The aim of this study is to assess the ability of a marketed Cetylpyridinium Chloride (CPC) mouthwash alongside a marketed Stannous Fluoride (SnF2) toothpaste in improving gingival health and reducing plaque accumulation, compared to the use of a regular fluoride toothpaste alone in participants with clinically measurable plaque-induced gingivitis.
This will be a single center, 12-week, randomized, controlled, examiner-blind, 3-treatment arm, parallel group, stratified (by sex \[male/female\]) study to evaluate the efficacy of using the SnF2 toothpaste/CPC mouthwash twice daily in reducing gingivitis and plaque accumulation in a population with clinically measurable levels of gingivitis. The clinical efficacy of the commercially available SnF2 toothpaste/CPC mouthwash will be compared with that of a commercially available, regular fluoride toothpaste with no known anti-gingivitis nor anti-plaque efficacy properties (negative control). This study will also explore whether a CPC mouthwash used with a SnF2 toothpaste could provide benefits in plaque accumulation reduction and gingival health improvement over the sole use of SnF2 toothpaste (reference product). Sufficient participants will be screened to randomize approximately 198 participants (approximately 66 per group) to ensure approximately 180 evaluable participants (approximately 60 per group) complete the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
195
Toothpaste containing 0.454 percent (%) weight by weight (w/w) SnF2.
Mouthwash containing 0.07% w/w CPC.
Toothpaste containing 0.243% w/w sodium fluoride.
Salus Research
Fort Wayne, Indiana, United States
Overall Number of Bleeding Sites (NBS) at Week 12 (Toothpaste/Mouthwash versus [vs.] Negative Control Toothpaste)
Gingival bleeding will be assessed according to the expanded bleeding index (EBI), by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing. The NBS for each participant will be calculated as the number of evaluable tooth sites (having two-thirds of the natural tooth surface gradable for the assessment) with bleeding observed immediately on probing or within 30 seconds of probing.
Time frame: Week 12
Interproximal NBS at Week 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing. The NBS for each participant will be calculated as the number of evaluable tooth sites (having two-thirds of the natural tooth surface gradable for the assessment) with bleeding observed immediately on probing or within 30 seconds of probing.
Time frame: Week 12
Overall NBS at Week 6 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing. The NBS for each participant will be calculated as the number of evaluable tooth sites (having two-thirds of the natural tooth surface gradable for the assessment) with bleeding observed immediately on probing or within 30 seconds of probing.
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Toothpaste containing 0.454% w/w SnF2.
Time frame: Week 6
Interproximal NBS at Week 6 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing. The NBS for each participant will be calculated as the number of evaluable tooth sites (having two-thirds of the natural tooth surface gradable for the assessment) with bleeding observed immediately on probing or within 30 seconds of probing.
Time frame: Week 6
Overall Mean Bleeding Index (Bl) at Weeks 6 and 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing and scored on a 3-points scale ranging from 0 to 2, where 0=no bleeding after 30 seconds; 1=bleeding observed within 30 seconds of probing; 2=bleeding observed immediately on probing. Mean BI will be calculated by taking the average over all tooth sites assessed for a participant. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Interproximal Mean BI at Weeks 6 and 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing and scored on a 3-points scale ranging from 0 to 2, where 0=no bleeding after 30 seconds; 1=bleeding observed within 30 seconds of probing; 2=bleeding observed immediately on probing. Mean BI will be calculated by taking the average over all tooth sites assessed for a participant. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Overall Mean Modified Gingival Index (MGI) at Weeks 6 and 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
