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The Cochrane Database of Systematic... Mar 2015Dental caries is a highly prevalent chronic disease which affects the majority of people. It has been postulated that the consumption of xylitol could help to prevent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental caries is a highly prevalent chronic disease which affects the majority of people. It has been postulated that the consumption of xylitol could help to prevent caries. The evidence on the effects of xylitol products is not clear and therefore it is important to summarise the available evidence to determine its effectiveness and safety.
OBJECTIVES
To assess the effects of different xylitol-containing products for the prevention of dental caries in children and adults.
SEARCH METHODS
We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 14 August 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 7), MEDLINE via OVID (1946 to 14 August 2014), EMBASE via OVID (1980 to 14 August 2014), CINAHL via EBSCO (1980 to 14 August 2014), Web of Science Conference Proceedings (1990 to 14 August 2014), Proquest Dissertations and Theses (1861 to 14 August 2014). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials assessing the effects of xylitol products on dental caries in children and adults.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference and 95% confidence interval (CI). We used the continuous data to calculate prevented fractions (PF) and 95% CIs to summarise the percentage reduction in caries. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. As there were less than four studies included in the meta-analysis, we used a fixed-effect model. We planned to use a random-effects model in the event that there were four or more studies in a meta-analysis.
MAIN RESULTS
We included 10 studies that analysed a total of 5903 participants. One study was assessed as being at low risk of bias, two were assessed as being at unclear risk of bias, with the remaining seven being at high risk of bias.The main finding of the review was that, over 2.5 to 3 years of use, a fluoride toothpaste containing 10% xylitol may reduce caries by 13% when compared to a fluoride-only toothpaste (PF -0.13, 95% CI -0.18 to -0.08, 4216 children analysed, low-quality evidence).The remaining evidence on children, from small single studies with risk of bias issues and great uncertainty associated with the effect estimates, was insufficient to determine a benefit from xylitol products. One study reported that xylitol syrup (8 g per day) reduced caries by 58% (95% CI 33% to 83%, 94 infants analysed, low quality evidence) when compared to a low-dose xylitol syrup (2.67 g per day) consumed for 1 year.The following results had 95% CIs that were compatible with both a reduction and an increase in caries associated with xylitol: xylitol lozenges versus no treatment in children (very low quality body of evidence); xylitol sucking tablets versus no treatment in infants (very low quality body of evidence); xylitol tablets versus control (sorbitol) tablets in infants (very low quality body of evidence); xylitol wipes versus control wipes in infants (low quality body of evidence).There was only one study investigating the effects of xylitol lozenges, when compared to control lozenges, in adults (low quality body of evidence). The effect estimate had a 95% CI that was compatible with both a reduction and an increase in caries associated with xylitol.Four studies reported that there were no adverse effects from any of the interventions. Two studies reported similar rates of adverse effects between study arms. The remaining studies either mentioned adverse effects but did not report any usable data, or did not mention them at all. Adverse effects include sores in the mouth, cramps, bloating, constipation, flatulence, and loose stool or diarrhoea.
AUTHORS' CONCLUSIONS
We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children, and that there are no associated adverse-effects from such toothpastes. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population. The remaining evidence we found is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults.
Topics: Adolescent; Adult; Candy; Cariostatic Agents; Child; Child, Preschool; Dental Caries; Dentition, Permanent; Female; Fluorides; Humans; Infant; Male; Oral Health; Oral Hygiene; Randomized Controlled Trials as Topic; Tablets; Toothpastes; Xylitol
PubMed: 25809586
DOI: 10.1002/14651858.CD010743.pub2 -
BMJ Clinical Evidence Jul 2008Halitosis can be caused by oral disease, or by respiratory tract conditions such as sinusitis, tonsillitis, and bronchiectasis, but an estimated 40% of affected... (Review)
Review
INTRODUCTION
Halitosis can be caused by oral disease, or by respiratory tract conditions such as sinusitis, tonsillitis, and bronchiectasis, but an estimated 40% of affected individuals have no underlying organic disease.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with physiological halitosis? We searched: Medline, Embase, The Cochrane Library and other important databases up to July 2008 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found five systematic reviews, RCTs or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: artificial saliva; cleaning, brushing or scraping the tongue; diet modification; regular or single use of mouthwash; sugar-free chewing gums; and zinc toothpastes.
Topics: Chewing Gum; Follow-Up Studies; Halitosis; Humans; Mouthwashes; Tongue; Toothpastes; Zinc
PubMed: 19445739
DOI: No ID Found -
Annals of Anatomy = Anatomischer... Jan 2023Tooth whitening is currently one of the most requested treatments to change the color of teeth. There are different types of whitening in the dental office and at home....
INTRODUCTION
Tooth whitening is currently one of the most requested treatments to change the color of teeth. There are different types of whitening in the dental office and at home. There are also many whitening agents on the market. Nowadays, the public has shown great interest in a new natural compound: activated charcoal. It has an abrasive effect and it is included in toothpastes to whiten teeth quickly and easily.
