To determine the difference in level of dental caries in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG or use alternatives such as lozenges, candies, rinses, tablets, and other nonchewing controls.
Methods:
Systematic review of published literature.
Results:
Twelve studies of interventions of SFG for dental caries outcomes were included. SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28% (95% CI, 7% to 48%). Including the 8 trials that used xylitol gum only as the basis of the intervention, the PF was 33% (95% CI, 4% to 61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included.
Conclusion:
The findings of this review provide tentative evidence that chewing SFG reduces caries increment in comparison to nonchewing controls. However, there is a considerable degree of variability in the effect and the trials included were generally of moderate quality. There is a need for future research to explore the acceptability and feasibility of the use of SFG as a public health intervention (PROSPERO 2018 CRD42018094676).
Knowledge Transfer Statement:
The results of this study can be used by clinicians when deciding how best to implement dental caries prevention regimes for their patients. With consideration of cost and patient preference, this information could help to develop national policy directives on caries prevention and dictate the direction of future clinical research.
AlamoudiNMHannoAGSabbaghHJMasoudMIAlmushaytASEl DerwiDA. 2012. Impact of maternal xylitol consumption on mutans streptococci, plaque and caries levels in children. J Clin Pediatr Dent. 37(2):163–166.
2.
AlanenPIsokangasPGutmannK. 2000. Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol. 28(3):218–224.
3.
Al-HaboubiMZoitopoulosLBeightonDGallagherJE. 2012. The potential benefits of sugar-free chewing gum on the oral health and quality of life of older people living in the community: a randomized controlled trial. Community Dent Oral Epidemiol. 40(5):415–424.
4.
AzarpazhoohALawrenceHPShahPS. 2016. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database of Systematic Reviews. (8):CD007095.
5.
BeiswangerBBBonetaAEMauMSKatzBPProskinHMStookeyGK. 1998. The effect of chewing sugar-free gum after meals on clinical caries incidence. J Am Dent Assoc. 129(11):1623–1626.
6.
BorensteinMHLHigginsJPRothsteinHR. 2011. Introduction to meta-analysis. West Sussex (UK): John Wiley & Sons. Chapter 4; p. 28–30.
7.
BurtBA. 2006. The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Dent Am Assoc. 137(2):190–196.
8.
CampusGCagettiMGSaleSPetruzziMSolinasGStrohmengerLLingströmP. 2013. Six months of high-dose xylitol in high-risk caries subjects—a 2-year randomised, clinical trial. Clin Oral Investig. 17(3):785–791
9.
ClaxtonLTMKayE. 2016. Oral health promotion: the economic benefits to the NHS of increased use of sugarfree gum in the UK. Br Dent J. 220(3):121–127.
10.
DeshpandeAJadadAR. 2008. The impact of polyol-containing chewing gums on dental caries: a systematic review of original randomized controlled trials and observational studies. J Dent Am Assoc. 139(12):1602–1614.
11.
Dos SantosAPPde OliveiraBHNadanovskyP. 2018. A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents. Int J Paediatr Dent. 28(1):3–11.
12.
EFSA Panel on Dietetic Products, Nutrition and Allergies. 2010. Scientific Opinion on the substantiation of a health claim related to sugar free chewing gum and reduction of tooth demineralisation which reduces the risk of dental caries pursuant to Article 14 of Regulation (EC) No 1924/2006. EFSA Journal. 8(10):1775.
13.
European Commission. 2012a. Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health Text with EEA relevance. [accessed 2018 March 7]. http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32012R0432
14.
European Commission. 2012b. Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health Text with EEA relevance. [accessed 2018 March 7] http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32012R0432.
GlassRL. 1983. A two-year clinical trial of sorbitol chewing gum. Caries Res.17(4):365–368.
17.
HannoAGAlamoudiNMAlmushaytASMasoudMISabbaghHJFarsiNM. 2011. Effect of xylitol on dental caries and salivary streptococcus mutans levels among a group of mother-child pairs. J Clin Pediatr Dent. 36(1): 25–30.
18.
HigginsJPAltmanDGGøtzschePCJüniPMoherDOxmanADSavovicJSchulzKFWeeksLSterneJA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. 2011. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 343:d5928
19.
HujoelPPMäkinenKKBennettCAIsotupaKPIsokangasPJAllenPMäkinenPL. 1999. The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention. J Dent Res. 78(3): 97–803.
20.
IsokangasPAlanenPTieksoJMäkinenKK. 1988. Xylitol chewing gum in caries prevention: a field study in children. J Am Dent Assoc. 117(2):315–320
21.
