Bio-Descaling Toothpaste for Dental Calculus Reduction (AntiCal)
Efficacy of a Novel Toothpaste Containing a Bio-Descaling Powder (BDP) in Reducing Dental Calculus: A Double Blind Randomized Controlled Clinical Trial
Dental calculus is a calcified mineralized plaque composed primarily of calcium phosphate salts covered by an unmineralized bacterial biofilm layer. It provides a substrate for bacterial colonization and soft biofilm retention, promoting the growth of pathogenic plaque, further calculus formation, gingival tissue inflammation, that could progress to periodontitis and tooth loss. Therefore, removal of dental calculus and prevention of its formation are important for maintaining periodontal health.
Professional mechanical removal remains the most effective approach to control existing dental calculus; however, it is labor-intensive and represents a burden for patients in terms of costs and access to oral health professionals. Several toothpastes have been developed to dissolve and soften mineralized deposits using abrasive and/or chemical agents. Nevertheless, highly abrasive formulations may damage tooth structures and only reduce approximately 30-50% of dental calculus, while dentifrices containing mineralization and crystallization inhibitors can prevent calculus formation but are unable to remove already formed deposits.
To address these limitations, a Bio-Descaling Powder (BDP) toothpaste has recently been introduced with the aim of removing existing dental calculus. Preliminary clinical evidence showed that the amount of calculus removed with D-Tart toothpaste was five times greater than that achieved with Colgate Total® toothpaste.
Given the high prevalence of periodontal diseases and the potential role of dental calculus in their initiation and progression, effective strategies for calculus removal and prevention are of considerable clinical interest. The use of an effective toothpaste could reduce the need for professional periodontal interventions or shorten treatment time, thereby decreasing costs and patient burden.
The aim of this study is to evaluate the efficacy of a Bio-Descaling Powder (BDP)-containing toothpaste, compared with a placebo toothpaste, in decreasing the presence of already formed dental calculus.
Visão geral do estudo
Status
Intervenção / Tratamento
Descrição detalhada
Dental calculus is a calcified mineralized plaque, composed primarily of calcium phosphate salts covered by an unmineralized bacterial biofilm layer. It is firmly attached to the tooth, fills the pits and irregularities of tooth surfaces and attaches to the exposed dental roots). It offers a substrate for bacteria colonization, soft biofilm retention and subsequently the growth of pathogenic plaque. This leads to further calculus formation and gingival tissue inflammation that could progress to periodontitis and tooth loss. Removal of dental calculus, and prevention of calculus formation, are, therefore, important to maintain adequate periodontal health.
The most effective approach to control already present dental calculus is to remove it professionally, by mechanical means, by dentists and dental hygienists at the dental clinic. This labor-intensive procedure poses a burden to patients in terms of costs and access to oral health professionals. Therefore, there has been substantial interest in the development and implementation of approaches that will reduce this burden. In this regard, newly introduced toothpastes have been designed aiming to dissolve and soften the mineralized deposits, using abrasive and/or chemical agents. However, toothpastes enriched with strong abrasives could damage the tooth structures, and are only able to reduce approximately 30-50% of dental calculus, while dentifrices containing mineralization and crystallization inhibitors can only prevent the calculus formation, and not remove calculus already formed.
To the best of our knowledge, there is no toothpaste that efficiently removes existing calculus deposits from teeth. Therefore, recently a new product has been introduced to overcome the limitations of previous agents: Bio-Descaling Powder (BDP) toothpaste is a new toothpaste (Visionaturolab Inc., QC, Canada) that aims to remove dental calculus. In a clinical trial, the calculus removed using D-Tart toothpaste was five times higher than that removed with Colgate Total® toothpaste.
Periodontal diseases (gingivitis and periodontitis) are amongst the most prevalent oral diseases worldwide and in North America, in Europe and in Spain. According to the 2007/09 Canadian Health Measures Survey, 16% of Canadian adults and 24% of older adults, 60 to 79 years of age, were found to have moderate periodontitis. Moreover, 11% of Canadian adults were found to have calculus scores in the highest range. On the other hand, recent reports on the prevalence of periodontitis in the USA showed that 47.2% of adults aged 30 years and older have some form of periodontitis and 70.1% of adults 65 years and older have periodontal disease. The estimates also showed that the expenditure for periodontal treatments in the USA is about approximately $ 14.3 billion. More recently, estimations have been calculated as an estimated loss of $154.06B in the USA and €158.64B in Europe, in 2018.
