Effect of Three Months' Frequent Use of Sugar-free Chewing Gum with and without Urea on Calculus Formation

Abstract

Studies on the relationship between gum-chewing and calculus formation have produced contradictory results, and it is not clear whether frequent use of chewing gum promotes or inhibits calculus formation. Also, little is known about whether the addition of a small amount of urea to the chewing gum influences calculus formation. The aim of this investigation was to study the effect of sugar-free chewing gum-with and without urea-on calculus formation and some associated clinical variables. Three three-month periods were studied in a double-blind, crossover design, during which the subjects: (1) chewed 5 pieces/day of a sugar-free, urea-containing chewing gum (20 mg urea/piece); (2) chewed 5 pieces/day of a sugar-free, non-urea-containing gum; or (3) performed no gum-chewing. Twenty-nine persons, all calculus-formers, participated. They were scored for calculus at mesio-lingual, lingual, and disto-lingual sites on the 6 anterior mandibular teeth according to the Volpe-Manhold index. Plaque and gingival bleeding index, stimulated salivary secretion rate and buffer capacity, resting plaque pH, mutans streptococci in saliva and plaque, and lactobacilli in saliva were also determined. No differences in calculus formation were found among the 3 periods. The resting plaque pH was higher after the period with urea-containing gum than after the period with non-urea-containing gum and the no-gum period (p < 0.05). A slight increase in stimulated salivary secretion rate was found after the 2 gum periods (p < 0.05). The plaque and gingival bleeding indices decreased, while resting plaque pH and salivary buffer capacity increased throughout the entire study (p < 0.05). No significant differences in prevalence of the acidogenic micro-organisms were found among the test periods. The main conclusion from this study is that three months' frequent use of sugar-free chewing gum-with or without urea-neither promotes nor inhibits calculus formation.

Keywords

acidogenic micro-organisms buffer capacity calculus chewing gum plaque pH salivary flow urea.

Get full access to this article

View all access options for this article.

References

Ainamo J. , Bay I. (1975). Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229-235.

Baumhammers A. , Cancro LP , Pader M. , Justice JD , Bolton SM (1973). Correlation of dental calculus weights with Volpe Manhold index scores. J Periodontol 44:78-80.

Belting CM , Gordon DL (1966a). In vitro effect of urea on artificial calculus formation. I. J Periodontol 37:20-25.

Belting CM , Gordon DL (1966b). In vivo effect of a urea containing dentifrice on dental calculus formation. II. J Periodontol 37:26-33.

Birkhed D. (1994). Cariologic aspects of xylitol and its use in chewing gum: a review. Acta Odontol Scand 52:116-127.

Birkhed D. , Bar A. (1991). Sorbitol and dental caries. World Rev Nutr Diet 65:1-37.

Conroy CW , Sturzenberger OP (1968). The rate of calculus formation in adults. J Periodontol 39:142-144.

Council on Dental Therapeutics (1988). Consensus: Oral health effects of products that increase salivary flow rate . J Am Dent Assoc 116:757-759.

Dawes C. , Dong C. ( 1995). The flow rate and electrolyte composition of whole saliva elicited by the use of sucrose-containing and sugar-free chewing-gums. Arch Oral Biol 40:699-705.

10.

Dawes C. , Macpherson LM (1993). The distribution of saliva and sucrose around the mouth during the use of chewing gum and the implications for the site-specificity of caries and calculus deposition. J Dent Res 72:852-857.

11.

Dong C. , Puckett AD Jr , Dawes C. (1995). The effects of chewing frequency and duration of gum chewing on salivary flow rate and sucrose concentration. Arch Oral Biol 40:585-588.

12.

Edgar WM , Geddes DA (1990). Chewing gum and dental health-a review. Br Dent J 168:173-177.

13.

Emilson CG (1983). Prevalence of Streptococcus mutans with different colonial morphologies in human plaque and saliva. Scand J Dent Res 91:26-32.

14.

Ericsson Y. (1959). Clinical investigations of the salivary buffering action. Acta Odontol Scand 17:131-165.

15.

Frostell G. (1962). The ureolytic activity of dental calculus. Acta Odontol Scand 20:411-418.

16.

Frostell G. (1969). Dental plaque pH in relation to intake of carbohydrate products. Acta Odontol Scand 27:3-29.

17.

Frostell G. (1971). Effects of mouthrinses on the pH of dental plaques . Swed Dent J 64:227-232.

18.

Fure S. , Zickert I. (1990). Salivary conditions and cariogenic microorganisms in 55, 65 and 75-year-old Swedish individuals. Scand J Dent Res 98:197-210.

19.

Gold OG , Jordan HV , van Houte J. (1973). A selective medium for Streptococcus mutans. Arch Oral Biol 18:1357-1364.

20.

