plaque - induced gingivitis is one of the most frequent periodontal diseases , affecting more than 90% of the population , regardless of age , sex or race20 .
brazilian epidemiologic studies show a high prevalence of gingival inflammation , ranging from 74% to 100% , although the mean individual percentage of gingival bleeding varies from 28% to 35%5 .
however , the inability of the normal adult population to perform adequate toothbrushing has led to the search for chemotherapeutic agents in order to improve plaque control12 .
these chemicals , mainly triclosan and chlorhexidine , have been used as mouthrinses or added to dentifrices to avoid plaque formation and development of gingivitis10,12,14,22 .
as some of these substances may have undesirable side effects , such as tooth staining and taste alteration , phytotherapic agents with antimicrobial and antiinflammatory properties have been investigated7,16,17 .
the use of natural products in the prevention and treatment of oral conditions has increased recently and could be of benefit to low - socioeconomic level urban and rural communities4 . among the various currently available herbal agents , aloe vera ,
popularly known as " babosa " , is a plant commonly found the northeast of brazil .
its foliage , extract and resin present antimicrobial , antiinflammatory and healing properties and are indicated to hepatic and stomach diseases9 .
the antimicrobial effect of a dentifrice containing aloe vera has been demonstrated in an in vitro study , in which this phytotherapic agent inhibited the growth of diverse oral microorganisms , such as s. mutans , s. sanguis , a. viscosus and c. albicans 
 7 .
the only study available evaluating the clinical effects of aloe vera showed a significant reduction of gingivitis and plaque accumulation after use of a mouthrinse containing this natural product20 . to the present date
, there is no reported controlled trial evaluating the efficacy of a dentifrice containing aloe vera in the control of plaque and gingivitis .
therefore , the purpose of the present study was to assess the antiplaque and antigingivitis effects of this phytotherapic agent compared to a fluoridated dentifrice .
thirty adult subjects from the university of fortaleza , brazil ( 15 male and 15 female , aged 35 to 43 years ) were enrolled in this double - blind , parallel , controlled clinical trial .
all randomly screened participants were informed about the nature of the study and signed an informed consent form in compliance with the guidelines of the brazilian national health council .
the protocol was approved by the institutional ethics committee ( report cotica / unifor : 407/ 2006 ) .
the subjects were entered in the study if they had gingival bleeding index ( gbi)1 > 40% , presence of at least 20 natural teeth and absence of supragingival calculus and other plaque retentive factors .
subjects with medical disorders or probing depth > 3 mm , individuals under antimicrobial therapy at least 1 month prior to the study and using mouthrinses or dentifrices containing substances with antiinflammatory properties , as well as smokers and pregnant women were excluded from the trial .
the participants were assigned to either the test group ( n=15 ) or the control group ( n=15 ) by random permutation of three .
the test group used a herbal dentifrice containing aloe vera ( forever bright , forever living products , tempe , az , usa ) and the control group used a fluoridated dentifrice ( sorriso dentes brancos , kolynos do brasil , so paulo , sp , brazil ) , with no antiinflammatory properties , but with color and taste similar to those of the test dentifrice .
a single , previously calibrated examiner3 scored the gingival bleeding index ( gbi)1 and the plaque index ( pi)19 , which were recorded on the buccal , mesial , distal and lingual surfaces of all teeth . the values of 4 sites of each tooth were averaged to determine the gbi and pi for each subject .
in addition to this examination , the hard and soft oral tissues were visually inspected for the presence of any adverse reaction by the same examiner .
after the initial examination , all teeth of each subject were polished with pumice and flossed to eliminate plaque remnants . a personal " kit " containing a new toothbrush ( leader ; facilit odontolgica e perfumaria ltda , rio de janeiro , rj , brazil ) and the test or control dentifrice was given to all participants .
they were instructed to brush their teeth for 1 min , three times a day , using the bass technique , and to refrain from any other oral hygiene procedures throughout the period of the clinical trial .
verbal and written instructions about the correct use of dentifrice were given to all subjects as well .
the tubes containing the dentifrices were previously coded to warrant that neither the examiner nor the volunteers knew their content , which was revealed only after completion of the study .
the subjects were asked to return their dentifrice tubes , that were weighted by a digital balance ( filizola , modelo bp6 , indstrias filizola s.a .
, so paulo , sp , brazil ) , previously and after the trial , so that compliance could be indirectly evaluated .
student 's t - test was used to evaluate statistical differences between the weights of dentifrice tubes on days 0 and 30 ( =0.01 ) .
mann - whitney test was performed to evaluate statistical differences between control and test groups on days 0 and 30 ( =0.01 ) . in each group ,
the mean scores of gbi and pi were compared between baseline and the end of the trial by the wilcoxon test ( =0.01 ) .
the test dentifrice had a good acceptance and did not show adverse effects , such as formation of abscess and ulcerations or allergic reactions .
only one subject in the test group reported unpleasant taste , but he did not drop out the clinical trial . there was a significant reduction of dentifrice tube weights between days 0 and 30 in both groups ( p<0.001 ) , which indirectly indicated that the volunteers actually used the dentifrices ( table 1 ) . on day 0 , there was no statistically significant difference between the control and test groups with respect to gbi ( p=0.8774 ) and pi ( p=0.0477 ) means .
these results indicated that both groups were well balanced at baseline ( tables 2 and 3 ) . at the 30th day ,
plaque ( p=0.2801 ) and gingival bleeding ( p=0.9346 ) were present in both groups , but the difference between them was not significant statistically ( tables 2 and 3 ) . comparing the means between baseline and day 30 in each group ,
there was statistically significant difference in both the gbi ( p=0.002 , control group and p=0.001 , test group ) and pi indexes ( p=0.002 , control group and p=0.001 , test group ) ( tables 2 and 3 ) .

