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Abstract

An earlier clinical study demonstrated that brushing with a commercial Arm & Hammer dentifrice containing baking soda physically removed significantly more plaque than brushing with either of two commercial dentifrices which did not contain baking soda. However, little has been done to confirm these results and to compare baking soda-containing dentifrices with more recently commercialized non-baking soda dentifrice formulations. The objective of this study was to compare commercial dentifrices containing 20% to 65% baking soda and commercial dentifrices without baking soda in enhancing plaque removal efficacy of tooth brushing. Five randomized, controlled, blinded, crossover clinical studies were performed among healthy adult volunteers who provided informed consent. After approximately 24 hours without oral hygiene, subjects with sufficient plaque were enrolled in the study phase. Plaque was scored before and after supervised brushing for one minute using the Turesky, et al. modification of the Quigley-Hein Plaque Index at six sites per tooth according to Soparkar's modification as described by Lobene, et al. In each study, wash-out periods with a regular dentifrice not evaluated in the study separated each product treatment. In all studies, every dentifrice exhibited a significant (p < 0.0001) reduction in 24-hour plaque scores. Between-group comparisons of whole mouth plaque scores in all five studies demonstrated that brushing with baking soda dentifrices resulted in statistically greater (p < 0.01) reductions in whole mouth mean plaque scores than brushing with dentifrices that did not contain baking soda. Results on other tooth surfaces, such as facial, lingual, proximal, and gingival surfaces also demonstrated statistically greater (p < 0.05) reductions in mean plaque scores for the baking soda-containing dentifrices as compared to the baking soda-free dentifrices. In three of the studies comparing different levels of baking soda, brushing with dentifrices with higher concentrations of baking soda consistently removed numerically more plaque than those containing lower levels. In one of these three studies, the difference in plaque removal between the baking soda dentifrices reached statistical significance. The results suggest a positive relationship between plaque removal efficiency and baking soda concentration. The collective results from the five controlled clinical studies on over 270 subjects reported in this paper, consistently demonstrate that Arm & Hammer baking soda dentifrices enhanced plaque removal effectiveness of tooth brushing to a significantly greater extent than the non-baking soda dentifrice products.
Abstract
Objective: An earlier clinical study demonstrated that brushing with a commercial Arm & Hammer®dentifrice containing baking
soda physically removed significantly more plaque than brushing with either of two commercial dentifrices, which did not contain
baking soda. However, little has been done to confirm these results and to compare baking soda-containing dentifrices with more
recently commercialized non-baking soda dentifrice formulations. The objective of this study was to compare commercial dentifrices
containing 20% to 65% baking soda and commercial dentifrices without baking soda in enhancing plaque removal efficacy of tooth
brushing.
Methods: Five randomized, controlled, blinded, crossover clinical studies were performed among healthy adult volunteers who
provided informed consent. After approximately 24 hours without oral hygiene, subjects with sufficient plaque were enrolled in
the study phase. Plaque was scored before and after supervised brushing for one minute using the Turesky, et al. modification of
the Quigley-Hein Plaque Index at six sites per tooth according to Soparkar’s modification as described by Lobene, et al. In each
study, wash-out periods with a regular dentifrice not evaluated in the study separated each product treatment.
Results: In all studies, every dentifrice exhibited a significant (p < 0.0001) reduction in 24-hour plaque scores. Between-group
comparisons of whole mouth plaque scores in all five studies demonstrated that brushing with baking soda dentifrices resulted in
statistically greater (p < 0.01) reductions in whole mouth mean plaque scores than brushing with dentifrices that did not contain
baking soda. Results on other tooth surfaces, such as facial, lingual, proximal, and gingival surfaces also demonstrated statistically
significantly greater (p < 0.05) reductions in mean plaque scores for the baking soda-containing dentifrices as compared to the baking
soda-free dentifrices. In three of the studies comparing different levels of baking soda, brushing with dentifrices with higher con-
centrations of baking soda consistently removed numerically more plaque than those containing lower levels. In one of these three
studies, the difference in plaque removal between the baking soda dentifrices reached statistical significance. The results suggest
a positive relationship between plaque removal efficiency and baking soda concentration.
Conclusion: The collective results from the five controlled clinical studies on over 270 subjects reported in this paper, consistently
demonstrate that Arm & Hammer baking soda dentifrices enhanced plaque removal effectiveness of tooth brushing to a significantly
greater extent than the non-baking soda dentifrice products.
(J Clin Dent 19:00–00, 2008)
Enhancement of Plaque Removal Efficacy by Tooth Brushing with
Baking Soda Dentifrices: Results of Five Clinical Studies
Mark S. Putt, MSD, PhD Kimberly R. Milleman, RDH, MS
University Park Research Center
Fort Wayne, IN, USA
Annahita Ghassemi, PhD Linda M. Vorwerk, BS William J. Hooper, PhD
Church & Dwight Company
Princeton, NJ, USA
Pramod M. Soparkar, DMD
The Forsyth Institute
Boston, MA, USA
Anthony E. Winston, BSc
R&D for Hire
New Brunswick, NJ, USA
Howard M. Proskin, PhD
H.M. Proskin and Associates, Inc.
Rochester, NY, USA
Introduction
The ability of a toothbrush and dentifrice to remove plaque
biofilm depends on several variables. For example, brushing
technique, bristle geometry, bristle stiffness, brush head config-
uration and brushing time may all potentially influence the ease
of plaque removal.1While toothbrush design is important, it
seems that the ability to remove plaque biofilm is not in general
greatly affected by the dentifrice formulation used.1-6 However,
it should be noted that some studies have seen significantly
enhanced plaque removal due to the use of a dentifrice.7,8
In recent years, dentifrice formulations have been developed
containing antimicrobial agents. Some of these have been shown
1
2 The Journal of Clinical Dentistry Vol. XIX, No. 4
achieve this, commercial dentifrices containing various levels of
baking soda were compared with several commercial baking
soda-free dentifrices for their ability to remove dental plaque in
controlled clinical studies.
Materials and Methods
A series of five independent, randomized, controlled, blinded,
crossover clinical studies in over 270 subjects was performed to
evaluate and compare commercially available dentifrices con-
taining baking soda, with several commercially available baking
soda-free dentifrices, for their ability to remove plaque during a
single brushing. Studies 1 through 4 were conducted at the same
study site using the same examiner with different subject popu-
lations, while Study 5 was conducted at a different study site with
a different examiner. Study 5 was performed to provide indepen -
dent confirmation of baking soda dentifrice activity for enhanced
plaque removal that was observed in the four studies done at the
same site. Prior to subject recruitment, studies were approved by
an independent institutional review board.
Subject Population
At screening, after reading and signing an informed consent
statement and completing a medical questionnaire, potential
subjects were examined to determine whether the subjects met
the study requirements. To be included in any of the studies,
subjects had to be aged 18 years or older, in good health, and
demonstrate adequate oral hygiene. They had to exhibit at least
20 natural teeth with both facial and lingual scoreable surfaces,
which were in a good state of repair. Grossly carious, fully
crowned, ortho dontically banded abutment teeth and third molars
were excluded from this count. Subjects had to present with a
24-hour full-mouth plaque score > 1.5 based on Soparkar’s
modification of the Turesky version of the Quigley-Hein Plaque
Index, as described below.24
The exclusion criteria included physical limitations affecting
the ability of subjects to brush, high levels of extrinsic stain, or
calculus deposits which might interfere with plaque assessments.
Dental neglect, soft tissue pathology or damage, moderate or
severe recession, periodontitis affecting more than two teeth, or
the presence of orthodontic bands, bridges, extensive crowns or
removable partial dentures were also grounds for exclusion. In
addition, subjects using antibiotics or with various medical condi -
tions or diseases which might affect the outcome were excluded
from the study.
Clinical Procedures
For each study, selected subjects meeting the inclusion/
exclusion criteria were initially provided with a regular baking
soda-free fluoride dentifrice for use during wash-out periods
between each product treatment. Each study visit involved a
baseline (pre-brushing) plaque assessment, a one-minute super-
vised brushing with the assigned test dentifrice, and a post-
brushing plaque assessment.
Subjects refrained from oral hygiene for 24 hours, and did not
eat, drink, or smoke the morning of their examination visit. All
sub jects were randomly assigned to one of the test products in
sequence of treatments according to a randomization plan
to inhibit plaque growth.9-11 However, antimicrobial agents do
not affect the ability of a toothbrush and dentifrice to physically
remove plaque. Reductions in plaque levels, resulting from the
ongoing use of dentifrices containing antimicrobials, are due to
inhibition of plaque growth between brushings, which results in
the toothbrush having less plaque to remove each time.12,13
Prior to the development of current dentifrices, baking soda
was widely used as a dentifrice. Since the crystals of baking soda
are soft, a major benefit of baking soda was considered to be its
low abrasivity and hence reduced potential for damage to enamel
and dentin.14,15 Indeed for many years, the American Dental As-
sociation recommended the use of baking soda as a dentifrice,
stating that “…if only a slight degree of abrasion is necessary
to keep teeth from staining, baking soda will usually be found
satis factory.”16 While baking soda itself seems to clean well, a
disadvantage of using baking soda alone is its lack of fluoride,
which is needed to provide cavity protection. Furthermore,
baking soda has a salty flavor that consumers may find ob -
jectionable. Therefore, more recently, baking soda has been
formulated as one of several ingredients in some dentifrices at
different concentrations. These dentifrices contain fluoride at
appropriate levels to provide cavity protection, and are flavored
and sweetened to overcome the salty taste of the baking soda.
