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Meta-Analysis
. 2013 Dec 5;2013(12):CD010514.
doi: 10.1002/14651858.CD010514.pub2.

Triclosan/copolymer containing toothpastes for oral health

Philip Riley  1 , Thomas Lamont
Affiliations
Meta-Analysis

Triclosan/copolymer containing toothpastes for oral health

Philip Riley et al. Cochrane Database Syst Rev. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Philip Riley: no interests to declare. Thomas Lamont: no interests to declare.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Plaque, outcome: 1.1 Plaque at 6 to 7 months (Quigley‐Hein Plaque Index).
5
5
Funnel plot of comparison: 2 Gingivitis, outcome: 2.1 Gingivitis at 6 to 9 months (Löe‐Silness Gingival Index).
1.1
1.1. Analysis
Comparison 1 Plaque, Outcome 1 Plaque at 6 to 7 months (Quigley‐Hein Plaque Index).
1.2
1.2. Analysis
Comparison 1 Plaque, Outcome 2 Plaque at 6 to 7 months (Plaque Severity Index).
1.3
1.3. Analysis
Comparison 1 Plaque, Outcome 3 Plaque at 6 to 7 months (Löe‐Silness Plaque Index).
2.1
2.1. Analysis
Comparison 2 Gingivitis, Outcome 1 Gingivitis at 6 to 9 months (Löe‐Silness Gingival Index).
2.2
2.2. Analysis
Comparison 2 Gingivitis, Outcome 2 Gingivitis at 6 to 7 months (Gingivitis Severity Index).
2.3
2.3. Analysis
Comparison 2 Gingivitis, Outcome 3 Gingivitis at 6 months (number of sites bleeding on probing or spontaneously).
3.1
3.1. Analysis
Comparison 3 Periodontitis, Outcome 1 Periodontitis at 36 months (attachment loss > 0 mm).
4.1
4.1. Analysis
Comparison 4 Caries, Outcome 1 Caries increment at 30 to 36 months (DFT).
4.2
4.2. Analysis
Comparison 4 Caries, Outcome 2 Caries increment at 24 to 36 months (DFS).
4.3
4.3. Analysis
Comparison 4 Caries, Outcome 3 Root caries increment at 36 months (Katz Root Caries Index).
5.1
5.1. Analysis
Comparison 5 Calculus, Outcome 1 Calculus at 6 months (Volpe‐Manhold Calculus Index in mm ‐ mean total calculus per participant).
5.2
5.2. Analysis
Comparison 5 Calculus, Outcome 2 Calculus at 7 months (Volpe‐Manhold Calculus Index in mm ‐ mean height of calculus).
6.1
6.1. Analysis
Comparison 6 Adverse effects, Outcome 1 Staining of teeth at 6 months (Meckel Stain Score).
See this image and copyright information in PMC

Comment in

References

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Mann 1996 {published and unpublished data}
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Archila 2004 {published data only}
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