Critical Review
The Potential of Dental-Protective Chewing Gum in Oral Health Interventions

https://doi.org/10.14219/jada.archive.2008.0215Get rights and content

ABSTRACT

Background

The authors provide an overview of chewing gum as a delivery vehicle for dental-protective agents, highlighting xylitol and its potential application in caries-prevention programs for children.

Types of Studies Reviewed

The authors reviewed selected clinical investigations and previous reviews associated with chewing gum containing substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol and their effects on reducing caries. They searched the MEDLINE database by using the key words “dental caries,” “oral health,” “calcium,” “bicarbonate,” “carbamide,” “chlorhexidine,” “fluoride” and “xylitol.”

Results

Chewing gum is being used as a delivery vehicle for substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol to improve oral health and reduce caries. These substances exhibit properties that are protective of the oral environment and mediate common oral diseases. The debate for advocating xylitol use in caries prevention is advancing; however, chewing gum use by young schoolchildren in the United States is hindered by choking hazard concerns and lack of specific xylitol dosing recommendations.

Clinical Implications

The use of chewing gum containing dental-protective substances, particularly xylitol, in caries-prevention programs can reduce the tooth decay epidemic. Chewing gum use by children in the school setting should be reconsidered.

Section snippets

THE EFFECTS OF GUM CHEWING ON ORAL HEALTH

Common claims for the effects of gum chewing include cleansing food debris from teeth and plaque, stimulating salivary flow, increasing the pH of saliva and plaque, and reducing gingivitis and periodontitis. In a critical literature review of gum chewing's effects and applications, Imfeld2 found that gum chewing is a potent stimulator of salivary flow, which is a function of the mechanical act of mastication. Gum chewing after meals stimulates salivary flow that has an increased concentration

CHEWING GUM CONTAINING FLUORIDE, MINERALS, ALKALINIZING AGENTS AND CHLORHEXIDINE

Fluoride-containing chewing gum was introduced in the early 1960s as an alternative to fluoride tablets for high-risk populations that were not served by fluoridated water systems or fluoridated salt distribution plans. Fluoride-containing chewing gum has more than 80 percent oral bioavailability,3 reduces demineralization and enhances remineralization of enamel.4, 5, 6 Fluoride-containing chewing gum, however, is not available in the United States, although it is elsewhere in the world.

The use

POLYOL-SWEETENED CHEWING GUM AND TOOTH DECAY

Polyol sweeteners, commonly known as sugar alcohols, have been used as substitutes for sucrose and fructose in sugar-free food and confectionary products, as well as in pharmaceutical and nutraceutical products, in the United States for several decades. They are absorbed and metabolized incompletely by the body and, thus, contribute fewer calories than do sucrose or fructose.21 Although most polyol sweeteners are less sweet than sucrose, maltitol and xylitol have comparable sweetness (Table 2,

XYLITOL IN FOCUS

Xylitol can be found in small quantities in fruits and vegetables and is produced as part of human metabolic processes. Similar to other polyols in its class, xylitol has been used mostly as a sugar-free sweetener in foods and candies in the United States but less often than other polyols because they are less expensive. There has been a recent increase in the use of xylitol in food, confections, chewing gums and dental products, which can be attributed, in part, to xylitol's caries-protective

POTENTIAL APPLICATIONS OF GUM CHEWING FOR CHILDREN AT HIGH RISK OF EXPERIENCING CARIES

The mainstays of primary prevention for children are fluoridated water, fluoridated toothpaste, professionally applied topical fluorides, sealants and dietary change. The fluorides, unless they are provided widely and consistently, are limited in their effectiveness against virulent dental caries. Sealants are used primarily to protect permanent molars. By the time the teeth are fully erupted and sealable, a sizeable minority already have caries. Effective strategies to reduce risk by modifying

CONCLUSION

Chewing gums containing protective substances are effective and have the potential to significantly improve oral health status toward Healthy People 201058 and World Health Organization Global59 oral health goals. Xylitol-containing chewing gum has been used successfully in Finland's national Smart Habits oral health campaign and by the U.S. Army, and its use for caries prevention is promoted widely in several countries. The American Academy of Pediatric Dentistry has endorsed the use of

References (60)

  • AS Richardson et al.

    Anticariogenic effect of dicalcium phosphate dihydrate chewing gum: results after two years

    J Can Dent Assoc (Tor)

    (1972)
  • LC Chow et al.

    Effects on whole saliva of chewing gums containing calcium phosphates

    J Dent Res

    (1994)
  • R Suda et al.

    The effect of adding calcium lactate to xylitol chewing gum on remineralization of enamel lesions

    Caries Res

    (2006)
  • F Cai et al.

    Effect of addition of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ

    Caries Res

    (2007)
  • T Imfeld

    Nutrition and dental caries: non-cariogenic between-meal snacks and sweets: a marketplace for small and average-size businesses in the food industry—an interview with Dr. med. dent. T. Imfeld [in German]

    Swiss Dent

    (1983)
  • K Nilner et al.

    Effect of a buffering sugar-free lozenge on intraoral pH and electrochemical action

    Acta Odontol Scand

    (1991)
  • K Igarashi et al.

    Effect of chewing gum containing sodium bicarbonate on human interproximal plaque pH

    J Dent Res

    (1988)
  • CJ Kleber et al.

    An evaluation of sodium bicarbonate chewing gum as a supplement to toothbrushing for removal of dental plaque from children's teeth

    Compend Contin Educ Dent

    (2001)
  • NC Sharma et al.

    An evaluation of a commercial chewing gum in combination with normal toothbrushing for reducing dental plaque and gingivitis

    Compend Contin Educ Dent

    (2001)
  • J Ainamo et al.

