This is originally from the HerbClips from the American Botanical Council I have been a member of the ABC for many years I highly encourage you to join the ABC.
Re: Papaya Leaf Extract Toothpaste/Mouthwash Found Effective in Treatment of Gingival Bleeding
Saliasi I, Llodra JC, Bravo M, et al. Effect of a toothpaste/mouthwash containing Carica papaya leaf extract on interdental gingival bleeding: a randomized controlled trial. Int J Environ Res Public Health. November 2018;15(12):E2660. doi: 10.3390/ijerph15122660.
Tooth brushing and interdental cleaning disrupt the biofilm on teeth and help prevent or reduce gingival (gum) inflammation. However, mechanical disruption alone is not sufficient. A dentifrice (toothpaste or powder) that has antibacterial properties is also needed. Mouthwashes may be used in addition to brushing to penetrate hard-to-reach areas in the mouth where biofilm accumulates. It is not known if combining a mouthwash and toothpaste significantly reduces gingival inflammation while still inhibiting plaque formation. Chemical agents are often added to dentifrices and mouthwashes to increase antibacterial activity, but these agents may cause mouth irritation, changes in taste, and other side effects or health hazards. One common agent is sodium lauryl sulfate (SLS), which is used as a surfactant to produce foam or lather. SLS-free products have been developed to meet the needs of consumers. Herbal medicines have been used for more than 2000 years to improve oral health and prevent inflammation. Consumers and dental professionals are looking to herbal rather than synthetic products because of concerns about bacterial resistance and side effects. Unlike conventional products, herb-based dentifrices and mouthwashes have not been researched extensively. Gencix (Esprit d'Ethique; Orvault, France) is a tooth powder containing papaya (Carica papaya, Caricaceae) leaf extract (CPLE) that is sold in Europe. The purpose of this randomized, single-blind, controlled trial was to evaluate the anti-inflammatory effects of a CPLE-based dentifrice on interdental bleeding in healthy people.
The study was conducted at the University of Granada in Granada, Spain beginning in April 2017. Participants were included if they were 18-26 years of age, nonsmokers, in good general health, and not pregnant or breastfeeding; had at least 20 natural teeth and no implants or orthodontic appliances; had no allergies to the test products; and were willing to abstain from using interdental brushes, dental floss, or dental products containing antibacterial agents during the study. Participants were excluded if they had moderate or advanced periodontal disease or other disease of the mouth, had two or more decayed teeth, used drugs that affect saliva flow, used antibiotics or antimicrobial drugs within the last 30 days, or used interdental brushes, dental floss, or mouthwashes more than once per week.
Participants were randomly assigned to one of the four groups. Group G received the CPLE-based Gencix dentifrice, which contained an aqueous extract of papaya leaf (40%) and pumice (60%). Group G+M received Gencix dentifrice plus mouthwash made from Gencix powder and water. Group Z received an SLS-free dentifrice that contained enzymes (Zendium Classic; Sara Lee; Amersfoort, The Netherlands). Group Z+L received Zendium dentifrice plus an alcohol-based mouthwash containing essential oils (Listerine Cool Mint; Johnson & Johnson Healthcare Products; Maidenhead, United Kingdom). The intervention lasted four weeks. Participants were instructed to brush their teeth twice daily for two minutes each time, using only the toothbrush and test products provided to them, and to avoid rinsing with water after brushing. Those randomized to one of the mouthwash groups were instructed to rinse with 20 mL mouthwash for 30 seconds after brushing. Participants returned for evaluation after each week of the intervention. Gingival bleeding was assessed at 26 interdental sites using the Bleeding on Interdental Brushing Index (BOIP). Plaque accumulation was assessed using the Turesky modification of the Quigley Hein Plaque Index.
A total of 100 participants were randomized, with 25 in each group, and none dropped out during the trial. There were no significant differences in characteristics, proportion of bleeding sites, or plaque accumulation among the groups at baseline. The proportion of bleeding sites decreased by 59-72% in all four groups from baseline to the end of the four-week intervention (all P < 0.01). The decrease in proportion of bleeding sites was greater in participants with ≥70% bleeding sites at baseline (-62% to -75%, all P < 0.01). [Note: The text states the decrease was -54% to -65%; however, Table 3 states the decrease was -62% to -75% for participants with ≥ 70%, bleeding sites at baseline.] Pairwise comparisons found no differences in proportion of bleeding sites among the groups when the entire study population was included. When stratifying by participants with ≥70% bleeding sites at baseline, the decrease in bleeding sites was greater in Group G+M compared to Group G (-75% versus -62%; P=0.04), and there was a lower proportion of bleeding sites in Group G+M compared to Group Z+L (21% versus 33%; P=0.05). Plaque accumulation was not significantly different among the groups. No safety issues were noted, and compliance appeared to be high.
The authors state this is the first clinical trial to compare the effects of a natural extract dentifrice and an SLS-free enzyme-containing dentifrice on the interdental inflammatory process. CPLE dentifrice with or without CPLE mouthwash and SLS-free enzyme-containing dentifrice with or without an alcohol-based mouthwash all dramatically reduced interdental inflammation to a similar extent. The authors conclude that the CPLE dentifrice "is effective when compared to an SLS-free enzyme-containing dentifrice in the reduction of gingival bleeding and inflammation and could constitute a valid parallel alternative to classical commercial dentifrices." A limitation of this trial was that participants knew what product(s) they used, which may have biased the outcome. Additional trials are needed to confirm findings of this study and should involve more participants, additional gum disease outcomes, and longer interventions to evaluate long-term safety and effectiveness.
The authors declare no conflicts of interest.