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Safety and Tolerability of Antiplaque Chewing Gum in a Gingivitis Population (APCG)

Primary Purpose

Plaque, Gingivitis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
2 mg KSL-W
4 mg KSL-W
6 mg KSL-W
10 mg KSL-W
20 mg KSL-W
30 mg KSL-W
50 mg KSL-W
75 mg KSL-W
100 mg KSL-W
Placebo
Sponsored by
U.S. Army Medical Research and Development Command
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Plaque focused on measuring Reducing plaque, Reducing gingivitis, safety, proof of concept, antiplaque chewing gum

Eligibility Criteria

18 Years - 64 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Subjects must meet all of the following criteria to be included in the Phase 1 portion of the study:

  • Males and females between 18 and 64 years of age
  • A negative urine pregnancy test and willingness to use a reliable form of contraception for the duration of the study (females of childbearing potential only), with reliable contraception defined as:

Abstinence Oral contraceptive, either estrogen progesterone combined, or progesterone alone Injectable progesterone Implants of levonorgestrel Estrogenic vaginal ring Percutaneous contraceptive patches Intrauterine device or intrauterine system Double barrier method [condom or occlusive cap (diaphragm or cervical vault caps) plus spermicidal agent (foam, gel, film, cream, suppository)] Male partner sterilization prior to the female subject's entry into the study, and this male is the sole partner for that subject

  • Good health, as determined by pertinent medical history, physical examination, vital signs, and clinical safety laboratory evaluations
  • A minimum of 16 natural teeth with 2 scorable surfaces (facial and lingual) per tooth Sufficient number of opposing posterior teeth to chew on both sides of the mouth as determined by the examining dentist Teeth that have gross caries, full crowns or extensive restorations on facial and/or lingual surfaces, orthodontic bands, and third molars are not included in the tooth count
  • Ability to comprehend and a willingness to sign an informed consent, which includes the Authorization for the Release of Health Information document
  • Willingness to comply with all study procedures

Phase 2a Inclusion Criteria

Subjects must meet all the criteria for the phase 1 portion of the study, and in addition must:

  • Have mild to moderate gingivitis and plaque MGI of 1.8 or greater (Ainamo and Bay-1975) PI of 1.95 or greater (Turesky et al-1970)
  • Willing to forgo any optional dental procedures during the study period, such as dental prophylaxis or teeth whitening

Exclusion Criteria:

Subjects meeting any of the following criteria will be excluded from the study:

  • Acute or chronic medical conditions, organ system disease, or medications that, in the principal investigator's opinion, would impair the subject's ability to participate
  • TMD
  • Self-reported use of tobacco products
  • Use of anticoagulant medications (eg clopidogrel)
  • Gross oral pathology, including widespread caries or chronic neglect, extensive restoration, pre-existing gross plaque or calculus, or soft or hard tissue tumor of the oral cavity
  • Orthodontic appliances or removable partial dentures that will compromise the ability of the potential subject to participate in the study
  • Periodontitis as indicated periodontal pockets greater than 4 millimeters on more than one site
  • Receipt of any investigational drug/test product within 30 days prior to study entry
  • Receipt of antibiotics within 30 days prior to study entry
  • Need for antibiotic prophylaxis prior to invasive dental procedures
  • Receipt of daily anti-inflammatory therapy [eg nonsteroidal anti-inflammatory drugs (NSAID), tumor necrosis factor (TNF) alpha blockers] within 30 days prior to study entry
  • Receipt of prescription antibacterial oral products (eg products containing chlorhexidine) within 30 days prior to study entry
  • Pregnant or breast-feeding female
  • Clinically significant abnormal laboratory tests as determined by the principal investigator
  • An employee of the study site directly involved with the study
  • Inability to comply with assigned treatment regimen

Sites / Locations

  • Indiana University School of Dentistry, Oral Health Research Institute

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm 9

Arm 10

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

2 mg KSL-W (Phase 1, 1a)

4 mg KSL-W (Phase 1, 2a; Phase 2a, 1b)

6 mg KSL-W (Phase 1, 3a; Phase 2a, 2b)

10 mg KSL-W (Phase 1, 4a; Phase 2a, 3b)