KandelmanDGagnonG. 1990. A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs. J Dent Res. 69(11):1771–1775.
22.
KovariHPienihakkinenKAlanenP. 2003. Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland. Acta Odontol Scand. 61(6):367–370.
23.
LyKAMilgromPRothenM. 2008. The potential of dental-protective chewing gum in oral health interventions. J Dent Am Assoc. 139(5):553–563.
24.
MachiulskieneVNyvadBBaelumV. 2001. Caries preventive effect of sugar-substituted chewing gum. Community Dent Oral Epidemiol. 29(4):278–288.
25.
MachiulskieneVNyvadBBaelumV. 2002. Determinants of dropout in a community intervention trial on the caries-preventive effect of chewing gums. J Public Health Dent. 62(1):21–27.
26.
MäkinenKKBennettCAHujoelPPIsokangasPJIsotupaKPPapeHRJrMäkinenP. 1995. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res. 74(12): 1904–1913.
27.
MäkinenKKHujoelPPBennettCAIsotupaKPMäkinenPLAllenP. 1996. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study. Caries Res. 30(6):408–417.
28.
MäkinenKKHujoelPPBennettCAIsokangasPIsotupaKPapeHRJrMäkinenPL. 1998. A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme. Caries Res. 32(2): 107–112.
29.
MäkinenKKMäkinenPLPapeHRJrAllenPBennettCAIsokangasPJIsotupaKP. 1995. Stabilisation of rampant caries: polyol gums and arrest of dentine caries in two long-term cohort studies in young subjects. Int Dent J. 45(1 Suppl 1): 93–107.
30.
MäkinenKKMäkinenPLPapeHRJrPeldyakJHujoelPIsotupaKPSoderlingEIsokangasPJAllenPBennettC. 1996. Conclusion and review of the Michigan Xylitol Programme (1986–1995) for the prevention of dental caries. Int Dent J. 46(1): 22–34.
MollerIJPoulsenS. 1973. The effect of sorbitol-containing chewing gum on the incidence of dental caries; plaque and gingivitis in Danish schoolchildren. Community Dent Oral Epidemiol. 1(2):58–67.
PengBPetersenPEBianZTaiBJiangH. 2004. Can school-based oral health education and a sugar-free chewing gum program improve oral health? Results from a two-year study in PR China. Acta Odontol Scand. 62(6):328–332.
36.
RethmanMPBeltrán-AguilarEDBillingsRJHujoelPPKatzBPMilgromPSohnWStammJWWatsonGWolffM, et al. 2011. Nonfluoride caries-preventive agents: executive summary of evidence-based clinical recommendations. J Am Dent Assoc. 142(9):1065–1071.
37.
RileyPMooreDAhmedFSharifMOWorthingtonHV. 2015. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev. (3):CD010743.
38.
RychlikRKreimendahlFBlaichCCalacheHGarcia-GodoyFKayESiYZilbermanDZimmerS. 2017. A global approach to assess the economic benefits of increased consumption of sugar-free chewing gum. Am J Dent. 30(2):77–83.
39.
SekiMKarakamaFKawatoTTanakaHSaekiYYamashitaY. 2011. Effect of xylitol gum on the level of oral mutans streptococci of preschoolers: block-randomised trial. Int Dent J. 61(5):274–280.
40.
SteinCSantosNMLHilgertJBHugoFN. 2018. Effectiveness of oral health education on oral hygiene and dental caries in schoolchildren: systematic review and meta-analysis. Community Dent Oral Epidemiol. 46(1):30–37.
41.
SzökeJBánóczyJProskinHM. 2001. Effect of after-meal sucrose-free gum-chewing on clinical caries. J Dent Res. 80(8):1725–1729.
42.
SzökeJBánóczyJ. 2005. Effect of after-meal sucrose-free gum-chewing on clinical caries. S Afr Dent J. 60(6):248–251.
43.
TaoDYShuCBLoECLuHXFengXP. 2013. A randomized trial on the inhibitory effect of chewing gum containing tea polyphenol on caries. J Clin Pediatr. 38(1):67–70.
44.
Van LoverenC. 2004. Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects?Caries Res. 38(3):286–293
45.
WesselSWvan der MeiHCMaitraADoddsMWBusscherHJ. 2016. Potential benefits of chewing gum for the delivery of oral therapeutics and its possible role in oral healthcare. Expert Opin Drug Deliv. 13(10):1421–1431.
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