Australasian experts review the role of triclosan/copolymer toothpaste in the management of periodontal disease

A paper resulting from an Australasian workshop was recently published in the British Dental Journal (BDJ (2009) 207, 117-125). The paper "Is there a role for triclosan/copolymer toothpaste in the management of periodontal disease?" was authored by A. Blinkhorn, PM Bartold, MP Cullinan, TE Madden, RI Marshall, SL Raphael, and GJ Seymour.

In July 2008, Colgate Oral Care, Australia, convened a working group of dental experts to examine the literature pertaining to the efficacy, mode of action and safety of triclosan/copolymer toothpaste and form a consensus opinion regarding the role of this toothpaste in the management of periodontal disease. A MEDLINE search using the terms 'triclosan and/or copolymer' was performed and 198 articles dated from 1989 - May 2008 were identified and reviewed and the following consensus statements were reached.

Efficacy

• Results of studies showed overall there was around a 23% reduction in both plaque and gingivitis compared to placebo toothpaste. The greatest effect seems to be related to those sites which harbour the most plaque and those sites with gingivitis as measured by bleeding on probing.
• Highly susceptible periodontal patients using triclosan/copolymer toothpaste experienced a significant difference in mean probing depth change over a three year period compared to patients using a placebo toothpaste and improved healing following periodontal therapy.
• Whilst the majority of studies showed that regular use of triclosan/copolymer toothpaste may offer benefits in lowered supragingival calculus formation, further investigations are warranted.
• The data supports the conclusion that triclosan/copolymer-containing toothpaste is at least as good as standard fluoride toothpaste in limiting the formation of new carious lesions.
• The available evidence suggested that the use of triclosan/copolymer toothpaste should result in an improvement in halitosis. However, this is an area of research that requires more investigation before definitive answers can be given to patients about managing 'bad breath'.

Mode of action

• In order to successfully incorporate triclosan into a toothpaste, it was necessary to develop a formula which optimized its delivery and retention in the mouth while remaining compatible with the other ingredients.
• A number of in vitro studies have addressed the anti-inflammatory properties of triclosan - implying an anti- inflammatory effect. In vivo studies are limited and although promising results with regard to the anti-inflammatory effect of triclosan/copolymer toothpaste use have been reported, further studies are needed to confirm this observation.
• The PVM/MA (Polyvinylmethylether maleic acid) copolymer significantly enhances the substantivity of triclosan in toothpaste. This enhances and prolongs the antibacterial and anti-gingivitis effects without interfering with any other ingredients in the toothpaste formulation. The presence of the copolymer appears to be necessary in a triclosan/fluoride toothpaste formulation in order for periodontal health benefits to achieve statistical significance over a prolonged study period.

Safety

• To date, there have been no reports of adverse systemic effects or local effects on the oral hard or soft tissues that could be attributed to the use of a triclosan/copolymer toothpaste.
• Triclosan has been used for many years in different household and clinical products in varying settings. Throughout this time, no significant differences in the frequency of antibiotic resistant bacteria have been found and no significant shifts in the oral microbiota have been reported with unsupervised, long-term daily use of triclosan-containing toothpaste.

In conclusion, the results from a number of scientific and clinical studies, together with two systematic reviews strongly support the anti-plaque and anti-gingivitis effect of the twice daily use of a triclosan/copolymer toothpaste. The current evidence suggests that patients will gain clinically significant improvements in plaque control and gingivitis and benefit from a slower progression of periodontal disease.

Given the proven safety profile, demonstrated benefits and relatively low cost of the use of a triclosan/copolymer toothpaste, it would seem prudent for dental professionals to recommend the use of such a toothpaste to many of their patients in place of regular fluoride toothpaste.