AN EXCITING NEW DEVELOPMENT IN ORAL HYGIENE

Newton D Johnson BDS FDSRCS describes how he was introduced to Janina Opale Whitening Toothpaste.

Several weeks ago, while minding my own business and getting on with duties supervising a group of undergraduate dental students on our primary oral health care clinic, a rather strong and determined hand came to rest on my shoulder with a request that I might like to spare a moment. Turning around, with the dread that only comes with experience, I expected to be confronted with, at worse, one of our more tenacious patients who simple could not understand why they could not have that ten-unit bridge made before lunch or, at best, a colleague requesting just a small favour ( you know the sort of favour - something that is promised to take a few moments and in reality takes three hours).

To my surprise it was nothing of the kind; it turned out to be an old friend and colleague, John, who is not a dentist but is a specialist in electronics, computer programming and all things radiographic, in particular radiovisiography. "I want you to examine my teeth," he said " I don’t have toothache, I just want you to examine my teeth." So we found a chair and an examination kit and in I plunged and saw the usual sort of thing: teeth, gums, the odd restoration or two, tongue, mucosa, what else is there?

From below came the question: "When do you think I last cleaned my teeth?" Hmm, odd question. So I scraped around the old Ramijford’s teeth and diligently inspected the probe for the telltale gunge: wait a minute, there was none. It couldn’t be so; after all, only dentists have immaculate oral hygiene (!). But it was true, the teeth were completely plaque free. Clearly, by the nature of the question, he couldn’t have cleaned his teeth within the last few hours so I said, " Well I don’t know when you last cleaned your teeth." "Go on, you are the dentist, estimate when I last cleaned my teeth."

Oh dear, whatever I said I was going to look an idiot, especially with several interested students hanging on every word just waiting for me to look silly. "Well, have you been using a mouthwash?"

"NO, now when did I last clean my teeth?" There was now doubt the teeth were clean and the gingivae looked pink and firm. "OK, your teeth look clean, have you been fasting for a day or two?" "For goodness sake what sort of question is that?" "Well, go on then, tell me. Your mouth looks like you cleaned your teeth within the last 24 hours, but no doubt there is more to it than that."

A smug look crossed John’s face. "Actually," (have you noticed that people who begin a statement with the word actually are about to put you firmly in your place?) "I have not cleaned my teeth for two days."

What nonsense could this be? Two days? Even my elementary knowledge of oral biology told me that there is a sort of physiological plaque that develops on the teeth in health, yet here there was virtually nothing to show. "Okay, all right, fine - so you don’t grow plaque; no brushing and no mouthwash for three and a half days - then you must be on anti-biotics or something?" "What sort of stupid question is that?" "Sorry John," (Johnson was getting desperate now) "so put me out of my misery".

Before I reveal the secret if John’s tale let me say that I am, like most people, worn down by the claims of the manufacturers of products, in particular products such as soap powder, shampoo ( if their claims were so good why is the top of my head now bald?) and, it has to be said, toothpastes.

Now this chap John is a remarkable fellow, always working and inventing things. "Well, what if I said I had invented a new toothpaste and that I had been experimenting with it in my own mouth and I have not had to brush my teeth for the past two days, how would you react to that?"

"Come off it, who are you kidding?" I know John is a wizard with computers, electronic gadgets and indeed dental radiography equipment, but a chemist?" No, never.

"It’s true, I have invented a brand new toothpaste that is superb at preventing plaque formation, it is anticaries in action and it lightens teeth without harming them in any way. It will sweep away the competition as there is nothing like it anywhere in the world."

"Right then, John, is it safe?" (visions of a toothpaste consisting of penicillin, metronidazole, nitric acid and pumice flash across my mind). " Of course it’s (expletive) safe!

After much further discussion I had several sample packs to take home and test. So of course I gave it to my wife to see what happened! When she survived, I tried the product myself. Well, knock me down with a feather, it seems everything John said was totally true. A good brush with a small quantity of this mysterious magic cream and the old teeth felt amazingly clean and smooth and the mouth felt fresh and zingy. The plaque did seem to be kept at bay and there was no doubt that the teeth lightened in colour; well my wife’s teeth did; I have an anterior bridge after a slight disagreement with a Neath Rugby Club prop forward on a fine point of scrummage law, so it would be asking much to lighten porcelain.

