A Clinical Study Investigating the Effects of a Dentifrice Containing 0.454% Stannous Fluoride on Gingivitis Treatment and Plaque Reduction When Used Twice Daily for 12 Weeks

Study Overview
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Brief Summary
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The purpose of this clinical study is to investigate the efficacy of a dentifrice containing 0.454 percent (%) weight by weight (w/w) stannous fluoride (SnF2), on gingivitis treatment and plaque reduction, compared to a regular fluoride dentifrice after 12 weeks twice daily brushing in a population of clinically diagnosed gingivitis without undergoing dental prophylaxis.

Detailed Description
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This will be a single center, randomized, controlled, single blind (examiner blind), two-treatment arm, parallel study. Study participants will be over 18 years old, non-smokers, in good general health with clinically measurable levels of gingivitis that meet all study criteria at the Screening and Baseline visits. Approximately 160 participants (approximately 80 per group) will be randomized to ensure approximately 144 evaluable participants (approximately 72 per group) complete the study.

Official Title
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A Randomized, Controlled, Examiner-Blind Clinical Study Investigating the Effects of a Dentifrice Containing 0.454% w/w Stannous Fluoride on Gingivitis Treatment and Plaque Reduction When Used Twice Daily for 12 Weeks

Conditions
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Gingivitis

Intervention / Treatment
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* Drug: Stannous fluoride toothpaste
* Drug: Sodium fluoride toothpaste


