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Malodor Control Effect by Using Dentifrice Containing Sodium Monofluorophosphate, Sodium Pyrophosphate, Green Tea Extract and Dental Type Silica
Int J Clin Prev Dent 2024;20(2):84-89
Published online June 30, 2024;  https://doi.org/10.15236/ijcpd.2024.20.2.84
© 2024 International Journal of Clinical Preventive Dentistry.

Mi-Sol Park1, Ja-Won Cho2, Ki-Jung Kim3, Da-Hui Kim4

1Department of Oral Health, Graduate School of Health and Welfare, Dankook University, Cheonan, 2Department of Preventive Dentistry, College of Dentistry, Dankook University, Cheonan, 3HBD Division, Amorepacific R&D Center, Yongin, 4Department of Dental Hygiene, Andong Science College, Andong, Korea
Correspondence to: Da-Hui Kim
E-mail: plusoten@naver.com
https://orcid.org/0000-0003-0226-0212
Received June 10, 2024; Revised June 10, 2024; Accepted June 10, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: The purpose of this study was to evaluate the effect of a dentifrice containing sodium fluoride, sodium pyrophosphate, green tea extract, and dental type silica on halitosis and dental plaque index.
Methods: Sixty adults aged 20-50 with mild to moderate gingivitis were enrolled and randomly assigned to either an experimental group (n=30) using a dentifrice with the active ingredients or a control group (n=30) using a dentifrice without these ingredients. Participants used the assigned dentifrice for 16 weeks. Measurements were taken at baseline, 1, 2, 4, 8, and 16 weeks, assessing halitosis with a BBChecker and Visual Analogue Scale (VAS), and dental plaque with the Patient Hygiene Performance (PHP) index and Turesky’s modified Quigley-Hein Plaque index.
Results: Halitosis measurements showed statistically significant improvements in the experimental group compared to the control group after 8 weeks (p<0.05). Significant reductions in halitosis were observed in the experimental group from week 4 (p<0.05). The PHP index showed significant improvements in the experimental group after 2 weeks (p<0.01), and the plaque index showed significant improvements from week 4 (p<0.01).
Conclusion: The study confirmed that the dentifrice containing sodium fluoride, sodium pyrophosphate, green tea extract, and dental type silica effectively reduces halitosis and dental plaque.
Keywords : green tea extract, dental type silica, sodium pyrophosphate, sodium monofluorophosphate
Introduction

Halitosis is defined as an unpleasant odor in the oral cavity, caused by volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan, produced by anaerobic bacteria acting on amino acids in the mouth. While halitosis can be caused by various factors including dental plaque, tartar, dental caries, and periodontal disease, the primary cause is dental plaque, a non- calcified bacterial biofilm attached to the tooth surface [1].

The fundamental method for removing dental plaque is proper and regular tooth brushing using toothpaste [2]. In the past, toothpaste was primarily expected to provide basic functions and cosmetic effects. However, with increasing interest in and awareness of healthy living, toothpaste is now recognized as playing an important role in oral health care. This has led to the commercialization and ongoing development of various specialized toothpastes aimed at preventing dental caries, gingivitis, and halitosis, as well as inhibiting tartar formation and reducing hypersensitivity [3].

Among these, many toothpastes have been developed specifically to reduce halitosis, and there is growing interest in tooth-pastes that include natural extracts such as green tea. Green tea has long been proven to have various efficacies. For instance, Lee et al. [4] reported through experiments on diabetic rats that green tea extract contains substances that lower blood sugar levels. Jang and Ko [5] confirmed through experiments on cats that the components of green tea reduce blood pressure and heart rate. Moreover, Watanabe et al. [6] reported that the major components of green tea, catechins, and caffeine, act through different mechanisms to increase heat generated by noradrenaline and reduce obesity.

In addition to these systemic benefits, green tea extract has been shown to be effective in reducing halitosis when applied to the oral cavity. Toothpaste generally contains abrasives, detergents, binders, and humectants, as well as flavoring agents, sweeteners, preservatives, prophylactic agents, and therapeutic agents [7].

Among the ingredients in toothpaste, sodium monofluoro-phosphate is used for preventing cavities, strengthening enamel, and alleviating tooth sensitivity [8]. Sodium pyrophosphate is known to be effective in inhibiting dental plaque and preventing tartar formation [9]. Jung et al. [10] reported through their study on toothpastes containing sodium pyrophosphate and sodium fluoride that sodium pyrophosphate is also effective in tooth whitening.

