Forever Bright Toothgel is the Best!

by admin on June 29, 2010

I would love to share this article I found about a independent study on Forever Bright Tooth Gel and two other commercial tooth pastes. It is published with the permission of the Academy Of General Dentistry.

Comparative evaluation of thein vitro studyDilip George, MDSn Sham S. Bhat, MDS n Beena Antony, PhDThe success of any toothpaste,1The gel or mucilage fromAloe(otherwisealoe vera) is a convenientAloe barbadensisvariety exhibits the2 Aloe vera juice3-6The efficacy ofAloe barbadensisincreases when the plant7Aloe gel will lose its complete7Thisin vitro evaluation comparedMaterials and methodsTo demonstrate antimicrobialStreptococcus mutans, Candidaand PeptostreptococcusThe organismsS.was cultured in Mitis SalivariusC. albicansin Sabouraud’s DextroseAloe vera (Aloe barbadensis Miller) has been suggested for aDental Materials238 May/June 2009General Dentistry www.agd.orgAgar,L. acidophilus in Rogosa SLS. mitis in Mitis-Salivaris Agar,E. faecalisin Mac Conkey’s Agar,Prevotella intermedia andPeptostreptococcus anaerobiusin8The purity of each test strain was9 The Muller HintonCandida.Three wells (4 mm in diameter10 The agarE. faecalis and C. albicans in theS. mutans and S. mitis inL. acidophilus,and Peptostreptococcusin an anaerobicFig. 1. Zone of inhibition as observed in Candida albicans for toothpastes A, B, and C, usingAAwww.agd.orgGeneral Dentistry May/June 2009 239technical errors that might haveResultsResults of this preliminaryin vitrostudy demonstrated that aloe veraC. albicans and all anaerobesin vitro.Compared to the Toothpastes BS. mitis (p = 0.034). The tableDiscussionA review of the literature suggested11 In relatively12 Saponins, which contain13-15Acemannan, a complex mannose16The organisms employed in theS. mutans has beenLactobacilli and the further17A 1995 study by Baiet al demonstratedCandida count in children18E. faecalishas been associated withTable. Mean diameter of the zone of inhibition obtained after 48 hours ofN Mean SD H pS. mutans 4.18 0.124 (not significant)240 May/June 2009General Dentistry www.agd.orgDental MaterialsAntimicrobial efficacy of aloe vera tooth gel and commercial toothpastesre-infection and subsequent failure of19Anaerobes are a significant partPrevotella intermediawere predominant among20The majority of the antimicrobialConclusionThis preliminaryin vitro studyS. mitis despiteDisclaimerThe authors have no relationshipAuthor informationDr. George is a senior lecturer/References1. Itthagarun A, Wei SH. Analysis of fluoride ionwww.agd.orgGeneral Dentistry May/June 2009 241

The success of any
toothpaste,

in part, lies on its ability to

eliminate pathogenic oral

microflora. Fluoride dentifrices

have been widely used all over the

world and extensive research has

established their abilities in terms of

caries resistance.1

The gel or mucilage from Aloe

barbadensis Miller (otherwise

known as aloe vera) is a convenient

homegrown remedy that can be

used both as a moisturizing agent

and for treating minor burns and

skin abrasions. Aloe vera is a cactuslike

plant that actually is part of the

lily family. There are more than 300

varieties of the aloe plant but the

Aloe barbadensis variety exhibits the

best medicinal properties.

Modern use of aloe vera was first

documented in the 1930s to heal

radiation burns.2 Aloe vera juice

taken internally has been shown to

have various beneficial effects on

the body.3-6

The efficacy of Aloe barbadensis

Miller increases when the plant

is harvested after three years of

growth but its nutritive potency

decreases after 12 years of growth.7

Aloe gel will lose its complete

potency if it is exposed to sunlight

for more than two hours, as it is

easily oxidized; consequently, it

is necessary to stabilize it under

pharmaceutical standards for ready

use and longer shelf life. Non-profit

organizations like the International

Aloe Science Council have set

standards for aloe vera approval and

give their seal of quality for aloe

products. Such products are more

beneficial, since the seal is given

to only those products with established

therapeutic benefits.7

This in vitro evaluation compared

the antimicrobial activity of an

aloe vera tooth gel and two commercially

popular, locally available

toothpastes. These toothpastes were

tested against seven pathogenic

microorganisms that frequently

dominate the oral microbiota. The

results are intended to show the

relative antimicrobial effectiveness

of each dentifrice against each

particular species.