Furthermore, other ingredients are often incorporated into these
dentifrices to provide additional specific targeted oral care ben-
efits. For example, some dentifrices containing baking soda are
formulated with pyrophosphates to inhibit tartar formation and
stain, while others contain additional abrasives or peroxides for
enhanced tooth whitening.17
A major benefit of dentifrices containing baking soda is the es-
pecially “clean feeling” which is imparted to the mouth after
brushing. To date, the specific cause of this clean feeling has not
been identified although it is tempting to propose that it might
be related to better plaque removal. Mankodi, et al. reported that
a dentifrice containing 65% baking soda removed significantly
more plaque than two conventional baking soda-free dentifrices
when compared in a single-use crossover clinical study.18 How-
ever, until now very little has been done to confirm these results
with other dentifrices or to investigate baking soda’s role in re-
moving plaque. While some in vitro studies have shown that long
periods of exposure to baking soda can inhibit bacterial growth
or even kill some oral bacteria, baking soda is not considered to
impart significant antibactericidal activity to dentifrices.19-21
Baking soda is highly soluble, and probably does not remain in
the mouth long enough to greatly affect the survival of plaque
bacteria or to inhibit plaque growth. It would seem that any ef-
fects of baking soda on enhancing plaque removal might be at-
tributed to: 1) physical properties of baking soda crystals in dis-
placing plaque from the tooth surface; 2) interactions with plaque
matrix by dissolved baking soda, which may, for example, reduce
plaque viscosity and make it more readily removable by the
toothbrush; or 3) its ability to favor the disruption of plaque
biofilm by improving the penetration of biofilm by toothbrush
bristles.
The purpose of this series of five clinical studies was to
confirm the ability of baking soda, as an ingredient in fluoride
dentifrices, to further enhance plaque removal by brushing. To
Vol. XIX, No. 4 The Journal of Clinical Dentistry 3
generated in advance of the study. Before the baseline plaque as-
sessment, subjects rinsed with an erythrosine-containing plaque
disclosing solution (G.U.M.®Dental Disclosing Solution [Red
Cote], Sunstar Americas, Chicago, IL, USA), followed by a
brief rinse with water to remove excess solution. They then
moved to a separate examination room.
After an oral soft tissue examination, the examiner scored
pre-brushing plaque using the grading scale of the Turesky mod-
ification of the Quigley-Hein Plaque Index23,24 (Figure 1), at
6 sites per tooth, according to Soparkar’s modification as de-
scribed by Lobene, et al. Each tooth was divided into six areas
for scoring: mesio-facial; mid-facial; disto-facial; mesio-lingual;
mid-lingual; and disto-lingual. The scores from the areas of each
tooth were summed and divided by six to yield the mean score
for the tooth. By adding the indices for the teeth and dividing by
the number of teeth examined, the mean whole mouth plaque
score for the individual subject was obtained.
After the baseline examination, subjects returned to the brush-
ing room where they were instructed to brush their teeth with
1.5 g of the assigned test dentifrice weighed onto a new manual
toothbrush (Oral-B®35 Compact Toothbrush, Procter & Gamble,
Cincinnati, OH, USA). In all five studies, the same type of tooth-
brush and weighed 1.5 g of assigned dentifrice were used to con-
trol for dentifrice dosing and toothbrush variability. The subjects
brushed their teeth for exactly one minute under supervision. The
subjects were then re-disclosed with the red disclosing solution,
and the same examiner re-scored the plaque level. The post-
brushing examination completed each test period and started
the wash-out period. The subjects were instructed to follow their
normal oral hygiene procedures at home during each wash-out
period, using the regular baking soda-free fluoride dentifrice
and toothbrush provided, until the next test period. The wash-out
periods ranged from three to five days, and after each wash-out
period the subjects refrained from oral hygiene for 24 hours, and
did not eat, drink, or smoke the morning of their examination
visit.
Test Products
All baking soda dentifrice products were manufactured by
Church & Dwight Co., Inc., Princeton, NJ, USA. The level of
baking soda ranged from 20% to 65%. The non-baking soda
dentifrices were: Colgate®Total®Clean Mint, containing 0.3%
triclosan and a copolymer (Colgate-Palmolive Company, New
York, NY, USA); Crest®Pro-Health, containing stannous
fluoride and sodium hexametaphosphate (Procter & Gamble,
Cincinnati, OH, USA); Crest®Regular Cavity Protection, con-
taining sodium fluoride and silica (Procter & Gamble, Cincinnati,
OH, USA); and Aim®Cavity Protection Gel, containing sodium
fluoride and silica (Church & Dwight Co., Inc., Princeton, NJ,
USA).
In the first study, the performance of a dentifrice containing
65% baking soda (Arm & Hammer® Dental Care®) and a denti-
frice containing 20% baking soda (Arm & Hammer®Advance
WhiteBrilliant Sparkle) were compared with a baking soda-
free dentifrice (Colgate Total Clean Mint). In the second study,
a dentifrice containing 48% baking soda (Arm & Hammer®
Advance WhiteBaking Soda and Peroxide), and a dentifrice
containing 20% baking soda (Arm & Hammer Advance White
Brilliant Sparkle) were compared with two baking soda-free
dentifrices (Colgate Total Clean Mint and Crest Pro-Health). In
the third study, a dentifrice containing 48% baking soda (Arm &
Hammer Advance White Baking Soda and Peroxide), and a den-
tifrice containing 27% baking soda (Arm & Hammer®Advance
WhiteLiquid Gel) were compared with two baking soda-free
dentifrices (Crest Regular Cavity Protection and Colgate Total
Clean Mint). In the fourth study, a dentifrice containing 65%
baking soda (Arm & Hammer Dental Care) and Aim Cavity
Protection Gel with no baking soda were compared. In the fifth
study, a dentifrice containing 20% baking soda (Arm & Hammer
Advance White Brilliant Sparkle) was compared with Colgate
Total Clean Mint.
Data Analysis
All data are presented as Mean ± Standard Deviation (SD). In
addition to whole mouth data, the plaque scores were analyzed
according to facial, lingual, proximal, and gingival surfaces. As
described previously, whole mouth plaque scores represented all
six scoring index sites. Facial surfaces comprised the mesio-
facial, mid-facial, and disto-facial scoring sites, and lingual
surfaces constituted the mesio-lingual, mid-lingual, and disto-
lingual sites. Proximal surfaces were defined as the mesio-facial,
disto-facial, mesio-lingual, and disto-lingual sites, while gingi-
val surfaces were the mid-facial and mid-lingual sites.
Pre- Brushing Assessments
Comparisons among treatment groups with respect to pre-
brushing plaque scores were performed using the same model
described above without the inclusion of the covariate. Within-
treatment comparisons of pre-brushing plaque scores versus
post-brushing plaque scores were performed using paired t-tests.
Pre- to Post-Brushing Assessments
Pre- to post-brushing plaque difference was calculated by
subtracting the post-brushing plaque score from the pre-brush-
ing plaque score. Comparisons among the study treatments were
performed using an analysis of covariance (ANCOVA) model
suitable for a crossover design, with the associated pre-brushing
plaque score included as a covariate. Specifically, the ANCOVA
model included the fixed effects treatment and period, the ran-
dom effect subject, the pre-brushing score as a covariate, and
-pre- to post-brushing reduction as the response variable. Post-
ANCOVA, pair-wise treatment comparisons were made using
Score Description
0 No visible plaque.
1 Separate flecks of plaque at the cervical margin of the tooth.
2 A thin, continuous band of plaque (up to 1 mm wide) at the cervical
margin.
3 A band of plaque wider than 1 mm but covering less than one-third
of crown.
4 Plaque covering at least one-third but less than two-thirds of crown.
5 Plaque covering two-thirds or more of crown.
Figure 1. Grading scale of the Turesky, et al. modification of the Quigley-Hein
Plaque Index.
4 The Journal of Clinical Dentistry Vol. XIX, No. 4
t-tests. Only subjects with data for all test periods of the study
were included in the analyses. All pair-wise treatment compar-
isons were based on two-sided tests at a significance level of
α = 0.05. Tukey’s method at a significance level of α = 0.05 was
employed for those studies involving multiple comparisons.
Results
Table I summarizes demographics for all five studies. Tables
II to VI present plaque results of the five studies for whole mouth,
facial, lingual, proximal, and gingival surfaces, respectively.
Study 1
A total of 71 subjects were qualified for this study, and six sub-
jects discontinued for non-product-related reasons. Of 65 subjects
completing the study, there were 15 males and 50 females, rang-
ing in age from 18 to 68 years (overall mean age was 42 ± 13 years).
