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The efficacy of baking soda dentifrice in controlling plaque and gingivitis: A systematic review

Valkenburg, C.; Kashmour, Y.; Dao, A.; van der Weijden, G.A.; Slot, D.E.

Published in:International Journal of Dental Hygiene

DOI:10.1111/idh.12390

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Citation for published version (APA):Valkenburg, C., Kashmour, Y., Dao, A., van der Weijden, G. A., & Slot, D. E. (2019). The efficacy of baking sodadentifrice in controlling plaque and gingivitis: A systematic review. International Journal of Dental Hygiene, 17(2),99-116. https://doi.org/10.1111/idh.12390

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Download date: 06 Dec 2020

Int J Dent Hygiene. 2019;17:99–116.  | 99wileyonlinelibrary.com/journal/idh

Received:12June2018  |  Revised:10November2018  |  Accepted:3December2018DOI:10.1111/idh.12390

R E V I E W A R T I C L E

The efficacy of baking soda dentifrice in controlling plaque and gingivitis: A systematic review

Cees Valkenburg  | Yasmin Kashmour | Angelique Dao | G. A. (Fridus) Van der Weijden  | Dagmar Else Slot

ThisisanopenaccessarticleunderthetermsoftheCreativeCommonsAttributionLicense,whichpermitsuse,distributionandreproductioninanymedium,providedtheoriginalworkisproperlycited.©2019TheAuthors.International Journal of Dental HygienePublishedbyJohnWiley&SonsLtd.

DepartmentofPeriodontology,AcademicCentreforDentistryAmsterdam(ACTA),UniversityofAmsterdamandVrijeUniversiteitAmsterdam,Amsterdam,TheNetherlands

CorrespondenceDagmarElseSlot.DepartmentofPeriodontology,AcademicCentreforDentistryAmsterdam(ACTA),UniversityofAmsterdamandVUUniversityAmsterdam,Amsterdam,TheNetherlands.Email:d.slot@acta.nl

AbstractObjective: Totesttheefficacyofadentifricecontainingbakingsoda(BS),comparedwithdentifricewithoutBSforcontrollingplaqueandgingivitis.Materials and methods: MEDLINE‐PubMedandCochrane‐CENTRALweresearched.Theinclusioncriteriawererandomizedcontrolledclinicaltrialsincludinghealthypar‐ticipantsaged18yearsorolder.StudieswereselectedthatcomparedtheeffectoftoothbrushingwithadentifricewithandwithoutBSon theclinicalparametersofplaqueandgingivitis.Datawereextractedfromtheselectedstudies,andameta‐analysiswasperformed.Results: Thesearchretrieved21eligiblepublications.Amongthesepapers,43com‐parisonswereprovided,with23involvingasingle‐usedesignand20beingevalua‐tionswithafollow‐up.Negativecontrolswerefound,orpositivecontrolsforwhichvariousactiveingredientshadbeenused.Theincludedstudiesshowedamoderateoverallpotential riskofbiasandconsiderableheterogeneity.Themeta‐analysisofplaquescoresfromthesingle‐brushingexperimentsshowedthatBSdentifrice(BS‐DF)wasassociatedwithsignificantlybetteroutcomesthanthenegativecontrolden‐tifrices (DiffM −0.20; P<0.0001; 95% CI: [−0.27; −0.12]) or the positive controldentifrices(DiffM−0.18;P<0.0001;95%CI:[−0.24;−0.12]).Thisfindingwasonlyconfirmedinstudiesthatusedafollow‐updesignascomparedtoanegativecontrol(DiffM−0.19;P=0.01;95%CI:[−0.34;−0.04]).Theindicesofgingivalbleedingalsoimprovedwhenthecomparisonwasanegativecontrol(DiffM−0.08;P = 0.02; 95% CI:[−0.16;−0.01]and(DiffM−0.13;P<0.001;95%CI:[−0.18;−0.08].However,forthe gingival index scores, the meta‐analysis did not reveal any significantdifferences.Conclusion: BS‐DFshowedpromisingresultswithrespecttoplaqueremovalinsin‐gle‐usestudies.However,thefindingwaspartiallysubstantiatedinfollow‐upstudies.Studies that assessed bleeding scores indicated that a small reduction can be ex‐pectedfromBS,relativetoacontrolproduct.

100  |     VALKENBURG Et AL.

1  | INTRODUC TION

Dentifrice,alsoknownastoothpaste,isusedinconjunctionwithatoothbrushtohelpmaintainoralhealth.Themostcommoncompo‐nentsofdentifriceareanabrasiveagent,abinder,asurfactantandahumectant.Themainintentionoftheuseofpasteistohelpremovedebrisandplaquebutitalsohassecondaryfunctionssuchasbreathfresheningandtoothwhitening,whicharewidelymarketed.Thereisanalmostuniversalrecommendationthatpeopleshouldbrushtheirteethtwiceadaywithafluoridateddentifrice.1

Several dentifricemanufacturers have incorporatedsodiumbi‐carbonate,commonlyknownasbakingsoda(BS),intotheirformulas.This isasaltcomposedofsodiumionsandbicarbonate ions.BSisnontoxicandismildonthesofttissuesofthegumsandoralmucosa.Incommercialdentifrices,BSmainlyservesthepurposeofanabra‐sive.Relativedentinabrasion testshave shown that theabrasive‐nessofsodiumbicarbonatehaslowabrasivityofthetoothsurface.Itisanalkalinesubstancecapableofneutralizingacids.Assuch,itpo‐tentiallycanpreventtoothdecaybyneutralizingtheacidsproducedbybacteriainthemouth.2BSalsoneutralizesacidiccomponentsofcommon tooth‐stainingchemicals, suchas thechromogens in tea,andredwine,3therebylesseningtheirstainingpotential.

ThecurrentwidespreaduseofBSindentifricesandhomeoralhygieneregimensislargelyattributabletotheimpactofDrPaulH.Keyes.4Inthe1970s,hewasamongthefirsttoemployanti‐infec‐tiveagentsandmicrobiological testing innon‐surgicalperiodontaltherapy,includingpatienthomeirrigationwithBSorsaltsolutions,andbrushingwithamixofBSandhydrogenperoxide.Thisapproachis known as “the Keyes technique,” popularly referred to as the“salt‐and‐soda”method.Themethodbecamewidelyintegratedintopeople'soralhygieneroutines.However, itwascriticallyevaluatedbytheAmericanAcademyofPeriodontologyfromwhichitwascon‐cludedthatthebenefitsofthetechniquearealmostexclusivelyde‐rivedfromthedetailedoralhygieneproceduresandrootplanning.4

Nowadays,BSisfoundinmanydentifrices.Inanerawithupcom‐ingpreferencefor“assumed”naturallybasedproducts,5itisimportanttoinvestigatetheassociatedoralhealthbenefits.Untilthisstudy,nosystematicevaluationhadbeenconductedontheadjuvanteffectofsodiumbicarbonateindentifrices.Theaimofthissystematicreview(SR)wastoestablishtheeffectofBSonplaqueremovalandgingivitis.

2  | MATERIAL S AND METHODS

This SR was prepared and described in accordance with theCochrane handbook for systematic reviews of interventions6 and the guidelines in Transparent Reporting of Systematic Reviews

andMeta‐analysis (PRISMA‐statement).7 The protocol for this re‐viewwasdeveloped“apriori”andregisteredwiththeInternationalProspectiveRegisterofSystematicReviews8undertheregistrationnumber CRD42018080649. All post hoc changes were appropri‐atelynoted(seeAppendixS1).

2.1 | Focused question

Inhealthyindividuals,whatistheefficacyoftoothbrushingwithadentifricethatcontainsBScomparedtoadentifricewithoutBSonclinicalindicesofplaqueandgingivitis?

2.2 | Search strategy

Astructured search strategywasdesigned to retrieveall relevantstudies. As proposed in the Cochrane handbook, the NationalLibraryofMedicine,Washington,DC(MEDLINE‐PubMed)andtheCochrane Central Register of Controlled Trials (CENTRAL) weresearchedfrominitiationtoSeptember2018forpapersrelatedtothefocusedresearchquestion.Thereferencelistsoftheincludedstud‐ieswere hand‐searched to identify additional potentially relevantstudies.Nolimitationswereplacedonlanguageordateofpublica‐tionintheelectronicsearchesofthedatabases.Fordetailsregardingthesearchtermsused,seeTable1.

2.3 | Screening and selection

Thetitlesandabstractsofthestudiesobtainedfromthesearcheswerescreenedindependentlybythreereviewers(AD,YKandCV)toselectstudiesthatpotentiallymettheinclusioncriteria.Nolan‐guage restrictionswere imposed.Basedon the title and abstract,thefull‐textversionsofpotentiallyrelevantpaperswereobtained.These paperswere categorized (byCV andDES) as definitely eli‐gible, definitely not eligible or questionable. Disagreements con‐cerningeligibilitywereresolvedbyconsensus,andifdisagreementpersisted,thedecisionwasresolvedthrougharbitrationbyanotherreviewer(GAW).Papersthatfulfilledalltheinclusioncriteriawereprocessedfordataextraction.

The included full report studies were considered tomeet thefollowingcriteria:(a)thestudydesignwaseitherarandomizedcon‐trolledclinical trial (RCT)oracontrolledclinical trial (CCT), (b) thestudies were conducted with healthy participants, who were notinstitutionalized andwere18yearsof ageorolder, (c) the studiesincluded participants without orthodontic treatment and/or re‐movableprostheses,(d)asanintervention,adentifricewithBSwasevaluated in comparisonwith a dentifricewithout this ingredient,(e)chlorhexidinewasnotaningredientincorporatedinadentifrice,

K E Y W O R D S

bakingsoda,bleeding,dentifrice,gingivitis,plaque,sodiumbicarbonate,systematicreview,toothpaste

     |  101VALKENBURG Et AL.