OBJECTIVES
The main objective of the systematic review is to perform a qualitative synthesis of the available literature on the use of activated charcoal-based toothpaste for tooth whitening.
MATERIAL AND METHODS
An electronic search was carried out in PubMed, Web of Science, and Scopus databases. The search included the terms (charcoal-based OR activated charcoal OR charcoal OR soot) AND (toothpaste OR dentifrices OR bleaching OR oral hygiene OR enamel OR teeth). Inclusion criteria were articles that were published in English, that included activated charcoal toothpastes, that assessed the efficacy of activated charcoal bleaching and/or the safety of using activated charcoal toothpastes, that were conducted on humans or extracted teeth regardless of their origin and the year of publication.
RESULTS
Out of 208 articles, 11 met the inclusion criteria, the Risk of Bias of the selected studies was determined as medium-high. Regarding the whitening effect, there is a variety of results depending on the study: in some there are no significant differences between the proposed treatments and in others activated charcoal is not the most whitening agent. Regarding the abrasive effect, most studies agree that activated charcoal toothpaste has a higher abrasive potential.
CONCLUSION
Toothpastes based on activated charcoal possess a lower whitening effect than other alternatives and can be considered as less safe due to its high abrasive potential.
Topics: Humans; Toothpastes; Bleaching Agents; Charcoal; Tooth Bleaching; Tooth
PubMed: 36183933
DOI: 10.1016/j.aanat.2022.151998 -
Journal of Indian Society of... 2018The aim of this study was to review literature on the effects of herbal dentifrice compared to conventional dentifrice on plaque and gingival inflammation. (Review)
Review
OBJECTIVE
The aim of this study was to review literature on the effects of herbal dentifrice compared to conventional dentifrice on plaque and gingival inflammation.
MATERIALS AND METHODS
MEDLINE, Cochrane Central Register of Controlled Trials, and major journals were explored for studies up to September 30, 2017. A comprehensive search was designed and the articles were independently screened for eligibility by two reviewers. Randomized controlled clinical trials, in which oral prophylaxis was undertaken before the intervention was introduced into the oral cavity using toothbrush were included. Where appropriate, a meta-analysis (MA) was performed and standardized mean differences (SMDs) were calculated.
RESULTS
Ten articles out of 1378 titles were found to meet the eligibility criteria. A MA showed that for plaque intervention the SMD was 2.14; 95% confidence interval (CI): 0.88-3.41, = 0.0009; test for heterogeneity: < 0.00001, = 96% in favor of conventional dentifrice; and for gingival inflammation, the SMD was 1.37; 95% CI: 0.49-2.26, = 0.002; test for heterogeneity: < 0.00001, = 94% which also was in favor of conventional dentifrice. Subgroup analysis for plaque intervention and gingival inflammation in case of long-term (more than 4 weeks and up to 6 months) and short-term effects (minimum of 4 weeks) of herbal dentifrice showed no difference when compared to conventional dentifrice.
CONCLUSION
Currently, there is no high-quality evidence to support or abnegate the anti-plaque and anti-gingivitis effects of the herbal dentifrice.
PubMed: 30210185
DOI: 10.4103/jisp.jisp_100_18 -
Frontiers in Public Health 2023This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.
Topics: Child; Adult; Humans; Child, Preschool; Toothpastes; Fluorides; Health Promotion; Health Personnel; Eating
PubMed: 37927882
DOI: 10.3389/fpubh.2023.1279915 -
Heliyon Dec 2019The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF) dentifrice in relation to dental... (Review)
Review
OBJECTIVES
The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining.
DATA AND SOURCES
Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018).
STUDY SELECTION
Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity.
CONCLUSIONS
The present review found that stabilized SnF toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings.
CLINICAL RELEVANCE
Adding a SnF toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.
PubMed: 31872105
DOI: 10.1016/j.heliyon.2019.e02850 -
International Journal of Dental Hygiene May 2019To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis. (Comparative Study)
Comparative Study
OBJECTIVE
To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis.
MATERIALS AND METHODS
MEDLINE-PubMed and Cochrane-CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies, and a meta-analysis was performed.
RESULTS
The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single-use design and 20 being evaluations with a follow-up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta-analysis of plaque scores from the single-brushing experiments showed that BS dentifrice (BS-DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM -0.20; P < 0.0001; 95% CI: [-0.27; -0.12]) or the positive control dentifrices (DiffM -0.18; P < 0.0001; 95% CI: [-0.24; -0.12]). This finding was only confirmed in studies that used a follow-up design as compared to a negative control (DiffM -0.19; P = 0.01; 95% CI: [-0.34; -0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (DiffM -0.08; P = 0.02; 95% CI: [-0.16; -0.01] and (DiffM -0.13; P < 0.001; 95% CI: [-0.18; -0.08]. However, for the gingival index scores, the meta-analysis did not reveal any significant differences.
CONCLUSION
BS-DF showed promising results with respect to plaque removal in single-use studies. However, the finding was partially substantiated in follow-up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product.
