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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 185-189

A comparative clinical evaluation of plaque removal efficacy of a chewable toothpaste tablet with conventional toothpaste in children – A randomized clinical trial

Department of Pediatric and Preventive Dentistry, College of Dental Sciences, Bhavnagar, Gujarat, India

Date of Submission19-Jun-2022
Date of Decision17-Nov-2022
Date of Acceptance06-Dec-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Dr. Shital Kiran Davangere Padmanabh
Department of Pediatric and Preventive Dentistry, College of Dental Sciences, At. Amargardh, Tal. Sihor, Bhavnagar - 364 210, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjoralsci.sjoralsci_26_22

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Introduction: One of the most important causative factors in the onset of dental caries and periodontal disorders is dental plaque. Mouthwashes and dentifrices, such as toothpaste, are examples of chemical plaque management treatments. Toothpaste is the most widely utilized oral health preventive measure. Dentifrices containing 950 PPM of fluoride have recently been developed as tablets. Tablets are a promising substitute for toothpaste.
Aim: This study aimed to compare the plaque removal efficacy of a novel chewable toothpaste tablet and a traditional toothpaste in children aged 6–12 years old.
Materials and Methods: A total of 128 children aged 6–12 years old were randomly split into two equal groups, with 64 subjects were given chewable toothpaste tablets and the other 64 received conventional toothpaste. The efficacy of a novel chewable toothpaste tablet with traditional toothpaste was compared, and the modified plaque index was measured at baseline at 0 weeks and after 4 weeks.
Results and Discussion: A total of 127 children were evaluated out of a total of 128. Between baseline and 4 weeks, there was a statistically significant difference in mean plaque scores within groups (P = 0.001). At 4 weeks, there was a statistically significant difference (P = 0.001) between the chewable tablet and toothpaste groups.
Conclusion: Due to the convenience of use for children and the unique type of toothpaste, chewable toothpaste tablets show a higher efficacy of plaque removal than conventional toothpaste. A chewable toothpaste tablet could be a viable alternative to conventional toothpaste for children's oral health.

Keywords: Chewable toothpaste tablet, dental plaque, toothpastes, plaque index

How to cite this article:
Padmanabh SK, Makhiya M, Mulchandani V, Jhamb V, Trivedi M, Upendrabhai MJ. A comparative clinical evaluation of plaque removal efficacy of a chewable toothpaste tablet with conventional toothpaste in children – A randomized clinical trial. Saudi J Oral Sci 2022;9:185-9

How to cite this URL:
Padmanabh SK, Makhiya M, Mulchandani V, Jhamb V, Trivedi M, Upendrabhai MJ. A comparative clinical evaluation of plaque removal efficacy of a chewable toothpaste tablet with conventional toothpaste in children – A randomized clinical trial. Saudi J Oral Sci [serial online] 2022 [cited 2023 Feb 6];9:185-9. Available from: https://www.saudijos.org/text.asp?2022/9/3/185/366531

  Introduction Top

Periodontal and dental caries are the most common childhood dental diseases that begin at a young age and have an insidious onset. Therefore, the prevention of these diseases should be early with newer accessory agents and aids that aid in preventing and controlling dental plaque, as plaque is the most critical factor in the initiation of periodontal and gingival diseases.[1] Dental plaque is specific and shows tremendous variability in structural entity resulting from microbial colonization and growth consisting of various strains and species surrounded by an extracellular matrix.[2] Interdental sites pose additional risks to the susceptibility of dental caries and periodontal diseases. Acidogenic plaque was seen at interproximal sites compared to other areas of the oral cavity.[3] According to Stoppelaar[4] and Scheie,[5] a positive correlation exists between a diet containing sucrose and the mutans streptococci level in dental plaque. Mattos-Graner[6] showed that caries incidence in children was more dependent on the capacity of mutans streptococci to synthesize insoluble glucans than on the number of these bacteria in dental plaque. According to the literature, in dental plaque of children with nursing caries, high levels of mutans streptococci have been found.[7],[8],[9],[10]

Mechanical plaque control such as toothbrushes, flosses, interdental brushes, and chemical plaque control techniques, such as mouthwashes and dentifrices, may be used for plaque control.[11] Personal daily oral hygiene by brushing and using various oral hygiene aids, including improved toothbrush designs, dental floss, interproximal brushes, end-tufted brushes, wooden tips, oral irrigation, dentifrices, and biological methods including probiotics and vaccines, which would also help to achieve better plaque control in children.[1],[12] Reductions in plaque levels resulting from the use of dentifrices containing antimicrobials are due to the inhibition of plaque growth between brushings, which results in the toothbrush having less plaque to remove each time.[13],[14] Toothbrush with any brush head cleans teeth effectively, but the size of the toothbrush should be considered according to the size of the oral cavity, which varies according to age: for 0–2 years: 15 mm, 2–6 years: 19 mm, 6–12 years: 22 mm, and above 12 years: 25 mm.[15]