There were no significant statistical differences (p > 0.05) in
the mean baseline whole mouth plaque scores for the three
groups (Table II). Within-group analysis showed that brushing
with each of the three dentifrices reduced the amount of plaque
remaining on the teeth (p < 0.0001). Between-group comparisons
showed that brushing with 65% and 20% baking soda dentifrices
resulted in significantly (p ≤ 0.0001) greater pre- to post- brushing
plaque removal scores (0.73 ± 0.26 and 0.64 ± 0.26, respectively)
than brushing with the triclosan dentifrice (0.52 ± 0.20). Brush-
ing with the 65% baking soda dentifrice reduced the mean plaque
score by 40% (p < 0.0001) more than the triclosan dentifrice, and
brushing with the 20% baking soda dentifrice reduced the mean
plaque score by 23% (p = 0.0001) more than the triclosan den-
tifrice. Comparison between the two baking soda dentifrices
showed a 13% greater mean plaque removal for the 65% baking
soda dentifrice than the 20% baking soda (p = 0.0033), as mea-
sured by comparison of plaque reduction scores.
Analyses of mean plaque scores for facial, lingual, proximal,
and gingival surfaces exhibited similar results as those of whole
mouth plaque scores (Tables III–VI). For each of the four surfaces,
mean baseline plaque scores were not statistically significantly
different (p > 0.05). For all surface areas, brushing with the 65%
baking soda dentifrice removed more plaque (i.e., greater reduc-
tion in mean plaque scores) than the triclosan dentifrice by 25%
for facial (p < 0.0001), 157% for lingual (p < 0.0001), 51% for
proximal (p < 0.0001), and 30% for gingival (p < 0.0001) sur-
faces. The 20% baking soda dentifrice removed more plaque
(i.e., greater reduction in mean plaque scores) than the triclosan
dentifrice by 15% for facial (p = 0.0008), 94% for lingual
(p = 0.0004), 32% for proximal (p < 0.0001), and 15% for gin-
gival (p = 0.0166) surfaces.
Study 2
A total of 68 subjects qualified for this study, and two subjects
discontinued for non-product-related reasons. Of 66 subjects
completing the study (Table I), there were 17 males and 49
females, ranging in age from 22 to 81 years (overall mean age
was 40 ± 13 years).
There were no significant statistical differences (p > 0.05) in
the mean baseline whole mouth plaque scores for the four groups
(Table II). Within-group analysis showed that brushing with
each of the four dentifrices reduced the amount of plaque re-
maining on the teeth (p < 0.0001). Between-group comparisons
showed that brushing with the 48% and 20% baking soda den-
tifrices resulted in significantly greater (p < 0.0001) pre- to post-
brushing plaque removal scores (0.72 ± 0.28 and 0.68 ± 0.27)
than brushing with the triclosan dentifrice (0.58 ± 0.25). Brush-
ing with the 48% baking soda dentifrice resulted in 23%
(p < 0.0001) and 21% (p < 0.0001) greater reductions in mean
plaque scores as compared to the triclosan dentifrice and the stan-
nous fluoride/silica dentifrice, respectively. Brushing with the
20% baking soda dentifrice resulted in 17% (p < 0.0001) and
14% (p = 0.0002) greater plaque removal scores as compared to
the triclosan dentifrice and the stannous fluoride/silica denti-
frice, respectively. While the mean plaque reduction score by the
48% baking soda dentifrice was numerically higher than the
20% baking soda dentifrice, the difference in performance be-
tween the two baking soda product groups was not statistically
significant (p = 0.5661).
For each of the facial, lingual, proximal, and gingival surfaces,
mean baseline plaque scores were not statistically significantly
different (p > 0.05). Analyses of mean plaque scores for facial,
lingual, proximal, and gingival surfaces produced similar re-
sults to those of whole mouth plaque scores (Tables III–VI), in
that brushing with the 48% or 20% baking soda dentifrices re-
duced more plaque (i.e., greater reduction in mean plaque scores)
than the triclosan dentifrice and the stannous fluoride/silica den-
tifrice. For example, brushing with the 48% baking soda denti-
frice reduced mean plaque scores by 15% for facial (p < 0.0001),
72% for lingual (p < 0.0001), 30% for proximal (p < 0.0001), and
17% for gingival (p < 0.0001) surfaces when compared to the
triclosan dentifrice. Furthermore, brushing with the 48% baking
soda dentifrice removed more plaque (i.e., greater reduction in
mean plaque scores) than brushing with the stannous fluoride/
silica dentifrice by 17% for facial (p < 0.0001), 42% for lingual
(p = 0.0012), 24% for proximal (p < 0.0001), and 18% for gin-
gival (p < 0.0001) surfaces.
Study 3
A total of 69 subjects qualified for this study, and five subjects
failed to complete the study for non-product-related reasons. Of
64 subjects completing the study, there were 18 males and 46
females, ranging in age from 22 to 68 years (overall mean age
was 41 ± 11 years).
There were no significant statistical differences (p > 0.05) in the
mean baseline whole mouth plaque scores for the four dentifrice
groups (Table II). Within-group analysis showed that brushing
with each of the four dentifrices reduced the average amount of
plaque remaining on the teeth (p < 0.0001). Between-group
Table I
Demographics
Female Male Age Age
N Subjects Subjects (Mean ± SD) Range
Study 1 65 50 15 42 ± 13 18–68
Study 2 66 49 17 40 ± 13 22–81
Study 3 64 46 18 41 ± 11 22–68
Study 4 36 27 9 38 ± 11 19–64
Study 5 41 33 8 42 ± 12 20–64
Vol. XIX, No. 4 The Journal of Clinical Dentistry 5
Table II
Studies 1–5: Whole-Mouth Plaque Results
Within-Group Analysis Between-Group Comparison Analysis
Pre-Brushing Pre- to Post-Brushing Group Greater Plaque
Dentifrice Group N Plaque Score* Reduction* Comparison Reduction Score#Significance
Study #1
A—65% Baking Soda 65 3.16 ± 0.35 0.73 ± 0.26 A vs. C 1.40×; 40% p < 0.0001
B—20% Baking Soda 65 3.18 ± 0.37 0.64 ± 0.26 B vs. C 1.23×; 23% p = 0.0001
C—Triclosan/Copolymer 65 3.16 ± 0.37 0.52 ± 0.20
Study #2
A—48% Baking Soda 66 3.05 ± 0.35 0.72 ± 0.28 A vs. C 1.23×; 23% p < 0.0001
A vs. D 1.21×; 21% p < 0.0001
B—20% Baking Soda 66 3.02 ± 0.36 0.68 ± 0.27 B vs. C 1.17×; 17% p < 0.0001
B vs. D 1.14×; 14% p = 0.0002
C—Triclosan/Copolymer 66 3.03 ± 0.33 0.58 ± 0.25
D—Stannous Fluoride/Silica 66 3.04 ± 0.40 0.59 ± 0.26
Study #3
A—48% Baking Soda 64 3.14 ± 0.31 0.78 ± 0.31 A vs. C 1.27×; 27% p < 0.0001
A vs. D 1.34×; 34% p < 0.0001
B—27% Baking Soda 64 3.15 ± 0.34 0.73 ± 0.32 B vs. C 1.18×; 18% p = 0.0009
B vs. D 1.25×; 25% p = 0.0001
C—Triclosan/Copolymer 64 3.12 ± 0.40 0.62 ± 0.27
D—Sodium Fluoride/Silica 64 3.13 ± 0.34 0.58 ± 0.24
Study #4
A—65% Baking Soda 36 2.94 ± 0.35 0.80 ± 0.31 A vs. B 1.71×; 71% p < 0.0001
B—Sodium Fluoride/Silica Gel 36 2.97 ± 0.34 0.47 ± 0.23
Study #5
A—20% Baking Soda 41 2.28 ± 0.36 1.07 ± 0.38 A vs. B 1.23×; 23% p = 0.0014
B—Triclosan/Copolymer 41 2.25 ± 0.33 0.87 ± 0.37
* Mean ± SD
#Greater plaque reduction score for the baking soda dentifrice is expressed as a ratio and percentage of plaque reduction score for the other dentifrice. A positive value indicates
greater plaque reduction in favor of brushing with baking soda dentifrice as compared to the other dentifrice. Ratio = (baking soda dentifrice mean plaque reduction) / (other
dentifrice mean plaque reduction); % difference in plaque reduction = 100% ×(baking soda dentifrice mean plaque reduction – other dentifrice mean plaque reduction) /
other dentifrice mean plaque reduction.
