Title Long-Term Use of Triclosan in Dentifrice Does Not Develop Oral Bacterial Resistance for Patients with Periodontal Disease
Clinical Question Does the long-term use of triclosan dentifrice for the treatment of patients with periodontal disease develop resistance on host’s oral bacteria?
Clinical Bottom Line Long-term use of triclosan-containing dentifrice for the treatment of patients with periodontal disease is safe and does not develop oral bacterial susceptibility or resistance. Triclosan can suppress microbial pathogen recognition of pathway molecules and acute and chronic inflammatory mediators. Triclosan anti-inflammatory/antimicrobial properties reduce plaque- and gingivitis-associated bleeding around natural teeth and dental implants. Triclosan in dentifrice does not shift plaque oral ecology.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
24889743Haraszthy/2014155 adults (97 non triclosan dentifrice users, 58 triclosan dentifrice users)Comparative study
Key resultsRegression analysis of 155 plaque samples over 19 years confirmed no changes in antimicrobial susceptibility or bacterial resistance to triclosan dentifrice. Supragingival plaque samples of subjects using triclosan and non triclosan dentifrice were cultured on non triclosan and triclosan media containing either 7.5 μg/ml or 25 μg/ml triclosan. Less bacterial growth was exhibited on the triclosan media versus the non triclosan media. Bacterial susceptibility was revealed on both sample groups on a triclosan media without a statistically significant difference (p=0.159 for 7.5 μg/ml concentration, p=0.299 for 25μg/ml concentration). No change in susceptibility pattern (p=0.05) was revealed on either triclosan concentrations. A trend for susceptibility changes on supragingival plaque bacteria during 5 to 13 years of triclosan dentifrice use over a 19-year period was not established. The long-term outcome of triclosan dentifrice use on supragingival plaque is reliable and safe.
Evidence Search ("triclosan"[MeSH Terms] OR "triclosan"[All Fields]) AND ("dentifrices"[Pharmacological Action] OR "dentifrices"[MeSH Terms] OR "dentifrices"[All Fields] OR "dentifrice"[All Fields]) AND bacterial[All Fields] AND ("mouth"[MeSH Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND resistance[All Fields]
Comments on
The Evidence
Validity: This study was developed to analyze supragingival plaque bacterial susceptibility to triclosan in the population in plaque samples collected over 19 years. The investigators obtained plaque samples on different sets of patients at 11 different times. At each of these 11 time points, plaque samples were collected from both triclosan dentifrice users and non-triclosan dentifrice users. These samples were added to two different triclosan media concentrations of 7.5 μg/ml and 25 μg/ml, and also cultured in non-triclosan media for susceptibility comparison. After 5-7 days of incubation, statistical analysis demonstrated fewer bacteria on both triclosan concentrations, and higher amounts of bacteria on non-triclosan media. Bacterial growth was susceptible to proliferation under triclosan media, however; long-term use of triclosan dentifrice did not result in development of bacterial resistance. Taking into consideration that triclosan demonstrated no susceptibility change patterns (p=0.05) on both triclosan concentrations with Wald-Wolfowitz linear regression test, the non-emergence of triclosan oral resistant bacteria after long-term use of triclosan dentifrice is evident. It is also important to note the possibility for the subjects to be exposed to additional triclosan concentrations through daily use of personal hygiene products such as soaps, mouthrinses, and chewing gum. Considering the common availability and use of triclosan hygiene products in the population, to include triclosan dentifrice, these results demonstrate that triclosan does not produce oral bacterial resistance on hosts, and it is safe to decrease inflammation and plaque levels of pathogenic bacteria known to induce periodontal disease. Perspective: Community level assessment of supragingival plaque samples demonstrated effectiveness and safe long-term use of triclosan-containing toothpaste for the treatment and prevention of inflammation and bleeding associated to periodontal disease. Susceptibility changes and resistant bacteria were not developed over a period of 19 years with triclosan use of at least 5 to 13 years.
Applicability Regular use of .03 % triclosan, 2% copolymer, and .243% sodium fluoride containing dentifrice was proven to be a safe and effective treatment to reduce signs of periodontal inflammation, bleeding, and bacterial plaque buildup. Triclosan is an effective inhibiting ingredient for plaque buildup. Long-term use of triclosan dentifrice does not develop oral bacterial resistance. Subjects in this 19-year community assessment were not excluded or included based on the type of dentifrice use, health status, amount of dental plaque, or degree of dental inflammation. Samples included 21 subjects who used triclosan dentifrice, and 20 control subjects. Additional triclosan exposure via personal use of mouthrinses, chewing gum, hand soaps or cosmetics could be possible. Triclosan has been shown to regulate TLR signaling pathway and to inhibit LPS induced pro-inflammatory response. It also reduced biosynthesis of PGE-2 by inhibiting mPGES-1 in gingival fibroblasts. In another study, after 28 weeks, triclosan reduced fusiforms, spirochetes, staphylococci, and increased S. sanguis (Zambon 1990, PMID: 2083042) . After 7 months, a comparison of samples from 13 females using triclosan/zinc citrate dentifrice and 13 females in a control group found no difference in the number of S. mutans or candida. Predominant plaque bacteria was unchanged, and no evidence was found for bacterial resistance to triclosan. There is no correlation between triclosan use and the number of triclosan resistant bacteria. However, some bacteria may be naturally resistant to triclosan. The properties of triclosan safely reduce plaque, gingivitis and the risk of periodontal-infection systemic related diseases (chronic obstructive pulmonary disease, diabetes mellitus, cardiovascular disease, and preterm low birth weight).
Specialty (General Dentistry) (Periodontics)
Keywords Triclosan, dentifrice, host response, oral bacteria, pathogenic bacteria, antimicrobial susceptibility, antimicrobial resistance, periodontal disease, plaque, biofilm, inflammation.
ID# 3098
Date of submission 11/15/2016
E-mail figueroarodr@livemail.uthscsa.edu
Author Maylee Figueroa Rodriguez
Co-author(s) e-mail
Faculty mentor Carol A. Nguyen, MPH, MS
Faculty mentor e-mail nguyenc@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available