While there have been reductions in caries prevalence in many countries ,levels of gingivitis remain high. Toothpastes aid tooth cleaning and provide a useful delivery agent for plaque control agents. The aim of this review was to compare the effectiveness of stannous fluoride (SnF) toothpastes with triclosan-containing (Tcs) toothpastes in improving gingival inflammation and plaque scores.
Searches were conducted in PubMed-Medline, the Cochrane Central Register of Controlled Trials and Embase. Manufactures were also contacted with requests to provide their unpublished data. Randomized, controlled trials (RCTs) or controlled clinical trials (CCTs) of at least 4 weeks duration that compared SnF toothpastes with TC toothpastes in patients ≥ 17 years of age were considered. Studies written in English, German or Dutch were included. Studies were screened independently by 3 reviewers and quality assessed.
- 15 RCTs (includes 4 unpublished studies from one manufacturer) met the criteria.
- There was no difference in gingival index (or its modification) between the two types of dentifrice [DiffM-0.04, 95% confidence interval CI (-0.11; 0.04); P = 0.34].
- The change in the average gingival bleeding score was significantly in favour of SnF [DiffM0.02, 95% CI (0.01; 0.02); P < 0.00001].
- Plaque scores demonstrated a statistical significant difference in favour of Tcs, according to Quigley-Hein Plaque Index (Q&H PI; DiffM-0.29, 95% CI [-0.45; -0.13]; P = 0.0004), but there was no difference according to Rustogi Modified Navy Plaque Index (RMNPI) [DiffM-0.09, 95% CI (-0.01; 0.18); P = 0.07]. Long-term results supported these findings.
The authors concluded
- In the context of inconclusive results for the primary outcome variable of gingival health, it can be concluded that there was a minor and most likely clinically insignificant difference between Tcs- and SnF-containing dentifrices. Meta-analysis of plaque score reduction was also inconclusive; whereas Tcs was more effective when assessed by the Q&H PI, it was not when scored with the RMNPI.
The recent Cochrane review by Riley and Lamont 2013) considered 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. They included 30 studies and concluded:-
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.
The Cochrane review only included studies with a minimum of 6 months duration so several of the studies included in this review would not have been included.
Sälzer S, Slot D, Dörfer C, Van der Weijden G. Comparison of triclosan and stannous fluoride dentifrices on parameters of gingival inflammation and plaque scores: a systematic review and meta-analysis. Int J Dent Hyg. 2014 Jun 19. doi: 10.1111/idh.12072. [Epub ahead of print] PubMed PMID: 24945592.
Riley P, Lamont T. Triclosan/copolymer containing toothpastes for oral health. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD010514. DOI: 10.1002/14651858.CD010514.pub2.