20 mg KSL-W (Phase 1, 5a; Phase 2a, 4b)

30 mg KSL-W (Phase 1, 6a; Phase 2a, 5b)

50 mg KSL-W (Phase 1, 7a; Phase 2a, 6b)

75 mg KSL-W (Phase 1, 8a; Phase 2a, 7b)

100 mg KSL-W (Phase 1, 9a)

Placebo

Arm Description

one 2 mg KSL-W tablet at day 0 at Phase 1

one 4 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. one 4 mg KSL-W tablet on days 1-6; two 4 mg KSL-W tablets on days 7-13 and days 14-20; and three 4 mg tablets at days 21-27 at Phase 2a.

One 6 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 6 mg KSL-W tablet on days 1-6; two 6 mg KSL-W tablets on days 7-13 and days 14-20; and three 6 mg tablets at days 21-27 at Phase 2a.

One 10 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 10 mg KSL-W tablet on days 1-6; two 10 mg KSL-W tablets on days 7-13 and days 14-20; and three 10 mg tablets at days 21-27 at Phase 2a.

One 20 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 20 mg KSL-W tablet on days 1-6; two 20 mg KSL-W tablets on days 7-13 and days 14-20; and three 20 mg tablets at days 21-27 at Phase 2a.

One 30 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 30 mg KSL-W tablet on days 1-6; two 30 mg KSL-W tablets on days 7-13 and days 14-20; and three 30 mg tablets at days 21-27 at Phase 2a.

One 50 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 50 mg KSL-W tablet on days 1-6; two 50 mg KSL-W tablets on days 7-13 and days 14-20; and three 50 mg tablets at days 21-27 at Phase 2a.

One 75 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 75 mg KSL-W tablet on days 1-6; two 75 mg KSL-W tablets on days 7-13 and days 14-20; and three 75 mg tablets at days 21-27 at Phase 2a.

one 100 mg KSL-W tablet at day 0 at Phase 1

Placebo

Outcomes

Primary Outcome Measures

Safety and Tolerability of KSL-W as Measured by Soft Tissue Erythema, Ulceration and Sloughing (AEs and SAEs)
Occurrence of local oral mucosal reactions, systemic reactions such as fever, nausea, headache, and changes in blood pressure, clinical laboratory measures of safety, and serious total body reactions will be assessed (AEs and SAEs)

Secondary Outcome Measures

Proof of Concept of KSL-W in Reducing Plaque in Phase 2a
Data summarizes plaque index scores changes from baseline. Supragingival plaque will be assessed after the MGI and BOP assessments and following use of a disclosing solution on the facial (buccal) and lingual surfaces of a minimum of 16 scorable teeth according to the criteria of the Turesky modification of the Quigley-Hein Plaque Index. Quigley-Hein Plaque Index Scores with Turesky Modifications: 0 No plaque Separate flecks of plaque at the cervical margin of the tooth A thin continuous band of plaque (up to one mm) at the cervical margin of the tooth A band of plaque wider than one mm but covering less than one-third of the crown of the tooth Plaque covering at least one-third but less than two thirds of the crown of the tooth Plaque covering two-thirds or more of the crown of the tooth
Proof of Concept of KSL-W in Reducing Gingivitis in Phase 2a
Data summarizes gingival index scores changes from baseline in phase 2a. Gingivitis will be assessed using both the MGI (Modified Gingival Index) and the Gingival Bleeding Index (BOP) The Modified Gingival Index assesses the buccal and lingual gingivae and interdental papillae. Modified Gingival Index Scores: 0 Absence of inflammation Mild inflammation; slight change in color, little change in texture of any portion of but not the entire marginal or papillary gingival unit Mild inflammation; criteria as above but involving the entire marginal or papillary gingival unit Moderate inflammation; glazing, redness, edema and/or hypertrophy of the marginal or papillary gingival unit Severe inflammation; marked redness, edema and/or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration.
Gingival Bleeding on Probing (BOP) - Percent of Bleeding Sites Upon Probing in Phase 2a
Proof of concept of KSL-W in reducing plaque as measured by percent of bleeding sites upon probing (BOP) in phase 2a. Gingivitis will be assessed using both the MGI (Modified Gingival Index) and the Gingival Bleeding Index (BOP). The Modified Gingival Index assesses the buccal and lingual gingivae and interdental papillae. The Gingival Bleeding Index assesses the percentage of sites that bleed on gentle probing. A periodontal probe (HU-Friedy UNC 15) will be gently inserted into the gingival sulcus until resistance is felt at mid-facial (buccal), mid-lingual, mesial, and distal interproximal sites of all scorable teeth, with the exception of the most posterior distal sites. Presence or absence of bleeding will be recorded for each site and the percentage of bleeding sites per subject will serve as the unit of analysis.

