Commentary

This 5-year, doubly blind, stratified, randomised and unsupervised trial demonstrates the benefit of the triclosan copolymer toothpaste in both the general population and patients at risk for, or with, periodontal disease (both numbers-needed-to-treat (NNT), approx. 100; see below).

Two points are remarkable here. First, classical studies indicate that in patients who have periodontal disease, only routine maintenance can slow or prevent progression. Yet here, there is a reduction in progression without maintenance. The second point revolves around the measure of benefit and value. Specifically, the study indicates that over the 5-year period about 40% of subjects in both groups displayed attachment loss — not necessarily a good outcome, but the subjects were unsupervised. On the positive side, there is approximately a 1% difference between the test and control subjects (NNT, approx. 100), a good outcome, supporting the benefit of the toothpaste.

For subjects who initially already had periodontal disease (4 sites with an initial PPD of 3.5 mm) there were also benefits. As was the case looking at subjects, the proportion of sites that had progression of periodontal disease also increased over time, with about a 0.5% difference between the test and control sites (NNT, about 200) — again supporting the benefit of toothpaste.

How might one apply these data to patient care? The NNT for subjects was around 100. In other words, 100 patients would need to be treated with the test toothpaste for one patient to benefit, compared with use of control toothpaste. Since the test toothpaste certainly reduces periodontal risk, if the costs of the toothpastes are similar, why not use it, as no harms have been reported? On the other hand, if the test toothpaste was significantly more expensive, then one might question its value compared with professional care.