Table III
Studies 1–5: Facial Surfaces Plaque Results
Within-Group Analysis Between-Group Comparison Analysis
Pre-Brushing Pre- to Post-Brushing Group Greater Plaque
Dentifrice Group N Plaque Score* Reduction* Comparison Reduction Score#Significance
Study #1
A—65% Baking Soda 65 3.28 ± 0.48 1.17 ± 0.44 A vs. C 1.25×; 25% p < 0.0001
B—20% Baking Soda 65 3.29± 0.46 1.07 ± 0.41 B vs. C 1.15×; 15% p = 0.0008
C—Triclosan/Copolymer 65 3.30 ± 0.50 0.93 ± 0.36
Study #2
A—48% Baking Soda 66 3.14 ± 0.51 1.14 ± 0.43 A vs. C 1.17×; 17% p < 0.0001
A vs. D 1.15×; 15% p < 0.0001
B—20% Baking Soda 66 3.12 ± 0.52 1.09 ± 0.44 B vs. C 1.09×; 9% p = 0.0107
B vs. D 1.11×; 11% p = 0.0030
C—triclosan/copolymer 66 3.13 ± 0.51 1.00 ± 0.39
D—Stannous Fluoride/Silica 66 3.13 ± 0.59 0.98 ± 0.43
Study #3
A—48% Baking Soda 64 3.24 ± 0.49 1.29 ± 0.51 A vs. C 1.23×; 23% p < 0.0001
A vs. D 1.25×; 25% p < 0.0001
B—27% Baking Soda 64 3.25 ± 0.55 1.21 ± 0.54 B vs. C 1.15×; 15% p = 0.0064
B vs. D 1.18×; 18% p = 0.0007
C—Triclosan/Copolymer 64 3.20 ± 0.62 1.05 ± 0.44
D—Sodium Fluoride/Silica 64 3.21 ± 0.54 1.03 ± 0.44
Study #4
A—65% Baking Soda 36 3.08 ± 0.51 1.22 ± 0.50 A vs. B 1.51×; 51% p < 0.0001
B—Sodium Fluoride/Silica Gel 36 3.12 ± 0.48 0.81 ± 0.39
Study #5
A—20% Baking Soda 41 2.40 ± 0.52 1.56 ± 0.48 A vs. B 1.16×; 16% p = 0.0102
B—Triclosan/Copolymer 41 2.37 ± 0.47 1.35 ± 0.53
* Mean ± SD
#Greater plaque reduction score for the baking soda dentifrice is expressed as a ratio and percentage of plaque reduction score for the other dentifrice. A positive value indicates
greater plaque reduction in favor of brushing with baking soda dentifrice as compared to the other dentifrice. Ratio = (baking soda dentifrice mean plaque reduction) / (other
dentifrice mean plaque reduction); % difference in plaque reduction = 100% ×(baking soda dentifrice mean plaque reduction – other dentifrice mean plaque reduction) /
other dentifrice mean plaque reduction.
6 The Journal of Clinical Dentistry Vol. XIX, No. 4
Table IV
Studies 1–5: Lingual Surfaces Plaque Results
Within-Group Analysis Between-Group Comparison Analysis
Pre-Brushing Pre- to Post-Brushing Group Greater Plaque
Dentifrice Group N Plaque Score* Reduction* Comparison Reduction Score#Significance
Study #1
A—65% Baking Soda 65 3.04 ± 0.39 0.29 ± 0.18 A vs. C 2.57×; 157% p < 0.0001
B—20% Baking Soda 65 3.06 ± 0.41 0.22 ± 0.21 B vs. C 1.94×; 94% p = 0.0004
C—Triclosan/Copolymer 65 3.02 ± 0.40 0.11 ± 0.17
Study #2
A—48% Baking Soda 66 2.96 ± 0.34 0.29 ± 0.23 A vs. C 1.72×; 72% p < 0.0001
A vs. D 1.42×; 42% p = 0.0012
B—20% Baking Soda 66 2.93 ± 0.35 0.27 ± 0.24 B vs. C 1.59×; 59% p = 0.0001
B vs. D 1.31×; 31% p = 0.0221
C—Triclosan/Copolymer 66 2.94 ± 0.33 0.17 ± 0.18
D—Stannous Fluoride/Silica 66 2.96 ± 0.37 0.20 ± 0.20
Study #3
A—48% Baking Soda 64 3.05 ± 0.32 0.27 ± 0.24 A vs. C 1.49×; 49% p = 0.0011
A vs. D 1.96×; 96% p < 0.0001
B—27% Baking Soda 64 3.04 ± 0.33 0.25 ± 0.23 B vs. C 1.36×; 36% p = 0.0331
B vs. D 1.78×; 78% p < 0.0001
C—Triclosan/Copolymer 64 3.05 ± 0.34 0.18 ± 0.19
D—Sodium Fluoride/Silica 64 3.04 ± 0.33 0.14 ± 0.16
Study #4
A—65% Baking Soda 36 2.80 ± 0.31 0.38 ± 0.22 A vs. B 2.95×; 195% p < 0.0001
B—Sodium Fluoride/Silica Gel 36 2.81 ± 0.29 0.13 ± 0.15
Study #5
A—20% Baking Soda 41 2.16 ± 0.33 0.58 ± 0.46 A vs. B 1.50×; 50% p = 0.0114
B—Triclosan/Copolymer 41 2.13 ± 0.34 0.39 ± 0.39
* Mean ± SD
#Greater plaque reduction score for the baking soda dentifrice is expressed as a ratio and percentage of plaque reduction score for the other dentifrice. A positive value indicates
greater plaque reduction in favor of brushing with baking soda dentifrice as compared to the other dentifrice. Ratio = (baking soda dentifrice mean plaque reduction) / (other
dentifrice mean plaque reduction); % difference in plaque reduction = 100% ×(baking soda dentifrice mean plaque reduction – other dentifrice mean plaque reduction) /
other dentifrice mean plaque reduction.
Table V
Studies 1–5: Proximal Surfaces
Within-Group Analysis Between-Group Comparison Analysis
Pre-Brushing Pre- to Post-Brushing Group Greater Plaque
Dentifrice Group N Plaque Score* Reduction* Comparison Reduction Score#Significance
Study #1
A—65% Baking Soda 65 3.31 ± 0.32 0.56 ± 0.25 A vs. C 1.51×; 51% p < 0.0001
B—20% Baking Soda 65 3.32 ± 0.34 0.49 ± 0.25 B vs. C 1.32×; 32% p < 0.0001
C—Triclosan/Copolymer 65 3,31 ± 0.35 0.37 ± 0.18
Study #2
A—48% Baking Soda 66 3.19 ± 0.33 0.55 ± 0.25 A vs. C 1.30×; 30% p < 0.0001
A vs. D 1.24×; 24% p < 0.0001
B—20% Baking Soda 66 3.18 ± 0.32 0.51 ± 0.23 B vs. C 1.21×; 21% p = 0.0004
B vs. D 1.16×; 16% p = 0.0049
C—Triclosan/Copolymer 66 3.18 ± 0.30 0.43 ± 0.22
D—Stannous Fluoride/Silica 66 3.19 ± 0.37 0.44 ± 0.22
Study #3
A—48% Baking Soda 64 3.29 ± 0.29 0.62 ± 0.31 A vs. C 1.32×; 32% p < 0.0001
A vs. D 1.45×; 45% p < 0.0001
B—27% Baking Soda 64 3.29 ± 0.31 0.58 ± 0.29 B vs. C 1.22×; 22% p = 0.0010
B vs. D 1.35×; 35% p < 0.0001
C—Triclosan/Copolymer 64 3.27 ± 0.37 0.47 ± 0.25
D—Sodium fluoride/silica 64 3.27 ± 0.32 0.43 ± 0.21
Study #4
A—65% Baking Soda 36 3.12 ± 0.32 0.63 ± 0.29 A vs. B 2.04×; 104% p < 0.0001
B—Sodium Fluoride/Silica Gel 36 3.13 ± 0.32 0.31 ± 0.20
Study #5
A—20% Baking Soda 41 2.31 ± 0.35 1.01 ± 0.36 A vs. B 1.25×; 25% p = 0.0007
B—Triclosan/Copolymer 41 2.30 ± 0.30 0.80 ± 0.36
* Mean ± SD
#Greater plaque reduction score for the baking soda dentifrice is expressed as a ratio and percentage of plaque reduction score for the other dentifrice. A positive value indicates
greater plaque reduction in favor of brushing with baking soda dentifrice as compared to the other dentifrice. Ratio = (baking soda dentifrice mean plaque reduction) / (other
dentifrice mean plaque reduction); % difference in plaque reduction = 100% ×(baking soda dentifrice mean plaque reduction – other dentifrice mean plaque reduction) /
other dentifrice mean plaque reduction.
Vol. XIX, No. 4 The Journal of Clinical Dentistry 7
comparisons showed that the reduction in whole mouth mean
plaque scores was greater for the 48% and 27% baking soda den-
tifrices than for the triclosan dentifrice and the sodium fluoride/
silica dentifrice (Table II). Brushing with dentifrices containing
48% and 27% baking soda exhibited 27% (p < 0.0001) and 18%
(p = 0.0009) greater reduction in mean plaque scores, respec-
tively, than the triclosan dentifrice. In addition, brushing with
dentifrices containing 48% and 27% baking soda exhibited 34%
(p < 0.0001) and 25% (p < 0.0001) greater reduction in mean
plaque scores, respectively, as compared to the sodium fluoride/
silica dentifrice. While the average plaque reduction by the den-
tifrice containing 48% baking soda was numerically higher than
the 27% baking soda dentifrice, the difference in performance be-
tween the two baking soda product groups was not statistically
significant (p = 0.1813).
For each of the facial, lingual, proximal, and gingival surfaces,
mean baseline plaque scores were not statistically significantly
different (p > 0.05). Analyses of mean plaque scores for facial,
lingual, proximal, and gingival surfaces produced similar results
as those of whole mouth plaque scores (Tables III –VI), in that
brushing with the 48% or 27% baking soda dentifrices removed
more plaque (i.e., greater reduction in mean plaque scores) than
the triclosan dentifrice and the sodium fluoride/silica dentifrice.
