The Total Package - Active Prevention, Advancing Oral Health Protection For Your Patients

As dental professionals, one of the most frequent questions we will be asked by our patients is which toothpaste should I use? As a general rule, we will recommend a toothpaste that contains fluoride. However, what I have recently gained a greater appreciation of is that not all toothpastes are made equal. When it comes to actively helping prevent oral care issues, we as dental professionals can be more proactive for our patients’ oral health by recommending a  multibenefit toothpaste, as well as a more systematic approach or oral hygiene regimen. 

In this article for Colgate-Palmolive, I will be sharing with you the science behind the Colgate Total Active Prevention toothpaste, which contains stannous fluoride, and the unique way in which the toothpaste is stabilized to ensure high bioavailability of the stannous ions. I will also share Colgate’s new approach to active prevention, which really aims to empower patients in their oral hygiene and improve oral health outcomes¹.

We know that twice daily use of a fluoride toothpaste delivers fluoride to the dental surfaces and is very much a cornerstone to caries prevention². However, we also know that caries isn’t the only oral care issue we want to help our patients prevent. Erosion, staining and bad breath are also key issues when it comes to oral health. This is where a multibenefit toothpaste should be part of our recommendation. An antibacterial and fluoridated toothpaste can play a key role in active prevention for our patients. It is also important to understand that not all toothpastes are equally effective in preventing oral care issues, and not all toothpastes have the clinical studies and research to support their use. Therefore, we should routinely ask ourselves, what benefits does this toothpaste offer my patients? What does it actively prevent? What is the science and evidence behind this toothpaste that I am recommending? 

Stannous fluoride (SnF2) is a tin-based fluoride compound known to have multiple benefits for oral health. These include anticaries and antibacterial effects. It is also able to modulate the microbial composition of the dental biofilm³. However, stannous fluoride toothpastes are challenging to develop as SnF2 is difficult to keep stable in a toothpaste, which can limit effectiveness. Exposing stannous ions to air, water, or heat can lead to oxidation of these ions from their active form (Sn2+) to stannic ions (Sn4+); this is a form which is no longer effective against bacteria. The key to an effective antibacterial toothpaste is keeping the stannous ions in their active Sn2+ form throughout the shelflife of the toothpaste⁴. These bioactive ions interfere with bacterial growth and metabolism pathways, disrupting and reducing growth, and inhibiting bacterial acid production⁵.

Historically, drawbacks of toothpastes containing stannous fluoride have been grittiness, enamel staining, and a disagreeable taste. This has meant stannous fluoride toothpastes in the past have not been patient friendly and, as a result, this discourages our patients from wanting to use them. Many of these drawbacks are a result of trying to ensure the toothpaste can deliver the clinical efficacy we need and keep the Sn2+ ions in their active form.  For example, low water or no water formulations can be useful to prevent hydrolysis and subsequent oxidation to the Sn4+ species, however these formulations can compromise the taste and feel of the paste. Some toothpastes may add stannous salts, such as stannous chloride, to replenish lost stannous ions, but this has proven ineffective as a high proportion of inactive stannic ions still forms. 

The Stannous Fluoride in the new Colgate Total Active Prevention toothpaste has been stabilised by Nitrates and Phosphates. Pyrophosphate-chelated Sn2+ ions are able to maintain stability in water, and the addition of nitrates has been shown to block the oxidation of bioactive Sn2+ ions to inactive Sn4+ ions⁶. This maintains a high concentration of bioavailable stannous ions in the toothpaste. This unique stabilisation technology addresses many formulation challenges toothpastes containing stannous fluoride face, to deliver an enjoyable brushing experience. This is a really important stand-out point for me too: if I am going to recommend a toothpaste, I want it to be something my patients will want to use.

The key to a healthy mouth and prevention of many oral care issues is a healthy oral biofilm. Mechanical plaque removal alone is not sufficient to disrupt the oral biofilm^7,8. This is where the use of antibacterial agents comes in. 

Stannous fluoride has multiple modes of action which promote its antibacterial effects. Stannous fluoride is able to alter and breakdown cell walls of bacteria, including those implicated in caries, and oral malodour^9,10,11,12. A single-centre, randomised, controlled, double-blinded clinical investigation involving 98 participants demonstrated that brushing twice daily with Colgate Total Active Prevention toothpaste with SNaP technology provided significantly greater and long-lasting antibacterial effects versus using a non-antibacterial fluoride toothpaste. Compared to baseline, the SNaP-containing toothpaste led to a significant reduction in bacterial load from the teeth (-39%), cheeks (-42%), gums (-62%), tongue (-24%) and even saliva (-30%) after 4 weeks of twice daily use¹³.

We know that typically patients only brush for 45 seconds, rather than the recommended 2 minutes⁷, and that mechanical plaque removal alone only removes plaque from 42% of oral surfaces⁸. An additional way to improve the oral health of our patients includes the addition of a mouthrinse to their daily routine. One well-established antibacterial agent for mouthwash formulation that has been shown to reduce plaque formation is Cetylpyridinium Chloride (CPC). CPC works by cationically attracting negatively-charged bacteria and penetrating the bacterial cell membrane by the hydrophobic portion of the molecule. The subsequent solubilisation of the bacterial membrane and altered permeability for the bacteria ultimately leads to bacterial cell death¹⁴.

The Colgate Total Active Prevention Mouthrinse contains CPC and Zinc which, when used alongside the Colgate Total Active Prevention Toothpaste and Colgate Total Active Prevention Foaming Clean toothbrush, exhibited fifteen times more plaque reduction when compared with non-antibacterial fluoride toothpaste and regular brush with 1 week of continued use¹⁴. In an additional clinical study, the test group used a full regimen of Total Active Prevention products, including Colgate Total Active Prevention Toothpaste, Colgate Total Active Prevention Foaming Clean toothbrush and Colgate Total Active Prevention Mouthrinse, versus a non-antibacterial toothpaste and an ordinary flat trim toothbrush. 100% of people had a healthier mouth in just 3 weeks¹⁴.

Dental professionals now have a clinically tested, comprehensive oral care solution for patients through the Colgate Total Active Prevention system. The combination of a toothbrush design complemented by a multibenefit toothpaste with SNaP technology, and clinically tested antibacterial, alcohol-free, CPC-containing mouthrinse, provides a complete oral care regimen system to help patients fight many common oral care issues and to help maintain optimum dental health.