    Optimal dosage of chlorhexidine acetate in chewing gum

    J Clin Periodontol

    (1990)
  • AJ Smith et al.

    The efficacy of an anti-gingivitis chewing gum

    J Clin Periodontol

    (1996)
  • SL Yankell et al.

    Efficacy of chewing gum in preventing extrinsic tooth staining

    J Clin Dent

    (1997)
  • D Simons et al.

    The effect of chlorhexidine/xylitol chewing-gum on cariogenic salivary microflora: a clinical trial in elderly patients

    Caries Res

    (1997)
  • KA Ly et al.

    Xylitol, sweeteners, and dental caries

    Pediatr Dent

    (2006)
  • A Scheinin et al.

    Turku sugar studies, part V: final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man

    Acta Odontol Scand

    (1976)
  • KK Makinen et al.

    Xylitol chewing gums and caries rates: a 40-month cohort study

    J Dent Res

    (1995)
  • P Milgrom et al.

    Mutans streptococci dose response to xylitol chewing gum

    J Dent Res

    (2006)
  • KA Ly et al.

    Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial [ISRCTN43479664]

    BMC Oral Health

    (2006)
  • D Kandelman et al.

    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

    (1990)
  • P Isokangas

    Xylitol chewing gum in caries prevention: a longitudinal study on Finnish school children

    Proc Finn Dent Soc

    (1987)
  • Cited by (85)

    • 3D printing of a controlled urea delivery device for the prevention of tooth decay

      2023, International Journal of Pharmaceutics
      Citation Excerpt :

      In addition to reducing the dissolution of enamel, the local pH rise also preserves the equilibrium of the oral microbiota including healthy acid-sensitive noncariogenic bacteria (Burne and Marquis, 2000), (Chen et al., 2000). The administration of various alkali agents, such as sodium bicarbonate, dicalcium phosphate, or urea-containing formulations has been investigated for the prevention of dental caries (Ly et al., 2008), (Chow et al., 1994). A study measured the urea concentration and pH in plaque in humans after the use of urea-containing chewing gums (Smith et al., 2004).

    • Effect of chewing gum containing Xylitol and blackberry powder on oral bacteria: A randomized controlled crossover trial

      2022, Archives of Oral Biology
      Citation Excerpt :

      While there is extensive knowledge of the effects of chewing xylitol-containing gum on salivary levels of S. mutans and dental caries prevention in children (Nasseripour et al., 2021; Soderling & Pienihakkinen, 2020), less is known about its effects on i) other oral bacteria in saliva, ii) the accumulation of bacteria on enamel, and iii) how rapidly the effects occur in adults. Chewing gum can be used to deliver additives that can influence oral health (Ly et al., 2008). Blackberries are a natural fruit containing polyphenol and flavonoid antioxidants.

    • Effect of sweetener containing Stevia on the development of dental caries in enamel and dentin under a microcosm biofilm model: Effect of sweetener containing Stevia on dental caries

      2021, Journal of Dentistry
      Citation Excerpt :

      Streptococcus mutans, gram-positive bacteria identified as being primarily responsible for the caries process, do not metabolize xylitol for obtaining energy. Xylitol is transported into the cells by the induced action of a fructose transporter, however, it causes a futile cycle because it does not go through to the glycolytic reactions and, when accumulated, induces cell damage [42–44]. Xylitol is also known to improve remineralization of artificial caries lesions in vitro and in situ [45,46].

    • Biodegradable medicated chewing gum: A modernized system for delivering bioactive compounds

      2021, Future Foods
      Citation Excerpt :

      Therefore, the sugar-free chewing gums called as “mechanical salivary stimulant” can remove the accumulation of dietary substances, microbes after meals in the mouth and teeth, improve buffering capacity to neutralize plaque acids (Keukenmeester et al., 2013). The primary goal of U. S. National oral health is extending the use of xylitol gums, alone or else combined with other dental care substances to prevent caries in high-risk population (Ly et al., 2008). For example, xylitol combined with minerals such as calcium phosphate and calcium lactate enhanced the efficieny of remineralization of enamel surfaces.

    • Art of Prevention: The importance of tackling the nail biting habit

      2021, International Journal of Women's Dermatology
      Citation Excerpt :

      This results in better oral hygiene and is (Massler and Malone, 1950). Sorbitol-based gum rather than a sugared variety can help prevent caries (Ly et al., 2008). Books and social media can provide support and strategies.

    • Application of nano/microencapsulated ingredients in chewing gum

      2020, Application of Nano/Microencapsulated Ingredients in Food Products
    View all citing articles on Scopus

    The work cited in this article was supported, in part, by grants 1 P50 DE14254 and T32 DE07132 from the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md., and grant R40MC03622 from the Maternal and Child Health Research Bureau, Health Resources Services Administration, Rockville, Md.

    Disclosure. Drs. Ly and Milgrom and Ms. Rothen did not report any disclosures.

    1

    Dr. Ly is an acting assistant professor, Department of Dental Public Health Sciences, Northwest/Alaska Center to Reduce Oral Health Disparities, Warren G. Magnuson Health Sciences Center, Room B-509, University of Washington, Seattle, Wash. 98195-7475.

    2

    Dr. Milgrom is a professor, Department of Dental Public Health Sciences, an adjunct professor, Health Services, and the director, Northwest/Alaska Center to Reduce Oral Health Disparities, Warren G. Magnuson Health Science Center, University of Washington, Seattle.

    3

    Ms. Rothen is a clinic manager, Regional Clinical Dental Research Center, Warren G. Magnuson Health Sciences Center, University of Washington, Seattle.

    View full text