This review has been conducted to assess the effects of using a toothpaste containing triclosan (an antibacterial ingredient) plus copolymer (an ingredient to reduce the amount of triclosan that is washed away by rinsing or saliva) plus fluoride (a mineral that prevents tooth decay) compared with using a fluoride toothpaste (without triclosan/copolymer) for oral health.
Gum disease and dental decay are the main reasons for tooth loss. Unless brushed away, plaque (a sticky film containing bacteria) can build up on the teeth. This can lead to gingivitis (a swelling and redness of the gums that affects most adults), which, if not treated, can then lead to a more serious form of gum disease called periodontitis (which affects up to one out of every five adults aged 35 to 44 years worldwide). Periodontitis can cause pain, eating difficulties, an unpleasant facial appearance and eventually tooth loss. Plaque build-up can also lead to tooth decay, a problem affecting up to 90% of schoolchildren in industrialised countries, and the majority of adults. Vast healthcare resources are used worldwide to treat gum disease and tooth decay, which are both preventable. Currently there is a lot of ongoing research into possible links between periodontitis and other medical conditions such as diabetes, rheumatoid arthritis, heart disease and also to the premature (too early) birth of underweight babies.
Adding an effective and safe antibacterial ingredient to toothpastes could be an easy and low-cost answer to these problems. It is thought that triclosan could fight the harmful bacteria in plaque while also reducing the swelling that leads to serious gum disease. It is important that adding triclosan to fluoride toothpastes does not reduce the beneficial effects that fluoride has on preventing tooth decay.
Authors from the Cochrane Oral Health Group carried out this review of existing studies and the evidence is current up to 19 August 2013. It includes 30 studies published from 1990 to 2012 in which 14,835 participants were randomised to receive a triclosan/copolymer containing fluoride toothpaste or a fluoride toothpaste that did not include triclosan/copolymer. The toothpaste that was used in most of the studies is sold by the manufacturer Colgate. Future versions of this review will consider a broader range of antibacterial agents in other toothpastes.
The evidence produced shows benefits in using a triclosan/copolymer fluoride toothpaste when compared with a fluoride toothpaste (without triclosan/copolymer). There was a 22% reduction in plaque, a 22% reduction in gingivitis, a 48% reduction in bleeding gums and a 5% reduction in tooth decay. There was insufficient evidence to show a difference between either toothpaste in preventing periodontitis. There was no evidence of any harmful effects associated with the use of triclosan/copolymer toothpastes in studies up to three years in length.
Quality of the evidence