title: Influence of a triclosan toothpaste on periodontopathic bacteria and periodontitis progression in cardiovascular patients: a randomized controlled trial.
abstract: OBJECTIVE
  Triclosan/copolymer toothpaste is effective in controlling plaque and gingivitis and in slowing the progression of periodontitis. This study describes its influence on microbiological and clinical outcomes, over a 5-year period, in patients with established cardiovascular disease (CVD).
  
  
  METHODS
  Four-hundred and thirty-eight patients were recruited from the Cardiovascular Unit at The Prince Charles Hospital, Brisbane, Australia, and randomized to triclosan or placebo groups. Six sites per tooth were examined annually for probing pocket depth and loss of attachment. These outcomes were analysed, using generalized linear modelling, in 381 patients who had measurements from consecutive examinations. Concurrent load of the periodontal pathogens Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Tannerella forsythia and Porphyromonas gingivalis was determined, using quantitative real-time PCR, in 437 patients with baseline plaque samples. Group comparisons were expressed as geometric means. The chi-square test was used to test for differences between the two groups of patients with regard to the proportion of patients with different numbers of bacterial species.
  
  
  RESULTS
  There was no difference in general health or periodontal status between the groups at baseline. There was a significant reduction in the number of interproximal sites showing loss of attachment between examinations, by 21% on average (p < 0.01), in the triclosan group compared with the placebo group. The prevalence of patients with F. nucleatum and A. actinomycetemcomitans was high and remained relatively constant throughout the 5 years of the study. In contrast, the prevalence of T. forsythia and P. gingivalis showed more variability; however, there was no significant difference between the groups, at any time point, in the prevalence of any organism. A significant difference in the geometric means for P. gingivalis (p = 0.01) was seen at years 1 and 4, and for F. nucleatum (p = 0.01) and in the total bacterial load (p = 0.03) at year 2; however, these differences were not statistically significant following a Bonferroni correction for multiple comparisons. There was no difference between the groups in the geometric means for each organism at year 5.
  
  
  CONCLUSIONS
  Within the limitations of the study, these data suggest that the use of triclosan/copolymer toothpaste significantly slowed the progression of periodontitis in patients with CVD but that it had little influence on key subgingival periodontopathic bacteria in these patients over the 5 years of the study.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.|The Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand.
authors.forename: G J
authors.initials: GJ
authors.lastname: Seymour
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Palmer
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.|School of Dentistry, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Leishman
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: H L
authors.initials: HL
authors.lastname: Do
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Westerman
authors.affiliation: Metro North Hospital and Health Service, The Prince Charles Hospital, Chermside, Qld, Australia.
authors.forename: A D
authors.initials: AD
authors.lastname: Carle
authors.affiliation: School of Mathematical Sciences, Queensland University of Technology, Brisbane, Qld, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Faddy
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: West
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Qld, Australia.|The Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand.
authors.forename: M P
authors.initials: MP
authors.lastname: Cullinan
mesh_terms: D016976:Aggregatibacter actinomycetemcomitans / Q000187:drug effects; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications*; D018450:Disease Progression; D005260:Female; D016967:Fusobacterium nucleatum / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D010514:Periodontal Pocket / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D010518:Periodontitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D016966:Porphyromonas gingivalis / Q000187:drug effects; D060888:Real-Time Polymerase Chain Reaction; D000070436:Tannerella forsythia / Q000187:drug effects; D014100:Toothpastes / Q000627:therapeutic use*; D014260:Triclosan / Q000627:therapeutic use*
chemical_list: D000891:Anti-Infective Agents, Local; D014100:Toothpastes; D014260:Triclosan
keywords: cardiovascular disease; periodontitis; periodontopathic bacteria; randomized clinical trial; triclosan toothpaste