Materials and methods

To demonstrate antimicrobial

activity, this study utilized an aloe

vera tooth gel (Forever Bright,

Forever Living Products, Scottsdale,

AZ; 888.440.2563), known as

Toothpaste A, and two commercial,

locally available toothpastes: Pepsodent

(Unilever, Englewood Cliffs,

NJ; 201.894.7660) and Colgate

(Colgate-Palmolive, Canton, MA;

800.821.2880), known as Toothpastes

B and C, respectively.

This study used freeze-dried stock

culture of the reference strains of

Streptococcus mutans, Candida

albicans, Lactobacillus acidophilus,

S. mitis, Enterococcus faecalis, Prevotella

intermedia, and Peptostreptococcus

anaerobius. The organisms

were cultured in trypticase soy broth

and transferred to the selective

media to revive from the stock.

The organisms employed in the

study were cultured in their respective

selective media. For example, S.

mutans was cultured in Mitis Salivarius

Bacitracin Agar (Gold’s Media),

C. albicans in Sabouraud’s Dextrose

Aloe vera (Aloe barbadensis Miller) has been suggested for a

wide variety of ailments but its use in dentistry is limited. This

article reviews the uses of the plant and describes an in vitro

investigation that compared the antimicrobial effectiveness of
aloe

vera tooth gel with two popular, commercially available
dentifrices.

The preliminary results showed that aloe vera tooth gel and the

toothpastes were equally effective against Candida albicans,

Streptococcus mutans, Lactobacillus acidophilus, Enterococcus

faecalis, Prevotella intermedia, and Peptostreptococcus
anaerobius.

Aloe vera tooth gel demonstrated enhanced antibacterial effect

against S. mitis.

Received: November 29, 2007

Accepted: February 8, 2008

Dental Materials

238 May/June 2009 General Dentistry www.agd.org

Agar, L. acidophilus in Rogosa SL

Agar, S. mitis in Mitis-Salivaris Agar,

E. faecalis in Mac Conkey’s Agar,

and both Prevotella intermedia and

Peptostreptococcus anaerobius in

Neomycin Blood Agar.8

The purity of each test strain was

checked during each trial by using

subculture, Gram’s stain, and colony

morphology. Antimicrobial susceptibility

was checked by using the

ditch method.9 The Muller Hinton

Agar was used to demonstrate the

antibacterial effect on aerobes, while

Wilkins Chalgren Blood Agar was

used for anaerobes and Sabouraud’s

Dextrose Agar for Candida.

Three wells (4 mm in diameter

and 3 mm deep) were made using

a sterile metallic template, with a

rubber teat in each plate. The inoculums

were prepared and adjusted to

0.5 McFarland turbidity standards,

according to National Committee

on Clinical Laboratory Standards

(NCCLS) guidelines.10 The agar

plates were streaked with the respective

stock culture microorganisms.

Using a sterile spoon excavator, the

toothpastes were dispersed into the

wells. At that point, the plates were

incubated at 37°C for 48 hours in

the respective environments—that

is, E. faecalis and C. albicans in the

incubator, S. mutans and S. mitis in

the candle jar, and L. acidophilus,

Prevotella intermedia, and Peptostreptococcus

anaerobius in an anaerobic

jar (Hi Anaerobic System-Mark

II with Anaerobic Hi Gas Pack, Hi

Media Laboratories, Mumbai, India;

91.022.2500.0970), which works

on the principle of gas generated

from chemicals.

After incubation, zones of inhibition

(that is, locations where no

growth of bacteria was present)

were examined around the wells

that contained the dentifrice. These

appeared as a clear, circular halo

surrounding the wells. Diameters

of the zones were measured with

a Hi Antibiotic Zone Scale (Hi

Media Laboratories). The mean

diameter of the well’s measurements

(in mm) represented the

inhibition value of the tested

product. No attempt was made

to obscure the identity of the test

agents. The test was repeated six

times in triplicate to overcome any

Fig. 1. Zone of inhibition as observed in Candida albicans for
toothpastes A, B, and C, using

Sabouraud’s Dextrose Agar.

Fig. 2. Zone of inhibition observed in Prevotella intermedia for
toothpastes A, B, and C, using Wilkins

Chalgren Blood Agar.