For example, brushing with the 48% baking soda dentifrice re-
duced mean plaque scores by 23% for facial (p < 0.0001), 49%
for lingual (p = 0.0011), 32% for proximal (p < 0.0001), and 21%
for gingival (p < 0.0001) surfaces when compared to the triclosan
dentifrice. Furthermore, brushing with the 48% baking soda
dentifrice removed more plaque (i.e., greater reduction in mean
plaque scores) than brushing with the sodium fluoride/silica
dentifrice by 25% for facial (p < 0.0001), 96% for lingual
(p < 0.0001), 45% for proximal (p < 0.0001), and 22% for gin-
gival (p < 0.0001) surfaces. Similar results were obtained in
favor of the 27% baking soda dentifrice when compared to the
triclosan or the sodium fluoride/silica dentifrice.
Study 4
A total of 36 subjects qualified for this study, and all of these
subjects completed the study. Of 36 subjects, there were 9 males
and 27 females, ranging in age from 19 years to 64 years (over-
all mean age 38 ± 11 years).
There was no significant statistical difference (p > 0.05) in the
mean baseline whole mouth plaque scores for the two groups
(Table II). Within-group analysis showed that brushing with
each of the two dentifrices reduced the average amount of plaque
left on the teeth (p < 0.0001). The pre- to post-brushing plaque
reduction for the 65% baking soda dentifrice (0.80 ± 0.31) was
significantly (p < 0.0001) greater than that for the sodium fluoride/
silica gel dentifrice (0.47 ± 0.23). Between-group comparisons
showed that brushing with the 65% baking soda dentifrice re-
sulted in a 71% greater plaque removal score than brushing with
the sodium fluoride/silica gel dentifrice.
For each of the facial, lingual, proximal, and gingival surfaces,
mean baseline plaque scores were not statistically significantly
different (p > 0.05). Analysis of mean plaque scores for facial,
lingual, proximal, and gingival surfaces produced similar
Table VI
Studies 1–5: Gingival Surfaces
Within-Group Analysis Between-Group Comparison Analysis
Pre-Brushing Pre- to Post-Brushing Group Greater Plaque
Dentifrice Group N Plaque Score* Reduction* Comparison Reduction Score#Significance
Study #1
A—65% Baking Soda 65 2.86 ± 0.43 1.07 ± 0.38 A vs. C 1.30×; 30% p < 0.0001
B—20% Baking Soda 65 2.89 ± 0.43 0.95 ± 0.38 B vs. C 1.15×; 15% p = 0.0166
C—Triclosan/Copolymer 65 2.86 ± 0.43 0.83 ± 0.33
Study #2
A—48% Baking Soda 66 2.76 ± 0.41 1.05 ± 0.41 A vs. C 1.17×; 17% p < 0.0001
A vs. D 1.18×; 18% p < 0.0001
B—20% Baking Soda 66 2.72 ± 0.49 1.00 ± 0.41 B vs. C 1.12×; 12% p = 0.0002
B vs. D 1.13×; 13% p < 0.0001
C—Triclosan/Copolymer 66 2.74 ± 0.43 0.89 ± 0.38
D—Stannous Fluoride/Silica 66 2.74 ± 0.48 0.89 ± 0.40
Study #3
A—48% Baking Soda 64 2.86 ± 0.38 1.10 ± 0.37 A vs. C 1.21×; 21% p < 0.0001
A vs. D 1.22×; 22% p < 0.0001
B—27% Baking Soda 64 2.86 ± 0.43 1.04 ± 0.46 B vs. C 1.14×; 14% p = 0.0056
B vs. D 1.15×; 15% p = 0.0008
C—Triclosan/Copolymer 64 2.83 ± 0.47 0.91 ± 0.37
D—Sodium Fluoride/Silica 64 2.84 ± 0.41 0.90 ± 0.36
Study #4
A—65% Baking Soda 36 2.58 ± 0.45 1.13 ± 0.43 A vs. B 1.45×; 45% p < 0.0001
B—Sodium Fluoride/Silica Gel 36 2.64 ± 0.40 0.78 ± 0.36
Study #5
A—20% Baking Soda 41 2.20 ± 0.39 1.20 ± 0.44 A vs. B 1.20×; 20% p = 0.0069
B—Triclosan/Copolymer 41 2.16 ± 0.40 1.00 ± 0.42
* Mean ± SD
#Greater plaque reduction score for the baking soda dentifrice is expressed as a ratio and percentage of plaque reduction score for the other dentifrice. A positive value indicates
greater plaque reduction in favor of brushing with baking soda dentifrice as compared to the other dentifrice. Ratio = (baking soda dentifrice mean plaque reduction) / (other
dentifrice mean plaque reduction); % difference in plaque reduction = 100% ×(baking soda dentifrice mean plaque reduction – other dentifrice mean plaque reduction) /
other dentifrice mean plaque reduction.
8 The Journal of Clinical Dentistry Vol. XIX, No. 4
results as those of whole mouth plaque scores (Tables III–VI),
in that brushing with the 65% baking soda dentifrice removed
more plaque (i.e., greater reduction in mean plaque scores)
than the sodium fluoride/silica gel dentifrice by 51% for facial
(p < 0.0001), 195% for lingual (p < 0.0001), 104% for proximal
(p < 0.0001), and 45% for gingival (p < 0.0001) sites.
Study 5
The fifth study was conducted at a different study site with a
different examiner from the above four studies. A total of 45 sub-
jects qualified for this study, and 4 subjects discontinued for
non-product-related reasons. Of the 41 subjects in the study,
there were 8 males and 33 females, ranging in age from 20 years
to 64 years (overall mean age 42 ± 12 years).
There were no significant statistical differences (p > 0.05) in
the baseline mean whole mouth plaque scores for the 20% baking
soda dentifrice group and the triclosan dentifrice group (Table II).
Within-group analysis showed that brushing with each of the
two dentifrices reduced the average amount of plaque remaining
on the teeth (p < 0.0001). Brushing with the 20% baking soda
dentifrice resulted in pre- to post-brushing plaque reduction of
1.07 ± 0.38, compared with a reduction of 0.87 ± 0.37 for the
triclosan dentifrice. The 20% baking soda dentifrice was asso-
ciated with 23% greater whole mouth plaque removal score as
compared to the triclosan dentifrice (p = 0.0014).
For each of the facial, lingual, proximal, and gingival surfaces,
mean baseline plaque scores were not statistically significantly
different (p > 0.05). Analysis of mean plaque scores for facial,
lingual, proximal, and gingival surfaces exhibited similar re-
sults as those of whole mouth plaque scores (Tables III–VI), in
that brushing with the 20% baking soda dentifrice removed more
plaque (i.e., greater reduction in mean plaque scores) than the
triclosan dentifrice, by 16% for facial (p = 0.0102 ), 50% for
lingual (p = 0.0114), 25% for proximal (p = 0.0007), and 20%
for gingival (p = 0.0069) surfaces.
Discussion
Five separate, controlled, crossover clinical studies consistently
demonstrated a significant benefit for baking soda dentifrices in
enhancing the physical removal of plaque biofilm by tooth brush-
ing as compared to commercial dentifrices without baking
soda. In all five studies, every dentifrice significantly reduced
24-hour whole mouth mean plaque scores following a single one-
minute supervised tooth brushing. Between-group comparisons
of whole mouth plaque scores in all five studies demonstrated
that brushing with dentifrices containing from 20% to 65%
baking soda resulted in greater plaque removal (i.e., greater re-
ductions in mean plaque scores) than brushing with other com-
mercial dentifrices that did not contain baking soda. Analysis of
plaque scores according to tooth surfaces and sites for each
study resulted in the same relationships between dentifrices as
observed for whole mouth scores, in which brushing with baking
soda dentifrices produced statistically significantly greater plaque
removal (i.e., greater reduction in mean plaque scores) than
brushing with non-baking soda dentifrices. In the three studies
(Studies 1–3) which also compared different levels of baking
soda, the results may suggest a positive relationship between
baking soda concentration and greater plaque reduction scores.
Also, it is noteworthy that Study 5 (which was conducted at a dif-
ferent site with a different examiner) confirmed the results of
Studies 1 and 2, wherein the same 20% baking soda dentifrice
demonstrated statistically significantly greater reductions in
plaque scores than the triclosan dentifrice. In fact, all three studies
provided similar plaque reduction scores, ranging from 17% to
23% for the whole mouth data.
The five studies confirm the findings of Mankodi, et al., who
demonstrated higher plaque removal from a dentifrice containing
65% baking soda over two baking soda-free dentifrices.18 In a sep-
arate comparison of three dentifrices containing baking soda,
Mankodi, et al. also seemed to detect a positive relationship be-
tween baking soda concentration and enhanced plaque removal
by brushing.18 In our studies, a significant dose-dependent effect
for baking soda in the removal of plaque was also found in one
of these comparisons (Study 1). In others, while the dentifrices
containing the highest levels of baking soda consistently removed
greater quantities of plaque than those with lower baking soda
concentration, those differences were not statistically significant.