(f)rinsingwithanadditionalantisepticwasnotapartofthe inter‐ventionorcontrolregimenand(g)thestudiesevaluatedplaqueandgingivitisscores.Fordetails,seeAppendixS2.

2.4 | Assessment of heterogeneity

Thefollowingfactorswereusedtoevaluatetheheterogeneityoftheoutcomesofthedifferentstudies:studydesign,participantcharac‐teristics,studygroupdetailsandregimens.Inaddition,sideeffectsandindustryfundingwereevaluated.

2.5 | Assessment of methodological quality and risk of bias

Allincludedstudieswereindependentlyscoredfortheirmethodo‐logicalqualityby three reviewers (AD,CVandYK).Disagreementwasresolvedbyconsensus,andifdisagreementpersisted,thedeci‐sionwas resolved through arbitration by a fourth reviewer (DES).TheassesseditemsaredetailedinAppendixS3.9

2.6 | Data extraction

Thecharacteristicsofthepopulation,intervention,comparisonandoutcomes were extracted from all studies independently by two

reviewers (AD and YK) using a specially designed data extractionform.Athirdreviewer(CV)alsoreadthefulltextsoftheincludedtrialsand,independentlyfromthetwoothers,checkedthedataex‐tracted.Disagreementbetweenthereviewerswasresolvedthroughdiscussionandconsensus.Ifthiswasnotsatisfactory,thejudgementofanotherreviewer(GAW)wasdecisive.Meansandstandarddevia‐tions(SDs)wereextracted.Somestudiesprovidedstandarderrors(SEs)ofthemeans.Wherepossible,thecurrentauthorscalculatedSDbased on the sample size (SE=SD/√N). For those papers thatprovided insufficient data to be included in the analysis, the firstand/or corresponding authorwas contacted to request additionaldata.

2.7 | Data analysis

Studieswere categorizedas single‐brushingdesigns thatwere se‐lectedtoevaluateachangeinplaquescores.Studieswithafollow‐upwereselectedtoevaluateplaqueaswellasgingivitisscores.Thedentifrices without BS were separated into negative and positivecontrols.Asapositivecontrol,dentifricescontainingstannousfluo‐ride (SnF)ortriclosan (Tcs)as ingredientswereconsidered.10,11AlltheotherdentifriceswithoutBSwereconsideredasnegativecon‐trols.Asasummary,adescriptivedatapresentationwasusedforallstudies.

TA B L E 1  Searchstrategy

Search terms used for Pub Med-MEDLINE and Cochrane-CENTRAL. The search strategy was customized according to the database being searched.

The following strategy was used in the search:

{ [<intervention>] AND [<outcome>] }

{ [ <intervention: toothpaste>

([text words] toothpaste OR dentifrice OR toothpastes OR dentifrices) ]

AND

([MeSH terms/all subheadings] baking soda OR ("sodium bicarbonate"[MeSH Terms] OR ("sodium" AND "bicarbonate") OR "sodium bicarbonate")))

AND

[ <outcome: dental plaque>

([MeSH terms/all subheadings] dental plaque OR dental plaque index OR dental deposits)

OR

([text words] plaque OR plaque removal OR plaque index OR dental plaque OR interdental plaque OR interproximal plaque)] }

102  |     VALKENBURG Et AL.

Wherefeasible,ameta‐analysis(MA)wasperformedwithatleasttwoincludedexperimentsevaluatingthesameoutcomeparameter.Whenastudyhadmultiplenon‐BSdentifricetreatmentarms,anddatafromtheBS‐DFwereusedinmorethanonecomparison,thenumberofparticipants(n)inthatgroupwasdividedbythenumberofcomparisons.Thedifferenceofmeans(DiffM)betweenthetestandcontrolgroupswascalculatedusinga“randomeffects”modelwithan“inversevariance”methodasproposedbyDerSimonianandLaird.12Theprimarymethodofcalculatingallpooledestimatesandasub‐analysiswasperformedwiththeKnapp‐Hartungadjustment13 in cases of at least five eligible studies.14 Formeta‐analyseswithmore than two comparisons, 95%predictive intervalswere calcu‐latedtoquantifytreatmenteffectsinafutureclinicalsetting.15

Heterogeneitywas tested using the chi‐square test and the I2 statistic.Achi‐squaredtestresultinginP<0.1wasconsideredtobeanindicationofsignificantstatisticalheterogeneity.Ifpossible,theformaltestingforpublicationbiasusingtheminimumamountof10comparisonswasapplied,asproposedbyEggeretal16andSterneetal.17

A sub‐analysis was performed using a network meta‐analy‐sis (NMA).18‐22 Treatmentswere ranked23,24 through a frequentistweighted leastsquaresapproach,asdescribedbyRücker.25,26 The directevidenceproportionasdescribedinKönigetal27wasusedtocalculatetheindirectevidence.26Adecompositionofheterogeneitywithindesignsandbetweendesignswasprovided,28andanetheatplotgraphicaltool,asproposedbyKrahnetal,29wasusedtolocateinconsistencyintheNMA.29Forthetransitivityassumption,11,30theingredientswereanalysed.AllcomputationswereperformedusingR(https://www.r‐project.org)withthepackagesmeta,31metafor32 andnetmeta.26

2.8 | Grading the “body of evidence”

TheGrading of Recommendations Assessment, Development andEvaluation (GRADE)systemwasusedtoranktheevidence.33 Two reviewers (CVandDES) rated thequalityof theevidenceandthestrengthanddirectionoftherecommendations34accordingtothefollowingaspects:riskofbias,consistencyofresults,directnessofevidence,precisionandpublicationbiasandmagnitudeoftheeffect.Any disagreement between the two reviewerswas resolved afteradditionaldiscussionwithathirdreviewer(GAW).

3  | RESULTS

3.1 | Search and selection results

The search of the MEDLINE‐PubMed and Cochrane‐CENTRALdatabases resulted in 184 unique papers. Manual searching ofthereference listsof the finalselectedpapersprovidedtwoad‐ditionalrelevantpapers,Al‐Kholanietal,35listedbyHosadurgaetal36andAkwagyirametal,37listedbyBosmaetal.38Altogether,21eligiblepublicationswerefound.5,35‐54Amongthese,Puttetal49 andMasonetal53providedfiveandtwosub‐studies,respectively,

within theirmain publications.Ghassemi et al50 providedwithinone study model, two single‐brushing exercises and also onestudywith a follow‐up. Finally, 43 comparisonswere identified.Asingle‐brushingdesignwasusedin23comparisons,12ofwhichhadapositivecontroland11withanegativecontrol.Forthe20brushingcomparisonswithafollow‐up,16hadanegativecontroland4hadapositivecontrol.Fornegativecontrols,sodiumfluo‐ride(NaF),monofluorophosphate(MFP)andanyotherdentifriceswithoutBS(non‐BS)wereconsidered.Fordetails,seeFigure1.

3.2 | Heterogeneity

The included studies exhibited considerable heterogeneity withrespect to the study design, participant characteristics, studygroup details and the regimens used. Information regarding thestudyoutlineandcharacteristicsisshownindetailinAppendixS2.

Studiesuseddifferentindices55,56andvaluesforplaqueandgin‐givitisastheinclusioncriteria.Smokingstatuswasgenerallyunclear.Hosadurgaetal36specificallyexcludedsmokers,andonlyLomaxetal,52Joseetal54andAkwagyirametal37reportedthesmokingsta‐tusof the includedparticipants.Thedurationof follow‐upstudiesranged from 1month to 6months. In five studies,5,35,37,46,52 par‐ticipants receivedprofessional oral prophylaxis at the startof theexperimentalperiod.TheRDAvalue,thepercentageofBSandthefluoridecontentwereinconsistentlyreported.Moststudiesalsodidnot report the average brushing time. Seven studiesmentioned abrushing time of 1minute, of which three included single‐brush‐ing exerciseswith supervised1‐minute brushing.37,38,47,49,53,54 The majorityofthestudiesprovidedtheirparticipantswithastandardtoothbrush,buttwostudies,Yankelletal42andYankellandEmling,40 allowedtheparticipantstousetheirowntoothbrush.However,allthesefactorscouldnotbefurtheranalysedinthecurrentreview.

3.3 | Adverse effects

Twelvepapers5,36‐38,44,45,48,50mentionedevaluationforpossiblead‐verseeffects.Onlyinonestudydidfourparticipantsdiscontinuethestudybecauseofdisliking thedentifrice taste.45 In another study,theparticipantscomplainedofanunpleasanttasteintheinitialpe‐riodwhenusingaBS‐DF.36Ulcerationswerereportedinonestudy,but theyappearedunrelatedto thetrialandeventually.5 InWineretal,39 twopersonsweredroppedoutof theexperimentalgroup,which was suggested to be product‐related. In one study, a par‐ticipantexperiencedamildburningsensationandmoderatedentalhypersensitivity.54

3.4 | Industry funding

Most of the 21 included studies reported on the use of commer‐cially available dentifrices and toothbrushes. For three studies, itwasunclearwhetherthedentifricesweremarketedproducts.35,39,40 Five other studies used non‐marketed experimental denti‐frices.38,42,45,52,54 Fifteen studies had industry involvement, with

     |  103VALKENBURG Et AL.