The MGI assessment is a non-invasive evaluation which focuses on the visual symptoms of gingivitis (for example, redness, texture, edema). MGI will be assessed on the buccal and lingual marginal gingiva and interdental papillae of all scorable teeth (second permanent molar to second permanent molar in each arch) and scored on a 5-point scale ranging from 0 to 4, where 0=Absence of inflammation; 1=Mild inflammation; slight change in colour, little change in colour; little change in texture of any portion of the marginal or papillary gingival unit; 2=Mild inflammation; criteria as 1 but involving the entire marginal or papillary gingival unit; 3=Moderate inflammation; glazing, redness, edema, and/or hypertrophy of the marginal or papillary gingival unit; 4=Severe inflammation; marked redness, edema and/or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Interproximal Mean MGI at Weeks 6 and 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
The MGI assessment is a non-invasive evaluation which focuses on the visual symptoms of gingivitis (for example, redness, texture, edema). MGI will be assessed on the buccal and lingual marginal gingiva and interdental papillae of all scorable teeth (second permanent molar to second permanent molar in each arch) and scored on a 5-point scale ranging from 0 to 4, where 0=Absence of inflammation; 1=Mild inflammation; slight change in colour, little change in colour; little change in texture of any portion of the marginal or papillary gingival unit; 2=Mild inflammation; criteria as 1 but involving the entire marginal or papillary gingival unit; 3=Moderate inflammation; glazing, redness, edema, and/or hypertrophy of the marginal or papillary gingival unit; 4=Severe inflammation; marked redness, edema and/or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Overall Mean Turesky Plaque Index (TPI) at Weeks 6 and 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
The TPI will be used to assess plaque on the facial and lingual surfaces of each scorable tooth (second molar to second molar). Three scores will be recorded buccally/labially (distal, body, mesial sites) and three scores lingually/palatally (distal, body, mesial sites) and mean will be calculated. The plaque will first be disclosed using a plaque disclosing dye solution and the disclosed plaque will be scored on a 6-point scale ranging from 0 to 5, where 0=No plaque, 1=Separate flecks of plaque at the cervical margin, 2=Thin, continuous band of plaque (up to 1 millimeter \[mm\]) at the cervical margin, 3= Band of plaque wider than 1 mm but covering less than (\<)1/3 of the tooth surface, 4= Plaque covering greater than or equal to (\>=) 1/3 but \< 2/3 of the tooth surface, 5= Plaque covering \>= 2/3 of the tooth surface. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Interproximal Mean TPI at Weeks 6 and 12 (Toothpaste/Mouthwash vs. Negative Control Toothpaste)
The TPI will be used to assess plaque on the facial and lingual surfaces of each scorable tooth (second molar to second molar). Three scores will be recorded buccally/labially (distal, body, mesial sites) and three scores lingually/palatally (distal, body, mesial sites) and mean will be calculated. The plaque will first be disclosed using a plaque disclosing dye solution and the disclosed plaque will be scored on a 6-point scale ranging from 0 to 5, where 0=No plaque, 1=Separate flecks of plaque at the cervical margin, 2=Thin, continuous band of plaque (up to 1 mm) at the cervical margin, 3= Band of plaque wider than 1 mm but covering \<1/3 of the tooth surface, 4= Plaque covering \>= 1/3 but \< 2/3 of the tooth surface, 5= Plaque covering \>= 2/3 of the tooth surface. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Overall NBS at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing. The NBS for each participant will be calculated as the number of evaluable tooth sites (having two-thirds of the natural tooth surface gradable for the assessment) with bleeding observed immediately on probing or within 30 seconds of probing.
Time frame: Week 6 and Week 12
Interproximal NBS at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing. The NBS for each participant will be calculated as the number of evaluable tooth sites (having two-thirds of the natural tooth surface gradable for the assessment) with bleeding observed immediately on probing or within 30 seconds of probing.