 aloe vera is a natural product contained in herbal dentifrices with commercial appeal on the control of plaque and gingivitis . despite its free commercial use
, this phytotherapic agent does not have sufficient data to support its antigingivitis and antiplaque claims21 .
to the best of our knowledge , the present study is the first report about effect of a dentifrice containing aloe vera on gingivitis .
the results showed that both toothpastes were efficient on plaque reduction ( 23% in test group and 19% in control group ) .
this percent difference was not significant at the end of the trial . in spite of
a reported in vitro inhibitory effect of aloe vera against microorganisms from supragingival biofilm7 , its in vivo antiplaque effect in the present study was not satisfactory .
it is interesting to note that this previous study7 evaluated a dentifrice that also contained other antiplaque agents , which probably masked the effect of aloe vera .
the test and control dentifrices reduced gingivitis significantly , although the fluoridated dentifrice presented a higher percent reduction on bleeding areas ( 56% versus 53% ) .
the gbi is a generally used dichotomous index to evaluate gingivitis , but it does not access the severity of gingival inflammation .
studies evaluating the reduction of gingivitis by a grading index could be interesting to complement these results .
gingival index uses a scale in which color changes in the gingival tissues precede bleeding on probing ; however this parameter is not necessarily an accurate indicator of gingivitis18 .
the findings of the present study are in agreement with those of villalobos , et al.20 ( 2001 ) , who observed a significant reduction on plaque and gingivitis after a 30-day use of mouthrinses containing aloe vera associated to toothbrushing .
this study20 also showed an additional antiplaque and antigingivitis effect of this phytotherapic agent , which was not observed in the present clinical trial .
villalobos , et al.20 ( 2001 ) used a higher concentration of aloe vera ( 50% ) , which could explain the better effect of this phytotherapic agent when compared to our findings .
although the manufacturer does not inform the concentration of aloe vera in the product used in the present study , the percentage of therapeutic agent in a dentifrice usually range from 0.4% to 1.0% of the total formulation6 , which was probably the concentration used in our study and could explain those results .
furthermore , villalobos , et al.20 ( 2001 ) used a mouthrinse containing only aloe vera as the active agent , favoring its action without interference of other components .
the test dentifrice used on the present trial contains other agents that can promote a moderate antiplaque effect , such as menthol and sodium lauryl sulfate12,21 . since the last two components are also present in the control dentifrice and considering that no difference was found between groups
the antagonism of diverse substances with similar effects , in the same product , should be considered as well .
this fact has been highlighted by wua and savitt21 ( 2002 ) and confirmed by other clinical trials comparing fluoridated and herbal dentifrices11,15 .
home - use dentifrice studies are often influenced by a number of factors which can mask the superiority of a test agent over the controls .
participants in clinical trials may experience some improvement associated not specifically to the therapeutic properties of the test agent but rather related to a behavior change - hawthorne effect15 .
subjects enrolled in oral hygiene studies usually improve their toothbrushing , irrespective of the product they receive11,13,15 .
although the volunteers of the present study were not aware of which dentifrice they were using , another important factor is the novelty effect , which is the motivation of oral hygiene practice by the use of a new substance . on
the other hand , lack of compliance in the correct use of dentifrice can occur as well15 . in order to minimize its occurrence ,
the participants were asked to bring the dentifrice tubes at the end of the trial to be weighed , so we could evaluate indirectly subject compliance . the significant difference between weights in both groups , before and after the study , indicates that the participants used the products , but does not confirm if they were used correctly .
however , it may not be sufficient to show the superiority of the test dentifrice over the control toothpaste15 .
further long - term studies must be performed to evaluate the antigingivitis effect of this herbal dentifrice .
if its real benefit is confirmed , the use of aloe vera should be advantageous in cases where patients have little motor skills and toothbrushing is compromised .
within the limits of this clinical study , it may be concluded that the dentifrice containing aloe vera did not show any additional effect on plaque and gingivitis control compared to the fluoridated dentifrice .
 the effect of aloe vera on the reduction of plaque and gingivitis was evaluated in a randomized , parallel and double - blind clinical trial . 
 subjects were randomly allocated to the test group ( n=15 )  dentifrice containing aloe vera - or the control group ( n=15 )  fluoridated dentifrice . plaque index ( pi ) and gingival bleeding index ( gbi ) 
 were assessed at days 0 and 30 . 
 subjects were asked to brush their teeth with the control or test dentifrice , three times a day , during a 30-day period . 
 there was a significant reduction on plaque and gingivitis in both groups , but no statistically significant difference was observed among them ( p>0.01 ) . 
 the dentifrice containing aloe vera did not show any additional effect on plaque and gingivitis control compared to the fluoridated dentifrice . 
INTRODUCTION
MATERIAL AND METHODS
RESULTS
DISCUSSION
CONCLUSION