F I G U R E 1  Searchandselectionresults

104  |     VALKENBURG Et AL.

sevendifferentcompaniesactingeitherasastudyinitiatororwherethe authors were employees; companies also provided products,funding or financial grants. Five studies did notmention industryconnections and one study included a disclosure statement of nofinancialinterest.39

3.5 | Methodological quality and assessment of bias

Toestimatethepotential riskofbias, themethodologicalqualitiesoftheincludedstudieswereused,asassessedinthechecklistpre‐sentedinAppendixS3(methodologicalqualityandpotentialriskofbiasscoresoftheindividualincludedstudies).Basedonasummaryoftheproposedcriteria,theestimatedpotentialriskofbiaswaslowforninestudies,5,37,38,45,48,51,53,54moderate forsixstudies42‐44,47,50 andhighforsixstudies.35,39‐41,46

3.6 | Study outcome results

Appendix S4presents the results of thedata extraction.Baselinescores,endscoresandincrementalchangeswithineachinterventiongrouparepresented.

3.7 | Descriptive analysis

Table2providesadescriptivesummaryofthesignificantdifferencesbetween toothbrushingwithaBS‐DFandwithoutBSas reportedby theoriginal authors. In all but oneof the23 comparisons thatpresented results using the single‐brushing design, when BS‐DFwascomparedtoeitheranegativecontrolorapositivecontrol, itwas found to be significantly more effective for plaque removal(Table2A).

Plaqueindexscoresobtainedfromthemajorityofstudieswithafollow‐upshowedapatternofnodifferencebetweenBS‐DFandtheir controls. An inconsistent patternwas noted for the gingivalindexscoresandforbleedingscoreswhenanegativecontrolwasused.IntwoofthethreecomparisonsthatusedTcs‐DFasapositivecontrol,BS‐DFshowedasignificantimprovementinplaqueremoval.Thiscouldnotbeconfirmedwithrespecttogingivalhealthscores.TheonlystudythatusedSnF‐DFasapositivecontrolshowedthatitwassignificantlymoreeffectivethanBS‐DFregardingthegingivalindexandbleedingscores(Table2B).

3.8 | Meta‐analysis

Theobtaineddataallowedforseveralmeta‐analyses,whichcouldbe performed separately for plaque, gingivitis and bleeding indexscores.TheresultsaresummarizedinTable3.TheforestplotsandcorrespondingfunnelplotsthatillustratetheseoutcomesareshowninAppendixS6‐S12.Forthestudiesthatevaluatedasingle‐usede‐sign,ameta‐analysisbasedontheTureskyetal(1970)modificationoftheQuigleyandHeinPlaqueIndex(1962) (TQ&H)wasfeasible.ComparedtoanegativecontrolDF,thedifferenceinmeansforendscores(−0.20;P<0.0001;95%CI: [−0.27;−0.12])andincremental

scores (−0.21; P<0.0001; 95% CI: [−0.27; −0.16]) showed a sig‐nificanteffect infavourofBS.AsimilarfindingwaspresentwhenthecontrolwasapositivecontrolDFforendscores(DiffM−0.18;P<0.0001;95%CI: [−0.24;−0.12])and incremental scores (DiffM−0.18;P<0.0001;95%CI:[−0.22;−0.14]).Thesefindingsaresup‐portedbythecorrespondingpredictionintervals.

Thestudiesusingafollow‐updesignevaluatedplaquescoresontheTQ&Htocomparethetreatmentgrouptonegativeandpositivecontrols.Thecomparisonwithnegativecontrolsshowedasignificanteffect(−0.19;P=0.01;95%CI:[−0.34;−0.04])butnotwhenthepre‐diction intervalwasconsidered.TheLöe (1967)modificationof theSilness&LöePlaque Index (S&L)wasused in studieswith anega‐tivecontrol.Noneshowedasignificanteffect.AsimilarpatternwasnotedfortheLöe&SilnessGingivalIndex(1963)andtheLöe&SilnessGingival Index(1967) (L&S).Nosignificantdifferencewasfoundforeitherthecomparisonwithanegativecontrolorthecomparisonwithapositivecontrol.Also,nosignificantdifferencewasfoundinthein‐crementalscores,whenthe95%predictionintervalwasconsidered.

Analysis of bleeding scoreswas possible only for comparisonswith a negative controlDF.Using the Saxer et al (1977) PapillaryBleeding Indexmodification of theAinamo&BayBleeding Index(1975)andtheSaxton&vanderOuderaa(1989)GingivalBleedingIndex, a significant difference inmeanswas found for end scores(DiffM−0.13;P<0.001;95%CI:[−0.18;−0.08]).The95%predictionintervalincludedthenulloroppositedirection[−0.29;0.03].WhentheAinamo&BayGingivalBleedingIndex(1975)andtheAbrahams,CatonandPolsonBleedingonProbingIndex(1984)wereused,theendscoresindicatedasignificanteffect(DiffM−0.08;P < 0.02; 95% CI:[−0.16;−0.01]),againwitha95%predictionintervalincludingthenulloroppositedirection[−0.28;0.11].

Thepublicationbiaswasformallytestedasindicated.Contour‐enhancedfunnelplots70,71showing10ormorecomparisonsarepre‐sentedinAppendixS9‐S10.Theasymmetricshapeofthefunnelplotand theEgger's testof the follow‐upbrushingexercisesanalysingendgingivalscoresoftheLöe&Silness(1963)GingivalIndexsug‐gestthatthepresenceofpublicationbiasislikely.

ThefindingsoftheMAweresupportedbytheNMAwhentheheterogeneity and the inconsistency across networks were ac‐countedfor.FordetailsoftheNMAresults,seeAppendixS11.

4  | E VIDENCE PROFILE

Table4presentsa summaryof thevarious factorsused to rate thequalityofevidenceandtoappraisethestrengthanddirectionofrec‐ommendationsaccordingtoGRADE.33Thereisevidencefromsingle‐brushingstudiestosupporttheuseofBSasaningredientforimprovingplaqueremoval.However,becauseofthefactthatthisdesigndoesnotreplicatehomeuse,itisconsideredindirectevidence.Withamoderateprecision,thestrengthanddirectionoftherecommendationbasedonsingle‐usestudieswereestimatedtobe“weaklyinfavour.”

Nodifferencewasdetermined forplaque scoresandgingivitisindex scores in studies with a follow‐up. However, based on the

     |  105VALKENBURG Et AL.

statisticallysignificantdifferenceinmeansandthepredictioninter‐vals,infuturestudies,asmalldifferenceinbleedingscoresbetweencontrolsandexperimentalparticipantscanbeexpected.Giventhestrength of the recommendation, there is a “moderate” certaintythat theBS‐DF did not provide an additional benefit in the stud‐ieswithafollow‐up.TheefficacyofBS‐DFiscomparabletothatofothercommerciallyavailabledentifrices.

5  | DISCUSSION

Fromapreviouslypublishedmeta‐reviewontheevidenceforden‐tifrices, itappearedthattherewasa lackofasystematicappraisaloftheevidenceconcerningtheefficacyofBS‐DF.74Therefore,theaimofthissystematicreviewwastoassesstheeffectoftoothbrush‐ingwithaBS‐DFonplaqueandtheclinicalparametersofgingivitis.Datawereextractedfrom21studieswhich included2517partici‐pants.ThepresentSRshows,basedonthesingle‐brushingexperi‐ments,asmallbutsignificantimprovementofplaqueremovalwhen

toothbrushing is performedwith aBS dentifrice.However, no fa‐vourableeffectofBSonplaquescoreswasfoundinstudieswithafollow‐upwhenthepredictionintervalwasconsidered.Ontheotherhand,follow‐upstudieshaveshownthatonbleedingscoresasmalleffectwitha95%predictionintervalincludingthenulloroppositedirectioncanbeexpectedfromtheuseofBS.

TheMAinthisreviewdifferentiatedbetweensingle‐usebrush‐ing exercises and the longer‐term effect of brushing, in order toeliminatedesign‐relateddifferences.Also,itdistinguishedbetweennegativecontroldentifricesandprovenpositivecontroldentifricessuchasthosecontainingTcsandSnF.Additionally,indirectanddi‐rectevidencewascombinedinaNMAtoprovideamoreprecisees‐timatesoftreatmenteffects.19,75,76However,intheNMAofstudieswithafollow‐up,problemsofheterogeneityandpotentialinconsis‐tencyarepresentwhichemphasizesthatconclusionsaboutrankingshouldbecarefullyinterpreted.

Interestingly, in the descriptive summary (see Table 2) of thestudieswithafollow‐up,theresultswerenotinfavourofTcsorSnF,with the only exception in one comparisonwhen the controlwas

TA B L E 2  Adescriptivesummaryofthestatisticalsignificanceofindividualstudyoutcomesforthesingle‐brushingandlong‐termstudies.(A)Descriptivesummaryofthesingle‐brushingdentifricecomparisons;(B)Descriptivesummaryfollow‐updentifricecomparisons

(A)

Control Study (year) % BS Plaque score Comparison

Negative Bosmaetal(2018)A38 67 > NaF

Bosmaetal(2018)B38 67 > NaF

Bosmaetal(2018)C38 62 > NaF

Masonetal(2017)1A53 45 > NaF

Masonetal(2017)1B53 67 > NaF

Puttetal(2008)3A49 27 > NaF

Puttetal(2008)3B49 48 > NaF

Puttetal(2008)449 65 > NaF

EmlingandYankell(1988)41 ? = NaF

Mankodietal(1998)B47 65 > NaF

Mankodietal(1998)C47 65 > MFP+NaF

Total 10/11>

Positive Ghassemietal(2008)150 ? > Tcs

Ghassemietal(2008)250 ? > Tcs

Puttetal(2008)1A49 20 > Tcs

Puttetal(2008)1B49 65 > Tcs

Puttetal(2008)2A49 20 > Tcs

Puttetal(2008)2B49 48 > Tcs

Puttetal(2008)3A49 27 > Tcs

Puttetal(2008)3B49 48 > Tcs

Puttetal(2008)549 20 > Tcs

Masonetal(2017)253 67 > SnF

Puttetal(2008)2A49 20 > SnF

Puttetal(2008)2B49 48 > SnF

Total 12/12>

(Continues)

106  |     VALKENBURG Et AL.