Time frame: Week 6 and Week 12
Overall Mean BI at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing and scored on a 3-points scale ranging from 0 to 2, where 0=no bleeding after 30 seconds; 1=bleeding observed within 30 seconds of probing; 2=bleeding observed immediately on probing. Mean BI will be calculated by taking the average over all tooth sites assessed for a participant. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Interproximal Mean BI at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
Gingival bleeding will be assessed according to the EBI, by inserting a periodontal probe into the gingival crevice and sweeping from distal to mesial around the tooth at an approximate angle of 60 degrees, while in contact with the sulcular epithelium. Each of six gingival areas (distobuccal, midbuccal, mesiobuccal, distolingual, midlingual, and mesiolingual) around each tooth will be assessed. Presence/absence of gingival bleeding will be assessed for 30 seconds after probing and scored on a 3-points scale ranging from 0 to 2, where 0=no bleeding after 30 seconds; 1=bleeding observed within 30 seconds of probing; 2=bleeding observed immediately on probing. Mean BI will be calculated by taking the average over all tooth sites assessed for a participant. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Overall Mean MGI at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
The MGI assessment is a non-invasive evaluation which focuses on the visual symptoms of gingivitis (for example, redness, texture, edema). MGI will be assessed on the buccal and lingual marginal gingiva and interdental papillae of all scorable teeth (second permanent molar to second permanent molar in each arch) and scored on a 5-point scale ranging from 0 to 4, where 0=Absence of inflammation; 1=Mild inflammation; slight change in colour, little change in colour; little change in texture of any portion of the marginal or papillary gingival unit; 2=Mild inflammation; criteria as 1 but involving the entire marginal or papillary gingival unit; 3=Moderate inflammation; glazing, redness, edema, and/or hypertrophy of the marginal or papillary gingival unit; 4=Severe inflammation; marked redness, edema and/or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Interproximal Mean MGI at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
The MGI assessment is a non-invasive evaluation which focuses on the visual symptoms of gingivitis (for example, redness, texture, edema). MGI will be assessed on the buccal and lingual marginal gingiva and interdental papillae of all scorable teeth (second permanent molar to second permanent molar in each arch) and scored on a 5-point scale ranging from 0 to 4, where 0=Absence of inflammation; 1=Mild inflammation; slight change in colour, little change in colour; little change in texture of any portion of the marginal or papillary gingival unit; 2=Mild inflammation; criteria as 1 but involving the entire marginal or papillary gingival unit; 3=Moderate inflammation; glazing, redness, edema, and/or hypertrophy of the marginal or papillary gingival unit; 4=Severe inflammation; marked redness, edema and/or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Overall Mean TPI at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
The TPI will be used to assess plaque on the facial and lingual surfaces of each scorable tooth (second molar to second molar). Three scores will be recorded buccally/labially (distal, body, mesial sites) and three scores lingually/palatally (distal, body, mesial sites) and mean will be calculated. The plaque will first be disclosed using a plaque disclosing dye solution and the disclosed plaque will be scored on a 6-point scale ranging from 0 to 5, where 0=No plaque, 1=Separate flecks of plaque at the cervical margin, 2=Thin, continuous band of plaque (up to 1 mm) at the cervical margin, 3= Band of plaque wider than 1 mm but covering \<1/3 of the tooth surface, 4= Plaque covering \>= 1/3 but \< 2/3 of the tooth surface, 5= Plaque covering \>= 2/3 of the tooth surface. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12
Interproximal Mean TPI at Weeks 6 and 12 (Reference Toothpaste vs. Negative Control Toothpaste)
The TPI will be used to assess plaque on the facial and lingual surfaces of each scorable tooth (second molar to second molar). Three scores will be recorded buccally/labially (distal, body, mesial sites) and three scores lingually/palatally (distal, body, mesial sites) and mean will be calculated. The plaque will first be disclosed using a plaque disclosing dye solution and the disclosed plaque will be scored on a 6-point scale ranging from 0 to 5, where 0=No plaque, 1=Separate flecks of plaque at the cervical margin, 2=Thin, continuous band of plaque (up to 1 mm) at the cervical margin, 3= Band of plaque wider than 1 mm but covering \<1/3 of the tooth surface, 4= Plaque covering \>= 1/3 but \< 2/3 of the tooth surface, 5= Plaque covering \>= 2/3 of the tooth surface. Lower score indicates improvement in the symptoms.
Time frame: Week 6 and Week 12