Topics: Databases, Bibliographic; Dental Plaque; Dentifrices; Gingivitis; Humans; Randomized Controlled Trials as Topic; Sodium Bicarbonate; Toothbrushing
PubMed: 30734996
DOI: 10.1111/idh.12390 -
Caries Research 2016To evaluate the available evidence that the use of arginine-containing dental care products prevents the development of new caries lesions and the progression of... (Review)
Review
OBJECTIVES
To evaluate the available evidence that the use of arginine-containing dental care products prevents the development of new caries lesions and the progression of existing lesions.
SEARCH METHODS
We performed a systematic literature search of databases including PubMed, the Cochrane Library and EMBASE.
SELECTION CRITERIA
We selected randomized controlled trials of treatment with arginine in fluoride-containing dental products measuring dental caries incidence or progression in children, adults and elderly subjects.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE classification.
MAIN RESULTS
Due to conflicts of interest and weak transferability to Swedish conditions, no conclusions can be drawn from studies on the effects of arginine-fluoride toothpaste in children. Arginine-containing toothpaste costs about 40% more than basic fluoride toothpaste; to determine whether it is more cost-effective, the higher cost must be considered in relation to any additional caries-preventive effect. The literature review also disclosed some questionable research ethics: in several of the studies, the children in the control group used non-fluoride toothpaste. Toothpaste without fluoride is not as effective against dental caries as the standard treatment - fluoride toothpaste - which has a well-documented effect. This contravenes the fundamental principles of research ethics.
CONCLUSION
At present there is insufficient evidence in support of a caries-preventive effect for the inclusion of arginine in toothpastes. More rigorous studies, and studies which are less dependent on commercial interests, are required.
Topics: Adolescent; Adult; Aged; Arginine; Bias; Cariostatic Agents; Child; Costs and Cost Analysis; Dental Caries; Disease Progression; Humans; Incidence; Randomized Controlled Trials as Topic; Toothpastes
PubMed: 27403876
DOI: 10.1159/000446249 -
Antibiotics (Basel, Switzerland) Oct 2022The aim of this systematic review was to verify if the presence of different antimicrobial agents in dentifrices is effective in reducing the number of microorganisms... (Review)
Review
The aim of this systematic review was to verify if the presence of different antimicrobial agents in dentifrices is effective in reducing the number of microorganisms for disease prevention. This review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and was registered with the Open Science Framework (OSF). A search was conducted in the PubMed, Embase, Scopus, and Web of Science databases. Two independent authors reviewed the titles and abstracts according to the inclusion criteria, which comprised in vitro studies published in English that evaluated the efficacy of antimicrobial agents in dentifrices and their antimicrobial activity. A total of 527 articles were found. Of these, 334 were included for reading of the title and abstract, and 69 were selected for reading in full. In the end, 39 articles remained in this review. Triclosan, sodium fluoride, and sodium monofluorophosphate were the most commonly used chemical antimicrobial agents. Among the herbal agents, miswak extract and neem extract were the most commonly used. The presence of antimicrobial agents in dentifrice formulations can promote the reduction of the number of microorganisms involved in oral diseases, but with variations in their effectiveness, depending on the agent used and the microorganism evaluated.
PubMed: 36290071
DOI: 10.3390/antibiotics11101413 -
Journal of International Society of... 2021The important cause of chronic gingivitis was proved to be dental plaque, which is a well-organized biofilm. However, self-care efforts or mechanical control of dental... (Review)
Review
INTRODUCTION
The important cause of chronic gingivitis was proved to be dental plaque, which is a well-organized biofilm. However, self-care efforts or mechanical control of dental plaque by toothbrushing was important; these alone will not be enough to prevent gingivitis.
AIM
The aim of the present systematic review was to compare the effectiveness of herbal and conventional toothpastes on reduction of dental plaque and gingivitis.
MATERIALS AND METHODS
Data from original scientific papers published in PubMed, Cochrane, Lilacs, and Google Scholar were taken for review up to November 2020. Randomized controlled trials and clinical trials compare the effectiveness of herbal and non-herbal toothpastes on reduction of dental plaque and gingivitis. Articles published in English language only were included. References from the identified publications were manually searched to identify additional relevant articles. Seven publications fulfilled all the inclusion criteria and were finally selected for systematic review. Outcome measurements for gingivitis were gingival index and dental plaque index.
RESULTS
As all the studies were randomized controlled trials, level of evidence was II. Among all studies, green tea dentifrice toothpastes showed significant reduction when compared with conventional dentifrice, and ayurvedic toothpaste and Carica papaya leaf extract were also effective.
CONCLUSION
Herbal toothpaste seems to be powerful similar to non-herbal toothpaste; however, it is no longer extra superior to fluoride toothpaste. Further, long-term randomized studies of >6 months are needed to investigate the beneficial effects of intervention alone.
PubMed: 35036369
DOI: 10.4103/jispcd.JISPCD_171_21