Toothpaste and plaque removal

Plaque off, Fluoride on. Brushing your teeth really is that simple.
Image: Adam Drewes (CC BY-NC-SA 2.0)

Caries and periodontal disease are two of the comments disease of man and strongly associated with the presence of dental plaque. Twice daily toothbrushing with fluoridated toothpaste is an important part of many people’s daily hygiene routine and considered by many to be the most cost effective method of maintaining or improving oral health. Toothpaste manufacturers make a number of claims for the favourable effects of various formulations of toothpaste e.g plaque removal, anti-cavity effects, remineralisation, anti-erosion effects, anti-bacterial effects, anti-plaque effects, anti-calculus effects, tooth whitening, reduction in oral malodor, anti-staining effects, anti-gingivitis effects, desensitization.

The aim of this review was to establish the efficacy of brushing with and without a dentifrice for dental plaque removal.


Cochrane Central Register of Controlled Trials (CENTRAL), Embase, the national Dutch (, EU ( and international (, registers and the NARCIS ( and OpenGrey (http:// databases.

Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) in patients 18yrs or older evaluating the effect of toothbrushing with a dentifrice compared to brushing without a dentifrice were considered. Two reviewers independently screened the studies abstracted data and quality assessed the studies meta-analysis was performed where feasible.


  • 10 RCTs ( 5 cross-over,3 split mouth and 2 parallel) involving a total of 444 patients
  • the 10 studies provided 20 comparisons.
  • 6 studies were considered to be at low risk of bias, 3 moderate risk and 1 at high risk.
  • Of the 20 comparisons 9 had inconclusive data;
    • 1 showed a significant difference in favour of the use of a dentifrice;
    • 3 found a significant difference favouring brushing without a dentifrice
    • 7 showed no significant difference between interventions
  • On average, 49.2% of plaque was removed when brushing was performed with a dentifrice, and 50.3% of plaque was removed when toothbrushing was performed without a dentifrice.
  • meta-analysis of post-brushing scores,( 18 comparisons) no significant difference was observed between toothbrushing with and without a dentifrice (DiffM 0.00, 95%CI [-0.05: 0.05], p = 0.91).


The authors concluded: –

The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque.


This review has used a sound methodological approach searching a good range of databases. 60% of the included RCTs were considered to be at low risk of bias. While the studies were relatively small with an average of 44 patients included (range 12-120) most were either of cross-over design or split mouth design.

While the findings of the review suggest that there are no differences brushing with or without toothpaste There is evidence from Cochrane reviews to confirm the value of fluoridated toothpaste to prevent caries in children and adolescents (Walsh et al) and to suggest that xylitol based pastes may have a further advantage (Dental Elf – 27th Mar 2015). There is also

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’ (Dental Elf – 27th Mar 2015).

The authors’ note that abrasives in toothpaste also play a role on removal of the pellicle and freshening the mouth and highlight that many people would not brush their teeth without the aid of toothpaste noting that they would not recommend that toothbrushing without toothpaste. Given the demonstrable benefits that have been shown from toothpaste use in other reviews its regular use should be actively encouraged.


Primary paper

Valkenburg C, Slot DE, Bakker EW, Van der Weijden FA. Does dentifrice use help to remove plaque? A systematic review. J Clin Periodontol. 2016 Aug 11. doi: 10.1111/jcpe.12615. Review. PubMed PMID: 27513809.

Other references

Dental Elf – 27th Mar 2015

Xylitol in toothpaste may provide small additional benefit over fluoride toothpastes

Dental Elf – 9th Dec 2013

Review shows that triclosan copolymer toothpaste reduced plaque, gingivitis and caries

Dental Elf – 8th Oct 2013

Teaching toothbrushing with fluoride toothpaste – are we doing it well?


Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VCC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007868. DOI: 10.1002/14651858.CD007868.pub2.



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