Are anti-inflammatory agents effective in treating gingivitis as solo or adjunct therapies? A systematic review.

OBJECTIVE Systematically review the scientific evidence for efficiency of anti-inflammatory agents against gingivitis, either as solo treatments or adjunctive therapies. METHODS A protocol was developed aimed to answer the following focused question: "Are anti-inflammatory agents effective in treating gingivitis as solo or adjunct therapies?" RCTs and cohort studies on anti-inflammatory agents against gingivitis studies were searched electronically. Screening, data extraction and quality assessment were conducted. The primary outcome measures were indices of gingival inflammation. A sub-analysis was performed dividing the active agents into anti-inflammatory and other drugs. RESULTS The search identified 3188 studies, of which 14 RCTs met the inclusion criteria. The use of anti-inflammatory or other agents, in general showed a higher reduction in the test than in the control in terms of gingival indexes and bleeding scores. Only two RCTs on inflammatory drugs could be meta-analysed, showing a statistically significant reduction in the GI in the experimental group [WMD = -0.090; 95% CI (-0.105; -0.074); p = 0.000]. However, the contribution of both studies to the global result was unbalanced (% weight: 99.88 and 0.12 respectively). CONCLUSIONS Most of the tested material showed beneficial effect as anti-inflammatory agents against gingivitis, either as a single treatment modality or as an adjunctive therapy.

[1]  H. Völzke,et al.  Association between serum vitamin D concentrations and inflammatory markers in the general adult population. , 2014, Metabolism: clinical and experimental.

[2]  P. Ramberg,et al.  The effect of a dentifrice containing Magnolia extract on established plaque and gingivitis in man: a six-month clinical study. , 2014, International journal of dental hygiene.

[3]  M. Barker,et al.  Evaluation of anti-gingivitis benefits of stannous fluoride dentifrice among triclosan dentifrice users. , 2013, American journal of dentistry.

[4]  V. Naik,et al.  Anti-inflammatory effect of vitamin D on gingivitis: a dose-response randomised control trial. , 2013, Oral health & preventive dentistry.

[5]  B. Gower,et al.  Associations of C-Reactive Protein to Indices of Vascular Health and the Influence of Serum 25(OH)D Status in Healthy Adults , 2012, Journal of nutrition and metabolism.

[6]  Ray Williams,et al.  Effect of an herbal mouth rinse in preventing periodontal inflammation in an experimental gingivitis model: a pilot study. , 2012, Compendium of continuing education in dentistry.

[7]  L. Litonjua,et al.  Plaque formation and marginal gingivitis associated with restorative materials. , 2011, Compendium of continuing education in dentistry.

[8]  J. Grbic,et al.  A phase II trial of a transmucosal herbal patch for the treatment of gingivitis. , 2011, Journal of the American Dental Association.

[9]  D. E. Slot,et al.  Effect of socket preservation therapies following tooth extraction in non-molar regions in humans: a systematic review. , 2011, Clinical oral implants research.

[10]  A. Poorsattar Bejeh Mir,et al.  The effect of Frankincense in the treatment of moderate plaque-induced gingivitis: a double blinded randomized clinical trial , 2011, Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences.

[11]  E. Hyppönen,et al.  25-Hydroxyvitamin D and Pre-Clinical Alterations in Inflammatory and Hemostatic Markers: A Cross Sectional Analysis in the 1958 British Birth Cohort , 2010, PloS one.

[12]  S. Ribeiro,et al.  Improving toothbrushing behaviour in an institution for the disabled in Lisbon, Portugal. , 2009, International journal of dental hygiene.

[13]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[14]  David J Spiegelhalter,et al.  A re-evaluation of random-effects meta-analysis , 2009, Journal of the Royal Statistical Society. Series A,.

[15]  K. Ekstrand,et al.  Short-term effect of chewing gums containing probiotic Lactobacillus reuteri on the levels of inflammatory mediators in gingival crevicular fluid , 2009, Acta odontologica Scandinavica.

[16]  L. Zaletel-Kragelj,et al.  Population groups at high risk for poor oral self care: the basis for oral health promotion , 2008, International Journal of Public Health.

[17]  R. Chandra,et al.  Efficacy of lycopene in the treatment of gingivitis: a randomised, placebo-controlled clinical trial. , 2007, Oral health & preventive dentistry.

[18]  C. Szabó,et al.  Inhibition of experimental gingivitis in beagle dogs with topical mercaptoalkylguanidines. , 2006, Journal of periodontology.

[19]  Brian Burt,et al.  Position paper: epidemiology of periodontal diseases. , 2005, Journal of periodontology.