It is unlikely that baking soda’s mechanism of action is based
on an antimicrobial activity. First, baking soda has relatively
weak antibacterial properties, and it is slow acting.19 Since baking
soda is highly soluble, it is not present in the mouth for long
enough at sufficient concentrations to reduce bacterial counts.
Furthermore, the single brushing technique used in these stud-
ies does not allow for the detection of plaque growth inhibitory
effects which would result from the use of a bactericide.
We propose three possible reasons for baking soda’s effect on
plaque. A first possible explanation is that baking soda’s crystals
are much larger than the conventional abrasive particles used in
other dentifrices. While the baking soda crystals are considerably
softer and potentially less damaging to tooth mineral, these
larger crystals may physically help the toothbrush displace the
soft sticky plaque from the tooth surface. Secondly, plaque con-
sists primarily of bacteria in a polysaccharide matrix.25 The vis-
cosity of many polymer-thickened gels is often affected by ionic
strength and pH. It is conceivable that baking soda dissolves in
plaque fluid and has a physical affect on the structure of this
adherent material, reducing its viscosity and adhesiveness/
|cohesiveness, and making it easier to remove by the toothbrush.
Rose, et al. proposed a role for fluoride in removing plaque from
teeth, suggesting that fluoride breaks calcium bonds between
adhering strains of bacteria and between bacteria and pellicle
surfaces.26 Busscher, et al. confirmed that sodium fluoride and
sodium lauryl sulfate from dentifrices stimulate bacterial
detachment from pellicle surfaces.27 Therefore, a third possible
explanation for baking soda’s effectiveness in promoting plaque
removal is that bicarbonate ions from baking soda play a similar
bond-breaking role by their detersive action, disrupting bacter-
ial attachment and possibly sequestering the calcium as calcium
carbonate. Carbon dioxide gas would be produced in the process,
which might further help loosen plaque. If this mechanism is cor-
rect, superior plaque removal could result from the relatively high
concentrations of baking soda present in the dentifrices used in
these studies, compared to the small amounts of sodium fluoride
and sodium lauryl sulfate present in baking soda-free dentifrices.
Vol. XIX, No. 4 The Journal of Clinical Dentistry 9
Collective data from five controlled clinical studies in over 270
subjects consistently demonstrate that baking soda dentifrices en-
hanced plaque removal efficacy of tooth brushing by exhibiting
significantly greater reduction in plaque scores compared to
tooth brushing with the baking soda-free dentifrices. Future
studies should focus on plaque reduction and control efficacy of
baking soda dentifrices under uncontrolled daily brushing home-
use conditions, and evaluate their potential for helping to enhance
the reduction and control of gingival inflammation.
Acknowledgment: This study was supported by the Church & Dwight Company.
For further correspondence with the author(s) of this paper,
contact Dr. Annahita Ghassemi—annahita.ghassemi@
churchdwight.com.
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... Details are provided in Table 4. However, a key difference between BS and common abrasives is the size of the particles (49). In the case of BS crystals, the particles are notably larger, softer and potentially less damaging to tooth mineral than the conventional abrasive particles in other dentifrices. ...
... In the case of BS crystals, the particles are notably larger, softer and potentially less damaging to tooth mineral than the conventional abrasive particles in other dentifrices. This size could play a role in disturbing the adhesion of plaque to the tooth surface, in addition to the force exerted by the toothbrush (49). The dissolved bicarbonate ions in BS are thought to bind with calcium ions, disrupting ...
... Although these proposed mechanisms are promising, BS is known to be easily soluble and slow-acting. Therefore, it is unlikely to reside long enough in the mouth to actually inhibit plaque growth (49,(86)(87)(88). ...
Article
Full-text available
Aim To test the efficacy of a dentifrice containing baking soda (BS), compared with dentifrice without BS for controlling plaque and gingivitis. Materials and Methods MEDLINE‐PubMed, and Cochrane‐CENTRAL were searched. The inclusion criteria were randomized controlled clinical trials including healthy participants aged 18 years or older. Studies were selected that compared the effect of toothbrushing with a dentifrice with and without BS on the clinical parameters of plaque and gingivitis. Data were extracted from the selected studies and a meta‐analysis was performed. Results The search retrieved 21 eligible publications. Among these papers, 43 comparisons were provided, with 23 involving a single‐use design and 20 being evaluations with a follow‐up. Negative controls were found, or positive controls for which various active ingredients had been used. The included studies showed a moderate overall potential risk of bias and considerable heterogeneity. The meta‐analysis of plaque scores from the single‐brushing experiments showed that BS dentifrice (BS‐DF) was associated with significantly better outcomes than the negative control dentifrices (DiffM ‐0.20; p<0.0001; 95%CI: [‐0.27; ‐0.12]) or the positive control dentifrices (DiffM ‐0.18; p<0.0001;95%CI: [‐0.24; ‐0.12]). This finding was only confirmed in studies that used a follow‐up design as compared to a negative control (DiffM ‐0.19; p=0.01; 95%CI:[‐0.34; ‐0.04]). The indices of gingival bleeding also improved when the comparison was a negative control (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, for the gingival index scores, the meta‐analysis did not reveal any significant differences. Conclusion BS‐DF showed promising results with respect to plaque removal in single‐use studies. However, the finding was partially substantiated in follow‐up studies. Studies that assessed bleeding scores indicated that a small reduction can be expected from BS, relative to a control product. This article is protected by copyright. All rights reserved.
... Regarding brushing with baking soda (Sodium bicarbonate), studies reported that it could effectively enhance plaque removal and improve gingival health. [33][34][35][36] In addition, it was reported that fluoridated toothpaste containing baking soda to be more effective than fluoridated toothpaste alone in reducing gingival inflammation, bleeding, and plaque removal. [33][34][35][36] Salt and water fluoridation were reported to be one of the community-level modalities of caries prevention for children. ...
... [33][34][35][36] In addition, it was reported that fluoridated toothpaste containing baking soda to be more effective than fluoridated toothpaste alone in reducing gingival inflammation, bleeding, and plaque removal. [33][34][35][36] Salt and water fluoridation were reported to be one of the community-level modalities of caries prevention for children. However, using either water or salt fluoridation was recommended to minimize dental fluorosis risk in children under the age of eight with developing teeth. ...
Article
Full-text available
Purpose: To evaluate and compare the attitude, practice, and knowledge of individuals who use fluoridated and non-fluoridated toothpaste in Jeddah city, Saudi Arabia. Methods: A digital questionnaire composed of 43 questions were formulated. The questionnaire was divided into five sections: eligibility questions, demographic data, attitude, practice, and knowledge. Content and face validation were done, and convenience sampling was used. The inclusion criteria were any citizen and resident who lives in Jeddah city, Saudi Arabia. Descriptive statistics, Chi-square, and Fischer's tests were conducted to compare fluoridated and non-fluoridated toothpaste users (α=0.05). Results: A total of 473 completed participants' responses were collected. Attitude: 41.8% of fluoridated toothpaste users reported that it was "very important" to rinse to remove the toothpaste compared to non-fluoridated toothpaste users (58.3%) (P-value<0.001). Healthy teeth were the most important to fluoridated toothpaste users (69.1%) (P <0.001). Practice: 28.6% of non-fluoridated toothpaste users have been using non-fluoridated toothpaste for >1 year, and 35.7% of them <2 years. 73.8% of fluoridated toothpaste users used whitening toothpaste. Significantly higher non-fluoridated toothpaste users (29%) used organic toothpaste (P<0.001). Knowledge: 57% of fluoridated toothpaste users believed that a good diet, tooth brushing, and fluoridated toothpaste are important to prevent caries, and the fluoride would strengthen the teeth (P<0.001). Approximately 60% of non-fluoridated toothpaste users did not know the proper age to start using fluoridated toothpaste (P<0.001). Also, 47.6% of non-fluoridated toothpaste users avoid using fluoride because it is toxic. Conclusion: Significantly higher number of Jeddah residents that used fluoridated toothpaste had a better attitude and knowledge than non-fluoridated toothpaste users. Nonetheless, most residents had similar oral hygiene practices. It is suggested to execute educational campaigns to explain the importance of fluoridated toothpaste to the population. Also, individuals should take caution from the source of obtaining their dental information and consult their dentist.
... 3 Sodium bicarbonate (NaHCO 3 ; baking soda) is a cleansing agent with mildly abrasive properties that has been used for tooth cleaning for decades. 4 NaHCO 3 is hypothesized to physically disrupt tooth surface plaque biofilm 5,6 and enhance biofilm dispersion 7 to allow for more effective cleaning during tooth brushing. Clinical studies performed since the 1980s have repeatedly shown that regular use of toothpastes containing relatively high levels of NaHCO 3 [> 60% weight by weight (w/w)] effectively removes plaque and improves measures of gingival health. ...
... The use of NaHCO 3 -based toothpastes has been shown to reduce plaque build-up with greater efficacy than those without NaHCO 3 5,6,9 -12,15-17 or bacteriostatic/bactericidal ingredients. 6,9,18,19 These reductions in plaque have generally been mirrored by improvements in gingival bleeding, [10][11][12] indicating an improvement in overall gum health. 8 This proof-of-principle clinical study was designed to explore the dose response of different concentrations of NaHCO 3 -containing toothpastes, as investigated by a single brushing plaque removal model. ...
