02 May 2023

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Randomized clinical trial on the effects of a toothpaste containing extra virgin olive oil, xylitol and betaine on gingivitis

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In this study, researchers aimed to determine the effects on gingival bleeding, dental biofilm, and salivary flow and pH in patients with gingivitis of using toothpaste with extra-virgin olive oil (EVOO), xylitol, and betaine in comparison to a placebo or commercial toothpaste. The research, published in Scientific Reports, was recently covered by Melissa Busch for Dr. Bicuspid. 

Few clinical trials have evaluated the effectiveness of herbal toothpastes to treat gingivitis, and only one study has assessed the in vitro antimicrobial activity of toothpaste prepared with olive fruit extract, according to the study.

Research is needed on the effectiveness of toothpaste composed of extra-virgin olive oil (EVOO), xylitol and betaine to reduce the formation of dental biofilm and gingivitis bleeding in comparison to conventional toothpastes. The research team's alternative hypothesis was that toothpaste with natural products may be more effective to improve periodontal and salivary variables in comparison to a placebo and a commercial anti-gingivitis toothpaste.

This controlled, double blinded, and multicenter randomized clinical trial included patients with gingivitis randomly assigned to one of three groups: test group (EVOO, xylitol, and betaine toothpaste), control group 1 (placebo toothpaste), or control group 2 (commercial toothpaste). Out of 85 patients initially recruited for the study, 61 were included. 

Percentage supragingival biofilm and gingival bleeding were evaluated at baseline (T0), 2 months (T2), and 4 months (T4), measuring non-stimulated salivary flow and salivary pH. Comparisons were performed between and within groups.

The final study sample comprised 20 in the test group, 21 in control group 1, and 20 in control group 2. In comparison to control group 1, the test group showed significantly greater decreases in gingival bleeding between T4 and T0 (p = 0.02) and in biofilm between T2 and T0 (p = 0.02) and between T4 and T0 (p = 0.01). This result can be attributed to multiple biological mechanisms, with a potential role played by the combined effect of the phenolic compounds and other minority compounds present in olive oil, especially in young EVOO.

In the test group, salivary flow significantly increased between T2 and T0 (p = 0.01), while pH alkalization was significantly greater between T4 and T0 versus control group 2 (p = 0.01) and close-to-significantly greater versus control group 1 (p = 0.06).

The toothpaste with EVOO, xylitol and betaine obtained the best outcomes in patients with gingivitis, who showed reductions in gingival bleeding and supragingival biofilm and an increase in pH at 4 months in comparison to a commercial toothpaste.

Study limitations include the relatively small sample size, although it was estimated to offer sufficient statistical power, and some statistically significant differences. On the other hand, this interim study is the first multicenter, parallel-group, double-blind, placebo-controlled randomized clinical trial to evaluate clinical changes in gingival bleeding, dental biofilm, salivary flow, and saliva pH after using a toothpaste with a natural product (EVOO) as the main ingredient.

Rodríguez-Agurto, A., Bravo, M., Magán-Fernandez, A. et al. "Randomized clinical trial on the clinical effects of a toothpaste containing extra virgin olive oil, xylitol, and betaine in gingivitis." Sci Rep 13, 6294 (2023). https://doi.org/10.1038/s41598-023-33521-4