Triclosan Revisited: Did you miss the good news about reduction in root caries and mucositis?
In December, I did what many of you across the country did. I attended the Science To Cities Educational Tour hosted by Colgate. What motivated me to leave home and attend a program such as this?
BY Karen Davis, RDH, BSDH
In December, I did what many of you across the country did. I attended the Science To Cities Educational Tour hosted by Colgate. What motivated me to leave home and attend a program such as this? Triclosan. Anything that can generate this title, "Is Cancer Lurking in Your Toothpaste?" from the September 2014 Newsweek gets my attention.
I decided it warranted a flight to Houston to listen to the evidence. Kudos to Colgate and all of the speakers who presented a "done and dusted" program (cool Australian phrase) loaded with scientific evidence that triclosan toothpaste does not have adverse health effects, and no evidence links it to cancer.1 I actually expected that outcome, but sadly, upon reviewing the information, I realized I had missed something important along the way. Maybe you did too.
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In my effort to educate patients about caries reduction and prevention of gingival inflammation I was aware of the published data surrounding the active ingredient in Colgate Total, triclosan, and frequently recommended it for patients with those conditions. What I missed, and fear other professionals may have missed too, is the promising clinical impact triclosan can have in the reduction of root caries, as well as mucositis surrounding implants.
Are you currently including Colgate Total in your armamentarium of products you recommend for the multitude of patients that present with either root caries, demineralized exposed roots that could develop root caries, or patients that present with bleeding tissue surrounding their implants? If not, then I invite you to continue reading.
In 2009, an interesting study was published that echoed what other studies had confirmed.2 Colgate Total with triclosan had been shown to be highly effective in plaque and gingivitis control (and is completely safe irrespective of the bad press). What was unique about this study, however, is that it was a three-year clinical trial investigating the question: Would Colgate Total with triclosan and sodium fluoride fare any better in the prevention of root caries and subsequent survival of dental crowns than a toothpaste with sodium fluoride and no triclosan?
This is a question that interests me as I have been in the same practice for 30 years and have observed many patients that start out with beautiful crowns and perfect margins that gradually develop recession, root exposure, and eventually root caries. Clearly, there are many lifestyle behaviors that are contributing factors such as sugar and carbohydrate exposure, pH status and salivary flow, and effective plaque control for susceptible patients.
Nevertheless, if a product has good evidence that it can contribute to slowing or preventing root caries, I want to know.
Over 1,300 patients completed the three-year study. The mean dental crown failure due to root caries was almost four-fold higher in the sodium fluoride toothpaste group without triclosan compared to the group using Colgate Total.
Hmm. The difference was triclosan. Perhaps results were primarily due to a reduction in plaque with the triclosan group, perhaps it was a synergistic effect of sodium fluoride and triclosan together, but the outcome is good news for patients wanting to protect their investment of full coverage crowns.
Another interesting study in 2009 examined the effect of triclosan on the common problem of peri-implant mucositis.3 It was a smaller study of only 60 individuals. Again, the comparison was between toothpaste with sodium fluoride and Colgate Total with triclosan. Bleeding upon probing scores went from 53.8% to 29.1% in the Colgate Total group compared to patients using sodium fluoride toothpaste without triclosan. The bleeding scores actually increased from 52.3% to 58.8% over the same six-month period for the group brushing with sodium fluoride toothpaste without triclosan.
Additionally, the pocket depths were reduced more in the Colgate Total group compared to those using sodium fluoride toothpaste without triclosan. This outcome is good news. Peri-implant mucositis can be reversible, or it can proceed to peri-implantitis. Colgate Total could be an effective agent in helping to prevent inflammation surrounding implants from progressing into the bone. It appears as though Colgate Total possesses both antimicrobial and anti-inflammatory properties, which makes it a desirable adjunct for many dental conditions.
Certainly, Colgate Total isn't the only agent on the market that possesses dual antimicrobial and anti-inflammatory properties. For patients questioning whether or not triclosan is safe to use, we should not only reassure them that it is, but should guide patients toward its use for two conditions extremely common to dental hygienists - prevention of root caries and peri-implant mucositis.
Hopefully, additional evidence will corroborate results from these 2009 studies. In the meantime, jump in with triclosan and see what you may have missed. RDH
1. Riley P, Lamont T. Triclosan/copolymer containing toothpastes for oral health. Cochrane Database of Systematic Reviews 2013, Issue 12.
2. Vered V, Zini A, Mann J, et.al. Comparison of a dentifrice containing 0.234% sodium fluoride, 0.3% triclosan, and 2.0% copolymer in a silica base, and a dentifrice containing 0.234% sodium fluoride in a silica base: A three-year clinical trial of root caries and dental crowns among adults. J Clin Dent 20:62-65, 2009.
3. Ramberg P, Lindhe J, Botticelli D, Botticelli A. The effect of a triclosan dentifrice on mucositis in subjects with dental implants: A six-month clinical study. J Clin Dent 20:103-107, 2009.
Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp., Periosciences, and Hu-Friedy/EMS. She can be reached at Karen@Karendavis.net.
Action Point Take-Aways:
1. Visit www.cochrane.org and download the review on triclosan/copolymer for a synopsis of its clinical benefits and safety.
2. Conduct your own "trial" for prevention of root caries and reduction of peri-implant mucositis with patients that could benefit from triclosan toothpaste.
3. Share the message of triclosan safety with your team.