Furthermore, green tea extract, as a natural antibacterial component, is reported to be effective in removing dental plaque, preventing gingivitis, reducing gum bleeding, and eliminating halitosis [11]. Dental type silica is known to play a fundamental role in removing plaque and extrinsic stains [12]. In an experiment by Shim and Jwa [13], it was reported that a toothpaste containing tocopherol acetate, tricalcium phosphate, and dental type silica could ultimately reduce halitosis due to the gingivitis-reducing effect of tocopherol acetate and the plaque-removing effects of tricalcium phosphate and dental type silica.

Therefore, this study aims to measure changes in dental plaque and halitosis over time after using toothpaste containing sodium monofluorophosphate, sodium pyrophosphate, green tea extract, and dental type silica in individuals with healthy oral conditions. The objective is to confirm the potential for managing dental plaque and preventing halitosis, and to provide reference for the ongoing development of specialized toothpastes containing natural extracts.

Materials and Methods

1. Study subjects

1) Participants

The study included 60 adult men and women aged between 20 and 49 years who consented to participate and signed a written consent form. Participants were selected based on the following criteria: no restorations or cervical caries, at least 24 remaining teeth, regular brushing at least twice a day, and relatively healthy oral conditions with mild to moderate gingivitis symptoms (Table 1).

Table 1 . Gender and age distribution of subjects

GenderAge

Total20s30s40s
Total60311811
Male271782
Female3314109

2) Study dentifrice

The experiment was conducted using two types of dentifrice: an experimental dentifrice with sodium monofluoropho-sphate, sodium pyrophosphate, green tea extract, and dental type silica as the main ingredients, and a control dentifrice from which these main ingredients were excluded (Table 2).

Table 2 . Ingredients and content of dentifrice

IngredientEC
Sodium monofluorophosphate0.76%0%
Sodium pyrophosphate3.4%0%
Green tea extract0.04%0%
Dental type silica13%0%
Formulation componentAppropriate amountAppropriate amount

E: experimental dentifrice for experimental group, C: control dentifrice for control group.



2. Research methods

1) IRB approval

This study was conducted with the approval of the Dankook University Institutional Review Board (Dankook University IRB), under approval numbers DKU 2017-01-009 and DKU 2017-03-024.

2) Participant assignment

Volunteers who signed the informed consent form were regi-stered and evaluated through a screening visit to determine eligibility based on inclusion and exclusion criteria. Partici-pants were then randomly assigned to either the experimental group or the control group, with 30 participants in each group, in the order of registration. The study was designed as a 16-week, randomized, parallel-comparison, controlled trial with double-blind conditions.

3) Dentifrice usage education

All participants assigned to each group were educated on the correct tooth brushing method using the Bass technique. They were instructed to use the designated dentifrice for each group three times a day for three minutes each time, employing the Bass technique over a period of 16 weeks.

4) Oral examination

Oral examinations were conducted six times: before use, and at 1 week, 2 weeks, 4 weeks, 8 weeks, and 16 weeks. The oral examination items included BB Checker measurements, Visual Analogue Scale (VAS) assessments, the Patient Hygiene Perfor-mance (PHP) index, and the modified Quigley-Hein plaque index as adapted by Turesky.

(1) Halitosis-related indicators

① BB Checker (Plustech, Daejeon, Korea) Measurements: Breath gases were measured using the medical device BB Checker.

② Visual Analogue Scale (VAS): Changes in VAS scores were measured using a numerical rating scale from 0 to 10.

(2) Dental plaque-related indicators

① Patient Hygiene Performance (PHP) Index: This was measured on the buccal surfaces of the maxillary left and right first molars, the lingual surfaces of the mandibular left and right first molars, the labial surfaces of the maxillary right central incisor, and the labial surfaces of the mandibular left central incisor.

② Modified Quigley-Hein Plaque Index by Turesky: Mea-surements were taken on the mesial, distal, central, buccal, and lingual surfaces of the maxillary right second molar, maxillary right canine, maxillary left first molar, mandibular left lateral incisor, mandibular left first molar, and mandibular right first premolar.