SnF‐DF.46InsystematicreviewsevaluatingtheefficacyofTcsorSnF,theseactiveingredientsgenerallyshowedbetterresultsforplaqueandgingival indexscores thanconventionaldentifrices.10,11,79,80 Inrankingthetreatmentsinstudieswithafollow‐upaccordingtotheNMA(seeAppendixS11),theefficacyofTcsorSnFwasinlinewiththefindingsofthesystematicreviewsdiscussedabove.

In addition to thedifferenceofmeans (DiffM) and95%confi‐denceintervals,wecalculated95%predictionintervals.Theadvan‐tageofpredictionintervalsistheyreflectthevariationintreatmenteffectsacrossdifferentsettings, includingwhateffect istobeex‐pected in future patients.15 The prediction interval of the single‐brushing studies indicated that ina future single‐brushing setting,thedifference inmeans forendplaquescoreswould likelybebe‐tween−0.28and−0.11(Table3A)ifcomparedwithanegativecon‐trolasrecordedonafive‐pointscaleaccordingtoTQ&H.Comparedto a positive control, this will most likely be between −0.33 and−0.03(Table3A).Consequently,theprobabilitythatinfuturestud‐iestheeffectsizeislessthanthethreshold0isquitecertainforbothnegativeandpositivecontrols.15

The favourable effect of BS on plaque was not substantiatedin studieswith a follow‐up. Table 3 shows eightMA that yielded

significantresults inafollow‐upcomparison.However,allcompar‐isonshada95%prediction intervalthat includedthenull,andtheseventhcomparisonexaminedagroupofdentifricesofwhichthreeoutoffivewerenotavailableonthemarket.Nevertheless,basedonthepredictionintervals,theprobability15isthat84%to96%oftheparticipantsinfuturestudiescanexpectasmalleffectonbleedingscores.

ThisSRfollowstherecommendationtoprovidethe95%confi‐denceintervalsaroundI2,giventhatI2itselfisnotprecise.84ValuesofI2rangingfrom0%to100%informuswhatproportionofthetotalvariation across studies is beyond chance.84With a small numberof includedstudies, I2has lowstatisticalpowerand itsconfidenceintervalscanbelargewithupper95%confidenceintervalsthatcrossintotherangeoflargeheterogeneity(I2≥50%).84,85Anexampleap‐pearsinTable3B3,inwhichaheterogeneityof14%showstheupperlimitofthe95%confidenceintervalsintherangeoflargeheteroge‐neity(87%).Withouttheinterval,onemighterroneouslyassumelowheterogeneity.Nonetheless, it isnotunreasonable toassume thattheoverallexternalvaliditywasreasonably.Consideringallaspects,theoveralljudgementoftheriskofbiasforallincludedstudieswasestimatedtobemoderate.DetailsareprovidedinTable4.

(B)

Control Study (year) % BS Plaque score Gingival Index Bleeding score Comparison

Negative Akwagyirametal(2018)37 67 > > >* NaF

Joseetal(2018)54 67 > > >* NaF

Lomaxetal(2016)52 67 □ > >* NaF

Al‐Kholanietal(2011)35 ? > > > NaF

YankellandEmling(1988)40 ? □ = >* NaF

Beiswangeretal(1997)46 ? = = = NaF

Hosadurgaetal(2017)36 ? = = □ MFP

Triratanaetal(2015)51 ? = = □ MFP+NaF

Mullallyetal(1995)5 ? = = = MFP+NaF

Al‐Kholanietal(2011)35 ? = = = Non‐BS

Saxeretal(1995)45 ? = = = Non‐BS

Saxeretal(1994)44 ? □ □ >* Non‐BS

Taller(1993)43 ? □ □ = Non‐BS

Yankelletal(1993)42 ? > = >* Non‐BS

YankellandEmling(1988)40 ? ? > >* Non‐BS

Wineretal(1986)39 ? = > □ Non‐BS

Total 7/16=;4/16> 8/16=;6/16> 5/16=;8/16>

Positive Triratanaetal(2015)51 ? > = □ Tcs

Ghassemietal(2008)50 ? > □ □ Tcs

Ozakietal(2006)48 ? = = □ Tcs

Beiswangeretal(1997)46 ? = < < SnF

Total 2/4=;2/4> 2/4= NA

>:significantdifferenceinfavouroftheBS‐DFgroup,<:significantdifferenceinfavourofthecontrolgroup,=:nosignificantdifference,□:nodataavailable,*:multipleindices,NA:notapplicable,%BS:percentagebakingsodaindentifrice.

TA B L E 2 (Continued)

     |  107VALKENBURG Et AL.

TAB

LE 3

 Overviewofthemeta‐analysisofthereportedindicesincludedinthissystematicreview.(A)Single‐brushingdesign:Meta‐analysisforsingle‐brushingdesignstudiesforthe

Tureskyetal(1970)modificationoftheQuigley&Hein(1962)plaqueIndex.Thebaseline,endanddifferencedataevaluatingadentifricewithBScomparedtoanegativeeitherapositive

controldentifrice;(B)Follow‐upstudiescomparedtoanegativeorpositivecontroldentifrice.(B1)Meta‐analysisforfollow‐upbrushingdesignstudiesforthebaseline,endanddifference

dataevaluatingadentifricewithBScomparedtoanegativeeitherapositivecontroldentifriceaccordingtoplaqueindices;(B2)Meta‐analysisforfollow‐upbrushingdesignstudiesforthe

baseline,endanddifferencedataevaluatingadentifricewithBScomparedtoanegativeeitherapositivecontroldentifriceaccordingtoGINGIVALIndex;(B3)Meta‐analysisforfollow‐up

brushingdesignstudiesforthebaseline,endanddifferencedataevaluatingadentifricewithBScomparedtoanegativecontroldentifriceaccordingtoBLEEDINGindices;(C)Sub‐meta‐

analysisoningredientsforfollow‐upbrushingdesigndentifricecomparisonsenddataevaluatingadentifricewithBScomparedtoanegativecontroldentifrice.plaqueindicesfortheTuresky

etal(1970)modificationoftheQuigley&Hein(1962)andtheSilness&Löe(Silness&Löe1964)includingthemodificationbyLöe(1967)

(A)

Sing

le‐b

rush

ing

desi

gn

Com

paris

on

Effe

ct s

ize

Het

erog

enei

tyPr

edic

tion

Inte

rval

(≥3

com

paris

ons)

For d

etai

ls s

ee

appe

ndix

Cont

rol

Incl

uded

stu

dies

Diff

M95

% C

IP‐

valu

eI2 9

5% C

IP‐

valu

e

Negative

control

Neg

ativ

e co

ntro

l 9comparisons

Emling&Yankell(1988)41

Puttetal(2008)*  4

9 3x

Masonetal(2017)*  5

3 2x

Bosmaetal(2018)*  3

8 3x

Baseline

0.01

(−0.05;0.07)

0.67

0%(0%‐0%)

1.00

(−0.06;0.09)

S6a1

End

−0.20

(−0.27;−0.12)

<0.0

001

0%(0%‐38%)

0.80

(−0.28;−0.11)

S6a3

Neg

ativ

e co

ntro

l 8comparisons

Puttetal(2008)*  4

9 3x

Masonetal(2017)*  5

3 2x

Bosmaetal(2018)*  3

8 3x

Difference

−0.21

−0.27;−0.16

<0.0

001

0%(0%‐57%)

0.62

(−0.28;−0.14)

S6a5

Positive

control

Posi

tive

cont

rol

12comparisons

Puttetal(2008)*  4

9 x

Ghassemietal(2008)*  50

2x

Masonetal(2017)53

Baseline

−0.01

(−0.06;0.04)

0.66

0%(0%‐22%)

0.88

(−0.06;0.04)

S6a2

FunnelplotS9A

End

−0.18

(−0.24;−0.12)

<0.0

001

30%(0%‐65%)

0.15

(−0.33;−0.03)

S6a4

FunnelplotS9B

Difference

−0.18

(−0.22;−0.14)

<0.0

001

27%(0%‐63%)

0.18

(−0.27;−0.09)

S6a6

(Con

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108  |     VALKENBURG Et AL.