Full Information

First Posted
May 14, 2013
Last Updated
February 11, 2020
Sponsor
U.S. Army Medical Research and Development Command
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1. Study Identification

Unique Protocol Identification Number
NCT01877421
Brief Title
Safety and Tolerability of Antiplaque Chewing Gum in a Gingivitis Population
Acronym
APCG
Official Title
A Double-Blind, Randomized, Controlled, Dose Escalation Clinical Trial of an Antiplaque Chewing Gum - Phase 1 Safety and Tolerability and Phase 2a Safety, Tolerability, and Proof of Concept in a Gingivitis Population
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
February 25, 2014 (Actual)
Primary Completion Date
August 25, 2015 (Actual)
Study Completion Date
March 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
U.S. Army Medical Research and Development Command

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is to assess the safety and tolerability of single doses and multiple doses in reducing plaque and gingivitis when delivered in a chewing gum formulation.
Detailed Description
This study is a Phase 1/2a placebo-controlled, double-blind, randomized, dose-escalation study to evaluate the safety and proof of concept of Antiplaque Chewing Gum. This is a 2-part trial with 9 dosing cohorts in Phase 1 and 7 dosing cohorts in Phase 2a. For both phases, the oral soft (OST) and oral hard tissues (OHT) will be examined. Changes from baseline, such as soft tissue erythema, ulceration and sloughing, will be noted and assessments will be made by the principal investigator as to whether they might be attributable to the antiplaque chewing gum. In the Phase 2a portion of the study, the efficacy of the antiplaque chewing gum in reducing existing supragingival plaque and gingivitis will also be assessed. Plaque will be assessed using the Turesky Modification of the Quigley-Hein Plaque Index (PI, Turesky et al-1970) and gingivitis will be assessed using both the Modified Gingival Index (MGI, Lobene et al-1986) and the percent of bleeding sites on gentle probing (BOP) using the methods described in Ainamo and Bay-1975.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Plaque, Gingivitis
Keywords
Reducing plaque, Reducing gingivitis, safety, proof of concept, antiplaque chewing gum

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
135 (Actual)

