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Cochrane's review of triclosan toothpastes

By Lynne Slim, RDH, BSDH, MSDH

I'm a big fan of public radio. Last week, I was listening to an early morning segment about science running into a brick wall. Naturally, I was all ears and what I heard didn't surprise me. The dental public health community perceives much misinformation and spurious connections, particularly regarding fluoridation and topical fluorides. As dental professionals already know, studies conducted in communities that fluoridate water have shown a lower rate of tooth decay than communities without fluoridated water. In addition, the benefits from water fluoridation build on those from fluoride in toothpaste.1

I was first introduced to evidence-based dentistry/medicine in the Old Dominion University classroom of now retired Professor Emeritus Michele L. Darby, RDH, MS. In the late 1970s, when I completed baccalaureate and master's degrees in dental hygiene, part of the curriculum included a thesis involving personal research and a detailed report that met established university standards. I chose to compare two periodontal probing techniques in the clinical detection of periodontal pockets. It was a grueling exercise, but it taught me how to move beyond opinions to critical thinking, and I work hard to remain objective when reviewing the literature.

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Other articles by Lynne Slim

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More than anything, I've learned how to appreciate the efforts of evidence-based clinicians who use published research in all aspects of their clinical and operational processes in an effort to improve health outcomes. Dental hygiene professionals need to focus on dispelling myths and misinformation, and become gatekeepers of proven preventive measures.

Just as we've read a lot of distorted information about fluorides, we are constantly bombarded in dentistry with media hype that is damaging to professional and patient decision-making. One example of media and public misconception is Colgate Total toothpastes with triclosan. I would like to summarize a Cochrane Oral Health Group intervention systematic review that discusses the benefits and safety of triclosan/copolymer over regular fluoride toothpaste as an antimicrobial agent. The copolymer aids in retention of triclosan and is added to toothpaste to reduce plaque/biofilm and gingivitis.

The Cochrane Oral Health Group (ohg.cochrane.org) is an international, nonprofit organization that networks in a way that helps clinicians, researchers, consumers, and patients make decisions about oral health care based on up-to-date, reliable, and accurate information.

The objective of the intervention review was to assess the effects of triclosan/polymer toothpastes containing fluoride in comparison to fluoride toothpastes for the long-term control of dental caries, plaque/biofilm, and gingivitis in children and adults.2 Electronic databases were searched, and randomized controlled trials (RCTs) were included. To reduce bias, two review authors independently assessed the search results against the inclusion criteria, extracted data, and then carried out their assessments. Thirty studies were analyzed in this review with 10 studies (33%) at low risk of bias, nine (30%) at high risk of bias and 11 (37%) as unclear.

Adverse effects: There were no data available for meta-analysis regarding adverse effects; 22 studies (73%) reported no adverse effects in experimental or control toothpaste in studies up to three years in length.

Key results (plaque, gingivitis, dental caries, calculus): A 22% reduction in plaque/biofilm, a 22% reduction in gingivitis, a 48% reduction in gingival bleeding, and a 5% reduction in dental caries were reported. There was insufficient evidence to show a difference between either toothpaste (control or triclosan/polymer toothpaste) in preventing periodontitis.

Authors' conclusions: The evidence was of "moderate quality" showing that toothpastes containing triclosan/copolymer, in addition to fluoride, reduced plaque/biofilm, gingival inflammation, and gingival bleeding. High quality evidence showed that triclosan/copolymer toothpastes led to a small reduction in coronal caries. Evidence to show that triclosan/copolymer toothpastes may have reduced root caries and calculus was weaker.

There was insufficient evidence to show whether or not triclosan/copolymer toothpastes prevented periodontitis.

There do not appear to be any serious safety concerns in studies up to three years in duration.

Reductions in plaque/biofilm, gingival inflammation, and gingival bleeding may or may not be clinically important but were evident regardless of initial plaque and gingivitis levels, or whether a baseline oral prophylaxis had taken place or not.

Science is about the process of discovery based on objectivism, the development of theories, and testing/confirming or rejecting them. Oral health-care professionals must learn to evaluate scientific claims and be prepared to educate patients about clinical evidence that will help them. Brick walls can be shattered even with sensationalistic media reports.

LYNNE SLIM, RDH, BSDH, MSDH, is an awardwinning writer who has published extensively in dental/dental hygiene journals. Lynne is the CEO of Perio C Dent, a dental practice management company that specializes in the incorporation of conservative periodontal therapy into the hygiene department of dental practices. Lynne is also the owner and moderator of the periotherapist yahoo group: www.yahoogroups.com/group/periotherapist. Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene-related topics. She can be reached at periocdent@mindspring.com or www.periocdent.com.

References

1. http://www.cdc.gov/fluoridation/benefits/
2. 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.

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