Since dental calculus may play an important role in initiation and progression of periodontal diseases, investigation and investment on technologies to prevent periodontal diseases are important for any health care system and its end-users. Furthermore, the removal of dental calculus and the prevention of its formation, using an effective toothpaste, could reduce the need for professional periodontal interventions or the time of these treatments that in turn will reduce their cost and other burdens on patients.
The aim of this study will be to evaluate the efficacy of a Bio-Descaling Powder (BDP)-containing toothpaste, compared to a placebo toothpaste, in decreasing the presence of already formed dental calculus.
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: Mariano Sanz
- Número de telefone: 913942010
- E-mail: marsan@ucm.es
Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion Criteria:
Patients with a healthy but reduced periodontium undergoing a supportive periodontal care (SPC) program and/or patients with biofilm induced gingivitis, fulfilling the following criteria:
- Aged 18 years and older;
- Systemically healthy, following the criteria of American Society of Anesthesiology (ASA), type I or II;
- Having at least 10 opposing teeth units with presence of at least three natural lower anterior teeth;
- Presenting at least 1.5 mm of calculus width on the lingual surface of at least one mandibular anterior teeth (Volpe-Manhold index of at least 1.5 in the lingual side of at least one of the lower anterior teeth) ;
- For patients in SPC, for at least 6 months, and the last tooth cleaning at least 3 months before, fulfilling the end point criteria of periodontal therapy [no pockets ≥ 6 mm or > 4 mm with bleeding on probing (BOP)] . Localized pockets of 6 mm, without bleeding on probing, are allowed, except in the anterior-inferior sextant.
- Agree to follow the study instructions, including adherence to study arm treatment, for the study timeline.
Exclusion Criteria:
Subjects will be excluded from participating in the study if:
- Pregnancy: pregnant women at high risk of developing gum inflammation that usually occurs during pregnancy, which could introduce bias to the study;
- Any physical handicap, psychological or health conditions that might jeopardize the ability of the patient to brush his/ her teeth, these complications may cause bias in the study. Smokers of 10 or more cigarettes per day will be excluded (Dietrich, Bernimoulin, & Glynn, 2004);
- Antibiotics or anti-inflammatory drugs taken within 1 month prior to the study, to avoid bias when assessing the gum health;
- Currently using chlorhexidine or other antiseptic products, since these products can affect biofilm and calculus formation, therefore they can introduce bias in the assessment of calculus removal by our toothpaste;
- Sensitivity to tartar-control toothpastes;
- Unable to return for evaluations/study recalls, to avoid the significant loss in the number of participants.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Triplo
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Experimental: Bio-Descaling Powder (BDP) Toothpaste
Participants assigned to this arm will use a toothpaste containing Bio-Descaling Powder (BDP) for 6 weeks according to standardized oral hygiene instructions.
Clinical assessments will be performed at baseline, 3 weeks, and 6 weeks to evaluate dental calculus accumulation, gingival inflammation, plaque levels, and other periodontal parameters.
At the end of the trial (6-week visit), the participants will be received professional mechanical plaque removal (PMPR).
|
Participants will be provided with the toothpaste (containing Bio-Descaling Powder) and standard advice on tooth brushing for those patients not enrolled in a SPC program (modified Stillman brushing technique, starting with the lower arch, brushing for 2 minutes, twice daily), and the use of 1 gr (pea size) of the assigned toothpaste.
Patients' interdental hygiene habits will not be modified.
The participant will be asked to mark a calendar each time they brushed their teeth with the allocated toothpaste, and to bring the toothpaste tubes and tooth brushes for assessment at each evaluation session in order to monitor their adherence to the trial instructions.