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant provision of a signed and dated informed consent document indicating that the participant has been informed of all pertinent aspects of the study before any assessment is performed. Participant is of either sex and any gender who, at the time of screening, is at least 18 years old, inclusive. A participant who is willing and able to comply with scheduled visits, treatment plan, and other study procedures. A participant in good general and mental health with, in the opinion of the investigator or medically qualified designee, no clinically significant/relevant abnormalities in medical history or upon oral examination, or condition, that would impact the participant's safety, wellbeing or the outcome of the study, if they were to participate in the study, or affect the participant's ability to understand and follow study procedures and requirements. Participant oral health that meets all the following: At Screening (Visit 1): Participant with at least 20 natural, permanent teeth. Participant with at least 40 evaluable surfaces for MGI, BI, and TPI (An evaluable surface is defined as having two thirds of the natural tooth surface gradable for the selected clinical indices. The following will not be included in the evaluable surface count: third molars; fully crowned/extensively restored, grossly carious, orthodontically banded/bonded or abutment teeth; surfaces with calculus deposits which, in the opinion of the clinical examiner, would interfere with the baseline assessments of the selected clinical indices). A participant with plaque-induced gingivitis, in the opinion of the clinical examiner, as confirmed by a gross visual examination. At Baseline (Visit 2): A participant with ongoing hard tissue eligibility and, in the opinion of the clinical examiner, at least 40 evaluable surfaces. A participant with 10% to 30% bleeding sites (following BI). A participant with mean whole mouth TPI score >=1.5. Exclusion Criteria: A participant who is an employee of the investigational site, either directly involved in the conduct of the study or a member of their immediate family; or an employee of the investigational site otherwise supervised by the investigator; or, a sponsor's employee directly involved in the conduct of the study or a member of their immediate family. A participant who has participated in other studies (including non-medicinal studies) involving investigational product(s) within 30 days prior to study entry and/or during study participation. A participant with, in the opinion of the investigator or medically qualified designee, an acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator or medically qualified designee, would make the participant inappropriate for entry into this study. A participant who has any other clinical serious or unstable conditions (for example, cardiovascular diseases, diabetes, liver disorders, and kidney disorders) which could have affected study outcomes and/or participant safety. A participant who is a pregnant female (self-reported) or is intending to become pregnant over the duration of the study. A participant who is a breastfeeding female. A participant who is known or suspected intolerance or hypersensitivity to the study materials (or closely related compounds) or any of their stated ingredients. A participant who is unwilling or unable to comply with the lifestyle considerations. Participant who is a current smoker or an ex-smoker who stopped within 6 months of Screening. Participant who is using smokeless forms of tobacco (for example, chewing tobacco, gutkha, pan containing tobacco, nicotine-based e-cigarettes). A participant who is diagnosed xerostomia or is taking any medication that in the view of the investigator is causing xerostomia. A participant who has a medical condition which could have directly influenced gingival bleeding (for example, type 2 diabetes). A participant who has a bleeding disorder that could have affected study outcomes and/or participant safety. A participant who has a recent history (within the last year) of alcohol or other substance abuse. A participant who has a severe oral condition (for example, acute necrotizing ulcerative gingivitis or oral or peri-oral ulceration including herpetic lesions) that could, in the opinion of the investigator, compromise study outcomes or the oral health of the participant/examiner if they participate in the study. Presence of a tongue or lip piercing, or any other oral feature that could interfere with the usage of a toothbrush. Medication exclusions at screening (Visit 1): A participant using any antibiotic medication within 14 days prior to screening or at any time during the study. A participant currently taking an anti-inflammatory medication which, in the opinion of the Investigator, could affect gingival condition. A participant currently taking a systemic medication (for example, anti-inflammatory, anticoagulant, immunosuppressants) or traditional/ herbal remedy which, in the opinion of the Investigator, could affect plaque/ gingival condition (for example, ibuprofen, aspirin, warfarin, cyclosporin, phenytoin, calcium channel blockers). Medication exclusions at Baseline (Visit 2): A participant who has taken (in the previous 14 days), any antibiotics. A participant who has taken (in the previous 14 days) a systemic medication (for example, anti-inflammatory, anti-coagulant, immunosuppressants) or traditional/ herbal remedy which, in the opinion of the Investigator, could affect plaque/ gingival condition (for example, ibuprofen, aspirin, warfarin, cyclosporin, phenytoin, calcium channel blockers). A participant who has used an antibacterial dentifrice or mouthwash (for example, chlorhexidine) or any oral care product that in the view of the investigator could interfere with plaque formation or measures of gingivitis, in the period between Screening and the Baseline visit. Periodontal exclusions: A participant who shows signs of active periodontitis (with probing pocket depths greater than [>] 3mm). A participant who is receiving or has received treatment for periodontal disease (including surgery) within 12 months of Screening. A participant who has gingivitis, which in the opinion of the investigator, is not expected to respond to treatment with an over the counter (OTC) dentifrice. Dental Exclusions: A participant who has active caries that could, in the opinion of the investigator, compromise study outcomes or the oral health of the participant if they participate in the study. A participant who has dentures (partial or full). A participant who has an orthodontic appliance (bands, appliances, or fixed/ removable retainers). A participant who received orthodontic therapy within 3 months of Screening. A participant who has numerous restorations in a poor state of repair. A participant who has any dental condition (for example, overcrowding) that could, in the opinion of the investigator, compromise study outcomes or the oral health of the participant if they participate in the study. A participant who has had dental prophylaxis within 12 weeks of Screening. A participant who has had teeth bleaching within 12 weeks of Screening. A participant who has high levels of extrinsic stain or calculus deposits, in the opinion of the investigator, that could have interfered with plaque assessments. A participant who has previously been enrolled in this study. A participant who, in the opinion of the investigator or medically qualified designee, should not participate in the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Test Product<br>Participants will be instructed to brush their teeth with full ribbon of toothpaste (0.454% w/w SnF2) on head of toothbrush provided for at least one (timed) minute twice a day (morning and evening) for 12 weeks. | Drug: Stannous fluoride toothpaste<br>* 0.454% w/w SnF2<br>|
