Comparision of Enzymatic and Active Salt Toothpaste

Introduction A diverse microbiota of more than 700 species of bacteria and other microorganisms inhabits the oral cavity. These are present in an organized form as dental plaque or biofilm. These commensal microorganisms live in harmony with the host and perform a number of important functions, such as preventing the colonization of pathogenic microorganisms. However, sometimes this commensalism relationship might collapse, leading to conditions including gingivitis, periodontitis and dental caries. This could be prevented by proper plaque control. Plaque control involves the utilization of chemical agents and mechanical techniques. Mechanical plaque control like toothbrushing is the key for maintaining oral hygiene at personal level. Despite the effectiveness of adequate mechanical removal of plaque having been demonstrated, only 11-51% of people clean their teeth properly . Chemical plaque control agents like toothpastes and mouthwashes are therefore required as an adjunct to mechanical plaque control. Triclosan, herbs, enzymes, chlorhexidine, metal ions, salt etc are incorporated in the toothpaste as an active agent.

In last decade, an in-vitro study on enzymatic toothpaste (active ingredients lactoperoxidase, amyloglucosidase, and glucose oxidase) has shown to strengthen the oral cavity's natural antibacterial system by raising salivary levels of hydrogen peroxide, lysozyme, and hypothiocyanite while also reducing the survival of oral bacterial biofilms. The similar enzyme containing toothpaste in a sequencing study on dental plaque samples has shown significant shift in the ecology of microbiome (at species level). There was increase in 12 taxa of periodontal health promoting microbes like Neisseria spp. and decrease in 10 taxa of pathogenic microbe like Treponema spp. Several clinical studies have shown encouraging results of the enzymatic toothpaste in reducing dental plaque and gingivitis. , , Another important active ingredient that is known for its effect as an anti-inflammatory action is salt (including sodium chloride and sodium bicarbonate). The recent studies on the salt have shown that rinsing with NaCl solution can stimulate gingival fibroblast migration and thereby enhances wound healing. A randomized clinical trial evaluating the effect of sodium bicarbonate containing toothpaste on mild to moderate gingivitis patient has shown to improve the gingival health and bleeding. Systemic review on salt containing toothpaste concluded promising result obtained on controlling plaque and reduction in bleeding score.

The objective of the current study was to evaluate and compare the efficacy of enzymatic toothpaste (lactoperoxidase, amyloglucosidase, and glucose oxidase) and active salt toothpaste (sodium bicarbonate and sodium chloride) in the reduction of dental plaque and gingivitis in North Indian population.

Review of literature Dental plaque is defined clinically as a structured resilient, yellow greyish substance that adheres tenaciously to the intraoral hard surfaces, including removal and fixed restorations.

Chemotherapeutic agents could also affect gingivitis directly if they possessed anti-inflammatory or prostaglandin synthetase inhibitory activity (Goodson). As a consequence many antimicrobial compounds have been added in the toothpaste or as mouthrinses with the aim of preventing or reducing plaque.

Enzymes and salt are few of the active ingredients that are added in the toothpaste. Previous studies have shown that the inclusion of enzymes in the mouthrinses and dentifrices reduce plaque and gingivitis. The enzymes that are most effective clinically have, as their active ingredients, Amyloglucosidase, Glucoseoxidase and Lactoperoxidase.

Hugoson A et al. conducted a study to test the efficiency of Lactoperoxidase in the prevention of plaque accumulation, gingivitis and dental caries. They used twenty-two dental students. The individuals in the test group rinsed with 10ml of of a test solution containing Amyloglucosidase, Glucoseoxidase 3 times a day. The controls rinsed with a placebo solution. They were refrained from the daily oral hygiene routine. At the end of the experimental period there were highly significant differences in caries distribution between the test and control groups, with a more pronounced aggravation of the caries lesions in the control group compared with the test group.

Afseth J and Rolla G did a study to test the efficiency of enzymatic toothpaste over SnF2 containing toothpaste. They found that the enzymatic toothpaste did not reduce the acidogenicity of dental plaque in vivo neither did it reduce plaque formation in a test panel. A toothpaste containing SnF2 showed measurable effect in both respects.

Salt (sodium chloride and sodium bicarbonate) are added as an active ingredient in the toothpaste. To find out the mechanism of salt on gingival healing, Nam Cong-Nhat Huynh et al.16 did a study and found out that rinsing with 1.8% NaCl significantly up regulate the expression of type-I collagen and fibronectin. They found that a high NaCl concentration especially with long term exposure causes DNA damage and inhibits its repair This may lead to apoptosis or may affect cellular survival and their function both in cell culture and in vivo.

Material and method

This randomized, prospective, double-blind, parallel-group clinical study evaluated and compared the efficacy of enzymatic toothpaste, active salt toothpaste, and standard fluoridated toothpaste in reducing dental plaque and gingival inflammation following non-surgical periodontal therapy (NSPT).

The study was conducted in the Department of Periodontology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India, from July 2021 to December 2022. The study protocol received approval from the Institutional Ethics Committee of Uttar Pradesh University of Medical Sciences (approval number: 222/2020-21). Written informed consent was obtained from all participants before study procedures.

A total of 93 eligible participants with mild to moderate gingivitis were enrolled and randomly allocated to three groups. All participants initially received non-surgical periodontal therapy and used standard fluoridated toothpaste for a four-week pretreatment period. Following the pretreatment period, baseline clinical assessments were performed, and participants received the toothpaste assigned to the respective study group.

Statistical analysis A Microsoft Excel spreadsheet was used to enter the data, and any discrepancies were looked at. Data analyses were done using SPSS version 20.0 and non parametric test (Wilcoxon signed rank test, Kruskal-wallis test, Mann-Whitney Test) and parametric test (Paired t-test, ANOVA, Turkey's post hoc analysis) used for comparing means in different group of individual before and after interval. Tables and figures were used to display the summarized data. Level of statistical significance was set at p-value less than 0.05, confidence level at 95% and power at 80%