By JoAnn R. Gurenlian, RDH, PhD
The title of this column conjures up an image of the movie "The Marathon Man." Sir Laurence Olivier is torturing Dustin Hoffman by drilling into his teeth while asking, "Is it safe?" That scene probably only remains in the minds of dental professionals, but it was compelling. So, too, is the concern we have about dental products we recommend to our patients.
We have all had moments where we read an article or saw a story on the news that indicated a procedure or product was not considered safe, and our patients flooded the office with phone calls or refused a procedure based on what they heard. We scrambled to find evidence to present to our patients to relieve and inform them of what we knew to be true. Such is the case with triclosan.
Over the past decade, concerns have been raised by the media about the use of triclosan in toothpastes, soaps, and other products. Triclosan is a chemical added to Colgate Total toothpaste, designed to work with a copolymer to prevent gingivitis. Dental science has demonstrated that it is effective as both an antibacterial and anti-inflammatory agent, and effective in managing biofilm and gingivitis. However, there are naysayers who claim that triclosan is unsafe.
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As reported in examiner.com, one assistant professor in civil and environmental engineering at Virginia Polytechnic Institute noted that triclosan in toothpaste could react with chlorine in tap water to produce chloroform gas. This reaction can cause depression, liver problems, and cancer. A similar finding was noted in a study published on the Environmental Science & Technology research website As Soon As Publishable suggesting that this antibacterial product may be ineffective and harmful. A study conducted by researchers at the University of California, Davis, and the University of Colorado also noted that triclosan hinders heart muscle cells and skeletal muscle fiber contractions at a cellular level, slows swimming in fish, reduces muscular strength in mice, and could cause disruption of reproductive hormone activity and cell signaling of the brain. Concern was also expressed that there was the possibility of resistant strains of bacteria developing due to overuse of antibacterial products. The recommendation was to use diluted tea tree oil or herbal ingredients that have antibacterial products.
Given these health concerns and the purported association of triclosan with adverse effects, it is difficult to discern the reality. Fortunately, we do have several sources that can be used to better understand this safety issue.
First, to be marketed in the United States, Colgate had to submit a New Drug Application to the Food and Drug Administration (FDA). Colgate Total was approved by the FDA in 1997 as safe and effective. The FDA continuously monitors this safety data. In a briefing conducted in December 2013, the FDA verified that Colgate Total is both safe and effective.
In addition, more than 80 published clinical trials involving more than 19,000 subjects have evaluated the safety and efficacy of Colgate Total toothpaste. It is the most widely studied toothpaste in the world. Other published meta-analyses and systematic reviews have confirmed the safety of this toothpaste. Further, the American Dental Association granted the Seal of Acceptance to Colgate Total after reviewing longitudinal studies that documented the safety of long-term use of this toothpaste. The criteria to receive this seal are both substantive and rigorous.
More recently, the Cochrane Oral Health Group conducted an independent review of Colgate Total toothpaste. The Cochrane Collaboration is an international organization designed to help individuals make well-informed decisions about health care by preparing, disseminating, and maintaining systematic reviews of the effects of health-care interventions. Cochrane Reviews are globally recognized by health professionals as the authority for high-quality clinical decision making.
The Cochrane Review evaluated 30 studies from 1990 to 2012, which included 14,835 subjects randomized to receive either a triclosan/copolymer-containing fluoride toothpaste (aka Colgate Total) or a traditional fluoride toothpaste that did not contain triclosan/copolymer. Results of this systematic review showed significant oral health benefits from using a triclosan/copolymer fluoride toothpaste that included a 22% reduction in plaque, a 22% reduction in gingivitis, and a 48% reduction in bleeding. There was no evidence of any harmful effects associated with the use of Colgate Total in studies up to three years in duration and no serious safety concerns. The entire report can be reviewed at onlinelibrary.wiley.com/doi/10.1002/14651858.CD010514.pub2/abstract;jessionid=217E52E32B87ADA7C2AD66C3244DFF12.f01t03.
Clearly, to effectively address our patients' health concerns, we must be apprised of the literature they are exposed to as well as the scientific literature. This discussion of triclosan illustrates how influential the media can be with the public. Being consumers of the scientific literature will help us use evidence to better address concerns about safety and efficacy. In the case of triclosan, safety appears to be assured.
JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.
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