Hine MK , O'Donnell JF (1943). Incidence of urease producing bacteria in saliva . J Dent Res 22:103-106.

21.

Imfeld T. (1983). Identification of low caries risk dietary components. Monographs Oral Science. Vol. 11. Basel: Karger, pp. 1-198.

22.

Imfeld T. , Birkhed D. , Lingstrom P. (1995). Effect of urea in sugar-free chewing gums on pH recovery in human dental plaque evaluated with three different methods. Caries Res 29:172-180.

23.

Isokangas [Isogangas in MEDLINE] PJ , Makinen KK , Tiekso J. , Alanen P. (1993). Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program. Caries Res 27:495-498.

24.

Jaffe EC , Roberts GJ , Chantler C. , Carter JE (1986). Dental findings in chronic renal failure. Br Dent J 160:18-20.

25.

Jensen ME (1986a). Effects of chewing sorbitol gum and paraffin on human interproximal plaque pH. Caries Res 20:503-509.

26.

Jensen ME (1986b). Responses of interproximal plaque pH to snack foods and effect of chewing sorbitol-containing gum. J Am Dent Assoc 113:262-266.

27.

Kleinberg I. (1967). Effect of urea concentration on human plaque pH levels in situ. Arch Oral Biol 12:1475-1484.

28.

Krasse B. (1966). Human streptococci and experimental caries in hamsters. Arch Oral Biol 11:429-436.

29.

Lingstrom P. , Imfeld T. , Birkhed D. (1993). Comparison of three different methods for measurement of plaque-pH in humans after consumption of soft bread and potato chips. J Dent Res 72:865-870.

30.

Macpherson LM , Dawes C. (1991). Urea concentration in minor mucous gland secretions and the effect of salivary film velocity on urea metabolism by Streptococcus vestibularis in an artificial plaque. J Periodont Res 26:395-401.

31.

Macpherson LM , Girardin DC , Hughes NJ , Stephen KW , Dawes C. (1995). The site-specificity of supragingival calculus deposition on the lingual surfaces of the six permanent lower anterior teeth in humans and the effects of age, sex, gum-chewing habits, and the time since the last prophylaxis on calculus scores. J Dent Res 74:1715-1720.

32.

Makinen KK , Bennet CA , Hujoel PP , Isokangas PJ , Isotupa KP , Pape HP Jr , et al. (1995). Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 74:1904-1913.

33.

Nancollas GH , Johnsson MA (1994). Calculus formation and inhibition. Adv Dent Res 8:307-311.

34.

Rosenhek M. , Macpherson LM , Dawes C. (1993). The effects of chewing-gum stick size and duration of chewing on salivary flow rate and sucrose and bicarbonate concentrations . Arch Oral Biol 38:885-891.

35.

Rømer Rassing M. (1994). Chewing gum as a drug delivery system. Adv Drug Delivery Rws 13:89-121.

36.

Scheie AA , Fejerskov O. , Lingstrom P. , Birkhed D. , Manji F. (1992). Use of palladium touch microelectrodes under field conditions for in vivo assessment of dental plaque pH in children. Caries Res 26:44-51.

37.

Shapiro WB , Kaslick RS , Chasens AI , Eisenberg R. (1973). The influence of urea peroxide gel on plaque, calculus and chronic gingival inflammation. J Periodontol 44:636-639.

38.

Sjogren K. , Lingstrom P. , Lundberg A-B. , Birkhed D. (1997). Salivary fluoride concentration and plaque pH after using a fluoride-containing chewing-gum. Caries Res 31:366-372.

39.

Stephan RM (1940). Two factors of possible importance in relation to the etiology and treatment of dental caries and other dental diseases. Science 92:578-579.

40.

Syed SA , Loesche WJ (1972). Survival of human dental plaque flora in various transport media. Appl Microbiol 24:638-644.

41.

Tanzer JM (1995). Xylitol chewing gum and dental caries. Int Dent J 45(Suppl 1):65-76.

42.

Volpe AR , Manhold JH , Hazen SP (1965). In vivo calculus assessment: Part I, A method and its examiner reproducibility. J Periodontol 36:292-298.

43.

Volpe AR , Kupczak LJ , King WJ ( 1967). In vivo calculus assessment: Part III, Scoring techniques, rate of calculus formation, partial mouth exams vs. full mouth exams., and intra-examiner reproductibility. Periodontics 5:184-193.

44.

Wennerholm K. , Arends J. , Birkhed D. , Ruben J. , Emilson CG , Dijkman AG (1994). Effect of xylitol and sorbitol in chewing-gums on mutans streptococci, plaque pH and mineral loss of enamel. Caries Res 28:48-54.

45.

Yankell SL , Emling RC (1988). Clinical effects on plaque pH, pCa, and swallowing rates from chewing a flavored or unflavored chewing gum. J Clin Dent 1:51-53.