So there we have it, a remarkable product. "What is the name of this balm John?" "Janina Opale Whitening Toothpaste". What is in this salve? How does it work? What is special about it?

I should make clear that I have no financial interest or reward for writing this article (damn it) and I have absolutely nothing to do with the product. I am simply impressed enough to bring it to the attention of members of the profession, who can then make up their own minds.

The modern trend with toothpaste manufacturers is to seek for "active" ingredients which will target the causes of gum diseases, calculus formation, dental caries and halitosis and to give the user a feel-good factor. Crest Complete, for example, contains three active ingredients, as does Crest Total.

It seems that Janina toothpaste contains no fewer than 23 ingredients of which 14 are classified as "active". For instance it contains fluoride at a level of 1450 parts per million, which is higher than any toothpaste on the market today. The fluoride is in the form of sodium fluoride, which in many recent publications has shown to be more efficacious than the sodium monofluorophosphate form.. This should prove to be of greater benefit in helping to prevent cavities and assist the remineralisation of early lesions. The fluoride has been shown to help reduce the cariogenic plaque formation.

The two well-known active ingredients 0.3% triclosan and 0.75% zinc citrate are also included. The agents have been proven from many studies to be effective against plaque and gingivitis and these are of value in preventing the development of gum problems. Mentadent P toothpaste takes advantage of these agents which in general act as broad-spectrum antimicrobials to reduce the amount of plaque in the mouth.

Xylitol has been selected, not only to help with the taste but because it has also been shown to reduce plaque micro-organisms.

Patented, whitening agents - part of the Bromaine Complex are included for removing both intrinsic and extrinsic staining from teeth.

About one-third of the product is calcium and phosphate. In use this gives a super-saturated solution of calcium and phosphate which precipitates within areas of demineralisation and should help the remineralisation process of carious lesions.

The use of enzymes in the mouth is an interesting and developing subject and this product takes full advantage of the latest technology. Proteolytic enzymes - papain and bromelain - are incorporated which, in theory, remove the proteinacious pellicle layer and slow down the development of plaque build-up on the teeth, thus reducing disease and staining. Papain has been used with success in Rembrandt whitening toothpaste. These enzymes are naturally occurring; for example, bromelain (derived from pineapple) which gives a pineapple zing to the toothpaste.

Sodium pyrophosphate, shown in many trials to reduce the development of calculus, is there too. Methyl paraben is an additional antibacterial agent and sodium laurel-sulphate is used as a general detergent within the oral cavity. Baking soda is there to give the fresh feel-good factor. The toothpaste has a pH of 7 and therefore is neutral.

The Department of Health Medicines Control Agency has granted the product full approval and permission to use the terms tartar control, gum protection, breath freshener and tooth whitener. I understand that initial results from double-blind clinical trials which are currently in progress are exceptional, and many other studies that are in the process of being submitted to learned professional bodies for publication are demonstrating that the active ingredients are not inactivated by being bound or blocked by the other ingredients.

This product, passed in full by the Department of Health as safe and acceptable, breaks new ground and puts the term a "complete" " toothpaste" into a whole new category. It is almost amazing that the giant toothpaste manufacturers have not attempted to develop a comprehensive and truly therapeutic toothpaste that is active against the development of dental caries, gingivitis, periodontal diseases, halitosis and so on.

It is exciting and encouraging to see this new development researched and produced by a wholly UK company. It certainly breaks new ground and brings toothpaste into the 21st century. Perhaps it takes someone from outside the dental profession and the world of pharmacy to see the wood for the trees and dear old John, with his inventive mind and common-sense skills, to put together a product that could rock the giant multi-national producers of the classical toothpaste.

Time will tell, but for now I take my hat off to John for his enthusiasm and his enterprise and I will be observing the results of the clinical trials with interest and keen anticipation. This product looks like being a really exciting winner.