| Active Comparator: Negative Control<br>Participants will be instructed to brush their teeth with full ribbon of toothpaste (0.243% w/w Sodium fluoride) on head of toothbrush provided for at least one (timed) minute twice a day (morning and evening) for 12 weeks. | Drug: Sodium fluoride toothpaste<br>* 0.243% w/w Sodium fluoride<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Number of Bleeding Sites (NBS) at Week 12 | The probe will be gently inserted into the gingival crevice to a depth of approximately 1 millimeter (mm) and then run around the tooth (at angle of approximately 60 degrees to the long axis of the tooth), gently stretching the epithelium while sweeping from interproximal to interproximal along the sulcular epithelium. The number of bleeding sites for each participant= the number of evaluable tooth sites with bleeding observed immediately on probing or within 30 seconds of probing. Change from baseline will be calculated by subtracting number of bleeding sites at baseline from number of bleeding sites at Week 12. | Week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in NBS at Week 12 (Test Product Versus [Vs] Negative Control) | The examiner will use a probe to assess bleeding. The probe will be gently inserted into the gingival crevice to a depth of approximately 1 mm and then run around the tooth (at angle of approximately 60 degrees to the long axis of the tooth), gently stretching the epithelium while sweeping from interproximal to interproximal along the sulcular epithelium. The number of bleeding sites for each participant= the number of evaluable tooth sites with bleeding observed immediately on probing or within 30 seconds of probing. Change from baseline will be calculated by subtracting number of bleeding sites at baseline from number of bleeding sites at Week 12. | Week 12 | 
| Change from Baseline in NBS at Weeks 3 and 6 (Test Product Vs Negative Control) | The examiner will use a probe to assess bleeding. The probe will be gently inserted into the gingival crevice to a depth of approximately 1 mm and then run around the tooth (at angle of approximately 60 degrees to the long axis of the tooth), gently stretching the epithelium while sweeping from interproximal to interproximal along the sulcular epithelium. The number of bleeding sites for each participant= the number of evaluable tooth sites with bleeding observed immediately on probing or within 30 seconds of probing. Change from baseline will be calculated by subtracting number of bleeding sites at baseline from number of bleeding sites at indicated timepoints. | Week 3 and Week 6 | 
| Change from Baseline in Mean Turesky Modification of the Quigley Hein Plaque Index (TPI) (Overall) at Weeks 3, 6 and 12 (Test Product Vs Negative Control) | The TPI will be used to assess plaque on all gradable teeth. The plaque will first be disclosed using a plaque disclosing dye solution and will be assessed on the facial and lingual surfaces of each scorable tooth (second molar to second molar). Disclosed plaque will be scored on 6 points scale ranging from 0 to 5, where 0= No plaque, 1= Separate flecks of plaque at the cervical margin, 2= Thin continuous band of plaque (up to 1mm) at the cervical margin, 3= Band of plaque wider than 1 mm but covering less than (<) 1/3 of the tooth surface, 4= Plaque covering greater than or equal to (>=) 1/3 but < 2/3 of the tooth surface, 5= Plaque covering >= 2/3 of the tooth surface. Lower score indicates improvement in the symptoms. Change from baseline will be calculated by subtracting baseline score from score at indicated timepoints. | Weeks 3, 6 and 12 | 
| Change from Baseline in Mean TPI (Interproximal) at Weeks 3, 6 and 12 (Test Product Vs Negative Control) | The TPI will be used to assess plaque on all gradable teeth. The plaque will first be disclosed using a plaque disclosing dye solution and will be assessed on the facial and lingual surfaces of each scorable tooth (second molar to second molar). Disclosed plaque will be scored on 6 points scale ranging from 0 to 5, where 0= No plaque, 1= Separate flecks of plaque at the cervical margin, 2= Thin continuous band of plaque (up to 1 mm) at the cervical margin, 3= Band of plaque wider than 1 mm but covering <1/3 of the tooth surface, 4= Plaque covering >=1/3 but < 2/3 of the tooth surface, 5= Plaque covering >= 2/3 of the tooth surface. Lower score indicates improvement in the symptoms. Change from baseline will be calculated by subtracting baseline score from score at indicated timepoints. | Weeks 3, 6 and 12 | 
| Change from Baseline in Bleeding Index (BI) at Weeks 3, 6 and 12 (Test Product Vs Negative Control) | The BI assesses the number of bleeding points elicited on probing as a measure of gingival condition. The probe will be gently inserted into the gingival crevice to a depth of approximately 1 mm and then run around the tooth (at angle of approximately 60 degrees to the long axis of the tooth), gently stretching the epithelium while sweeping from interproximal to interproximal along the sulcular epithelium. The BI will be assessed on the facial and lingual gingival surfaces of each scorable tooth (second molar to second molar). The BI index scoring will be done on 3 points scale ranging from 0 to 2, where 0= No bleeding after 30 seconds, 1= Bleeding observed within 30 seconds of probing, 2= Bleeding observed immediately on probing. Lower score indicates improvement in the symptoms. Change from baseline will be calculated by subtracting baseline score from score at indicated timepoints. | Weeks 3, 6 and 12 | 
| Change from Baseline in Modified Gingival Index (MGI) at Weeks 3, 6 and 12 (Test Product Vs Negative Control) | The MGI assessment is a non-invasive evaluation which focuses on the visual symptoms of gingivitis (for example, redness, texture, edema). The MGI will be assessed on the facial and lingual surfaces of each scorable tooth by examiner using a scale ranging from 0 to 4, where 0= Absence of inflammation, 1= Mild inflammation; slight change in colour, little change in colour; little change in texture of any portion of the marginal or papillary gingival unit, 2= Mild inflammation; criteria as above but involving the entire marginal or papillary gingival unit, 3= Moderate inflammation; glazing, redness, edema, and/ or hypertrophy of the marginal or papillary gingival unit, 4= Severe inflammation; marked redness, edema and/ or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration. Lower score indicates improvement in the symptoms. Change from baseline will be calculated by subtracting baseline score from score at indicated timepoints. | Weeks 3, 6 and 12 |