(B1)

Follo

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to

nega

tive

and

posi

tive

cont

rol

Com

paris

on

Effe

ct s

ize

Het

erog

enei

tyPr

edic

tion

Inte

rval

(≥3

com

paris

ons)

For d

etai

ls s

ee

appe

ndix

Inde

xIn

clud

ed s

tudi

esD

iffM

95%

CI

P‐va

lue

I2 95%

CI

P‐va

lue

PITQ&H

a  N

egat

ive

cont

rol

9comparisons

Yankell&Emling(1988)

*  40

2x

Yankelletal(1993)42

Mullallyetal(1995)5

Saxeretal(1995)45

Triratanaetal(2015)51

Hosadurgaetal(2017)36

Joseetal(2018)54

Akwagyirametal(2018)37

Baseline

0.01

(−0.03;0.05)

0.59

0%(0%‐60%)

0.53

(−0.04;0.06)

S6‐B1

End

−0.19

(−0.34;−0.04)

0.01

85%(72%‐91%)

<0.0

1(−0.69;0.31)

S6‐B3

Neg

ativ

e co

ntro

l 3comparisons

Mullallyetal(1995)5

Triratanaetal(2015)51

Hosadurgaal.(2017)36

Difference

0.02

(−0.20;0.24)

0.84

74%(12%‐92%)

0.17

(−2.51;2.55)

S6‐B5

Posi

tive

cont

rol

3comparisons

Ozakietal(2006)48

Ghassemietal(2008)50

Triratanaetal(2015)51

Baseline

−0.09

(−0.09;0.09)

0.94

0%(0%‐0%)

0.99

(−0.58;0.59)

S6‐B2

End

0.44

(−0.80;1.69)

0.49

99%(99%‐99%)

<0.0

1(−15.65;16.53)

S6‐B4

Difference

0.42

(−0.39;1.24)

0.31

99%(98%‐99%)

<0.0

1(−10.09;10.94)

S6‐B6

PIS&Lb  

Neg

ativ

e co

ntro

l 2comparisons

Wineretal(1986)39

Beiswangeretal(1997)46

Baseline

0.06

(−0.02;0.14)

0.14

0%0.

76NA

S6‐C1

End

0.04

(−0.01;0.10)

0.14

0%0.

67NA

S6‐C2

TAB

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(Continued)

(Con

tinue

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     |  109VALKENBURG Et AL.

(B2)

Follo

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and

posi

tive

cont

rol

Com

paris

on

Effe

ct s

ize

Het

erog

enei

tyPr

edic

tion

Inte

rval

(≥3

com

paris

ons)

For d

etai

ls s

ee

appe

ndix

Inde

xIn

clud

ed s

tudi

esD

iffM

95%

CI

P‐va

lue

I2 95

% C

IP‐

valu

e

GIL&Sc  

Neg

ativ

e co

ntro

l 11comparisons

Wineretal(1986)39

YankellandEmling(1988)

*  40 2x

Yankelletal(1993)42

Mullallyetal(1995)5

Saxeretal(1995)45

Beiswangeretal(1997)46

Al‐Kholanietal(2011)*  2x35

Triratanaetal(2015)51

Hosadurgaetal(2017)36

Baseline

0.02

(−0.01;0.04)

0.23

0.0%(0%‐52%)

0.61

(−0.01;0.04)

S7‐1

End

−0.04

(−0.11;0.03)

0.25

71%(45%‐84%)

<0.0

1(−0.24;0.16)

S7‐3

Neg

ativ

e co

ntro

l 3comparisons

Mullallyetal(1995)5

Triratanaetal(2015)51

Hosadurgaetal(2017)36

Difference

−0.07

(−0.14;0.00)

0.04

0%(0%‐10%)

0.68

(−0.51;0.37)

S7‐5

Posi

tive

cont

rol

3comparisons

Beiswangeretal(1997)46

Ozakietal(2006)48

Triratanaetal(2015)51

Baseline

0.01

(−0.04;0.07)

0.59

0%(0%‐60%)

0.77

(−0.33;0.36)

S7‐2

End

0.24

(−0.04;0.51)

0.09

93%(83%‐97%)

<0.0

1(−3.21;3.69)

S7‐4

Posi

tive

cont

rol

2comparisons

Ozakietal(2006)48

Triratanaetal(2015)51

Difference

0.31

(−0.11;0.73)

0.15

95%

<0.0

1NA

S7‐6

MGIf  

Neg

ativ

e co

ntro

l 3comparisons

Akwagyirametal(2018)37

Joseetal(2018)54

Lomaxetal(2016)52

Baseline

−0.01

(−0.05;0.03)

0.54

0%(0%‐16%)

0.88

(−0.26;0.23)

S7‐7A

End

−0.37

(−0.61;−0.14)

<0.0

0196%(91%‐98%)

<0.0

1(−3.41;2.66)

S7‐7B

TAB

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(Continued)

(Con

tinue

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110  |     VALKENBURG Et AL.

(B3)

Follo

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cont

rol

Com

paris

on

Effe

ct s

ize

Het

erog

enei

tyPr

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tion

Inte

rval

(≥3

com

paris

ons)

For d

etai

ls s

ee

appe

ndix

Inde

xIn

clud

ed s

tudi

esD

iffM

95%

CI

P‐va

lue

I2 95%

CI

P‐va

lue

BIGBI

d  N

egat

ive

cont

rol

4comparisons

YankellandEmling(1988)

*  2x40

Yankelletal(1993)42

Taller(1993)43

Baseline

0.03

(−0.06;0.12)

0.56

54%(0%‐85%)

0.09

(−0.32;0.37)

S8‐A1

End

−0.08

(−0.16;−0.01)

0.02

14%(0%‐87%)

0.32

(−0.28;0.11)

S8‐A2

BISaxer

e  N

egat

ive

cont

rol

5comparisons

Saxeretal(1994)44

Saxeretal(1995)45

Lomaxetal(2016)52

Joseetal(2018)** 54

Akwagyirametal(2018)37

Baseline

0.00

(−0.02;0.03)

0.84

2%(0%‐80%)

0.39

(−0.05;0.05)

S8‐B1

End

−0.13

(−0.18;−0.08)

<0.0

0169%(21%‐88%)

0.01

(−0.29;0.03)

S8‐B2

(C)

Follo

w‐u

p br

ushi

ng d

esig

n co

mpa

red

to n

egat

ive

cont

rol

Incl

uded

stu

dies

Effe

ct s

ize

Het

erog

enei

tyPr

edic

tion

Inte

rval

(≥3

com

paris

ons)

For d

etai

ls s

ee

appe

ndix

Inde

xIn

gred

ient

Diff

M95

% C

IP‐

valu

eI2 9

5% C

IP‐

valu

e

PITQ&H

NaF

3comparisons:

Akwagyirametal

(2018)37

Joseetal(2018)54

YankellandEmlingB

1988

40

−0.43

(−0.49;−0.36)

<0.0

001

33%(0%;78%)

0.22

(−1.08;0.23)

S6‐B3

MFP

3comparisons:

Mullally(1995)

5 TriratanaA(2015)

51

Hosadurga(2017)36

−0.07

(−0.29;0.14)

0.50

77%(24%;93%)

0.01

(−2.64;2.49)

Non‐BS

3comparisons:

YankellandEmlingA

(1988)40

Yankell(1993)42

Saxer(1995)45

−0.13

(−0.37;0.11)

0.28

51%(0%;86%)

0.13

(−2.57;2.30)

TAB

LE 3

(Continued)

(Con

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     |  111VALKENBURG Et AL.

(C)

Follo

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egat

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cont

rol

Incl

uded

stu

dies

Effe

ct s

ize

Het

erog

enei

tyPr

edic

tion

Inte

rval

(≥3

com

paris

ons)

For d

etai

ls s

ee

appe

ndix

Inde

xIn

gred

ient

Diff

M95

% C

IP‐

valu

eI2 9

5% C

IP‐

valu

e

GIL&S

NaF

3comparisons:

YankellandEmlingB

(1988)40

BeiswangerA(1997)46

Al‐KholaniB(2011)35

−0.10

(−0.26;0.07)

0.26

55%(0%;87%)

0.11

(−1.85;1.66)

S7‐3

MFP

3comparisons:

Mullally(1995)

5 Hosadurga(2017)36

TriratanaA(2015)

51

−0.08

(−0.15;−0.02)

0.01

0%(0%;69%)

0.72

(−0.49;0.33)

Non‐BS

5comparisons:

Winer(1986)39

YankellandEmlingA

(1988)40

Yankell(1993)42

Saxer(1995)45

Al‐KholaniA(2011)35

0.07

(0.04;0.10)

<0.0

001

0%(0%;68%)

0.63

(0.02;0.12)

Not

e.NA:notapplicable.P‐valuesarepresentedinboldif

P≤0.05.

a TheTureskyetal(1970)60modificationoftheQuigleyandHeinPlaqueIndex(1962).55

b TheLöe(1967)

58modificationoftheSilness&LöePlaqueIndex(1964).57

c TheLöe&SilnessGingivalIndex(1963)

56andTheLöe&SilnessGingivalIndex(1967).58

d TheAinamo&BayGingivalBleedingIndex(1975)

62andTheAbrams,CatonandPolsonBleedingonProbingIndex(1984).65

e TheSaxeretal(1977)64 PapillaryBleedingIndexmodificationoftheAinamo&BayBleedingIndex(1975)

62andTheSaxton&VanderOuderaa(1989)GingivalBleedingIndex.

68

f TheLobeneetal(1986)modificationoftheGingivalIndex(MGI).

69

* Multiplecomparisonswiththenumbertakenfromthispublication.

**Onlyendscores.

TAB

LE 3

(Continued)

112  |     VALKENBURG Et AL.