Article
Objectives: This randomized, examiner-blind, crossover clinical study compared the plaque removal efficacy of three experimental toothpastes containing 20%, 35%, and 50% w/w sodium bicarbonate (NaHCO3) with commercial toothpastes containing 67% and 0% w/w NaHCO3 (positive and negative controls, respectively). Methods: Fifty-six adults with a mean Turesky Modification of the Quigley-Hein Plaque Index (TPI) score of = 2.00 at screening and at the first treatment visit (pre-brushing) were randomized to a supervised single, timed (one minute) brushing with a 0%, 20%, 35%, 50%, or 67% w/w NaHCO3-containingtoothpaste. TPI was measured pre- and post-brushing. Participants completed five treatment visits, separated by a four- to six-day washout, and brushed once with each toothpaste. The primary efficacy analysis was change in whole mouth TPI score from pre- to post-brushing between the positive and negative control toothpastes (validation step). Secondary analyses were comparisons between each experimental toothpaste and the control toothpastes. Change in TPI score was analyzed using a mixed effect analysis of covariance. Results: The difference in adjusted mean TPI change from pre- to post-brushing between the 67% and 0% w/w NaHCO3 toothpastes was -0.01 points (95% CI -0.06, 0.04), with no statistically significant difference between them (p = 0.6674). As such, study validity was not attained. Differences in adjusted mean change from pre- to post-brushing between each experimental toothpaste and the positive and negative controls ranged from 0.00 to -0.02 points. Twenty-two treatment-emergent, treatment-related adverse events, all oral, were reported by 17 participants (30.4%). These were spread uniformly across test toothpastes and controls. No serious adverse events were reported. Conclusions: There was no statistically significant difference in change in mean TPI score between toothpastes containing 67% w/w NaHCO3 and 0% w/w NaHCO3 following a single timed brushing. This unexpected observation may be attributed to lower than expected reduction in overall plaque and a possible Hawthorne effect. As study validation was not met, no further conclusions can be made. The study products were generally well tolerated.
... In smokers the similar treatment reduced levels of the inflammatory biomarker IL-1β [376]. NaHCO3containing dentifrices have been shown to be effective at neutralizing plaque pH [389], enhancing plaque removal [390], and inhibiting formation of caries [391]. pH-stabilizing resins used in restorative dentistry have also been suggested to be useful cariostatic by releasing OH - [392]. ...
Article
Baking soda and vinegar have been used as home remedies for generations and today we are only a mouse-click away from claims that baking soda, lemon juice, and apple cider vinegar are miracles cures for everything from cancer to COVID-19. Despite these specious claims, the therapeutic value of controlling acid-base balance is indisputable and is the basis of Food and Drug Administration-approved treatments for constipation, epilepsy, metabolic acidosis, and peptic ulcers. In this narrative review, we present evidence in support of the current and potential therapeutic value of countering local and systemic acid-base imbalances, several of which do in fact involve the administration of baking soda (sodium bicarbonate). Furthermore, we discuss the side effects of pharmaceuticals on acid-base balance as well as the influence of acid-base status on pharmacokinetic properties of drugs. Our review considers all major organs systems as well as information relevant to several clinical specialties such as anesthesiology, infectious disease, oncology, dentistry, and surgery.
... 68 Baking soda crystals are notably large but soft and potentially less damaging to tooth minerals than conventional dentifrice abrasives. 69 A major complaint from patients when brushing with a baking soda containing-dentifrice was the unpleasant taste. 62 ...
Article
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It is well established that dental plaque on teeth leads to gingivitis and periodontitis, and that several mechanical and chemical methods of plaque control can prevent gingivitis. The aim of the current review is to summarize and synthesize the available scientific evidence supporting practices for mechanical oral hygiene to prevent periodontal diseases. Evidence for contemporary practices of mechanical oral hygiene to prevent periodontal disease relies on studies of gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, toothbrushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen.
... Hal ini dikarenakan struktur kristal baking soda yang bersifat besar dan lembut, sehingga efektif dalam melepaskan lapisan lengket plak dari permukaan gigi dan tidak terlalu merusak permukaan gigi. . (Putt M,et all, 2008) Baking soda merupakan salah satu bahan yang dapat mencegah karies selain fluor, karena baking soda memiliki sifat alkali atau menetralkan asam, sehingga dapat menetralkan asam yang diproduksi bakteri plak. Baking soda juga dapat menetralkan kondisi lingkungan asam bakteri rongga mulut. ...
Article
Full-text available
Baking soda memiliki sifat alkali yang dapat menetralkan pH rongga mulut sehingga dapat menghambat proses metabolisme bakteri yang menghasilkan asam. Selain itu memiliki kemampuan mempengaruhi tekanan osmotik. Sifat hipertonik dari baking soda menyebabkan hipotonik sel bakteri kehilangan air, sehingga sel akan dehidrasi dan akhirnya dapat membunuh sel bakteri. Penelitian ini bertujuan untuk mengetahui daya hambat larutan baking soda konsentrasi 70% terhadap bakteri Streptococcus mutans (In vitro, merupakan penelitian eksperimental murni kelompok perlakuan dan control group design. Pembuatan larutan baking soda 70% dan bakteri Streptococcus mutans diperoleh di Research Center Fakultas Kedokteran Gigi Universitas Airlangga. Paper disk yang berisi baking soda 70% dimasukkan oven sampai kering, control(+) Chlorhexedine 0,2% dan control(-) Aquades diinkubasi 37˚C selama 24 jam, zona yang terbentuk disekeliling paper disk diukur diameternya dalam mm. Data dikumpulkan dilakukan uji normalitas dan di cari rata-rata serta SD, dianalisa menggunakan uji T independen. Hasil penelitian terlihat rata-rata diameter zona bening menunjukkan daya hambatnya masih belum melebihi kelompok kontrol positif dimana rata-rata kelompok perlakuan 14,21mm sedang kelompok kontrol angka rata-rata 19,42mm. Berdasarkan hasil penelitian ini disimpulkan ada perbedaan daya hambat yang terbentuk pada lempeng agar perbenihan streptococcus mutans. Diharapkan bisa dimanfaatkan sebagai bahan antibakteri untuk mencegah karies gigi dengan pemakaian baking soda yang murah,mudah didapatkan oleh masyarakat, baik berupa kumur-kumur dan diolesan ke permukaan gigi, maupun sebagai bahan tambahan dalam pasta gigi. Kata kunci : Bakingsoda 70%, streptococcus mutans
Article
Objective: The objective of this study was to investigate the antigingivitis and antiplaque treatment effect of a toothpaste containing 67% w/w sodium bicarbonate, at the individual tooth site, tooth region and whole mouth (overall) level, by way of a pooled analysis of data from similarly designed clinical trials. Methods: Six randomized controlled GSKCH clinical trials, 12 to 24 weeks in duration, were selected based on pre-specified criteria which included access to patient level data, pre-treatment dental prophylaxis, >20 bleeding sites and mild-moderate gingivitis at screening and use of 67% sodium bicarbonate toothpaste and non-sodium bicarbonate (regular) toothpaste (negative control) for ≥4 weeks. Efficacy outcomes comprised plaque index (TPI), modified gingival index (MGI) and gingival bleeding (bleeding index (BI), number of bleeding sites (BS)). Treatment comparisons were made using ANCOVA for whole mouth (overall) scores and by tooth site region (facial overall, lingual overall; margin/body overall, facial margin/body, lingual margin/body; papillae/interproximal overall, facial papillae/interproximal, lingual papillae/interproximal). Pooled data for BI, MGI, and TPI at individual tooth sites was plotted as a mouthmap to summarise treatment response (change from baseline) by tooth site, at the 24-week timepoint. Results: For all measures, whole mouth and for all tooth regions at all post-treatment timepoints, significant (p<0.001) differences in favor of the 67% sodium bicarbonate toothpaste compared to control were observed. At the 24-week timepoint, facial regions demonstrated greater improvements than lingual regions, with the greatest between treatment improvement seen for the facial-papillae regions for bleeding (BS/BI), facial-margin regions for MGI and facial-body regions for TPI. All individual tooth sites demonstrated numerically greater reductions from baseline for the 67% sodium bicarbonate toothpaste than the control toothpaste following 24 weeks use, with the greatest improvements (change from baseline) seen for posterior and papillae tooth sites for bleeding, margin tooth sites for MGI and body tooth sites for TPI. Conclusion: This pooled analysis of patient level-data, limited to GSKCH long-term gingivitis clinical studies, demonstrates that twice daily use of a 67% sodium bicarbonate toothpaste effectively removes plaque from all tooth sites, and results in clinically significant improvements in measures of gingival health, overall and for all the tooth regions investigated, compared to a non-sodium bicarbonate (regular) toothpaste following 24 weeks twice daily use.