A

B

C

A

B

C

www.agd.org General
Dentistry
May/June 2009 239

technical errors that might have

occurred during a single attempt.

The Kruskall Wallis Test was

utilized, with SPSS Version 14 software

used to analyze the results.

Results

Results of this preliminary in vitro

study demonstrated that aloe vera

tooth gel was equally effective as

Toothpastes B and C for controlling

all of the organisms in the

study. All three toothpastes showed

maximum antimicrobial activity

against C. albicans and all anaerobes

in vitro.

Compared to the Toothpastes B

and C, Toothpaste A demonstrated

an increased antibacterial effect

against S. mitis (p = 0.034). The table

lists the zone of inhibition obtained

from each toothpaste after 48 hours.

Discussion

A review of the literature suggested

that the potential of using aloe

vera for oral hygiene had not been

evaluated prior to this study. The

antibacterial, antifungal, and antiviral

properties of aloe vera have

been established; in addition, it

reduces inflammation and pain and

aids in healing.

The antimicrobial effects of aloe

vera have been attributed to the

plant’s natural anthraquinones:

aloe emodin, aloetic acid, aloin,

anthracine, anthranol, barbaloin,

chrysophanic acid, ethereal oil,

ester of cinnamonic acid, isobarbaloin,

and resistannol.11 In relatively

small concentrations together with

the gel fraction, these anthraquinones

provide analgesic, antibacterial,

antifungal, and antiviral activity;

in high concentrations, they can

be toxic.12 Saponins, which contain

glycosides, are soapy substances

that have both cleansing and antiseptic

properties.13-15

Acemannan, a complex mannose

carbohydrate derived from the

aloe vera plant, has an inherent

stickiness/viscosity, which makes it

ideal for denture adhesive formulations.

A 1998 study reported that

acemannan formulations of 150:1

(containing 0.05% benzalkonium

chloride, 0.1% methylparaben, and

0.01% hyamine 1622) exhibited

ideal adhesive strength and pH and

minimal cytotoxicity.16

The organisms employed in the

present study include both the

normal flora and pathogens of the

oral cavity. S. mutans has been

strongly associated with the initiation

of caries, while there is a correlation

between Lactobacilli and the further

development of carious lesions.17

A 1995 study by Bai et al demonstrated

a high Candida count in children

with insulin-dependent diabetes

mellitus, a condition associated with

symptoms like dry mouth, burning

sensations, and painful fissures.18

E. faecalis has been associated with

Table. Mean diameter of the zone of inhibition obtained after 48
hours of

incubation.

N Mean SD H p

S. mutans 4.18 0.124 (not significant)

A 6 15.8333 0.75277

B 6 15.5000 1.04881

C 6 16.8333 1.16905

C. albicans 5.48 0.058 (not significant)

A 6 24.0000 0.823666

B 6 25.0000 0.89443

C 6 23.6667 1.03280

L. acidophilus 0.87 0.647 (not significant)

A 6 23.1667 3.54495

B 6 23.8333 3.37145

C 6 22.8333 3.06050

S. mitis 6.76 0.034 (significant)

A 6 17.0000 3.16228

B 6 14.6667 1.50555

C 6 14.3333 1.75119

E. faecalis 0.84 0.659 (not significant)

A 6 22.3333 2.06559

B 6 23.0000 2.19089

C 6 23.3333 2.06559

Prevotella intermedia 4.83 0.09 (not significant)

A 6 21.3333 1.03280

B 6 22.1667 0.98319

C 6 20.8333 0.75277

Peptostreptococcus anaerobius 0.07 0.968 (not significant)

A 6 21.6667 0.81650

B 6 21.5000 1.37840

C 6 21.6667 1.36626

240 May/June 2009 General Dentistry www.agd.org

Dental Materials Antimicrobial efficacy of aloe vera tooth gel and commercial
toothpastes

re-infection and subsequent failure of

endodontically treated teeth.19

Anaerobes are a significant part

of orodental flora. Their role in

periodontal disease and root canal

infection is well-established, as is

their role as foci for disseminated

infectious disease. Prevotella intermedia

were predominant among

the anaerobes recovered from these

periodontal infections, which meant

these particular organisms were

appropriate for the present study.20

The majority of the antimicrobial

effects of commercially available

toothpastes can be attributed to

their fluoride content, in the form

of sodium monoflourophosphate (a

concentration of 500–1,000 ppm).

