Gingivitis: anti-plaque agents may help

A number of oral hygiene products have been developed to assist with the removal of dental plaque. These include a number of agents for chemical plaque control in a range of delivery systems, eg. toothpastes, mouthwashes and gels. The aim of this review was to evaluate the efficacy of anti-plaque chemical formulations for home-use for managing gingivitis.

Methods

The search was conducted in PubMed Central. Two reviewers selected studies, abstracted data and assessed risk of bias. Randomised controlled trials (RCTs) with at least 6 month follow up evaluating the use of test products used in mouthrinses, toothpastes or gels as adjuncts to mechanical oral hygiene (including toothbrushing) were considered. Primary outcome measures were (gingivitis and/or bleeding indices). Mean treatment effects were calculated to obtain weighted mean differences (WMD) and 95% confidence intervals.

Results

87 studies with 133 comparisons [toothpastes (n = 59), mouthrinses (n = 63), or the combination (n = 7). Gels (n = 3) and liquid toothpastes (n = 1)], were included.
4 studies were considered to be at low risk of bias, 8 with unclear risk and 75 at high risk of bias.
There were 15 different categories of active agent in the toothpastes and 10 in the mouthwashes
65 studies contributed to the meta-analyses.
- The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD -0.217), modified gingival index (n = 23, -0.415), gingivitis severity index (n = 26, -14.939%) or bleeding index (n = 23, -7.626%), with significant heterogeneity.
- For plaque, additional effects were found for Turesky (66 studies, WMD -0.475), Silness & Löe (n = 26, -0.109), and plaque severity (n = 12, -23.4%) indices, with significant heterogeneity.

Conclusions

The authors concluded: –

Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices.

Comments

This new review pulls together a large volume of information on a wide range of home use anti-plaque agents even though only a single database was used for the search. This means that some relevant studies could have been excluded. The review also has opted to include a wide range of agents as well as delivery systems previous reviews (see links) have chosen to limit themselves to a particular delivery system and or anti-plaque agent, and from my perspective this would have simplified the task for both the reviewers and the reader.

The reviewers note that 82 out of 87 of the included studies produced positive results and that a majority of the studies were supported by companies with commercial interests. The reviewers also note the high level of heterogeneity in the studies and limited information on adverse effects. The authors also point out that the benefits found were statistically significant. However, it should be noted that which the benefits may be statistically significant they might not be clinically important.