Article
Objective : Previous studies demonstrated a dose-dependent efficacy of sodium bicarbonate when added to dentifrices for the mechanical control of dental biofilm. The present systematic review and meta-analysis aimed to evaluate the efficacy of a 67% sodium bicarbonate-based toothpaste for gingival health parameters improvement in subjects with gingivitis. Materials and methods : An electronic search on MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), was performed using a combination of keywords, followed by a hand search on pertinent Journals. Randomized controlled trials (RCTs) and prospective comparative studies in English language were included. There was no publication date and language restriction. The data regarding gingival, bleeding and plaque index were extracted from the selected studies. Included studies underwent risk-of-bias assessment. When at least three studies reporting the same outcome were found, a meta‐analysis was undertaken, to estimate the combined effect. Trial Sequential Analysis (TSA) was also performed to evaluate the power of the meta-analysis for primary outcomes. Results : The search strategy yielded 83 articles. After screening, seven RCTs were included. Three were at high risk, one at moderate risk, and three at low risk-of-bias. Significant improvement of gingival index, bleeding index, and plaque index was observed in patients using 67% sodium bicarbonate toothpaste as compared with control subjects. TSA showed sufficient power for modified Gingival index and bleeding scores. Conclusions : The clinical use of 67% sodium bicarbonate toothpaste can improve periodontal health in patients with gingivitis.
Article
The aim of the study: Was to evaluate the clinical efficacy of parodontax Comprehensive Protection (GlaxoSmithKline, London, UK) toothpaste in the complex therapy of chronic gingivitis. Materials and methods: The study involved 119 volunteers; group 1 (n=59, age range 18 to 32 years) and group 2 (n=60, age range 20 to 35 years) with a diagnosis of chronic gingivitis (K05.1). The criterion for inclusion in the study was sulcus bleeding index (SBI) more than 1 point. Dental examination included SBI, papillary-marginal-alveolar index (PMA), and Green-Vermillion oral hygiene index (OHI-S). After determining the indices, all patients underwent professional oral hygiene and controlled tooth cleaning. Patients in group 1 (parodontax) were prescribed parodontax Comprehensive Protection toothpaste (GlaxoSmithKline, London, UK), patients in group 2 - a toothpaste that did not contain sodium bicarbonate. Repeated clinical examinations with the determination of the SBI, PMA, OHI-S were carried out after week 2 and 4. Results: After 4 weeks, SBI scores in group 1 were 63% lower than at baseline, and in group 2 - by 30%. PMA values at 4 weeks in group 1 were 58% and in group 2 30% lower, compared to baseline levels. The results of the analysis of the OHI-S index showed a statistically significant decrease in group 1 by 75%, while in group 2 by only 8% from the initial values. The difference in all index values between groups at 4 weeks of the study was statistically significant (p<0.05). Conclusion: The use of parodontax Comprehensive Protection Toothpaste (GlaxoSmithKline, London, UK) has been shown to reduce the clinical signs of biofilm-associated gingivitis and effectively maintain optimal oral hygiene in patients.
Article
Since the mid-20th century, a great deal of research and development has been directed to improve the quality, effectiveness and functionality of toothpastes. This review considers the technological advances and scientific background to the development of dentifrices for a variety of expressed different purposes, from caries reduction through incorporation of fluoride, through periodontal disease prevention by use of anti-microbials to tooth whitening, breath freshening and reducing hypersensitivity and calculus formation.
Article
Dental plaque growth was observed among 180 teenage boys during a 28-day period following prophylaxis. During this period, subjects brushed their teeth under supervision for 2 minutes daily. Plaque levels were measured immediately after brushing and 24 hours after brushing. Both levels increased rapidly during the first 14 days and appeared to be leveled off at 28 days. Less than half of the plaque was removed with one brushing per day leaving about 60% after brushing to promote rapid regrowth. Regrowth rate after brushing on the 28th day was 0.032 plaque units per hour over a 24-hour period. The regrowth rate for the group brushing with dentifrice was 27% lower than for the group brushing without a dentifrice.
Article
The purpose of this trial was to compare the plaque removal effectiveness of professional toothbrushing with dentifrice and with only water. Fifty three subjects were divided into a dentifrice and a water group. Both groups had their teeth professionally brushed for one minute using either dentifrice or water. Plaque scores were recorded before and immediately after brushing. The results of this trial show that toothbrushing with dentifrice was more effective in removing plaque compared to brushing with water alone. The amount of plaque reduction was low, and varied with tooth surfaces. The mid buccal surface had the greatest reduction of plaque. No significant differences were observed on the distobuccal and distolingual surfaces when the dentifrice group was compared with the water group.
Article
Antimicrobial agents have been proposed as playing an important role in controlling plaque and gingivitis. Unfortunately, a large number of potential compounds are unsuitable for use in dentifrices because they lack "substantivity", produce undesirable side-effects, or are incompatible with toothpaste ingredients. New agents that have been successfully incorporated into dentifrices include plant extracts, phenolic compounds and metal salts. Several products are currently being based on the phenol, Triclosan. Triclosan has a broad spectrum of antimicrobial activity against yeasts and oral bacteria. To enhance its clinical efficacy, Triclosan has been combined either with a co-polymer or with another compatible antimicrobial agent, zinc citrate. The co-polymer acts to increase the oral retention of Triclosan, and has resulted in further reductions in salivary bacterial counts in vivo. Zinc salts also have antimicrobial activity, and at low concentrations, can inhibit glycolysis and bacterial proteases. In mixed culture chemostat studies, Triclosan selectively inhibited Gram-negative periodontopathic bacteria; additive effects were obtained when zinc citrate and Triclosan were combined. In an experimental human gingivitis study, a zinc citrate/Triclosan dentifrice reduced plaque accumulation and gingivitis compared to a placebo paste; the ratio of anaerobic/aerobic bacteria and the proportions of Actinomyces species in plaque were also reduced. The prolonged use of a zinc citrate/Triclosan dentifrice neither significantly altered the ecology of supragingival plaque nor led to the selection of Triclosan-resistant bacteria. The data suggest that dentifrices containing new antimicrobial agents could be of clinical relevance in the prevention and control of plaque and gingivitis.
Article
Organisms representative of soil, skin and fecal flora and of supragingival and subgingival flora were tested for inhibition of growth and killing by various salts (NaHCO3, NaCl, MgSO4). The antimicrobial activities of KHCO3, NaF, sodium lauryl sulfate (SLS) and chloramine T were also compared with that of NaHCO3, and the rate at which NaHCO3 exerts its bactericidal effect was studied. Suspected periodontal pathogens were more susceptible to salts than were control non-oral bacteria. Supragingival plaque organisms showed intermediate susceptibility. Periodontal pathogens were more susceptible to NaHCO3 than to NaCl; NaHCO3 and KHCO3 showed similar activity against all strains tested. Accordingly, the antibacterial activity of NaHCO3 is not simply an osmotic effect and is due to the bicarbonate ion. NaF, SLS and chloramine T had greater antimicrobial activity than NaHCO3. Supragingival bacteria required at least 6-hour exposure to 1.0 M NaHCO3 to produce 99% lethality (decrease colony-forming units by 2 log10), whereas selected periodontal pathogens were killed more rapidly (30-120 minutes). The higher the concentration of bicarbonate, the faster the lethality. Morphologic examination by transmission electron microscopy of organisms exposed to bactericidal salt concentrations revealed marked fibrillar condensations within the cytoplasm and shrinkage of the cytoplasm from the outer membrane. For NaHCO3 to be clinically effective, a high concentration must be introduced into the periodontal pocket and maintained there long enough to kill periodontal pathogens. Furthermore, NaHCO3 must be reapplied often enough to prevent recolonization by these pathogens. An advantage of NaHCO3 over NaF, SLS and other antimicrobial agents is its safety, availability and low cost.
Article
This clinical trial was primarily designed to determine to what extent the stiffness of toothbrush bristles and the abrasiveness of dentifrices influence the degree of gingival erosion. Further, the plaque removing effectiveness of the toothbrushes and dentifrices tested was evaluated. 24 dental hygienist students with clinically healthy gingivae volunteered for the study. A “soft” toothbrush with a bristle thickness of 0.15 mm, a “hard” toothbrush with a bristle thickness of 0.23 mm and 2 dentifrices of different abrasiveness were used for the experiment. The 2 brushes were also used without a dentifrice. Prior to each examination the teeth of the test subjects were brushed by the same dental hygienist. Evident signs of laceration or ulceration at any 1 of 4 gingival aspects of each tooth were recorded as brushing injuries. The teeth were then stained with basic fuchsin and the amount of remaining plaque was assessed according to the PLQ Index (Bay & Ainamo 1974). The use of the hard brush resulted in lower plaque scores and, at the same lime, more gingival erosions than the use of the soft brush. With both brushes a significantly greater number of lesions was recorded after use of an abrasive powder than when no dentifrice was employed. The difference in the amount of erosions occurring when utilizing either brush, without a dentifrice or with a moderately abrasive toothpaste, was not, however, found to be statistically significant. When assessed separately for the 2 brushes, the slight tendency towards lower PLQ scores with increasing abrasiveness of the dentifrice was not considered statistically significant. The study showed that the modest decrease observed in mean PLQ scores with increasing stiffness of the toothbrush bristles and with increasing abrasiveness of the dentifrice is accompanied by increased damage caused to the soft gingival tissues.