8. Arms, Groups, and Interventions

Arm Title
2 mg KSL-W (Phase 1, 1a)
Arm Type
Experimental
Arm Description
one 2 mg KSL-W tablet at day 0 at Phase 1
Arm Title
4 mg KSL-W (Phase 1, 2a; Phase 2a, 1b)
Arm Type
Experimental
Arm Description
one 4 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. one 4 mg KSL-W tablet on days 1-6; two 4 mg KSL-W tablets on days 7-13 and days 14-20; and three 4 mg tablets at days 21-27 at Phase 2a.
Arm Title
6 mg KSL-W (Phase 1, 3a; Phase 2a, 2b)
Arm Type
Experimental
Arm Description
One 6 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 6 mg KSL-W tablet on days 1-6; two 6 mg KSL-W tablets on days 7-13 and days 14-20; and three 6 mg tablets at days 21-27 at Phase 2a.
Arm Title
10 mg KSL-W (Phase 1, 4a; Phase 2a, 3b)
Arm Type
Experimental
Arm Description
One 10 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 10 mg KSL-W tablet on days 1-6; two 10 mg KSL-W tablets on days 7-13 and days 14-20; and three 10 mg tablets at days 21-27 at Phase 2a.
Arm Title
20 mg KSL-W (Phase 1, 5a; Phase 2a, 4b)
Arm Type
Experimental
Arm Description
One 20 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 20 mg KSL-W tablet on days 1-6; two 20 mg KSL-W tablets on days 7-13 and days 14-20; and three 20 mg tablets at days 21-27 at Phase 2a.
Arm Title
30 mg KSL-W (Phase 1, 6a; Phase 2a, 5b)
Arm Type
Experimental
Arm Description
One 30 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 30 mg KSL-W tablet on days 1-6; two 30 mg KSL-W tablets on days 7-13 and days 14-20; and three 30 mg tablets at days 21-27 at Phase 2a.
Arm Title
50 mg KSL-W (Phase 1, 7a; Phase 2a, 6b)
Arm Type
Experimental
Arm Description
One 50 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 50 mg KSL-W tablet on days 1-6; two 50 mg KSL-W tablets on days 7-13 and days 14-20; and three 50 mg tablets at days 21-27 at Phase 2a.
Arm Title
75 mg KSL-W (Phase 1, 8a; Phase 2a, 7b)
Arm Type
Experimental
Arm Description
One 75 mg KSL-W tablet on day 0 at both Phase 1 and Phase 2a. One 75 mg KSL-W tablet on days 1-6; two 75 mg KSL-W tablets on days 7-13 and days 14-20; and three 75 mg tablets at days 21-27 at Phase 2a.
Arm Title
100 mg KSL-W (Phase 1, 9a)
Arm Type
Experimental
Arm Description
one 100 mg KSL-W tablet at day 0 at Phase 1
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo
Intervention Type
Drug
Intervention Name(s)
2 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
4 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
6 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
10 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
20 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
30 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
50 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
75 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Drug
Intervention Name(s)
100 mg KSL-W
Other Intervention Name(s)
Antiplaque Chewing Gum
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Cetylpyridinium chloride (CPC) as an additive, isomalt as a bulk sweetener, peppermint powder for flavoring, sucralose as an intense sweetener, colloidal silicon dioxide is a flow enhancer, magnesium stearate as a process aid, and the proprietary gum base formulation.
Primary Outcome Measure Information:
Title
Safety and Tolerability of KSL-W as Measured by Soft Tissue Erythema, Ulceration and Sloughing (AEs and SAEs)
Description
Occurrence of local oral mucosal reactions, systemic reactions such as fever, nausea, headache, and changes in blood pressure, clinical laboratory measures of safety, and serious total body reactions will be assessed (AEs and SAEs)
Time Frame
Up to 28 days
Secondary Outcome Measure Information:
Title
Proof of Concept of KSL-W in Reducing Plaque in Phase 2a
Description
Data summarizes plaque index scores changes from baseline. Supragingival plaque will be assessed after the MGI and BOP assessments and following use of a disclosing solution on the facial (buccal) and lingual surfaces of a minimum of 16 scorable teeth according to the criteria of the Turesky modification of the Quigley-Hein Plaque Index. Quigley-Hein Plaque Index Scores with Turesky Modifications: 0 No plaque Separate flecks of plaque at the cervical margin of the tooth A thin continuous band of plaque (up to one mm) at the cervical margin of the tooth A band of plaque wider than one mm but covering less than one-third of the crown of the tooth Plaque covering at least one-third but less than two thirds of the crown of the tooth Plaque covering two-thirds or more of the crown of the tooth
Time Frame
days 14, 28, 34
Title
Proof of Concept of KSL-W in Reducing Gingivitis in Phase 2a
Description
Data summarizes gingival index scores changes from baseline in phase 2a. Gingivitis will be assessed using both the MGI (Modified Gingival Index) and the Gingival Bleeding Index (BOP) The Modified Gingival Index assesses the buccal and lingual gingivae and interdental papillae. Modified Gingival Index Scores: 0 Absence of inflammation Mild inflammation; slight change in color, little change in texture of any portion of but not the entire marginal or papillary gingival unit Mild inflammation; criteria as above but involving the entire marginal or papillary gingival unit Moderate inflammation; glazing, redness, edema and/or hypertrophy of the marginal or papillary gingival unit Severe inflammation; marked redness, edema and/or hypertrophy of the marginal or papillary gingival unit, spontaneous bleeding, congestion, or ulceration.
Time Frame
days 14, 28, 34
Title
Gingival Bleeding on Probing (BOP) - Percent of Bleeding Sites Upon Probing in Phase 2a
Description
Proof of concept of KSL-W in reducing plaque as measured by percent of bleeding sites upon probing (BOP) in phase 2a. Gingivitis will be assessed using both the MGI (Modified Gingival Index) and the Gingival Bleeding Index (BOP). The Modified Gingival Index assesses the buccal and lingual gingivae and interdental papillae. The Gingival Bleeding Index assesses the percentage of sites that bleed on gentle probing. A periodontal probe (HU-Friedy UNC 15) will be gently inserted into the gingival sulcus until resistance is felt at mid-facial (buccal), mid-lingual, mesial, and distal interproximal sites of all scorable teeth, with the exception of the most posterior distal sites. Presence or absence of bleeding will be recorded for each site and the percentage of bleeding sites per subject will serve as the unit of analysis.
Time Frame
days 0, 14, 28, 34