TAB

LE 4

 Summaryoffindingstableonbodyoftheestimatedevidenceprofile(Guyattetal,2008)andappraisalofthestrengthoftherecommendationregardingtheefficacyofBSas

ingredientaddedtoadentifriceontheparametersofinterest

Stud

y de

sign

Plaq

ueBl

eedi

ngG

ingi

vitis

Sing

le‐b

rush

ing

Follo

w‐u

pFo

llow

‐up

Follo

w‐u

p

Neg

ativ

e co

ntro

lPo

sitiv

e co

ntro

lN

egat

ive

cont

rol

Posi

tive

cont

rol

Neg

ativ

e co

ntro

lPo

sitiv

e co

ntro

lN

egat

ive

cont

rol

Posi

tive

cont

rol

#Comparisonsdescriptive

analysis(Figure1,Table2)

812

104

111

123

#Comparisonsinmeta‐analy‐

sis(Table3)

411

7+2

34+3

NA

113

Riskofbias(OnlineAppendix

S3)

Low‐high

Low‐high

Low‐high

Low‐high

Low‐high

high

Low‐high

Low‐high

Consistency

Consistent

Consistent

Inconsistent

Inconsistent

Ratherconsistent

NA

Inconsistent

Inconsistent

Directness

Slightly

Indirect

Direct

Direct

Direct

NA

Direct

Direct

Precision

Ratherprecise

Precise

Precise

Ratherprecise

Ratherprecise

NA

Precise

Ratherprecise

Reportingbias

Possible

Possible

Possible

Possible

Possible

NA

Possible

Possible

Magnitudeoftheeffect(Table

3)Small

Small

Nodifference

Nodifference

Nodifference

NA

Nodifference

Nodifference

Strengthanddirectionofthe

recommendationbasedon

thequalityandbodyof

evid

ence

Weakinfavourof

Weakinfavourof

Moderate

certaintyofno

difference

Moderate

certaintyofno

difference

Moderate

certaintyofno

difference

NA

Moderate

certaintyofno

difference

Moderate

certaintyof

nodifference

Recommendation

Withrespecttoplaqueandgingivitis,BSdentifricemaybeconsideredasanalternativeforothercommerciallyavailabledentifrices.

     |  113VALKENBURG Et AL.

Putt et al49 investigated the effect of varying concentrationsof BS. The results suggested a possible positive relationship be‐tweentheconcentrationofBSandplaquereduction. Intherank‐ingoftheNMAresults(OnlineAppendixS11‐C),suchapatternisclearly visible. An almost inverse relationship exists between thepercentageofBS inadentifriceand itsabrasiveness.86However,akeydifferencebetweenBSandcommonabrasivesisthesizeoftheparticles.49InthecaseofBScrystals,theparticlesarenotablylarger, softer andpotentially lessdamaging to toothmineral thanthe conventional abrasive particles in other dentifrices. This sizecouldplayaroleindisturbingtheadhesionofplaquetothetoothsurface, inadditiontotheforceexertedbythetoothbrush.49 The dissolvedbicarbonateionsinBSarethoughttobindwithcalciumions,disruptingthemutualbondbetweenbacteriaanddisruptingtheattachmentofbacteria to the toothsurface.Thesebicarbon‐ate ions are also thought to charge the tooth surface negatively,whichenhancesthedetachmentofbacteria.50Furthermore,BSisan alkali,whichboosts the cleansing activity of the surfactant inthedentifrice.50Although theseproposedmechanismsareprom‐ising,BSisknowntobeeasilysolubleandslow‐acting.Therefore,itisunlikelytoresidelongenoughinthemouthtoactuallyinhibitplaquegrowth.49,86,87

A recent systematic review found, with moderate certainty,thattheadjunctiveuseofastandardfluoridedentifricewithtooth‐brushingdidnotcontributetotheeffectivenessofmechanicalre‐moval of dental plaque, in single‐brushing experiments.74 Given that in single‐use studies,BS showedapositiveeffect in instantplaqueremoval,incorporatingthisingredientintonoveldentifricesseemsthereforeaninterestingapproachtoimproveaproduct.

OtherresultsindicatethatBSindentifriceisaneffectivebuff‐ering agent through its ability to increase pH to a safe, neutrallevel.2,89 A long‐term in situ crossover study showed that BS didnotsignificantlyenhancetheabilityoffluoridedentifricetoreducedemineralizationandincreaseremineralizationoftheenamel.MostBS‐based dentifrices contain fluoride, which is compatible withBS.90,91Findingsfrominvitrostudiessuggest,however,thataddingBStoadentifricemayinterferewiththereactivityoffluoridewithenamel,reducingmainlytheconcentrationofCaF2formed.92,93ThisindicatesthataddingBStodentifricerequirescarefulformulation.

5.1 | Limitations

Animportantlimitationofthisreviewwasthevariabilityofdentifriceformulationsintheincludedpapers.Thecompositionofthestudieddentifriceswas often not clear. The choice of a control dentifricewithwhichtocomparedentifricesformulatedforplaquecontrolisalsoimportantandcouldaffectconclusionsdrawnfromclinicaltri‐alsofsuchproducts.94Inmoststudies,greateffortwasinvestedincreating neutral packaging.However, the uniqueproperties ofBSmakeblindingrelativelyhard.BShasthereputablepropertyofanoddtasteandtexture.49ThismakesaBS‐DFeasilydistinguishable,especiallytoparticipantswhoareaccustomedtoaregularfluoridedentifrice.

Only6outof21studiesprovidedinformationaboutallocationconcealment,acriticaldesignfeaturetominimizebias.

Themajority of the studieswere published between 1986 and2011,andinmostcases,themannerofreportingdidnotfollowcur‐rentstandards,suchasTIDieR2014.95Also,morerecentlypublishedstudies contain data fromover 5years ago.53This limitation is alsoreflected in the results of the risk of bias assessment.However, allgroupsseemtohavebeentreatedequallyandinmostofthestudiesseemtohavebeenwellbalanced.Unclearintheincludedstudiesweretheinstructionsonbrushingdurationandbrushingfrequency,detailsconcerningthetoothbrushesandthestudyprocedures.

6  | CONCLUSION

BS‐DFshowedpromisingresultswithrespecttoplaqueremovalinsingle‐usestudies.However,thefindingwaspartiallysubstantiatedinfollow‐upstudies.StudiesthatassessedbleedingscoresindicatedthatasmallreductioncanbeexpectedfromBS,relativetoacontrolproduct.

7  | CLINIC AL RELE VANCE

7.1 | Scientific rationale for the study

Twice daily toothbrushingwith a fluoride dentifrice is a universalrecommendationforpersonaloralcare.

7.2 | Principal findings

Withmoderatecertainty,adentifricecontainingBSiscomparabletoothercommerciallyavailabledentifrices forcontrollingplaqueandgingivitis.

7.3 | Practical implications

Inordertoremoveplaqueandimprovegingivalhealth,toothbrush‐ingcanbecombinedwithabakingsodadentifrice.

ACKNOWLEDG EMENTS

TheauthorsgratefullyacknowledgethesupportofJoostBouwman,theheadlibrarianoftheACTA,andStephenM.SiegelfromtheJournalofClinicalDentistrywhohelpedtoretrievefull‐textpapers.Theau‐thorsarealsogratefultoDr.C.Parkinson,Dr.A.Jose,Dr.S.Mason,Dr.B.Mullally,Dr.U.Saxer,Dr.C.Pannuti,Dr.L.M.Vorwerk,Dr.S.Yankell,Dr.S.H.Taller,Dr.R.HosadurgaandDr.Y‐PZhangfortheirresponses,timeandeffortinsearchingforadditionaldata.

CONFLIC T OF INTERE S T

The authors declare that they have no conflicts of interest. VanderWeijden,SlotandtheirresearchteamatACTAhavepreviously

114  |     VALKENBURG Et AL.

received either external advisor fees, lecturer fees or researchgrantsfromtoothbrushanddentifricemanufacturers.Thosemanu‐facturersincluded:Colgate,Dentaid,GABA,GSK,Lactona,Oral‐B,Procter&Gamble,SaraLee,SunstarandUnilever.Ethicalapprovalwasnotrequired.

AUTHOR CONTRIBUTIONS

Allauthorsgavefinalapprovalandagreedtobeaccountableforallaspectsoftheworkensuringintegrityandaccuracy.CVcontributedto design, search and selection, analysis and interpretation, anddrafted themanuscript. YK andAD involved in search and selec‐tion,contributedtoanalysisanddraftedthepreliminarymanuscript.GAWcontributedtoconceptionanddesign,analysisandinterpreta‐tion,andcriticallyrevisedthemanuscript.DEScontributedtocon‐ceptionanddesign,searchandselection,analysisandinterpretation,andcriticallyrevisedthemanuscript.

ORCID

Cees Valkenburg https://orcid.org/0000‐0002‐6656‐6934

G. A. (Fridus) Van der Weijden https://orcid.org/0000‐0002‐5075‐8384

Dagmar Else Slot https://orcid.org/0000‐0001‐7234‐0037

R E FE R E N C E S

1. Chapple IL, Van derWeijden GA, Doerfer C, et al. Primary pre‐vention of periodontitis: managing gingivitis. J Clin Periodontol. 2015;42:S71‐S76.

2. Blake‐HaskinsJC,GaffarA,VolpeAR,BanoczyJ,GintnerZ,DombiC.Theeffectofbicarbonate/fluoridedentifricesonhumanplaquepH.J Clin Dent.1997;8:173‐177.

3. Kumar A, Kumar V, Singh J, Hooda A, Dutta S. Drug‐induceddiscoloration of teeth: an updated review. Clin Pediatr (Phila). 2012;51:181‐185.

4. AmericanDentalAssociation (ADA).Fameddental researcherDr.Paul Keyes dies. ADANews. 48; 2017. https://www.ada.org/en/publications/ada‐news/2017‐archive/february/famed‐dental‐re‐searcher‐dr‐paul‐keyes‐dies.AccessedFebruary19,2019.