5) Data analysis

Comparisons between groups were analyzed using the 2-sample t-test, while within-group comparisons were analyzed using the paired t-test. The experimental results were analyzed using SPSS Statistics version 23.0 (IBM, New York, U.S.A.).

Results

1. Results of changes in dental plaque index

The results of the dental plaque index tests are shown in Table 3, 4.

Table 3 . Changes of patient hygiene performance index

GroupNPatient hygiene performance index (mean±SD)

BaseAfter 1 weekAfter 2 weeksAfter 4 weeksAfter 8 weeksAfter 16 weeks
C302.26±0.682.21±0.732.13±0.582.34±0.562.28±0.432.15±0.75
E301.90±0.921.93±0.981.60±0.79**1.52±0.86**1.28±0.81**1.17±0.76**
p-value0.0940.2260.005<0.001<0.001<0.001

C: control group, E: experimental group, SD: standard deviation, p-value: p value by 2-sample t-test.

**p<0.01 by paired t-test between base and after.


Table 4 . Changes of Turesky Plaque index

GroupNTuresky Plaque index (mean±SD)

BaseAfter 1 weekAfter 2 weeksAfter 4 weeksAfter 8 weeksAfter 16 weeks
C301.17±0.681.14±0.651.17±0.691.18±0.481.22±0.471.17±0.64
E300.99±0.520.99±0.530.88±0.470.81±0.44*0.72±0.46**0.72±0.45*
p-value0.2470.3260.0610.003<0.0010.002

C: control group, E: experimental group, SD: standard deviation, p-value: p value by 2-sample t-test.

*p<0.05 by paired t-test between base and after.

**p<0.01 by paired t-test between base and after.



2. Results of changes in halitosis index

The results of the changes in the halitosis index are shown in Table 5, 6.

Table 5 . Changes of BB Checker Value (BBV)

GroupNChanges of BB Checker Value (mean±SD)

BaseAfter 1 weekAfter 2 weeksAfter 4 weeksAfter 8 weeksAfter 16 weeks
C3076.2±34.474.3±36.072.8±33.370.1±35.068.1±33.1*70.9±36.0
E3074.8±38.461.7±31.7**59.2±33.1**55.6±43.7*45.3±35.7**46.6±40.8**
p-value0.8850.1540.1180.1620.0130.018

C: control group, E: experimental group, SD: standard deviation, p-value: p value by 2-sample t-test.

*p<0.05 by paired t-test between base and after.

**p<0.01 by paired t-test between base and after.


Table 6 . Changes of Value by VAS (Visual Analogue Scale) method

GroupNChanges of Value by VAS (mean±SD)

BaseAfter 1 weekAfter 2 weeksAfter 4 weeksAfter 8 weeksAfter 16 weeks
C304.40±2.044.97±2.24*4.90±2.26*4.73±2.574.57±2.644.40±2.81
E304.60±2.624.67±2.544.23±2.333.70±2.38**2.93±2.36**2.27±2.33**
p-value0.7430.6290.2660.1120.0140.002

C: control group, E: experimental group, SD: standard deviation, p-value: p value by 2-sample t-test.

*p<0.05 by paired t-test between base and after.

**p<0.01 by paired t-test between base and after.


Discussion

As modern society becomes more complex and industries advance, the concept of well-being, which aims for physical and mental health and harmony, has become increasingly important. Consequently, awareness of not only overall health but also oral health is positively changing. Various oral hygiene products and aids are being developed to prevent oral diseases. Among oral diseases, halitosis is a highly sensitive and important issue for maintaining smooth interpersonal relationships. In line with the era of well-being, various studies are continuously being conducted to reduce halitosis using natural extracts.

Bae et al. [14] demonstrated the effects of NaF, CPC, green tea extract, and pine needle extract-containing mouthwash in preventing periodontal disease, reducing halitosis, and preventing dental caries. Kim et al. [15] reported that using an oral spray containing grapefruit seed extract, tea extract, and UDCA can reduce S. mutans, decrease halitosis, and alleviate gingivitis.

Although natural extracts in mouthwash or spray form can effectively reduce halitosis, Kim et al. [16] suggested that the mechanical removal of dental plaque through tooth brushing using dentifrice shows significantly higher removal rates com-pared to mouthwash or sprays, enhancing the effectiveness of dental plaque and halitosis removal.

