Discussion
biofilm reduction, gingivitis, stinging, TNF-α
ADHESION, GINGIVITIS, GINGIVAL BLEEDING, PLAQUE
The main finding of this study was a reduction in gingival bleeding among patients with gingivitis who used a toothpaste with EVOO as main ingredient compared with those using a placebo toothpaste (control group 1). 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, as discussed below.Hydroxytyrosol, obtained by oleuropein hydrolysis, is a phenolic compound present in olive leaves and fruit that exerts potent antioxidant, anti-inflammatory, and antibacterial effectsOleocanthal is a phenolic compound obtained in just-pressed EVOO, and its structure was found in an in vitro study to be similar to that of ibuprofen (non-steroidal anti-inflammatory drug) and to produce a comparable stinging sensation in the throatOleacein, another phenolic compound in EVOO, structurally derives from glucoside oleuropeinThe test toothpaste also contains xylitol, which has been found to inhibit the synthesis of TNF-α and IL-1β induced by lipopolysaccharides from In our study, dental biofilm reduction was greater with the test toothpaste than with the control toothpastes, which may also be related to the antibacterial effect of Karygianni et al. conducted an in vitro study to determine the antibacterial effect of maslinic acid, hydroxytyrosol, oleocanthal, and oleacein against eight oral bacterial species (Other documented effects of xylitol include the reduction of bacterial plaque by decreasing the adhesion of Other main component of this toothpaste is betaine (trimethylglycine.). Animal studies showed that betaine suppressed the activity of NF-κB and a wide range of inflammation-related genes, including TNF-α, VCAM-1 and ICAM-1Salivary flow was not significantly increased by the test toothpaste in comparison to the control toothpastes. However, it significantly increased in the test group alone over the first 2 months (The test toothpaste increased salivary pH to a slightly alkaline pH with a mean of 7.5, being more favorable for oral eubiosisIt was recently demonstrated that periodontal pathogens grow in a moderately acid environment, e.g., pH of 5.0–7 for 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.Superior clinical outcomes were obtained at 4 months in patients with gingivitis who brushed their teeth three times daily with the toothpaste containing EVOO, xylitol, and betaine in comparison to a placebo toothpaste and commercial anti-gingivitis toothpaste, including a reduction in gingival bleeding as well as an increase in salivary pH, contributing to oral eubiosis. Further research is warranted to verify these findings in wider samples.