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
64 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Subjects must meet all of the following criteria to be included in the Phase 1 portion of the study: Males and females between 18 and 64 years of age A negative urine pregnancy test and willingness to use a reliable form of contraception for the duration of the study (females of childbearing potential only), with reliable contraception defined as: Abstinence Oral contraceptive, either estrogen progesterone combined, or progesterone alone Injectable progesterone Implants of levonorgestrel Estrogenic vaginal ring Percutaneous contraceptive patches Intrauterine device or intrauterine system Double barrier method [condom or occlusive cap (diaphragm or cervical vault caps) plus spermicidal agent (foam, gel, film, cream, suppository)] Male partner sterilization prior to the female subject's entry into the study, and this male is the sole partner for that subject Good health, as determined by pertinent medical history, physical examination, vital signs, and clinical safety laboratory evaluations A minimum of 16 natural teeth with 2 scorable surfaces (facial and lingual) per tooth Sufficient number of opposing posterior teeth to chew on both sides of the mouth as determined by the examining dentist Teeth that have gross caries, full crowns or extensive restorations on facial and/or lingual surfaces, orthodontic bands, and third molars are not included in the tooth count Ability to comprehend and a willingness to sign an informed consent, which includes the Authorization for the Release of Health Information document Willingness to comply with all study procedures Phase 2a Inclusion Criteria Subjects must meet all the criteria for the phase 1 portion of the study, and in addition must: Have mild to moderate gingivitis and plaque MGI of 1.8 or greater (Ainamo and Bay-1975) PI of 1.95 or greater (Turesky et al-1970) Willing to forgo any optional dental procedures during the study period, such as dental prophylaxis or teeth whitening Exclusion Criteria: Subjects meeting any of the following criteria will be excluded from the study: Acute or chronic medical conditions, organ system disease, or medications that, in the principal investigator's opinion, would impair the subject's ability to participate TMD Self-reported use of tobacco products Use of anticoagulant medications (eg clopidogrel) Gross oral pathology, including widespread caries or chronic neglect, extensive restoration, pre-existing gross plaque or calculus, or soft or hard tissue tumor of the oral cavity Orthodontic appliances or removable partial dentures that will compromise the ability of the potential subject to participate in the study Periodontitis as indicated periodontal pockets greater than 4 millimeters on more than one site Receipt of any investigational drug/test product within 30 days prior to study entry Receipt of antibiotics within 30 days prior to study entry Need for antibiotic prophylaxis prior to invasive dental procedures Receipt of daily anti-inflammatory therapy [eg nonsteroidal anti-inflammatory drugs (NSAID), tumor necrosis factor (TNF) alpha blockers] within 30 days prior to study entry Receipt of prescription antibacterial oral products (eg products containing chlorhexidine) within 30 days prior to study entry Pregnant or breast-feeding female Clinically significant abnormal laboratory tests as determined by the principal investigator An employee of the study site directly involved with the study Inability to comply with assigned treatment regimen
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Domenick T Zero, DDS, MS
Organizational Affiliation
Oral Health Research Institute, Indiana University School of Dentistry
Official's Role
Principal Investigator
Facility Information:
Facility Name
Indiana University School of Dentistry, Oral Health Research Institute
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Safety and Tolerability of Antiplaque Chewing Gum in a Gingivitis Population

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