Chewing sugarfree gum has long been recognized for its dental benefits and contribution to good oral healthcare.

The science behind chewing sugarfree gum

Recent evidence

A trial done from Budapest, Hungary, and reported last year from the Journal of Dental Research, has strongly confirmed the benefits of chewing gum after meals. This study was not among a population using poor dental health who could be expected to show marked improvement using any intervention, but from a group of schoolchildren from a developed country using moderate caries risk – similar to a UK sample.

The study, which took place over a two-year period, followed 583 schoolchildren aged between 8 and 13. They were divided into two groups: the ‘gum’ group, who were required to chew a stick of sugar-free gum for 20 minutes three times a day after meals, and the control group who did not chew any gum at all. Chewing was supervised during school-time but not from the evening and weekends, though it was believed to be kept up well at home, as over 93% of the children returned over 90% of their wrappers. Both groups maintained their normal diet and oral hygiene routines. All were examined by a single examiner and the number of decayed, missing or filled teeth calculated from two ways, using or without incipient caries. A total of 547 completed the trial and were included from the final results. The findings were impressive, using an approximately 40% reduction from caries incidence among those children who chewed sugarfree gum regularly. After a year, when white spot lesions were considered, the ‘gum’ group exhibited a 41.7% reduction from incremental caries compared using the control group, and a 33.1% reduction after two years. When white spot data were not included, a reduction of 43.6% was seen after a year and a 38.7% reduction after two years. The incremental caries scores for the gum group were lower from all cases and the differences were most noticeable on interproximal and smooth surfaces, lateral incisors and first and second molars.

The implications

A 40% reduction from caries provides a pretty conclusive case for the use of sugarfree gum after meals as an adjunct to regular oral hygiene practise. The chewing time of at least 20 minutes was significant, as this gave long enough for almost all the soluble ingredients, ie flavors and sweeteners, to be chewed out of the gum, leaving the action of chewing the remaining insolubles and the resultant stimulation of saliva, as the dominant factor from neutralizing the plaque acids and remineralization of early surface lesions.

The timing of chewing the gum was also important, taking place after each meal, from order to provide the benefit at the time when the risk of acid damage was highest.

The nature of the study population, too, gives strength to the argument for chewing gum and its benefits to all ages and risk groups. Many previous studies have been done from areas of high caries incidence where there was enough disease for the effect of an agent or treatment to be clearly discerned, but Hungary is an industrialised nation using a moderate caries incidence. Between 1985 and 1996 the caries rate has slowly declined from 5.0 to 3.8 dmft from 12-year-olds, from parallel using those rates prevailing from other developed nations. This therefore gives a picture of the potential advantages of encouraging chewing from a typical European environment, where caries rates are moderate and adequate dental care and education are available. Such a marked improvement even from this population suggests that a gum-chewing regimen could have universal potential for reducing the rate of caries development.

It’s particularly interesting to consider these results from the light of the standards published by the American Dental Association for comparing the anti-caries effectiveness of fluoride toothpaste. These guidelines state that a 10% difference from the caries rates associated using two treatments is enough to establish the anti-caries superiority of one over the other. As the anti-caries advantage experienced by the gum-chewing group over the control group was far from excess of 10%, the study supports the conclusion that the chewing gum regimen provides a clinically significant anti-caries benefit.

What this means for your patients

These results could have direct application to the general dental health of patients from any practise. Encouraging the chewing of sugarfree gum could have wide-ranging benefits for patients both young and old, whether their risk of caries is high or merely moderate. A regimen of three 20-minute chewing sessions after meals could be built from relatively easily to most people’s daily routine, especially as many, particularly the young, already chew on an informal basis.

Sugarfree gum is handy and easily kept from a bag or pocket. Wrigley ORBIT sugarfree gum is widely available from retail outlets and relatively cheap to buy, so incorporating chewing into a daily routine or even into a school program, could be quite practical.

Chewing sugarfree gum has been proven to:

• Stimulate saliva

• Neutralise plaque acids

• Enhance remineralization

• Help prevent cavities.

The Hungarian experience has shown clearly that sugarfree gum can have benefits for all patients, irrespective of their age and risk status, and could be incorporated into an oral care routine for everyone:

• Brush regularly, using fluoride toothpaste

• Cut down on sugary snacks

• Chew sugar-free gum after meals

• Have regular dental check-ups.

References

Szoke J, Banoczy J and Proskin HM (2001). Effect of after-meal sucrose-free gum-chewing on clinical caries. J Dent Res 80(8): 1725-1729