryl sulphate (SLS) compared to two SLS-containing dentifrices.

MATERIAL AND METHODS

For this double-blind, parallel study, 90 volunteers having moderate gingival inflammation (≥40%) were randomly divided among three groups: one group using non-SLS dentifrice containing enzymes, colostrum and low concentrations of zinc and two control groups each using different SLS-containing dentifrices. Dental plaque scores (Turesky modification of Quigley & Hein) and gingivitis scores (Bleeding On Marginal Probing) were assessed at baseline, after 2 and 4 weeks.

RESULTS

Eighty-nine participants provided evaluable data. A slight decrease in gingivitis scores was observed for all groups over 4 weeks, which was statistically significant for the non-SLS group. Mean values for dental plaque scores did not show major differences over 4 weeks. For both parameters, no significant differences between groups could be observed at any time point. Patient appreciation was in favour of the SLS groups especially regarding the foaming effect.

CONCLUSION

No significant differences could be observed with respect to the effect on plaque and gingivitis between SLS-containing and SLS-free dentifrice containing enzymes, colostrum and low concentration zinc. Patients enjoyed the duration of taste and the 'foaming effect' of SLS-containing dentifrices better.

Plaque-left-behind after brushing: intra-oral reservoir for antibacterial toothpaste ingredients

Objectives

Plaque is never fully removed by brushing and may act as a reservoir for antibacterial ingredients, contributing to their substantive action. This study investigates the contribution of plaque-left-behind and saliva towards substantivity of three antibacterial toothpastes versus a control paste without antibacterial claims.

Materials and methods

First, volunteers brushed 2 weeks with a control or antibacterial toothpaste. Next, plaque and saliva samples were collected 6 and 12 h after brushing and bacterial concentrations and viabilities were measured. The contributions of plaque and saliva towards substantivity were determined by combining control plaques with experimental plaque or saliva samples and subsequently assessing their viabilities. Bacterial compositions in the various plaque and saliva samples were compared using denaturing gradient gel electrophoresis.

Results

The viabilities of plaques after brushing with Colgate-Total® and Crest-Pro-Health® were smaller than of control plaques and up to 12 h after brushing with Crest-Pro-Health® plaques still contained effective, residual antibacterial activity against control plaques. No effective, residual antibacterial activity could be measured in saliva samples after brushing. There was no significant difference in bacterial composition of plaque or saliva after brushing with the different toothpastes.

Conclusions

Plaque-left-behind after mechanical cleaning contributes to the substantive action of an antibacterial toothpaste containing stannous fluoride (Crest-Pro-Health®).

Clinical relevance

The absorptive capacity of plaque-left-behind after brushing is of utmost clinical importance, since plaque is predominantly left behind in places where its removal and effective killing matter most. Therewith this study demonstrates a clear and new beneficial effect of the use of antibacterial toothpastes.

Enzymes in the acquired enamel pellicle

The acquired pellicle is a biofilm, free of bacteria, covering oral hard and soft tissues. It is composed of mucins, glycoproteins and proteins, among which are several enzymes. This review summarizes the present state of research on enzymes and their functions in the dental pellicle. Theoretically, all enzymes present in the oral cavity could be incorporated into the pellicle, but apparently enzymes are adsorbed selectively onto dental surfaces. There is clear evidence that enzymes are structural elements of the pellicle. Thereby they exhibit antibacterial properties but also facilitate bacterial colonization of dental hard tissues. Moreover, the immobilized enzymes are involved in modification and in homeostasis of the salivary pellicle. It has been demonstrated that amylase, lysozyme, carbonic anhydrases, glucosyltransferases and fructosyltransferase are immobilized in an active conformation in the pellicle layer formed in vivo. Other enzymes, such as peroxidase or transglutaminase, have been investigated in experimental pellicles. Despite the depicted impact of enzymes on the formation and function of pellicle, broader knowledge on their properties in the in vivo-formed pellicle is required. This might be beneficial in the development of new preventive and diagnostic strategies.

