Efficacy of 67% Sodium Bicarbonate toothpaste for plaque and gingivitis control: a systematic review and meta-analysis

Objective: Previous studies demonstrated a dose-dependent efficacy of sodium bicarbonate when added to dentifrices for the mechanical control of dental biofilm. The present systematic review and meta-analysis aimed to evaluate the efficacy of a 67% sodium bicarbonate-based toothpaste for gingival health parameters improvement in subjects with gingivitis. Materials and methods: An electronic search on MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), was performed using a combination of keywords, followed by a hand search on pertinent Journals. Randomized controlled trials (RCTs) and prospective comparative studies in English language were included. There was no publication date and language restriction. The data regarding gingival, bleeding, and plaque index were extracted from the selected studies. Included studies underwent risk-of-bias assessment. When at least 3 studies reporting the same outcome were found, a meta‐analysis was undertaken, to estimate the combined effect. Trial Sequential Analysis (TSA) was also performed to evaluate the power of the meta-analysis for primary outcomes. Results: The search strategy yielded 83 articles. After screening, 7 RCTs were included. Three were at high risk, one at moderate risk, and 3 at low risk-of-bias. Significant improvement of gingival index, bleeding index, and plaque index was observed in patients using 67% sodium bicarbonate toothpaste as compared with control subjects. TSA showed sufficient power for modified Gingival index and bleeding scores. Conclusions: The clinical use of 67% sodium bicarbonate toothpaste can improve periodontal health in patients with gingivitis.