[20]  A. Pistorius,et al.  The clinical application of hyaluronic acid in gingivitis therapy. , 2005, Quintessence international.

[21]  C. Schwahn,et al.  The effect of a dexibuprofen mouth rinse on experimental gingivitis in humans. , 2005, Journal of clinical periodontology.

[22]  A. Gürkan,et al.  Adjunctive subantimicrobial dose doxycycline: effect on clinical parameters and gingival crevicular fluid transforming growth factor-beta levels in severe, generalized chronic periodontitis. , 2005, Journal of clinical periodontology.

[23]  J. Lindhe,et al.  The effect of systemic administration of ibuprofen in the experimental gingivitis model. , 2005, Journal of clinical periodontology.

[24]  S. Soukoulis,et al.  The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. , 2004, Australian dental journal.

[25]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[26]  A. Pistorius,et al.  Efficacy of subgingival irrigation using herbal extracts on gingival inflammation. , 2003, Journal of periodontology.

[27]  I. Needleman,et al.  A guide to systematic reviews. , 2002, Journal of clinical periodontology.

[28]  Y. Açil,et al.  Local application of n-3 or n-6 polyunsaturated fatty acids in the treatment of human experimental gingivitis. , 2002, Journal of clinical periodontology.

[29]  J. Albandar,et al.  Global epidemiology of periodontal diseases: an overview. , 2002, Periodontology 2000.

[30]  D. Duran,et al.  Pilot study on n-3 polyunsaturated fatty acids in the treatment of human experimental gingivitis. , 1997, Journal of clinical periodontology.

[31]  R. Seymour,et al.  The effect of systemically-administered flurbiprofen as an adjunct to toothbrushing on the resolution of experimental gingivitis. , 1994, Journal of clinical periodontology.

[32]  R. Seymour,et al.  Flurbiprofen in the prevention and treatment of experimental gingivitis. , 1993, Journal of clinical periodontology.

[33]  I. Waite,et al.  The effect of systemic ibuprofen on gingival inflammation in humans. , 1993, Journal of clinical periodontology.

[34]  J. Fiorellini,et al.  Effect of the NSAID piroxicam, topically administered, on the development of gingivitis in beagle dogs. , 1991, Journal of periodontal research.

[35]  R. H. Johnson,et al.  Assessment of the efficacy of a nonsteroidal anti-inflammatory drug, Naprosyn, in the treatment of gingivitis. , 1990, Journal of periodontal research.

[36]  N. Lang,et al.  The microbiota associated with successful or failing osseointegrated titanium implants. , 1987, Oral microbiology and immunology.

[37]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[38]  J. Macedo,et al.  The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis. , 1986, Journal of periodontology.

[39]  N. Ross,et al.  A modified gingival index for use in clinical trials. , 1986, Clinical preventive dentistry.

[40]  N. Chilton,et al.  Reduction of baseline gingivitis scores with repeated prophylaxes. , 1977, The Journal of preventive dentistry.

[41]  D. Lange,et al.  [Clinical methods for the objective evaluation of oral hygiene]. , 1977, Deutsche zahnarztliche Zeitschrift.

[42]  Schroeder He,et al.  Pathogenesis of inflammatory periodontal disease. A summary of current work. , 1976 .

[43]  A. Sheiham,et al.  Testing therapeutic measures for controlling chronic gingivitis in man: a suggested protocol. , 1975, Journal of clinical periodontology.

[44]  J. Ainamo,et al.  Problems and proposals for recording gingivitis and plaque. , 1975, International dental journal.

[45]  H. Mühlemann,et al.  Gingival sulcus bleeding--a leading symptom in initial gingivitis. , 1971, Helvetica odontologica acta.

[46]  I Glickman,et al.  Reduced plaque formation by the chloromethyl analogue of victamine C. , 1970, Journal of periodontology.

[47]  H. Löe,et al.  EXPERIMENTAL GINGIVITIS IN MAN. , 1965, The Journal of periodontology.

[48]  H. Löe,et al.  PERIODONTAL DISEASE IN PREGNANCY. II. CORRELATION BETWEEN ORAL HYGIENE AND PERIODONTAL CONDTION. , 1964, Acta odontologica Scandinavica.

[49]  H. Löe,et al.  PERIODONTAL DISEASE IN PREGNANCY. I. PREVALENCE AND SEVERITY. , 1963, Acta odontologica Scandinavica.

[50]  G A QUIGLEY,et al.  Comparative cleansing efficiency of manual and power brushing. , 1962, Journal of the American Dental Association.