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
There are three ways in which gingivitis reductions can be achieved:
Gingivitis affects 4 of 5 adults globally
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.
Reference: Mankodi S, Bartizek RD, Winston JL, et al. J Clin Periodontol. 2005;32(1):75-80.
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).
To investigate the long-term anti-gingivitis efficacy of a 0.454% stabilized stannous fluoride dentifrice (with sodium hexametaphosphate for cosmetic benefits) compared to a negative control dentifrice.
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.
Reference: He T, Barker ML, Goyal CR, Biesbrock AR. Am J Dent. 2012;25:136-140
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.
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.
Reference: CR Goyal1, JG Qaqish1, T He2, R Eusebio2. 1All Sum Research, Mississauga, Ontario, Canada. 2Procter & Gamble, Mason, OH USA
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).
To compare the anti-gingivitis efficacy of a stabilized SnF2 dentifrice versus a positive control triclosan dentifrice over a 2-month period.
- 0.454% stabilized SnF2 dentifrice (Crest® PRO-HEALTH™ Clean Mint [Smooth Formula], Procter & Gamble)
- Positive control dentifrice with 0.3% triclosan and 0.243% sodium fluoride (Colgate® Total®, Colgate-Palmolive)
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.
Reference: Gerlach RW, Sagel PA, Barker ML, et al. J Dent Res 2015; 94 (Spec Iss A): Abstract 0293.
Plaque and Gingivitis
Figure 1. Percent Plaque Coverage
* 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. Tooth color lightness (L*) change from baseline (Combined Arches, Analysis of Covariance)
To assess the effect of a daily 2-step dentifrice and gel system versus chlorhexidine (with regular brushing) using imaging of plaque, gingivitis and tooth color in an induced gingivitis model.
Figure 4. Study Design
* Standard Test Method for Objective Measurement of Gingival Color Using Digital Still Cameras. ASTM E2545 - 07(2012).