Kharaeva ZF, Mustafaev MS, Khazhmetov A, et al. Anti-bacterial and anti-inflammatory effects of toothpaste with Swiss medicinal herbs towards patients suffering from gingivitis and initial state of periodontitis: From clinical efficacy to mechanisms. Dent J. January 2020;8(1). doi: 10.3390/dj8010010.
Regular use of toothpaste containing safe active ingredients with antibacterial, anti-inflammatory, antioxidant, and regenerative properties is an effective strategy for preventing gingivitis, pathologies, and cavities. Herbal toothpastes and gingival gels have demonstrated antimicrobial effects with a better safety profile than conventional mouthwashes. For example, arnica (Arnica montana, Asteraceae) has demonstrated wound-healing effects with topical application; German chamomile (Chamomile recutita syn. Matricaria chamomilla, Asteraceae) has been shown to have antioxidant, anti-inflammatory, and antimicrobial properties; echinacea (Echinacea purpurea, Asteraceae) has been used in traditional medicine to treat infections and promote wound healing; and sage (Salvia officinalis, Lamiaceae) has been shown to specifically to suppress inflammation in oral cavities. The purpose of this double-blind, placebo-controlled trial was to determine the efficacy of toothpaste containing herbal extracts in patients diagnosed with gingivitis and initial stages of periodontitis. Additionally, a laboratory component of the study was designed to better understand which types of oral bacteria the herbal toothpaste had an effect on.
Fifty patients of both sexes between the ages of 35 and 55 years were recruited from the Dentistry and Maxillofacial Surgery Department of the Kabardino-Balkar Berbekov's State University (Nal'chik, Russia). Patients had a previous diagnosis of gingivitis or initial stages of periodontitis. Patients were excluded with severe chronic and/or infectious diseases in the acute phase, hepatitis, taking drugs or nutraceuticals supplements known to interfere with the redox status or inflammation up to six weeks prior to the study, or with a history of alcohol or drug abuse. Patients were randomly assigned to the experimental toothpaste (ETP) (n = 35) or control toothpaste (CTP) (n = 15) groups. Prior to beginning the study, patients were asked to refrain from using toothpaste for 72 hours to facilitate a wash-out period. Patients received traditional hygienic and therapeutic protocols, education, plaque removal, teeth enamel polishing, and tarter removal. Efficacy of ETP and CTP was determined using subjective evaluation by patients and doctors as well as clinical indices of gingivitis and chronic mild periodontitis.
The ETP was manufactured by TRISA AG (Trisa Revital Sensitive; Triengen, Switzerland) and contained sodium monofluorophosphate (1450 ppm), xylitol, and aqueous-ethanol extracts of German chamomile, sage, arnica, and echinacea as its active ingredients. The herbal extracts were purchased from Biologic AG (Switzerland). The CTP contained sodium monofluorophosphate (1450 ppm) and xylitol as its active ingredients. Patients were instructed how to brush their teeth and were asked to brush twice daily for 60 days using either the ETP or CTP.
For the laboratory research, 25 healthy donors, with similar demographics to the patients included for the study, were recruited by the medical department. Donors had no current diagnosis of gingivitis or initial stages of periodontitis. The healthy participants donated gingival crevicular fluid (GCF). Ten different strains of Staphylococcus aureus isolated from oral and nasal cavities were used in the in vitro analysis. The bacteria were grown in a tryptic soy broth consistent with previous research.
There were no significant differences between the two groups at baseline. Patients in the ETP group experienced diminished bleeding of the gums (n = 32) and teeth whitening (n = 17). No self-reported clinical effect was reported in the CTP group. The indices of gingivitis, general oral hygiene, plaque, tarter buildup, and mild periodontitis decreased in both groups over the 60-day trial period, the effects were significantly greater in the ETP group compared to the CTP group (P < 0.05). Normal levels were reached in the ETP group by the end of the study period.
In the GCF analysis, the pro-inflammatory cytokines were highly, and equally elevated, and anti-inflammatory cytokines were decreased in both the ETP and CTP groups compared to the healthy donors. GCF cytokine concentrations reached normal levels in the ETP group by the end of the study period with a significant difference between the ETP and CTP groups (P < 0.05).
In vitro comparisons of nitrite and nitrate content showed elevated levels in the ETP and CTP groups compared to the healthy donors. Baseline levels were not significantly different between the ETP and CTP groups; however, nitrite and nitrate levels returned to a normal values in the ETP group by the end of the study. Total antioxidant activity (AOA) was initially lower in the ETP and CTP groups. AOA returned to normal following treatment with ETP. In the CTP group, the mean total AOA increased slightly but remained significantly lower than normal (P < 0.05).
Qualitative polymerase chain (PRC) reaction analysis was conducted on selected patients from the ETP (n = 15) and CTP (n = 5) groups. Seven periodontal pathogens involved in pathogenesis of chronic inflammation were identified. Both toothpastes eliminated several bacterial periodontal pathogens. However, ETP was more efficient against Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia when compared to CTP.
Both ETP and CTP demonstrated bactericidal action against S. aureus strains. Both the active herbal extracts and ETP strongly inhibited bacterial catalase activity in the 10 S. aureus strains compared to CTP which only slightly inhibited catalase activity. The results were significant for the ETP, sage, echinacea, and the combined herbal extracts (P < 0.05). Catalase activity was found to be directly correlated with bacterial survival following phagocytosis (P < 0.05) and inversely correlated with intracellular bacterial death.
The authors conclude that safe and efficient oral hygiene products should contain a combination of chemical and plant-derived antibacterial compounds to prevent and/or treat gingivitis and early stage periodontitis. Plant-derived extracts have safer toxicity profiles for human use. According to the authors, the herbs used in this study demonstrate positive anti-inflammatory, antioxidant, antiseptic, and indirect antibacterial actions. The authors state there is an immediate need for effective and safer treatments to maintain oral hygiene.
LS is the Head of Marketing at TRISA AG. WM is the Head of Research and Development at MEDENA AG, CDL is the Head of the Regulatory Affairs Department at MEDENA AG. Steiner, De Luca, and Mayer did not influence the process of evaluation and presentation of major results or the conclusions drawn from the results obtained.
All other co-authors declare no conflict of interest.