The major goal of toothpaste is to clean and polish the sides of teeth that are accessible when used in conjunction with a toothbrush, aid plaque clearance, and prevent the spread of bad breath.[16] Dentifrices are offered as toothpaste tubes, gels, liquids, and to a lesser extent, toothpowder and are used for therapeutic or cosmetic purposes. Fluoride is a frequently utilized medicinal agent in dentifrices due to its anti-caries capabilities.[17] In 1960, the American Dental Association approved the use of fluoride salts in toothpaste, paving the door for a global fluoride toothpaste initiative.[18] Dentifrices in the form of tablets have recently been developed. Tablets are a more environmentally friendly alternative to toothpaste. Tablets are a dry formulation containing all the chemicals required for tooth care. Fluoride-containing toothpaste tablets have been sold alongside fluoride-free toothpaste tablets. Chewable toothpaste tablets have the advantage of being able to be unpacked and put into the mouth, then chewed off and brushed with a wet toothbrush. To the best of our knowledge, no research has been conducted to assess the plaque removal efficacy between chewable toothpaste tablets and conventional toothpaste in children.

  Materials and Methods Top

The parallel randomized clinical trial included 128 children aged 6–12 years old, both males and females, recruited from the outpatient department of pediatric and preventive dentistry. The present investigation received ethical clearance approval from the Institutional Ethical Committee (IEC) CODS/IEC/101/2021. In the clinical trials registry-India (CTRI), our study has been registered as CTRI/2021/12/038442. Our research took place over 6 months, from April 1st to September 30th.

In total, 128 children were screened by the investigator. The total sample size obtained was 128 children with 80% power and a 5% margin of error. One hundred and twenty-eight children were allocated equally into two groups, 64 children in each group. In our study, the plaque removal efficiency was assessed for mixed dentition. Criteria for inclusion were children between the ages of 6 and 12 years old, both sexes, and the ability to follow instructions verbally and in writing. Exclusion criteria included children treated with antibiotics at the time of study duration in the previous 6 months. Those children who received prophylactic oral prophylaxis and children with a cognitive or physical disability were also excluded from the study.

After examining inclusion and exclusion criteria, the patients were assigned by the primary investigator in Group I if patients visited the pediatric dentistry department on Monday, Tuesday, and Wednesday. Similarly, patients were assigned to Group II if they visited the pediatric dentistry department on Thursday, Friday, and Saturday. Following the CONSORT criteria, a simple random sampling approach was employed to divide the entire sample of 128 children into two groups. CONSORT flowchart [Figure 1]: A unique chewable toothpaste tablet was given to Group I (n = 64 children) (Denttabs GmbH GerichtstraBe, Berlin, Germany) [Figure 2]. Conventional toothpaste (Colgate – Palmolive India Ltd., Ahmedabad, Gujarat) was used in Group II (n = 64 children) [Figure 3].
Figure 1: CONSORT flowchart

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Figure 2: Chewable toothpaste tablet

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Figure 3: A conventional toothpaste

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During the initial visit, participants were chosen based on predetermined criteria. The study's aim was explained to the child's parents/guardians, who then gave their informed consent to participate in the study. Modification of the plaque index Loe[6] was used to get the baseline plaque score. A simple random sampling approach was carried out to give the participants one package of chewable toothpaste tablets containing 30 tablets or one conventional toothpaste. Following the randomization, participants were given either one package of chewable toothpaste tablets containing 30 tablets or one conventional toothpaste. The subject was told to use chewable toothpaste pills or conventional toothpaste once a day in the morning and not to use regular toothpaste while brushing. Toothbrush and brushing instructions were provided to both the groups. The diameter of the brush head should be approximately 22 mm.[15] The candidates in Group 1 were also told only to use one tablet at a time, and a video presentation was used to demonstrate how to use the tablet to the parents/guardians and children.

After 4 weeks, the children were summoned back with their parents/guardians for a follow-up visit, and they were told not to brush for 48 h before the next visit. On the second visit, the initial investigator noted the plaque score using the revised plaque index Loe.[19] The data were tabulated using Microsoft Excel 2016, and subsequent data were examined using IBM SPSS for Windows, Version 23. (IBM Corp., Armonk, New York, USA). A paired t-test was used to compare the mean plaque rate between groups. The P value (significance threshold) was set to 0.05.