5. MullallyBH, JamesJA,CoulterWA,LindenGJ.Theefficacyofaherbal‐basedtoothpasteonthecontrolofplaqueandgingivitis.J Clin Periodontol.1995;22:686‐689.

6. Higgins JP,GreenS.Cochrane Handbook for Systematic Reviews of Interventions.Chichester:Wiley‐Blackwell;2011.

7. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reportingitemsforsystematicreviewsandmeta‐analyses:thePRISMAstate‐ment.BMJ.2009;339:b2535.

8. PROSPERO. International prospective register of systematic re‐views.National InstituteforHealthResearchCfRaD,editor.2014.https://www.crd.york.ac.uk/prospero/.AccessedFebruary19,2019.

9. Van derWeijden F, Dell'Acqua F, Slot DE. Alveolar bone dimen‐sionalchangesofpost‐extractionsocketsinhumans:asystematicreview. J Clin Periodontol.2009;36:1048‐1058.

10. Serrano J, EscribanoM, Roldan S,Martin C, HerreraD. Efficacyof adjunctive anti‐plaque chemical agents in managing gingi‐vitis: a systematic review and meta‐analysis. J Clin Periodontol. 2015;42:S106‐138.

11. Escribano M, Figuero E, Martín C, et al. Efficacy of adjunctiveanti‐plaque chemical agents: a systematic review and networkmeta‐analysesoftheTureskymodificationoftheQuigleyandHeinplaqueindex.J Clin Periodontol.2016;43:1059‐1073.

12. DerSimonianR,LairdN.Meta‐analysisinclinicaltrials.Control Clin Trials.1986;7:177‐188.

13. Hartung J, Knapp G. On tests of the overall treatment effect inmeta‐analysis with normally distributed responses. Stat Med. 2001;20:1771‐1782.

14. IntHoutJ,IoannidisJP,BormGF.TheHartung‐Knapp‐Sidik‐Jonkmanmethod for random effectsmeta‐analysis is straightforward andconsiderablyoutperformsthestandardDerSimonian‐Lairdmethod.BMC Med Res Methodol.2014;14:25.

15. IntHout J, Ioannidis JP, Rovers MM, Goeman JJ. Plea for rou‐tinely presenting prediction intervals inmeta‐analysis.BMJ open. 2016;6:e010247.

16. EggerM,DaveySmithG,SchneiderM,MinderC.Biasinmeta‐anal‐ysisdetectedbyasimple,graphicaltest.BMJ.1997;315:629‐634.

17. Sterne JA,GavaghanD, EggerM. Publication and related bias inmeta‐analysis:powerofstatisticaltestsandprevalenceintheliter‐ature.J Clin Epidemiol.2000;53:1119‐1129.

18. Salanti G, Kavvoura FK, Ioannidis JP. Exploring the geometry oftreatmentnetworks.Ann Intern Med.2008;148:544‐553.

19. IoannidisJP.Integrationofevidencefrommultiplemeta‐analyses:aprimeronumbrellareviews,treatmentnetworksandmultipletreat‐mentsmeta‐analyses.Can Med Assoc J.2009;181:488‐493.

20. BafetaA,TrinquartL,SerorR,RavaudP.Reportingofresultsfromnetwork meta‐analyses: methodological systematic review. BMJ. 2014;348:g1741.

21. Leucht S, Chaimani A, Cipriani AS, Davis JM, Furukawa TA,Salanti G. Network Meta‐Analyses Should Be the Highest Level of Evidence in Treatment Guidelines Eur Arch Psychiatry Clin Neurosci. 2016;266:477‐480.

22. John MT, Michalowicz BS, Kotsakis GA, Chu H. Network meta‐analysisofstudiesincludedintheClinicalPracticeGuidelineonthenonsurgical treatment of chronic periodontitis. J Clin Periodontol. 2017;44:603‐611.

23. RückerG,SchwarzerG.Rankingtreatmentsinfrequentistnetworkmeta‐analysis works without resampling methods. BMC Med Res Methodol. 2015;15:58.

24. RückerG,SchwarzerG.Resolveconflictingrankingsofoutcomesinnetworkmeta‐analysis:partialorderingoftreatments.Res Synth Methods.2017;8:526‐536.

25. Rücker G, Schwarzer G. Reduce dimension or reduce weights?Comparingtwoapproachestomulti‐armstudiesinnetworkmeta‐analysis.Stat Med.2014;33:4353‐4369.

26. RückerG,SchwarzerG,KrahnU,KönigJ.netmeta: Network Meta‐Analysis using Frequentist Methods.Rpackageversion0.9‐0.2016.

27. KönigJ,KrahnU,BinderH.Visualizingtheflowofevidenceinnet‐workmeta‐analysis and characterizingmixed treatment compari‐sons.Stat Med.2013;32:5414‐5429.

28. Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consis‐tency in mixed treatment comparison meta‐analysis. Stat Med. 2010;29:932‐944.

29. Krahn U, Binder H, Konig J. A graphical tool for locating incon‐sistency in network meta‐analyses. BMC Med Res Methodol. 2013;13:35.

30. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extensionstatement for reporting of systematic reviews incorporating net‐workmeta‐analysesofhealthcareinterventions:checklistandex‐planations.Ann Intern Med.2015;162:777‐784.

31. Schwarzer G. Meta: an R package for meta‐analysis. R News. 2007;7:40‐45.

32. ViechtbauerW.Conductingmeta‐analyses inRwith themetaforpackage.J Stat Softw.2010;36:1‐48.

     |  115VALKENBURG Et AL.

33. GRADE. Grading of recommendations assessment, developmentandevaluation(shortGRADE)working.group.. 2018.

34. SmileyCJ,TracySL,AbtE,etal.Evidence‐basedclinicalpracticeguidelineonthenonsurgicaltreatmentofchronicperiodontitisbymeansofscalingandrootplaningwithorwithoutadjuncts.J Am Dent Assoc.2015;146:525‐535.

35. Al‐KholaniAI.Comparisonbetweentheefficacyofherbalandcon‐ventionaldentifricesonestablishedgingivitis.Dent Res J (Isfahan). 2011;8:57‐63.

36. HosadurgaR,BoloorVA,RaoSN,MeghRaniN.Effectivenessoftwodifferentherbaltoothpasteformulationsinthereductionofplaqueandgingivalinflammationinpatientswithestablishedgingivitis–Arandomizedcontrolledtrial.J Tradit Complement Med.2017;8:113‐119.

37. Akwagyiram I, Amini P, BosmaM‐L,Wang N, Gallob J. Efficacyandtolerabilityofsodiumbicarbonatetoothpasteinsubjectswithgingivitis:a6‐monthrandomizedcontrolledstudy.Oral Health Prev Dent.2018;16:401‐407.

38. BosmaML,Milleman KR, Akwagyiram I, TargettD,Milleman JL.Arandomisedcontrolledtrialtoevaluatetheplaqueremovaleffi‐cacyofsodiumbicarbonatedentifricesinasinglebrushingclinicalmodel. BDJ Open.2018;4:17037.

39. WinerRA,EpsteinS,ChaunceyHH.Effectofanexperimentalden‐tifriceonplaqueaccumulationandgingivalinflammation.Spec Care Dentist.1986;6:228‐230.

40. YankellSL,EmlingRC.TwomonthevaluationofParodontaxdenti‐frice.J Clin Dent.1988;1(Suppl.A):A41‐A43.

41. Emling RC, Yankell SL. The comparative clinical evaluation ofovernight plaque trials with Parodontax and Crest. J Clin Dent. 1988;1(Suppl.A):A20–A21.

42. Yankell SL, Emling RC, Perez B. Six‐month evaluation ofParodontaxdentifricecomparedtoaplacebodentifrice.J Clin Dent. 1993;4:26–30.

43. TallerSH.Theeffectofbakingsoda/hydrogenperoxidedentifrice(Mentadent) and a 0.12 percent chlorhexidine gluconate mouth‐rinse (Peridex) in reducing gingival bleeding. J N J Dent Assoc. 1993;64(23–25):27.

44. SaxerU,JaschouzV,LeyF.TheeffectofParodontaxdentifriceongingivalbleeding.J Clin Dent.1994;5:63–64.

45. Saxer UP, Menghini G, Bohnert KJ, Ley F. The effect of twotoothpastes on plaque and gingival inflamation. J Clin Dent. 1995;6:154–156.

46. BeiswangerBB,McClanahanSF,BartizekRD,LanzalacoAC,BaccaLA,WhiteDJ.Thecomparativeefficacyofstabilizedstannousflu‐oride dentifrice, peroxide/baking soda dentifrice and essential oilmouthrinseforthepreventionofgingivitis.J Clin Dent.1997;8:46–53.

47. MankodiS,BerkowitzH,DurbinK,NelsonB.Evaluationoftheef‐fectsofbrushingontheremovalofdentalplaque.Journal of Clinical Dentistry. 1998;9:57–60.

48. OzakiF,PannutiCM,ImbronitoAV,etal.Efficacyofaherbaltooth‐paste on patients with established gingivitis–a randomized con‐trolledtrial.Braz Oral Res. 2006;20:172–177.

49. PuttMS,MillemanKR,GhassemiA,etal.Enhancementofplaqueremoval efficacy by tooth brushingwith baking soda dentifrices:resultsoffiveclinicalstudies.J Clin Dent. 2008;19:111–119.

50. GhassemiA,Vorwerk LM,HooperWJ,PuttMS,MillemanKR.Afour‐weekclinicalstudytoevaluateandcomparetheeffectivenessofabakingsodadentifriceandanantimicrobialdentifriceinreduc‐ingplaque.J Clin Dent. 2008;19:120–126.