Bactericidal effects of a fusion protein of llama heavy-chain antibodies coupled to glucose oxidase on oral bacteria

Enzymes such as lactoperoxidase and glucose oxidase (GOx) are used as antimicrobial agents in oral care products. Their low specificities and substantiveness can be reduced by covalent coupling of antimicrobial molecules to antibodies. Variable domains (V(HH)) derived from llama heavy-chain antibodies are particularly suited for such an approach. The antibodies are composed solely of heavy-chain dimers; therefore, production of active fusion proteins by using molecular biology-based techniques is less complicated than production by use of conventional antibodies. In this study, a fusion protein consisting of V(HH) and GOx was constructed and expressed by Saccharomyces cerevisiae. A llama was immunized with Streptococcus mutans strain HG982. Subsequently, B lymphocytes were isolated and cDNA fragments encoding the V(HH) fragments were obtained by reverse transcription-PCR. After construction of a V(HH) library in Escherichia coli and screening of the library against mutans group streptococci and Streptococcus sanguinis strains, we found two V(HH) fragments with high specificities for S. mutans strains. A GOx gene was linked to the two V(HH) genes and cloned into S. cerevisiae yeasts. The yeasts expressed and secreted the recombinant proteins into the growth medium. The test of binding of fusion proteins to oral bacteria through their V(HH) fragments showed that S. mutans had been specifically targeted by GOx-S120, one of the fusion protein constructs. A low concentration of the fusion protein was also able to selectively kill S. mutans within 20 min in the presence of lactoperoxidase and potassium iodide. These findings demonstrate that the fusion protein GOx-V(HH) is potentially valuable in the selective killing of target bacteria such as S. mutans.

Proteolytic degradation of oral biofilms in vitro and in vivo: potential of proteases originating from Euphausia superba for plaque control

This paper deals with enzymatic removal of dental plaque, in vitro as well as in vivo, using proteases from the Antarctic krill shrimp (Euphausia superba), referred to as Krillase. Krillase exhibits both endo- and exopeptidase activity but has no microbicidal effect. In model systems with pure cultures of oral microorganisms. Krillase demonstrated inhibition of microbial adhesion to saliva-coated hydroxyapatite. Furthermore, a protocol for the growth of reproducible in vitro plaque films has been developed, and effects of Krillase on the plaque film were investigated by means of scanning electron microscopy (SEM). The results showed that Krillase efficiently released microorganisms from plaque in vitro, the effect being dependent on the enzymatic activity. The surface energy of the substratum had a minor influence on the formation and removal of plaque in vitro. Ellipsometric studies on the formation and enzymatic removal of a salivary pellicle indicated that the enzymatic effect on plaque may partly depend on degradation of the salivary pellicle. Krillase was also able to remove plaque accumulated on dentures in vivo. Our results demonstrate the potential of Krillase for plaque control, and that these enzymes are worthy of further investigations including clinical studies and work to find a suitable vehicle.

Effect of xylitol in an enzyme-containing dentifrice without sodium lauryl sulfate on mutans streptococci in vivo

The aim of this investigation was to compare the effect of an enzyme-containing dentifrice without sodium lauryl sulfate but with addition of xylitol (Zendium Dentine) on mutans streptococci (MS) in saliva and dental plaque with that of the same dentifrice without xylitol. The subjects were divided into a test group, using a dentifrice with 10% xylitol (part A) or 5% xylitol (part B), and a control group, using a dentifrice without xylitol, for 3 months. In part A the MS counts in saliva and plaque were significantly lower in the xylitol group (n = 50) than in the control group (n = 57) (P < 0.01 and P < 0.001, respectively). In part B (n = 89 + 91), evaluating MS counts in saliva only, no significant difference was found. Thus, this study demonstrated I) that addition of 10% xylitol to an enzyme-containing dentifrice without sodium lauryl sulfate has an inhibitory effect on MS counts in saliva and dental plaque, and 2) that the inhibitory effect seems to be dose-dependent.