  Results Top

One hundred and twenty-seven children were evaluated because one subject from group II was lost during the follow-up. The mean age of the participants was 8.65 ± 2.09, and the number of male and female subjects was 81 and 46, respectively. Between 0 and 4 weeks, a paired t-test of mean plaque values among the chewable tablet and toothpaste groups revealed a statistically significant difference of P = 0.001. The Mean standard deviation (SD) plaque score from baseline and 4 weeks in the chewable toothpaste tablet group-I were 0.35. The Mean SD plaque score between 0 and 4 weeks in the conventional toothpaste group-II was 0.20 [Table 1]. At 4 weeks, there was a statistically significant difference between the chewable pill group and the conventional toothpaste group P = 0.001 [Table 2].
Table 1: Comparison of mean plaque scores between visits within each group

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Table 2: Comparison of mean plaque scores between groups

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  Discussion Top

Brushing the teeth twice a day with a dentifrice is the traditional technique of dental hygiene practice. Tooth brushing is still the most important oral health measure globally, and dentifrice has been viewed as a delivery vehicle for fluoride.[20] People use dentifrices intending to clean their teeth excessively, including anticaries action, desensitization effect, cleanliness sensation, and malodor reduction.[21] Volpenhein[22] compared the effectiveness of tooth brushing with water alone versus using dentifrice while brushing for plaque removal and found that the use of dentifrices with tooth bushing resulted in a measurable reduction in plaque compared to brushing with water alone.

Bundesverb and Deutscher Industrie-und Handelsunternehmen Germany has certified Denttabs chewable toothpaste tablets as 100% natural, meaning they are free of chemical preservatives, artificial stabilizers, and any other unwanted components. Denttabs chewable Toothpaste pills contain stevia extracts, which help prevent plaque formation and promote tooth mineralization. Stevia extracts have a powerful sweet flavor and are noncariogenic and nonerosive since oral bacteria cannot agitate them. The antibacterial efficacy of stevia extract against streptococcus mutans and lactobacillus acidophilus was demonstrated in an in vitro study.[23] Siraj[24] discovered that stevia leaf extract did not affect plaque pH in a clinical setting, demonstrating that Stevia leaf extract is nonfermentable and does not aid bacterial survival.

The American Dental Association approved the use of fluoride salts in toothpaste in 1960, paving the way for fluoride toothpaste worldwide.[18] Brushing with fluoride toothpaste is a great strategy for public health since it is convenient, affordable, culturally acceptable, and widespread.[25] In our study, chewable tablets and conventional toothpaste had 950 and 1000 parts per million fluorides, respectively. Gujarathi[26] tested commercially available child formula dentifrices for remineralizing potential, and the authors discovered that Colgate and Cheerio gel are beneficial for remineralizing carious lesions.

A plaque near the gingiva will have a greater impact on the gingiva than plaque near the incisal borders of teeth. As a result, the extent of plaque in the gingival area remains more sensitive over time than an index designed to cover the entire tooth surface.[27] The modified Plaque Index Loe[19] was used to record the baseline plaque score and the plaque score over the next 4 weeks in the current study. This index is based on the essential principle of distinguishing clearly between the location and the extreme of a soft debris build-up. Although we did not utilize a disclosing solution for plaque detection in our research, it could be a good option for identifying plaque films. As a result, Plaque Index scores only look at differences in the width of soft deposits in the gingival zone of the tooth surface not the plaque in the coronal extension will not be measured.

Many new dentifrices and other oral care products are being introduced to the market, all claiming to improve dental health; as a result, choosing the right toothpaste for a family has remained a difficult chore for many.[28] In our study, a significant reduction in plaque index score was seen when chewable toothpaste tablets were compared with conventional toothpaste due to the reason that children assigned to the chewable toothpaste tablet group may be motivated by a different type of toothpaste as well as a different way of using the toothpaste tablet. The findings of our study agree with Eid,[29] who found that tooth brushing with dentifrices was more effective in plaque removal than tooth brushing with water alone. Dentifrices considerably increased the plaque removal efficacy of tooth brushing, according to Putt,[30] which is debatable to what extent this impact lingers in the mouth to reduce microbial load. However, the effectiveness of various ingredients in toothpaste used is more important than adequate dental hygiene measures and brushing procedures for optimal oral health conservation.[28] The dexterity in the 6 years old and 12 years old varies, in our study, we have not compared the age between the groups which is the limitation of our study.

  Conclusion Top

Because the chewable toothpaste tablet is easier for children to use and the structure of toothpaste is different, it has a higher plaque removal efficacy than conventional toothpaste. The chewable toothpaste tablet could be a good alternative to traditional toothpaste for keeping kids' teeth healthy.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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