51. Triratana T, Kraivaphan P, Amornchat C, et al. Comparing threetoothpastesincontrollingplaqueandgingivitis:a6‐monthclinicalstudy.Am J Dent.2015;28:68–74.

52. LomaxA,Patel S,WangN,KakarK,KakarA,BosmaML.A ran‐domized controlled trial evaluating the efficacyof a67% sodiumbicarbonatetoothpasteongingivitis.Int J Dent Hyg. 2016.

53. MasonS,KarwalR,BosmaML.Tworandomizedclinicalstudiestoconfirmdifferentialplaqueremovalbysodiumbicarbonatedenti‐fricesinasingletimedbrushingmodel.J Clin Dent.2017;28:44–48.

54. JoseA,PrattenJ,BosmaML,MillemanKR,MillemanJL,WangN.Six‐month evaluation of a sodium bicarbonate‐containing tooth‐paste for reduction of established gingivitis: a randomized USA‐basedclinicaltrial.J Clin Dent.2018;29:33–39.

55. QuigleyGA,HeinJW.Comparativecleansingefficiencyofmanualandpowerbrushing.J Am Dent Assoc. 1962;65:26–29.

56. LöeH, Silness J. PeriodontalDisease in Pregnancy. I. PrevalenceandSeverity.Acta Odontol Scand.1963;21:533–551.

57. SilnessJ,LöeH.PeriodontaldiseaseinpregnancyII.Correlationbe‐tweenoralhygieneandperiodontalcondition.Acta Odontol Scand. 1964;22:121–135.

58. Loe H. The Gingival Index, the Plaque Index and the RetentionIndexSystems.J Periodontol.1967;38(Suppl.):610–616.

59. Podshadley AG, Haley JV. A method for evaluating oral hygieneperformance.Public Health Rep.1968;83:259–264.

60. Turesky S, Gilmore ND, Glickman I. Reduced plaque forma‐tion by the chloromethyl analogue of victamine C. J Periodontol. 1970;41:41–43.

61. MuhlemannHR,SonS.Gingivalsulcusbleeding–aleadingsymptomininitialgingivitis.Helv Odontol Acta.1971;15:107–113.

62. AinamoJ,BayI.Problemsandproposalsforrecordinggingivitisandplaque.Int Dent J.1975;25:229–235.

63. Lange DE, Plagmann HC, Eenboom A, Promesberger A. Clinicalmethods for the objective evaluation of oral hygiene. Dtsch Zahnarztl Z.1977;32:44–47.

64. SaxerUP,TurconiB,ElsasserC.Patientmotivationwiththepap‐illary bleeding index. The Journal of Preventive Dentistry. 1977;4: 20–22.

65. AbramsK,CatonJ,PolsonA.Histologiccomparisonsofinterproxi‐malgingivaltissuesrelatedtothepresenceorabsenceofbleeding.J Periodontol.1984;55:629–632.

66. LobeneRR.Aclinicalstudyoftheanticalculuseffectofadentifricecontaining soluble pyrophosphate and sodium fluoride. Clin Prev Dent. 1986;8:5–7.

67. FischmanS,CancroLP,Pretara‐SpaneddaP,JacobsD.Distalmesialplaque index. A technique for assessing dental plaque about thegingiva.Dent Hyg (Chic).1987;61:404–409.

68. SaxtonCA,vanderOuderaaFJ.Theeffectofadentifricecontain‐ingzinccitrateandTriclosanondevelopinggingivitis.J Periodontal Res.1989;24:75–80.

69. Lobene RR, Weatherford T, Ross NM, Lamm RA, Menaker L.Amodified gingival index for use in clinical trials.Clin Prev Dent. 1986;8:3–6.

70. PetersJL,SuttonAJ,JonesDR,AbramsKR,RushtonL.Contour‐en‐hancedmeta‐analysisfunnelplotshelpdistinguishpublicationbiasfromothercausesofasymmetry.J Clin Epidemiol. 2008;61:991–996.

71. SterneJA,SuttonAJ,IoannidisJP,etal.Recommendationsforex‐aminingandinterpretingfunnelplotasymmetryinmeta‐analysesofrandomisedcontrolledtrials.BMJ.2011;343:d4002.

72. AhmedI,SuttonAJ,RileyRD.Assessmentofpublicationbias,se‐lectionbias,andunavailabledatainmeta‐analysesusingindividualparticipantdata:adatabasesurvey.BMJ.2012;344:d7762.

73. SchwarzerG,CarpenterJR,RückerG.Meta‐Analysis with R.Springer;2015.https://www.springer.com/us/book/9783319214153

74. ValkenburgC,VanderWeijdenGA,SlotDE.Plaquecontrolandre‐ductionofgingivitis:theevidencefordentifrices.Periodontol 2000. 2019;Accepted.

75. Lu G, Ades AE. Combination of direct and indirect evidence inmixedtreatmentcomparisons.Stat Med.2004;23:3105–3124.

76. MillsEJ,ThorlundK,IoannidisJP.Demystifyingtrialnetworksandnetworkmeta‐analysis.BMJ.2013;346:f2914.

116  |     VALKENBURG Et AL.

77. Neupane B, Richer D, Bonner AJ, Kibret T, Beyene J. Networkmeta‐analysis using R: a review of currently available automatedpackages.PLoS ONE.2014;9:e115065.

78. GatsonisC,MortonSC.Methods in Comparative Effectiveness Research. Chapman & Hall/CRC; 2017. https://www.crcpress.com/Methods‐in‐Comparative‐Effectiveness‐Research/Gatsonis‐Morton/p/book/9781466511965

79. DaviesRM,EllwoodRP,DaviesGM.Theeffectivenessofatooth‐paste containing triclosanandpolyvinyl‐methyl ethermaleic acidcopolymer in improvingplaquecontrolandgingivalhealth:asys‐tematicreview.J Clin Periodontol.2004;31:1029–1033.

80. HioeKP,VanderWeijdenGA.Theeffectivenessofself‐performedmechanicalplaquecontrolwithtriclosancontainingdentifrices.Int J Dent Hyg.2005;3:192–204.

81. ParaskevasS,VanderWeijdenGA.Areviewoftheeffectsofstan‐nousfluorideongingivitis.J Clin Periodontol.2006;33:1–13.

82. Gunsolley JC.Ameta‐analysisof six‐month studiesof antiplaqueandantigingivitisagents.J Am Dent Assoc.2006;137:1649–1657.

83. RileyP,LamontT.Triclosan/copolymercontainingtoothpastesfororalhealth.Cochrane Database Syst Rev.2013;12:CD010514.

84. IoannidisJP,PatsopoulosNA,EvangelouE.Uncertaintyinhetero‐geneityestimatesinmeta‐analyses.BMJ.2007;335:914–916.

85. Huedo‐MedinaTB, Sánchez‐Meca J,Marín‐Martínez F,Botella J.Assessing heterogeneity inmeta‐analysis:Q statistic or I2 index?Psychol Methods.2006;11:193.

86. NewbrunE.Theuseofsodiumbicarbonateinoralhygieneproductsandpractice.Compend Contin Educ Dent Suppl.1997;18:S2–S7.

87. Newbrun E, Hoover CI, Ryder MI. Bactericidal action of bicar‐bonate iononselectedperiodontalpathogenicmicroorganisms.J Periodontol.1984;55:658–667.

88. ThongS,HooperW,XuY,GhassemiA,WinstonA.Enhancementofplaqueremovalbybakingsodatoothpastesfromlessaccessibleareasinthedentition.J Clin Dent. 2011;22:171–178.

89. SilhacekKJ, TaakeKR. Sodiumbicarbonate and hydrogen perox‐ide:theeffectonthegrowthofStreptococcusmutans.J Dent Hyg. 2005;79:7–7.

90. Ciancio SG. Baking soda dentifrices and oral health. J Am Dent Assoc.2017;148:S1–S3.

91. CuryJA,HashizumeLN,DelBelCuryAA,TabchouryCP.Effectofden‐tifricecontainingfluorideand/orbakingsodaonenameldemineraliza‐tion/remineralization:aninsitustudy.Caries Res.2001;35:106–110.

92. Kashket S, Yaskell T. Effects of a high‐bicarbonate dentifriceon intraoral demineralization. Compend Contin Educ Dent Suppl. 1997;18:S11–16.

93. Peres PE, SantosDC, TabchouryC, Cury JA. Effect of bicarbon‐ate on fluoride reactivity with enamel. Revista Odonto Ciência. 2009;24:6–9.

94. BinneyA,AddyM,McKeownS,EverattL.Thechoiceofcontrolsintoothpastestudies.Theeffectofanumberofcommerciallyavail‐abletoothpastescomparedtowateron4‐dayplaqueregrowth.J Clin Periodontol.1996;23:456–459.

95. HoffmannTC,GlasziouPP,BoutronI,etal.Betterreportingofin‐terventions: template for interventiondescriptionand replication(TIDieR)checklistandguide.BMJ.2014;348:g1687.

SUPPORTING INFORMATION

Additional supporting information may be found online in theSupportingInformationsectionattheendofthearticle.

How to cite this article:ValkenburgC,KashmourY,DaoA,(Fridus)VanderWeijdenGA,SlotDE.Theefficacyofbakingsodadentifriceincontrollingplaqueandgingivitis:Asystematicreview.Int J Dent Hygiene. 2019;17:99–116. https://doi.org/10.1111/idh.12390