They will be instructed to not use mouthwashes or other toothpastes for the duration of the study.
|
|
Comparador de Placebo: Placebo Toothpaste
Participants assigned to this arm will use a placebo toothpaste with identical packaging and standardized oral hygiene instructions for 6 weeks.
Clinical assessments will be performed at baseline, 3 weeks, and 6 weeks to evaluate dental calculus accumulation, gingival inflammation, plaque levels, and other periodontal parameters.
At the end of the trial (6-week visit), the participants will be received professional mechanical plaque removal (PMPR).
|
Participants will receive a placebo toothpaste provided in identical packaging and standard advice on tooth brushing for those patients not enrolled in a SPC program (modified Stillman brushing technique, starting with the lower arch, brushing for 2 minutes, twice daily), and the use of 1 gr (pea size) of the assigned toothpaste.
Patients' interdental hygiene habits will not be modified.
The participant will be asked to mark a calendar each time they brushed their teeth with the allocated toothpaste, and to bring the toothpaste tubes and tooth brushes for assessment at each evaluation session in order to monitor their adherence to the trial instructions.
They will be instructed to not use mouthwashes or other toothpastes for the duration of the study.
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Change in dental calculus accumulation
Prazo: From Baseline to 6 weeks
|
The calculus accumulation will be measured on the lingual aspect of the six mandibular anterior teeth using the Volpe-Manhold Calculus Index score (Volpe et al., 1965). For values less than 0.5, the assessment should be 0. At this stage, dental plaque will be mechanically removed from the lingual area of the 5th sextant, by the clinician, in order to remove soft deposits, for a more accurate evaluation of the presence of calculus. After toothbrushing, the area of interest will be dried with the dental unit syringe. Furthermore, an intra oral scanner will be used to scan lower anterior teeth in order to quantify reduction in calculus volume. In addition, a photograph of the lingual side of the 5th sextant will be taken to further assess calculus presence. At the time of taking clinical photographs, their quality taken will be checked. |
From Baseline to 6 weeks
|
|
Change in gingival inflammation
Prazo: From baseline to 6 weeks
|
Bleeding on probing (BOP) by dichotomous assessment of bleeding after gentle probing, at six sites per tooth (Ainamo & Bay, 1975).
Furthermore, an intra oral scanner will be used to scan lower anterior teeth, to assess adjacent gingival tissues, in order to quantify the reduction in gingival inflammation.
|
From baseline to 6 weeks
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Change in plaque levels
Prazo: From baseline to 6 weeks
|
The plaque accumulated on the buccal and lingual surfaces of all teeth will be assessed using a dichotomous plaque index (PlI), (Quigley & Hein, 1962; Turesky, Gilmore, & Glickman, 1970), assessing six areas per tooth, visually, and/or with the periodontal probe, identifying the presence of plaque.
|
From baseline to 6 weeks
|
|
Change in extrinsic stains
Prazo: From baseline to 6 weeks
|
The extrinsic stains on the buccal surfaces of the lower and upper central and lateral incisors will be quantified using the Gründemann (Grundemann, Timmerman, Ijzerman, van der Weijden, & van der Weijden, 2000) modification of staining index (GMSI), modified by Koertge and Gunsolley (Koertge, Gunsolley, Domke, & Nelson, 1993), by evaluating one standardized clinical photograph, with teeth in edge-to-edge bite.
|
From baseline to 6 weeks
|
|
Change in Probing Pocket Depth
Prazo: from baseline to 6 weeks
|
Probing Pocket Depth (PPD) will be measured in millimeters at six sites per tooth using a periodontal probe.
PPD is defined as the distance from the gingival margin to the bottom of the periodontal pocket.
|
from baseline to 6 weeks
|
|
Change in gingival recession
Prazo: From Baseline to 6 weeks
|
Gingival Recession (REC) will be measured in millimeters at six sites per tooth as the distance from the cemento-enamel junction to the gingival margin, allowing for the calculation of clinical attachment level (CAL).
|
From Baseline to 6 weeks
|
|
Acidity (pH) of the participants' saliva
Prazo: From baseline to 6 weeks
|
The acidity (pH) of the participants' saliva will be measured using a pH meter, after collecting unstimulated saliva samples for 5 min (in order to collect 2.5 ml).