Pharmacological control of periodontal disease. I. Antiplaque agents

Inhibition of the development of dental plaque remains one of the primary aims of periodontal care. Many patients, however, are unable to master completely the mechanical methods of plaque control and for this reason, considerable research efforts have been directed towards the development and use of chemical agents to inhibit the growth of plaque. This first of two articles, therefore, examines the pharmacological properties and efficacy of commercially available antiplaque agents. We have also summarized the findings of some of the major clinical trials that have provided the scientific basis for the introduction of these agents for the management of gingival inflammation.

A 6-month home usage trial of a 1% chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining

Research and development has been aimed towards the development of toothpastes for oral hygiene and gingival health benefits. The most effective antiplaque agent to date, chlorhexidine, is difficult to formulate into active toothpaste products. Despite some encouraging findings for experimental chlorhexidine toothpastes, there are to date no commercially available products. Based on positive findings from an experimental gingivitis study, this investigation evaluated 2 chlorhexidine toothpastes, one with fluoride, as adjuncts to oral hygiene. The study was a double-blind controlled, parallel, balanced group design, extending over 6 months. A total of 297 volunteers commenced the study after screening for a minimum acceptance level of gingivitis. At baseline, 6, 12 and 24 weeks, stain, gingival, bleeding and plaque indices were recorded, together with a calculus index at 6, 12 and 24 weeks. After a baseline prophylaxis, volunteers used the allocated product 2 x per day, with no other oral hygiene instructions given. Plaque, gingival and bleeding scores improved in all 3 groups, but to an overall significantly greater extent in the active groups. However, staining and calculus indices were significantly increased in the active compared to the control group. If the local side-effects of chlorhexidine are considered to be acceptable, these chlorhexidine toothpastes could be recommended for the same clinical applications as other chlorhexidine products. The apparent compatibility of fluoride with chlorhexidine in the one product may be pertinent to caries prevention.

The effects of a chlorhexidine toothpaste on the development of plaque, gingivitis and tooth staining

Chlorhexidine has found many uses in clinical dentistry as an antiplaque agent. To date, effective chlorhexidine-containing toothpastes have not been made available. This study was the first phase in the evaluation of a 1% chlorhexidine toothpaste, formulated to ensure a high availability of the contained antiseptic. The study was a 19-day, randomised double-blind placebo-controlled, crossover experiment al gingivitis clinical trial employing 14 healthy human volunteers. From a zero plaque and low gingivitis baseline, the development of plaque, gingivitis and dental staining was measured on days 12 and 19 of the 2 study periods. The toothpaste was used 2x a day as a slurry rinse with no other form of oral hygiene. The washout period was 21 days. The development of plaque and gingivitis was statistically and clinically highly significantly reduced during the use of the active compared to the placebo product. Conversely, dental staining was statistically and clinically significantly increased. The product deserves further evaluation for potential clinical use.

Triclosan and sodium lauryl sulphate mouthwashes (I). Effects on salivary bacterial counts

A number of commonly used toothpaste ingredients, such as detergents, possess not inconsiderable antimicrobial activity. Additionally, specific ingredients including triclosan are now added to toothpastes to enhance such activity and to improve plaque inhibition. To date, there have been few studies of the antimicrobial properties in vivo of individual toothpaste ingredients. Most investigations have evaluated the whole toothpaste product. Persistence of antimicrobial action in vivo has been shown to relate to potential plaque inhibitory action. The aim of this study was to compare the magnitude and duration of salivary bacterial count reductions produced by a single rinse of 0.2% triclosan, 1% sodium lauryl sulphate (SLS) and 0.2% chlorhexidine mouthwashes. 16 volunteers took part in a single-blind latin-square randomised crossover designed study with balanced residual effects. Before and for time periods up to 420 min following rinsing with the allocated mouthwashes, saliva samples were obtained and processed for total anaerobic counts. With the exception of the saline control rinse, the 3 test solutions produced considerable reductions in bacterial counts which remained significant to 3 h for triclosan and 7 h for SLS and chlorhexidine. However, at most time periods after baseline, the effects of chlorhexidine were significantly greater than triclosan and SLS. Overall, SLS had significantly greater effects than triclosan. Incremental values from 30 min post rinsing were always positive for SLS and triclosan, indicating bacterial recovery, whereas these values were negative for chlorhexidine. The results indicate that triclosan and SLS provide some persistence of antimicrobial activity in the oral cavity when used at relatively high dose compared to a toothpaste vehicle.

