Oral microbiome boost: Toothpaste containing extra virgin olive oil, xylitol and betaine may benefit gingivitis patients - RCT

Disruption of the oral microbiome results in diseases such as gingivitis, a reversible inflammatory condition caused by biofilm accumulation on the surface of the teeth. Its symptoms include reddening, edema and gingival bleeding.

Several studies have recommended the use of herbal toothpastes to control dental biofilm. These toothpastes typically contain natural ingredients, essential mineral salts, sodium fluoride, sodium chloride and plant extracts, which are known for their anti-inflammatory and anti-bacterial properties. 

Previous research has also found that EVOO may be able to help prevent the progression of gum disease by reducing inflammation and help prevent tooth decay by minimising harmful oral bacteria in the mouth. At the same time, xylitol has been reported to limit the production of oral bacteria, lower acid levels on teeth and re-mineralise dental enamel, while the sugar beet-derived chemical compound betaine encourages saliva production and can relieve gum irritation.

However, not many clinical trials have assessed the effectiveness of herbal toothpastes against gingivitis. As such, researchers at the University of Granada in Spain conducted a double-blind, randomised clinical trial to determine the effects of toothpaste formulated with EVOO, xylitol and betaine on gingival bleeding, supragingival biofilm, and salivary flow and pH. In comparison, they also tested the effects of a placebo toothpaste and a commercial toothpaste indicated for gingivitis.

Herbal solution for oral complication?

The trial had 61 gingivitis patients enrolled and randomly assigned to one of three groups: 20 to the test group (given the herbal toothpaste containing EVOO, xylitol and betaine), 21 to control group 1 (given the placebo toothpaste) and 20 to control group 2 (given the commercial toothpaste).

Each study subject was instructed to brush their teeth with their assigned toothpaste for four minutes three times daily, over the course of four months; they were also told not to use any other oral hygiene product during the trial.

After the four-month trial, the researchers observed a reduction in gingival bleeding among those in the test group, especially when compared to those in control group 1 (who had used the placebo toothpaste). They attributed this 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”

These compounds included hydroxytyrosol, oleacanthal and oleacein and, in combination with the xylitol in the test toothpaste, reportedly exerted strong antioxidant, anti-inflammatory, and antibacterial effects. The researchers also noted a greater reduction in dental biofilm in the test group compared to the other two groups, adding that xylitol helped to reduce bacterial plaque in the test group.

Despite a lack of statistical significance, betaine was still found to have significantly increased salivary flow in the test group in the first two months of the trial, with a higher flow observed at the end of the trial compared to the beginning. The test toothpaste also made salivary pH slightly alkaline, which meant that the test group’s oral bacteria was properly balanced with the host immune system and microenvironment. This also meant lower inflammation and risk of cell destruction.

Positive indications, wider implications

The researchers acknowledged that the study’s sample size was relatively small, though it still managed to provide enough statistical power. It was also the first RCT of its kind and offered a positive indication for further research to validate its findings in larger sample sizes.

Source: Scientific Reports

https://doi.org/10.1038/s41598-023-33521-4​

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

Authors: Alejandro Rodríguez-Agurto, et al.