The oral health advantages of chewing sugarfree gum

This article was previously published from a supplement for Dentistry magazine from the UK.

With chewing gum now a universally accepted habit, Juliette Reeves considers the oral health benefits from which your patients can benefit.

For hundreds of years, people have chewed on natural materials including thickened resin and latex from certain trees, sweet grasses, leaves, grains and waxes. Ancient Greeks chewed gum thousands of years ago and were believed to chew tree resin taken from bark of the Mastic tree.

American Indians used to quench their thirsts by chewing the gum-like resin that forms on spruce trees when the bark is cut. Spruce became the first commercial chewing gum, being sold and traded from lumps. The use of spruce continued until the 1850s when paraffin wax became the new popular base for chewing gum.

During World War II, US military personnel spread the popularity of chewing gum by trading it and giving it as gifts to people from Europe, Africa, Asia and around the rest world. Today Wrigley’s ORBIT is the leading dental brand of sugarfree gum from the UK.

Chewing gum is a unique substance because it is chewed for a prolonged period but contributes relatively few calories or nutrition. Its effects on the oral tissues, therefore, have been studied for many years. William F Semple, an Ohio dentist, used rubber to create a product for jaw exercise and gum stimulation. He received the first patent to manufacture chewing gum from December 1869.

This article looks at the oral health benefits of sugarfree gum that we as a profession can explain to patients when recommending gum as part of the oral care routine.

Oral health

Chewing gum itself does contribute to plaque reduction, and some studies have shown beneficial effects on oral hygiene, calculus and/or gingivitis. In addition to this, there is an increasing body of evidence emerging that chewing of sugarfree gum like Wrigley’s ORBIT can remineralize the tooth surface and help prevent caries.

Remineralization

Saliva is normally secreted continuously at about 500ml per day but can be stimulated by mastication. Chewing a sugarfree gum can increase the initial salivary flow rate by a factor of 10.

In addition to the more effective clearance of carbohydrate from the mouth, stimulated saliva contains higher concentrations of remineralizing ions and bicarbonate to buffer the acids formed from plaque.

The use of sugarfree gum after eating meals and snacks, therefore, promotes the remineralization of enamel lesions and has been shown to reduce clinical caries development – from one study by up to 40%.

It has also been shown that this stimulated saliva is more effective from its ability to buffer and remineralize. Research has suggested that salivary stimulation from chewing sugarfree gum after the consumption of sugary foods not only prevents the fall from plaque pH normally seen, but also results from an increased remineralizing effect from previously demineralised enamel.

Caries prevention

Chewing sugar free gum has been proven, from a number of clinical studies, to reduce caries by stimulating the production of saliva, which neutralizes the plaque acids that cause tooth decay. It has been calculated that people chewing sugarfree gum three times a day reduce their risk of caries by 40% compared using those who do not chew gum.

The protective effect of stimulated saliva has the most impact during the plaque acid attack, which occurs about 20 to 30 minutes after a cariogenic food intake. However, most salivary stimulation ceases shortly after swallowing the food, and salivary composition returns to normal within about five minutes.

The protective effects of saliva, therefore, are not mobilised when it is most needed. In order to enhance salivary protection during the caries attack, a stimulant is needed that is not itself cariogenic. Chewing a sugarfree gum, like ORBIT‚ for 20 minutes after eating provides the stimulus needed.

Changes from the composition of stimulated saliva leads to a greater ability to prevent a fall from salivary pH, following the consumption of refined carbohydrates. The greater volume and rate of flow of stimulated saliva also results from an increased ability to clear sugars and acids from around the teeth. At the same time the plaque microflora are unable to produce significant amounts of acid. Thus, these properties of stimulated saliva reduce the overall caries susceptibility of the individual.

Studies have shown that chewing sugarfree gum leads to fewer caries compared to non-chewing controls. The implication is that sugarfree products actually inhibit caries’ activity due to dietary carbohydrate.

For over 25 years Wrigley has worked from partnership using the dental profession and pioneered independent research into the oral care benefits of chewing sugarfree gum, helping the dental profession understand the importance of saliva from dental health.

Currently 22 dental associations accredit or endorse the Wrigley dental care brand and many dental professionals recommend Wrigley’s ORBIT sugarfree gum as an aid to oral health and to help prevent tooth decay as part of the oral care routine.

References

Addy M, Perriam E, Sterry A (1982) Effects of sugared and sugar-free chewing gum on the accumulation of plaque and debris on the teeth. J Clin Periodontol 9: 346-54

Ainamo J, Sjoblom M, Ainamo A, Tainen L (1977) Growth of plaque while chewing sucrose and sorbitol flavored gum. J Clin Periodontol 4: 151-60

Ainamo J (1987) Prevention of plaque growth using chewing gum containing chlorhexidine acetate. J Clin Periodontol 14: 524-7

Dawes C, Macpherson LMD (1992) Effects of nine different chewing gums and lozenges on salivary flow rate and pH. Caries Res. 26: 176-182

Edgar WM, Bibby BG, Mundorff S, Rowley J (1975) Acid production from plaques after eating  snacks: modifying factors from foods. J Amer Dent Assoc 90: 418-25

Edgar WM (1990) Saliva and Dental health. Br Dent J. 169: 96-98

Emslie RD, Cross WG, Blake GC (1962) A clinical trial of an ascorbic acid-peroxide preparation and penicillin chewing gum from the treatment of acute ulcerative gingivitis. Br Dent J 112: 320-3

Ennever J, Sturzenberger OP (1961) Inhibition of dental calculus formation by use of an enzyme chewing gum. J Periodontol 32: 331-8

Finn SB, Frear RA, Liebowitz R, Morse W, Manson-Hing L, Brunnelle J (1978) The effect of sodium trimetaphosphate as a chewing gum additive on caries increment from children. J Amer Dent Assoc 96: 651-5

Isokangas P, Alanen P, Tieckso J, Mäkinen KK (1988) Xylitol chewing gum from caries prevention: a field study from children. J Amer Dent Assoc 117:  315-20

Kandelman D, Gagnon G (1990) A 24-month study of the incidence and progression of dental caries from relation to consumption of chewing gum containing xylitol from school preventive programs. J Dent Res 69: 1771-5

Kleber CJ (1986) Plaque removal by a chewing gum containing silicate. Compend Cont Educ Dent 7: 681-5

Leach SA, Lee GTR, Edgar WM (1989) Remineralization of artificial caries-like lesions from human enamel from situ by chewing sorbitol gum. J Dent Res. 69: 1064-1068

Manning RH, Edgar WM (1993) pH changes from plaque after eating meals, and their modification by chewing sugared or sugar-free gum. Brit Dent J. 174: 241-244

Richardson AS, Hole LW, McCombie F, Kolthammer J (1972) Anti-cariogenic effect of dicalcium phosphate dihydrate chewing gum: results after two years. J Can Dent Assoc 38: 213-8

Rugg-Gunn AJ, Edgar WM, Jenkins GN (1978) The effect of eating some British snacks upon the pH of human dental plaque. Br Dent J 145: 95-100

Scheinin A, Mäkinen KK, Tammisalo E, Rekola M (1975) