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Gingivitis in a common oral disease, reported to affect 4 of 5 adults across the globe (Beaglehole 2009). The onset of gingivitis follows the accumulation of dental plaque and can be evident as early as 48 hours after dental plaque begins to form (Figure 3). Gingivitis can be prevented by maintaining low levels of plaque, and it can also be reversed (Tonetti et al. 2015).

 

 Plaque produces an inflammatory reaction in the gingival tissues that results in increased blood flow and dilation of blood vessels. This is accompanied by an increase in all types of inflammatory cells, leading to swelling and reddening of the tissues after 48–96 hours. Continued exposure to plaque bacteria and their byproducts, such as metabolic toxins and proteolytic enzymes, promotes further inflammation and swelling, as well as engorgement and stasis of blood flow giving the tissues a bluish or purplish hue after fourteen to twenty- one days. At this point it is defined as an established gingivitis and it is not associated with irreversible damage. Without intervention, it may remain stable or progress to periodontitis with loss of attachment and destruction of the alveolar bone.

Figure 3. Gingivitis with redness and swelling

Gingivitis with redness and swelling

 

There are three ways in which gingivitis reductions can be achieved:

  • Mechanical removal of plaque
  • Anti-bacterial control of plaque
  • Suppression of the host (human) inflammatory response

Gingivitis affects 4 of 5 adults globally

Gingivitis affects four out of five adults

Mechanism of action of stannous fluoride

The reductions in gingivitis observed with stabilized stannous fluoride dentifrice are due to the broad-spectrum anti-bacterial activity of stannous fluoride (Ramji et al. 2005). Stannous fluoride inhibits bacterial metabolism, and thus reduces bacterial growth, bacterial adhesion and the production of toxins that potentiate gingival inflammation (Ramji et al. 2005, White 1995). Stannous fluoride also reduces the virulence of plaque by blocking the reactivity of LPS with tissue receptors that trigger inflammation (Haught et al. 2016a).

The stannous ion has high substantivity in the oral cavity, imparting a long-lasting antibacterial effect (Scott et al. 2009). Stannous levels in plaque remain above levels that are sufficient to inhibit metabolic activity up to twelve hours after exposure (Ramji et al. 2005). Otten et al. (2012) demonstrated that twelve hours after brushing with stabilized stannous fluoride dentifrice, plaque samples retained enough residual anti-bacterial activity to inhibit fresh, unexposed plaque samples. Given that dental plaque is associated with gingivitis, reducing and inhibiting plaque contributes to reductions in gingivitis. Retention of the stannous ion in plaque that remains after oral hygiene is important since the plaque that is missed during brushing is often in hard-to-reach areas where removal matters most to prevent the build-up of plaque and the onset of gingivitis.

Gingivitis Research Summaries

The following study summaries represent a sample of research demonstrating the benefits of stabilized stannous fluoride dentifrice for the reduction of gingivitis.

Reference: Mankodi S, Bartizek RD, Winston JL, et al. J Clin Periodontol. 2005;32(1):75-80.

CONCLUSION

Over a 6-month period a 0.454% stabilized stannous fluoride (Crest® PRO-HEALTH) dentifrice showed a statistically significant and clinically relevant effect on the control and prevention of gingivitis compared to a negative control dentifrice (Colgate® Cavity Protection).

OBJECTIVE

To compare the anti-gingivitis efficacy of a stabilized SnF2 dentifrice versus a positive control triclosan dentifrice over a 2-month period.

METHODS

  • This was a randomized, positive-controlled, double-blind, parallel-group clinical trial involving generally healthy adults with mild to moderate gingivitis.
  • Qualifying subjects were randomized to one of two treatment groups:
  • - 0.454% stabilized SnF2 dentifrice (Crest® PRO-HEALTH Clean Mint [Smooth Formula], Procter & Gamble)

    or

    - Positive control dentifrice with 0.3% triclosan and 0.243% sodium fluoride (Colgate® Total®, Colgate-Palmolive)

     

  • Dentifrice was distributed over-labeled or over-tubed for blinding purposes, with a soft manual flat-trim toothbrush (Oral-B® Indicator, Procter & Gamble). Subjects were instructed to brush with their respective dentifrice according to each manufacturer’s instructions.
  • The following efficacy and safety evaluations were conducted at Baseline and Month 2: Gingival Bleeding Index; Modified Gingival Index; and Oral Soft Tissue.
  • Treatment groups were compared using analysis of covariance with Baseline value as covariate. All statistical tests were two-sided with a 5% level of significance.

a Adjusted means and standard errors from analysis of covariance with baseline score as covariate.
b Percent reduction = 100% x (control-experimental mean)/control mean.

Anti-Gingivitis Efficacy of a Stabilized 0.454% Stannous Fluoride Dentifrice: A Controlled 6-Month Clinical Trial

KEY CLINICAL RESULTS

  • Baseline values were balanced across the treatment groups (P>0.36) with overall baseline means of 2.09 for gingivitis, 15.8 for gingival bleeding and 15.6 for number of bleeding sites. Relative to baseline, both the stannous fluoride dentifrice group and the positive control group demonstrated a statistically significant (P<0.0001) reduction in gingivitis, gingival bleeding, and number of bleeding sites at Month 2.
  • Between-treatment group comparisons for change from baseline showed the improvement from baseline for the stannous fluoride group was 45% greater for gingivitis, 60% greater for gingival bleeding and 62% greater for number of bleeding sites versus that of the positive control group (P<0.0001). See Figures 1–3.
  • At Month 2, the stannous fluoride dentifrice group demonstrated statistically significantly lower adjusted mean scores versus the positive control group for all 3 measures (P<0.0001).

Figure 1. Analysis of Covariance Summary for gingivitis (MGI). Improvement from baseline at Month 2.

Figure 2 - Analysis of Covariance Summary for gingival bleeding (GBI). Improvement from baseline at Month 2.

Figure 3 - Analysis of Covariance Summary for number of bleeding sites. Improvement from baseline at Month 2.

OBJECTIVE

To assess the effects of a 0.454% stannous fluoride dentifrice on the treatment of gingivitis as compared to a positive control dentifrice in a 2-month clinical trial.

STUDY DESIGN

  • This was a randomized, positive-controlled, double-blind, parallel-group, single-center study with two treatment groups composed of healthy adult volunteers.
  • 200 qualified subjects were enrolled; each treatment group contained 100 subjects. 99 subjects in the stannous fluoride group and 97 in the positive control group completed the study.
  • During the treatment phase, subjects performed their treatment routine unsupervised using their assigned dentifrice (Crest® PRO-HEALTH Clinical Gum Protection with 0.454% stannous fluoride, Procter & Gamble, or Colgate® Total with 0.3% triclosan and 0.32% sodium fluoride, Colgate-Palmolive) per manufacturers’ instructions (twice daily for stannous fluoride dentifrice; three times daily for the control) for 2 months. Both groups used an ADA soft reference manual toothbrush.
  • Efficacy measurements were obtained at Baseline and 2-months post-treatment. Antigingivitis efficacy was determined using mean Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI).
  • Oral soft tissue and hard tissue assessments were conducted at each examination interval.

A Randomized 2-Month Clinical Trial Evaluating the Anti-Gingivitis Efficacy of a Stabilized Stannous Fluoride Dentifrice versus a Triclosan Dentifrice

Reference: CR Goyal1, JG Qaqish1, T He2, R Eusebio2. 1All Sum Research, Mississauga, Ontario, Canada. 2Procter & Gamble, Mason, OH USA

KEY CLINICAL FINDINGS

  • After 2 months of use, the stabilized stannous fluoride (SnF2) test dentifrice group had 21.8% fewer bleeding sites versus the triclosan positive control dentifrice group (P<0.001).
  • Both groups showed statistically significant reductions in bleeding sites from Baseline (P<0.0001).

Figure 1. Number of bleeding sites per group

* Significant difference between groups at Month 2, P<0.001. Groups were not significantly different at Baseline (P>0.05).

OBJECTIVE

To compare the anti-gingivitis efficacy of a stabilized SnF2 dentifrice versus a positive control triclosan dentifrice over a 2-month period.

METHODS

  • This was a randomized, positive-controlled, double-blind, parallel-group clinical trial involving generally healthy adults with mild to moderate gingivitis.
  • Qualifying subjects were randomized to one of two treatment groups:
  • - 0.454% stabilized SnF2 dentifrice (Crest® PRO-HEALTH Clean Mint [Smooth Formula], Procter & Gamble)

    or

    - Positive control dentifrice with 0.3% triclosan and 0.243% sodium fluoride (Colgate® Total®, Colgate-Palmolive)

     

  • Dentifrice was distributed over-labeled or over-tubed for blinding purposes, with a soft manual flat-trim toothbrush (Oral-B® Indicator, Procter & Gamble). Subjects were instructed to brush with their respective dentifrice according to each manufacturer’s instructions.
  • The following efficacy and safety evaluations were conducted at Baseline and Month 2: Gingival Bleeding Index; Modified Gingival Index; and Oral Soft Tissue.
  • Treatment groups were compared using analysis of covariance with Baseline value as covariate. All statistical tests were two-sided with a 5% level of significance.

CLINICAL COMMENT

Gingival bleeding is an important early sign of gingivitis, the initial stage of periodontal disease. Reducing gingival bleeding is the ultimate goal of treating gingivitis, since research indicates the absence of gingival bleeding is a reliable indicator for sustained periodontal health.* This clinical trial showed subjects using the SnF2 dentifrice had significantly fewer (21.8%) bleeding sites than those using a positive control triclosan dentifrice after 2 months of use. Based on these findings, dental professionals should consider recommending the SnF2 dentifrice to patients with gingivitis to reduce bleeding and improve periodontal health.

* Lang NP. et al. J Clin Periodontol. 1990 Nov;17(10):714-21.

A Randomized Clinical Trial to Assess Gingivitis, Plaque, and Tooth Color after Use of a Daily Two-Step Dentifrice and Gel System versus Chlorhexidine Rinse

Reference: Gerlach RW, Sagel PA, Barker ML, et al. J Dent Res 2015; 94 (Spec Iss A): Abstract 0293.

KEY CLINICAL FINDINGS

Overall

  • Use of a daily 2-step dentifrice and gel system resulted in plaque and gingivitis reductions comparable to chlorhexidine (with regular brushing) plus provided tooth whitening benefits. Step 1 is a 0.454% stannous fluoride dentifrice and Step 2 is a whitening gel.

Plaque and Gingivitis

  • The daily 2-step dentifrice and gel system group and the chlorhexidine group had statistically significant (P<0.01) improvements in plaque area and gingivitis color measurements at both Day 7 and Day 21 from Day 0. See Figures 1 and 2.
  • There were no statistically significant differences between the 2-step dentifrice and gel system group and the chlorhexidine group in plaque and gingivitis reduction at Day 7 and Day 21.

Tooth Color

  • The 2-step dentifrice and gel system group demonstrated statistically significantly (P<0.03) greater improvement in tooth color lightness (L*) values compared to the chlorhexidine group at Day 7 and 21. See Figure 3.

Figure 1. Number of bleeding sites per group

* Day 7 and Day 21 are Means adjusted for Day 0. For both groups, Day 7 and Day 21 scores were statistically significantly different (P<0.0001) from Day 0.

Figure 2. Gingivitis (Digital Gingival Imaging, a higher G-value indicates less gingivitis)

* Day 7 and Day 21 are Means adjusted for Day 0 For both groups, Day 7 and Day 21 scores were statistically significantly different (P<0.007) from Day 0.

Figure 3 - Analysis of Covariance Summary for number of bleeding sites. Improvement from baseline at Month 2.

OBJECTIVE

To compare the anti-gingivitis efficacy of a stabilized SnF2 dentifrice versus a positive control triclosan dentifrice over a 2-month period.

METHODS

  • This was a randomized, positive-controlled, double-blind, parallel-group clinical trial involving generally healthy adults with mild to moderate gingivitis.
  • Qualifying subjects were randomized to one of two treatment groups:
  • - 0.454% stabilized SnF2 dentifrice (Crest® PRO-HEALTH Clean Mint [Smooth Formula], Procter & Gamble)

    or

    - Positive control dentifrice with 0.3% triclosan and 0.243% sodium fluoride (Colgate® Total®, Colgate-Palmolive)

     

  • Dentifrice was distributed over-labeled or over-tubed for blinding purposes, with a soft manual flat-trim toothbrush (Oral-B® Indicator, Procter & Gamble). Subjects were instructed to brush with their respective dentifrice according to each manufacturer’s instructions.
  • The following efficacy and safety evaluations were conducted at Baseline and Month 2: Gingival Bleeding Index; Modified Gingival Index; and Oral Soft Tissue.
  • Treatment groups were compared using analysis of covariance with Baseline value as covariate. All statistical tests were two-sided with a 5% level of significance.

Figure 4. Study Design

Figure 4. Study Design

Clinical Significance: Gingivitis

Stannous Fluoride Clinical Significance
  • These results demonstrate significant gingivitis and bleeding site reductions with use of stabilized stannous fluoride dentifrice.
  • The comparative results demonstrate a significant improvement with stabilized stannous fluoride dentifrice compared to 0.3% triclosan/copolymer dentifrice in gingivitis and bleeding site reductions.
  • These results indicate the significant reductions in gingivitis that can be anticipated with twice-daily use of 0.454% stabilized stannous fluoride-dentifrice as part of an oral hygiene regimen.

RESSOURCES PROFESSIONNELLES

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MARQUEURS CLINIQUES DE LA GINGIVITE

Un examen complet des gencives inclut une évaluation de la couleur, la taille, la forme (ou le contour), la consistance, la texture de la surface, la position de la marge gingivale et de l’épithélium de jonction, les jonctions muco-gingivales, les saignements et l’exsudat.

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DISTRIBUTION DE LA GINGIVITE

La notation de la condition gingivale fait partie de tout examen intrabuccal. La détection précoce des infections gingivales et parodontales permet d’éviter de négliger les conditions pouvant mener à de graves maladies.

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CLASSIFICATION DES MALADIES GINGIVALES

La classification des maladies gingivales est une partie importante de l’examen intrabuccal. Le diagnostic et le traitement d’un patient reposent sur une bonne classification des maladies gingivales.

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ÉTUDES DE CAS

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Profil du patient : Le patient est un homme caucasien de 48 ans mesurant 1,75 m et pesant 79 kilos. Il est employé d’un entrepôt industriel.

Motif de consultation : “J’observe une accumulation de tartre sur mon pont et mes gencives saignent lorsque je me brosse les dents. Vous aurez de la difficulté à effectuer mon nettoyage.”

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Profil du patient : La patiente est une femme caucasienne de 48 ans mesurant 1,57 m et pesant 50 kilos.

Motif de consultation : “Mes dents sont très sensibles et mes gencives saignent lorsque je me brosse les dents.”

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Case07 jpg

Profil du patient : La patiente est une femme afro-américaine de 42 ans mesurant 1,72 m et pesant 79 kilos. Elle n’a pas reçu de soins dentaires sur une base régulière et affirme que ses dents ont besoin d’un nettoyage.

Motif de consultation : “Je pense avoir une maladie des gencives. J’ai mauvaise haleine et mes gencives saignent lorsque je me brosse les dents.”

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Case08 jpg

Profil du patient : La patiente est une femme afro-américaine de 29 ans mesurant 1,63 m et pesant 68 kilos. La patiente signale qu’elle ne s’est jamais fait nettoyer les dents et que les traitements dentaires l’angoissent.

Motif de consultation : “Mes gencives saignent lorsque je me brosse les dents. Je ressens de la sensibilité au chaud et au froid la plupart du temps et j’ai une lésion sur ma langue.”

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Profil du patient : Le patient est un homme caucasien de 35 ans.

Motif de consultation : “Mes gencives sont irritées et saignent lorsque je me brosse les dents.”

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ÉTUDES CLINIQUES – OFFERTES EN ANGLAIS UNIQUEMENT

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Epidemiology of Pregnancy Gingivitis: Evidence from the OHMOM Study

Purpose: To review selected past research and evaluatehypothesis that anatomical distortions and dysfunction of the craniomandibular cervical complex lead to systemic inflammationaffecting neural and hormonal pathways.

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A Randomized Clinical Trial Evaluating the AntiGingivitis Efficacy of an Oral Hygiene Routine including a Novel Stabilized Stannous Fluoride Dentifrice, OscillatingRotating Electric Toothbrush and Floss

Purpose:To evaluate the antigingivitis efficacy of an experimental oral hygiene routine (stabilized stannous fluoride dentifrice, oscillatingrotating electric toothbrush and floss) versus a control (dental prophylaxis, standard anticavity dentifrice and soft manual toothbrush) over a 6week period.

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The effects of different levels of brush end rounding on gingival abrasion: a double‑blind randomized clinical trial

Purpose: The objective of this study was to evaluate the effect of different levels of filament end rounding on gingival abrasions (GAs).

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ÉDUCATION DU PATIENT

Gingival Clinical Markers
QU'EST-CE QUE LA GINGIVITE?

Éduquez vos patients sur la gingivite et comment prévenir et traiter cette affection.

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Distribution of Gingivitis
GROSSESSE ET GINGIVITE

Éduquer les futures mères sur l'importance de bonne santé bucco-dentaire pendant la grossesse.

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SAIGNEMENT DES GENCIVES

Enseignez à vos patients les causes de saignement des gencives et comment vous les traitez.

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MALADIE DES GENCIVES

Dites à vos patients les symptômes et le traitement pour les maladies des gencives et partager des conseils sur comment prévenir les maladies des gencives à l'avenir.

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