Stallard [17] and Harris and Christen [18] classified dentifrices into general and specialized types based on the inclusion of medicinal compounds. They reported that tooth brushing with general dentifrice can prevent dental caries and periodontal disease and treat gingivitis, but using specialized dentifrice with medicinal compounds further enhances these effects. Bae et al. [14] and You et al. [19] also reported that incorporating green tea extract in dentifrice can reduce halitosis. In this study, BB checker measurements showed statistically significant differences between the experimental and control groups starting from 8 weeks (p<0.05). In the experimental group, significant reduction in halitosis was observed from 1 week post-experiment compared to pre-experiment (p<0.05). Sensory evaluations of halitosis also showed statistically significant differences between the experimental and control groups starting from 8 weeks (p<0.05), with significant reduction in the experimental group starting from 4 weeks post-experiment compared to pre-experiment (p<0.05).

Fehr reported that using a dentifrice containing sodium monofluorophosphate increased the acid resistance of dental tissues, thus preventing dental caries [20]. Chikte et al. [21] reported that dentifrice containing sodium pyrophosphate and dental type silica was effective in removing dental plaque and stains. In this study, the dentifrice containing sodium pyrophosphate and dental type silica showed statistically significant changes in the Plaque Index starting from 4 weeks (p<0.01). The experimental group showed a significant reduction in the Plaque Index from 4 weeks post-experiment compared to pre- experiment (p<0.05).

McClanahan et al. [22] reported the preventive effects of inhibiting dental plaque and tartar formation. In this study, the reduction in dental plaque was confirmed by the PHP index measurements, showing statistically significant differences between the experimental and control groups starting from 2 weeks (p<0.01). The experimental group showed a significant reduction in the PHP index from 2 weeks post-experiment compared to pre-experiment (p<0.05).

These results indicate that using dentifrice containing sodium monofluorophosphate, sodium pyrophosphate, green tea extract, and dental type silica is effective in removing dental plaque and reducing halitosis. Therefore, the authors recommend using such dentifrice for preventing dental plaque and halitosis. Additionally, the effectiveness is likely to be enhanced when used with oral hygiene aids, considering individual oral conditions. Further development of various products using natural extracts is also deemed necessary.

Conclusion

To verify the effectiveness of a dentifrice containing sodium monofluorophosphate, sodium pyrophosphate, green tea extract, and dental type silica in removing dental plaque and reducing halitosis, a study was conducted using two types of dentifrice. The experimental dentifrice included the aforementioned active ingredients, while the control dentifrice contained only the formulation components such as humectants, foaming agents, and flavors, without the active ingredients. Sixty volunteers were divided into two groups of 30 each, with one group using the experimental dentifrice and the other group using the control dentifrice for 16 weeks. Measurements were taken at six intervals: before the experiment, and at 1 week, 2 weeks, 4 weeks, 8 weeks, and 16 weeks. The PHP index, plaque index, BB checker, and halitosis tests were conducted to record and compare the results. The following conclusions were drawn:

1. Halitosis-related indicators

BB Checker Measurements: Statistically significant differences between the experimental and control groups were observed starting from 8 weeks (p<0.05). The experimental group showed a significant reduction in halitosis from 1 week post-experiment compared to pre-experiment (p<0.05).

Halitosis Test Measurements: Statistically significant differences between the experimental and control groups were observed starting from 8 weeks (p<0.05). The experimental group showed a significant reduction in halitosis from 4 weeks post-experiment compared to pre-experiment (p<0.05).

2. Dental plaque-related indicators

PHP Index Measurements: Statistically significant differences between the experimental and control groups were observed starting from 2 weeks (p<0.01). The experimental group showed a significant reduction in the PHP index from 2 weeks post-experiment compared to pre-experiment (p<0.05).

Turesky’s Plaque Index Measurements: Statistically significant differences between the experimental and control groups were observed starting from 4 weeks (p<0.01). The experimental group showed a significant reduction in the plaque index from 4 weeks post-experiment compared to pre-experiment (p<0.05).

Throughout the study period, no adverse reactions were observed in any participants due to the dentifrice. It was confirmed that using a dentifrice containing sodium monofluoro-phosphate, sodium pyrophosphate, green tea extract, and dental type silica can significantly improve dental plaque removal and effectively reduce halitosis.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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