Effects of Different Types of Toothpaste on Fasting Blood Glucose Levels in Diabetic Individuals: A Systematic Review of Pre-Test/Post-Test Studies
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Edung Emem Samuel
Emergency Department, Basildon and Thurock University Hospital, London, NHS Trust Foundation, United Kingdom.
Benjamin Essien
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Bassey Okon Bassey
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ughwusuena Ufuoma Louis
Independent Researcher, Nottinghamshire, United Kingdom.
Ramatu Umar Ibrahim
Department of Undergraduate Medical Education Department, Wynthenshawe Hospital, University of Manchester, NHS Foundation Trust, England, United Kingdom.
Eunice Akomu Aji
Department of Acute Medicine, United Lincolnshire Teaching Hospitals NHS Trust, Boston, United Kingdom.
Ewa Anthony Obi
Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Idiege Idiege Omang
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Akaba Kingsley Onoridea
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar, Cross Rivers State, Nigeria.
Ugwuanyi Ifeanyichukwu Samson
Department of Internal Medicine, Darlington Memorial Hospital, England, United Kingdom.
Makata, Rex Oseloka
Department of Internal Medicine, Ilogbo Central Hospital Lagos, Lagos State, Nigeria.
Promise Chika Kemas-Uneze
Department of Public Health, Birmingham City University, England, United Kingdom.
Jane Ulifo Falade
Department of General Medicine, Mashi Hospital and specialist Clinics, Kaduna, Nigeria.
Wisdom Effiong
Department of Internal Medicine, The Bank Hospital, Accra, Ghana.
David Ikechukwu Achuzia
Department of Family Medicine, Federal Medical Centre, Asaba, Delta State, Nigeria.
Oluwaseun Abiodun Oloyede
Barking Havering and Redbridge University Hospital, Romford, England, United Kingdom.
Isoboye, Manuel Bokoye
Department of Accident and Emergency, Royal Free London NHS Foundation Trust, North Middlesex University Hospital, London, United Kingdom.
Nnaji Chimuanya Joseph
Department of Surgery, Nnandi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
Immaculate Ihuoma Ekeagba
Worcaccce Union Group Integrated Healthcare Sciences, Technological Development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O. Box 45 Bamenda, North West Region, Cameroon.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Toothpastes marketed as sugar-free, herbal, probiotic, paraprobiotic or diabetes-specific are sometimes presumed to influence glycaemia. The evidence relevant to fasting blood glucose (FBG), however, is easily conflated with studies of salivary glucose or periodontal outcomes.
Objective: To determine whether different toothpaste formulations alter FBG in individuals with diabetes and, secondarily, whether they affect other systemic glycaemic outcomes such as glycated haemoglobin (HbA1c).
Methods: A systematic review was conducted for 1 January 1990 to 30 May 2026 and reported in accordance with PRISMA 2020, PRISMA-S and SWiM. A completed open-source verification search covered PubMed/MEDLINE, PubMed Central and Europe PMC, Crossref, DOI and publisher records, DOAJ, the Cochrane Library, ClinicalTrials.gov, the Clinical Trials Registry–India, WHO ICTRP, and backward and forward citation checking. Subscription-database exports were unavailable; therefore, no unverified Embase, Scopus, Web of Science, CINAHL or PsycINFO counts were reported. Eligible studies compared toothpaste types in people with diabetes and measured FBG, fasting plasma glucose or HbA1c. Salivary glucose alone was not accepted as a systemic glycaemic outcome. Risk of bias was assessed with RoB 2, and certainty was judged using a structured GRADE-informed approach.
Results: The manually preserved candidate log contained 12 source records; three duplicate source records were removed, leaving nine unique full-text reports. Eight were excluded: three measured salivary glucose only, two reported no systemic glycaemic outcome, and three did not compare toothpaste types. One randomised trial (40 adults with type 1 diabetes) was included. It compared a paraprobiotic toothpaste-plus-mousse protocol with a natural-extract toothpaste protocol after professional oral hygiene. No FBG outcome was reported. Mean HbA1c changed from 7.04% to 6.82% in the paraprobiotic group and from 7.29% to 7.10% in the natural-extract group over six months; the study reported no significant between-group differences. Overall risk of bias raised some concerns, and certainty for a toothpaste-specific effect on HbA1c was very low.
Conclusions: No direct evidence demonstrates that one toothpaste type lowers FBG in people with diabetes. The single indirect HbA1c trial did not isolate toothpaste effects from professional periodontal care, brushing instruction or an additional mousse. Salivary-glucose findings cannot be interpreted as evidence of systemic glycaemic benefit. Well-powered, preregistered trials with FBG and HbA1c as prespecified outcomes are required.
Keywords: Diabetes mellitus, dentifrices, toothpaste, fasting blood glucose, HbA1c, oral hygiene, periodontal disease, systematic review