Unstimulated whole saliva, directly expectorated, will be collected in sterile test tubes.
The subjects will be instructed to fast (not drinking coffee or tea, or eating), and not to smoke for at least one hour prior to the saliva collection\.
Salivary pH will be measured after collection using a pH meter (Crison® micropH 2001 pH-meter).
Samples will be immediately transported to the laboratory for pH evaluation, determination of volume and proper conservation for additional processing.
|
From baseline to 6 weeks
|
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Patient-reported taste acceptability of the assigned toothpaste
Prazo: at the 3-week and 6-week visit
|
Patient-reported rating of the statement "The taste of the toothpaste is pleasant" using a 4-point Likert scale (1 = Totally disagree, 2 = Rather disagree, 3 = Rather agree, 4 = Totally agree).
A questionnaire will be used.
|
at the 3-week and 6-week visit
|
|
Patient-reported texture acceptability of the assigned toothpaste
Prazo: at the 3-week and 6-week visit
|
Patient-reported rating of the statement "The consistency of the toothpaste is pleasant" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3-week and 6-week visit
|
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Patient-reported perception of tooth cleanliness after using the assigned toothpaste
Prazo: at the 3-week and 6-week visit
|
Patient-reported rating of the statement "The toothpaste provides a sensation of clean teeth" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
A questionnaire will be used.
|
at the 3-week and 6-week visit
|
|
Patient-reported perception of healthier teeth after using the assigned toothpaste
Prazo: at the 3-week and 6-week visit
|
Patient-reported rating of the statement "The toothpaste provides a sensation of healthier teeth" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3-week and 6-week visit
|
|
Patient-reported perception of fresh breath after using the assigned toothpaste
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "The toothpaste provides a sensation of fresh breath" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3- and 6-week visit
|
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Patient-reported perception of the effectiveness of the assigned toothpaste in removing dental plaque
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "The toothpaste effectively helps remove dental plaque" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3- and 6-week visit
|
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Patient-reported perception of the effectiveness of the assigned toothpaste in removing dental calculus
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "The toothpaste effectively helps reduce dental calculus" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3- and 6-week visit
|
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Patient-reported tooth and oral mucosal staining after using the assigned toothpaste
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "I have noticed increased staining of my teeth or oral mucosa" using a 4-point Likert scale (1 = Totally disagree, 2 = Rather disagree, 3 = Rather agree, 4 = Totally agree).
|
at the 3- and 6-week visit
|
|
Patient-reported dry mouth after using the assigned toothpaste
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "I have noticed a drier mouth" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3- and 6-week visit
|
|
Patient-reported altered taste perception after using the assigned toothpaste
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "I have noticed changes in my perception of taste" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3- and 6-week visit
|
|
Patient-reported oral burning, soreness, or other oral mucosal problems after using the assigned toothpaste
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "I have noticed burning, soreness, or other problems in my oral mucosa" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree)
|
at the 3- and 6-week visit
|
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Overall patient satisfaction with the assigned toothpaste
Prazo: at the 3- and 6-week visit
|
Patient-reported rating of the statement "My overall evaluation of the toothpaste is very positive" using a 4-point Likert scale (1 = Totally disagree to 4 = Totally agree).
|
at the 3- and 6-week visit
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Estimado)
Conclusão Primária (Estimado)
Conclusão do estudo (Estimado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Doenças bucais
- Doenças estomatognáticas
- Cálculos
- Condições Patológicas, Anatômicas
- Doenças de dente
- Infecções
- Doenças Gengivais
- Depósitos Dentários
- Condições Patológicas, Sinais e Sintomas
- Doenças Periodontais
- Gengivite
- Cálculo Dentário
- Materiais biomédicos e dentários
- Materiais fabricados
- Tecnologia, indústria e agricultura
- Dentífricos
- Pastas de dente
- alpha-ketoisovalerate dehydrogenase phosphatase
Outros números de identificação do estudo
- 24/825-EC_X
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