Is there an Advantage in Using Triclosan containing Dentifrice?

1. Is there an Advantage in Using Triclosan containing Dentifrice? Group 1 Agustin, Andres, Aquitania, Aradanas, Asama, Austria, Bagasan, Bantegui, Bare, Bondoc, Borlagon, Buyawe, Cabrera, Cheung

2. TRICLOSAN Triclosan (2,4,4’-trichloro-2’-hydroxydiphenyl ether) - Broad-spectrum, non-ionic, anti-bacterial/antimicrobial agent incorporated in soaps and cosmetics.

3. http://i.ivillage.com/uk_en/competitions/images/colgate_main.jpghttp://i.ivillage.com/uk_en/competitions/images/colgate_main.jpg

4. Triclosan Toothpastes versus Fluoride Toothpastes: Are they Different? Ragy et. al, 2001

5. OBJECTIVE Determine whether Triclosan Toothpastes could be shown to be more effective than conventional fluoride toothpaste when utilized in a twice daily home use for two months.

6. Effect of Triclosan/copolymer-containing Toothpaste on the Association between Plaque and Gingival Bleeding: a Randomized Controlled Clinical Trial Muller et. al, 2006

7. OBJECTIVE To study longitudinal associations between plaque and gingival bleeding and multilevel variance/covariance structures after introducing triclosan-containing toothpaste.

8. The Effectiveness of a Toothpaste containing Triclosan and Polyvinyl-methyl ether maleic acid copolymer in Improving Plaque Control and Gingival Health Davies et. al, 2004

9. OBJECTIVE To compare the effectiveness of triclosan/copolymer and fluoride dentifrices in improving plaque control and gingival health.

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26. RESULTS

27. Ragy et. al., 2001 Baseline averages of the whole mouth plaque index scores were initially very similar to each other ranging from 2.65-2.73. At the end of the 8th week mean values were 2.45, 2.33 and 2.5 for Col. Total, gingilacer and Col. regular respectively Table 1: summary of the whole mouth plaque index scores (mean+/- SD)

28. There were no statistically significant differences in plaque scores between groups at either the 4th or 8th weeks Table 2: Least square means of plaque index scores

29. The gingival index for the whole mouth showed no difference between products during the 4th and 8th weeks Table 3: Summary of the whole mouth gingival index scores (mean +/-SD) 3:

30. There was no significant statistical difference in gingivitis score between the groups at either 4 or 8 weeks Table 4:Least square means of gingival index scores

31. Although the difference in plaque scores among the three groups was not found to be statistically significant, there was a decrease in plaque scores for all three groups between the baseline and 4th week. A similar pattern was observed in the gingival index of all three groups. No statistical significance was noted, but a decrease in gingival index was observed for all three groups from baseline to week 4.

32. Muller et. al., 2006 • Volunteers: 34  32 (due to examination stress after week 4) • Volunteers: mild-moderate plaque-induced gingivitis with few sites with increased PPD of >4mm at partially erupted 8s • No loss of attachment (only due to few facial areas with gingival recession)

33. Table 1. Clinical periodontal conditions of the study population at the onset and alterations 6 weeks after introducing experimental toothpastes are presented

34. No significant difference between groups neither at baseline nor at the end of the study

35. The difference were small within groups although bleeding tendency attenuated in both groups

36. Ecological Approach

37. Ecological Approach • Table 2. Correlation between individual mean plaque and BI after week 4

38. Ecological Approach

39. Multivariate Multilevel Models • Table 3. Fixed effects estimates during Prep Any increase in the PLI by 1 score  inc in the odds of BOP by 34-44%

40. Multivariate Multilevel Models • Table 3. Fixed effects estimates during Prep Any 1 mm increase of PPD  inc by 60% BOP odds ratio

41. Multivariate Multilevel Models • Table 4. Random part of multivariate four-level model

42. Table 4. Random part of multivariate four-level model Constraining the model to fit binomial variation at the lowest level did not substantially alter any of the other parameter estimates (not shown).

43. Table 5. Fixed effects estimates after Prep and during Exp • There was gradually increasing negative effect of test toothpaste on BOP proportions • At the end of the Exp phase, odds of BOP decreased by 30% in the Test Group (OR 0.71%. 95% Confidence Interval 0.56-0.9, p= 0.005)

44. Table 6. Subject Variation

45. Multivariate Multilevel Models – with PLI and CLS as responses • Test toothpaste had no significant (no reducing) effect on PLI • Test toothpaste had a small, albeit not significant (negative), effect on LCS • Owing to highly localized occurrence of CLS, the model revealed considerable underdispersion at the site level, making the assumption of Binomial distribution questionable. • When level 4 (tooth) was removed from the model, extrabinomial variation was essentially reduced. • In contrast to the bleeding scores, biserial correlations for CLS were high (about 0.6) at the site level

46. Table 7. Association: BOP and PLI • At the end of the Exp phase, • Association between BOP and Plaque Scores: • Test Group < Control Group ( =8.39, p<0.05)

47. Adverse Effects • One only, but disappeared after termination of the experiment • Benign migratory glossitis (painless geographic tongue)

50. Meta- analyses for both Quigley- Hein Plaque Index and Plaque severity index: - the triclosan/copolymer toothpaste is effective in reducing plaque. Davies et. al., 2004