The aloe vera tooth gel used in the

present study has no added fluoride

content but still exerts almost an

equal amount of antimicrobial

activity.

Conclusion

This preliminary in vitro study

demonstrated that aloe vera tooth

gel was as effective as two commercially

popular toothpastes in

controlling all of the organisms used

in the study. In addition, the gel

demonstrated superior antibacterial

effect against S. mitis despite

the absence of additional fluoride.

However, to guarantee these results

and the effectiveness of these tooth

care products, additional long-term

clinical trials should be performed

that incorporate more isolates from

clinical samples.

Disclaimer

The authors have no relationship

with any of the manufacturers cited

in this article.

Author information

Dr. George is a senior lecturer/

assistant professor, Department

of Pedodontics and Preventive

Dentistry, Pushpagiri College of

Dental Sciences, Tiruvallam, Kerala,

India. Dr. Bhat is a professor and

head, Department of Pedodontics

and Preventive Dentistry, Yenepoya

Dental College Hospital, Mangalore,

Karnataka, India. Dr. Antony

is a professor, Department of

Microbiology, Father Muller Medical

College Hospital, Mangalore,

Karnataka, India.

References

1. Itthagarun A, Wei SH. Analysis of fluoride ion

concentrations and in vitro fluoride uptake from

different commercial dentifrices. Int Dent J

1996;46(4);357-361.

2. Collins CE. Alvagel as a therapeutic agent in the

treatment of roentgen and radium burns. Radiol

Rev Chicago Med Rec 1935;57:137-138.

3. PDR for herbal medicines. Montvale, NJ: Medical

Economics Company;1998:631.

4. Red book, 2004. Montvale, NJ: Thomson

Healthcare;2004:53.

5. Tyler V. The honest herbal: A sensible guide to

the use of herbs and related remedies, ed. 3.

New York: Pharmaceutical Products Press;1993:

25-28.

6. Krinsky DL, Hawkins EB, Pelton R, Willis NA, Lavalle

JB. Natural therapeutics pocket guide, ed.

2. Cleveland: Lexi-Comp, Inc.;2003:379.

7. Venkatrama EV. The miracle worker. New Indian

Express 2005;November 22:3.

8. Gold DG, Jordan HV, Van Houte J. A selective

medium for Streptococcus mutans. Arch Oral

Biol 1973;18:1357-1364.

9. Ananthanarayanan R, Panicker CKJ. Text book of

microbiology, ed. 7. Hyderabad, India: Orient

Black Swan;2005:628.

10. National Committee for Clinical Laboratory

Standards. Performance standards for antimicrobial

disc susceptibility tests; approved standard,

ed. 8. Wayne, PA: National Committee for Clinical

Laboratory Standards;2003:9.

11. Wynn RL. Aloe vera gel: Update for dentistry.

Gen Dent 2005;53(1):6-9.

12. Davis RH. Aloe vera: A scientific approach. New

York: Vantage Press;1997.

13. Plaskett LG. The health and medical use of aloe

vera. Tacoma, WA: Life Sciences Press;1996.

14. Coats BC. The silent healer: A modern study of

aloe vera. Garland, TX: B.C. Coats;1979.

15. Gage D. Aloe vera: Nature’s soothing healer.

Rochester, VT: Healing Arts Press;1996.

16. Tello CG, Ford P, Iacopino AM. In vitro evaluation

of complex carbohydrate denture adhesive formulations.

Quintessence Int 1998;29(9):585-593.

17. Zickert I, Emilson CG, Krasse B. Streptococcus

mutans, lactobacilli and dental health in 13-14-

year-old Swedish children. Community Dent

Oral Epidemiol 1982;10(2):77-81.

18. Bai KY, Reddy CD, Abu-Talib SH. Oral candidial

carriage in young insulin dependent diabetics. J

Ind Pedo Prev Dent 1995;13(1):20-23.

19. Kayaoghu G, Orstavik D. Virulence factors of

Enterococcus faecalis: Relationship to endodontic

disease. Crit Rev Oral Biol Med 2004;15(5):

308-320.

20. Newman MG. Anaerobic oral and dental infections.

Rev Infect Dis 1984;6 Suppl 1:S107-S114.

Published with permission by the Academy of

General Dentistry. © Copyright 2009 by the

Academy of General Dentistry. All rights reserved.

www.agd.org
General Dentistry
May/June 2009 241

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