Triclosan and sodium lauryl sulphate mouthrinses. (II). Effects of 4-day plaque regrowth

Toothpastes have been shown to exert some plaque inhibitory effects probably due to the action of detergents such as sodium lauryl sulphate (SLS). Recently the antimicrobial, triclosan, has been added to experimental and commercial toothpaste products to enhance activity against plaque. There is, however, little information as to the plaque inhibitory effects alone of ingredients such as SLS and triclosan. This investigation compared the effects on 4-day plaque regrowth of a 1% SLS, 0.2% triclosan and 0.2% chlorhexidine rinse with a 0.9% saline rinse. The study was single blind, latin square, four-period crossover design, balanced for residual effects and employing 16 healthy dentate volunteers. During each period, normal oral hygiene ceased and plaque regrowth from a zero baseline was measured by score and area after 2 x daily rinses with 10 ml volumes of each rinse. Washout was a minimum of 60 h. Plaque scores and areas were significantly lower with chlorhexidine than the other preparations and significantly higher with saline. There were no significant differences between SLS and triclosan. The results were essentially consistent with the similar substantivity of SLS and triclosan demonstrated from the salivary bacterial count investigation. Taste acceptability may, however, explain the small reverse trends noted between the two studies. It is concluded that both SLS and triclosan would individually confer plaque inhibitory properties to toothpaste formulations. However, when combined in a single formulation, their effects may not be additive.

The effect of triclosan, stannous fluoride and chlorhexidine products on: (I) Plaque regrowth over a 4-day period

A number of substances have been incorporated into toothpastes or gels to inhibit plaque regrowth. The aim of this study was to evaluate triclosan and stannous fluoride products for plaque inhibitory properties by comparison with a chlorhexidine or saline rinse and a control product which was a conventional commercially available toothpaste. In a blind 8 cell cross-over study, 15 volunteers rinsed 2 x a day for 4 days with slurries of the products or the saline and chlorhexidine solutions. No other form of oral hygiene was performed and plaque regrowth from a zero baseline was recorded by plaque score and plaque area. Plaque regrowth was significantly less with the chlorhexidine rinse and significantly greater with the saline rinse compared to the toothpaste and gel products. No significant differences were found between the test and control products. The results again demonstrate that commercially available toothpastes have plaque inhibitory effects which so far appear difficult to improve upon by the addition of specific ingredients, in this case stannous fluoride or triclosan. Commercially available products of known activity would appear useful benchmarks for comparison of experimental formulations.

The effects of 0.5% chlorhexidine and 0.2% triclosan containing toothpastes on salivary bacterial counts

A number of antimicrobial compounds could be incorporated into toothpastes to enhance plaque inhibitory effects. However, the number of possible formulations is immense and makes clinical testing in plaque and gingivitis studies difficult. In this study, the effects on salivary bacterial counts of a number of chlorhexidine and triclosan toothpastes was evaluated as a predictor of persistence of antimicrobial action in the mouth. The study was a supervised, randomised 15-way crossover study employing 10 healthy human volunteers. All toothpastes were brushed for 1 min and comparison made with a 0.2% chlorhexidine rinse. The latter produced a large drop in salivary bacterial counts to the end of the 7-h study period. The toothpastes decreased salivary bacterial counts and all but two had notably more effect than a water brushing. No toothpaste showed a significant persistence of antimicrobial effect beyond 5 h. In the light of available plaque inhibition data for the toothpastes, persistence of antimicrobial activity beyond 5 h will be necessary for a clinical effect on plaque and gingival health. The method appears to be a simple and rapid screening technique for products formulated to enhance plaque inhibition mediated through an antimicrobial action.