biofilm | the teeth, gingivae and oral mucosa. Inevitably, a build-up of microorganisms, biofilm, can form on the pellicle and threaten the enamel. The enzymes and proteins in sa- liva, however, are able to act extremely effectively against unwanted bacteria, fungi and viruses, by restricting their formation and breaking down potentially harmful sugars. Zendium studies A 2017 study by Adams, published in Scientific Reports, showed how a toothpaste containing certain enzymes and proteins can significantly shift the ecology of the plaque microbiome at species level, resulting in a community with a stronger association with gingival health.2 That year, two other studies, presented at the oral health research con- gress of the Continental European and Scandinavian divi- sions of the International Association for Dental Research in Vienna in Austria, shed light on how a toothpaste con- taining enzymes and proteins naturally present in saliva positively affects gingival health. The two different teams of scientists compared Zendium (Unilever), a commer- cial toothpaste that, in addition to fluoride, contains these natural salivary components, with control fluoride tooth- pastes. One team did so in an epidemiological setting, and the other in a clinical trial. Epidemiological setting An epidemiology study at the University of Copen- hagen led by Prof. Anne Marie Lynge Pedersen, head of the university’s Department of Odontology, examined 305 people regarding the long-term effects of their per- sonal choice of toothpaste on their gingival health. Long- term Zendium users were found to have significantly better gingival health than those who used regular, fluo- ride-only toothpastes. These results were irrespective of diet and brushing or smoking habits. This landmark study showed for the first time that long-term everyday use of a toothpaste that contains enzymes and proteins positively affects gingival health. Clinical trial A study in the UK at the Bristol Dental School’s Clinical Trials Unit found similar results. Prof. Nicola West and her colleagues examined the gingival health of 229 partici- pants regarding plaque, inflammation and bleeding. After 13 weeks, the participants who had been brushing twice a day with Zendium had significantly better gingival health on all three parameters than the group that had been brushing with a fluoride control toothpaste. Moreover, 83 per cent of the Zendium users had improved gingival health. Speaking at the congress in Vienna, West said, “It is very exciting to see two studies demonstrating the ben- efits brushing with Zendium can bring to gingival health.” Prevention and the microbiome Consistent with the findings of the Adams investiga- tion, the two studies present evidence that a toothpaste containing enzymes and proteins enhances the effects of the innate immune factors in the oral cavity. The result is a shift of the oral microbiome towards healthy symbi- osis and improved gingival health. The number of bac- teria associated with gingival health increases, and the number of bacteria associated with periodontal disease decreases. “With the new information that has become available, it is clear that oral disease is the result of dysbi- osis,” said Kilian. “Prevention is a crucial part of dentistry, prevention aimed at restoring the balance within our oral microbiome and between the microbiome and us.” Editorial note: A list of references can be obtained from the publisher. prevention 1 2018 37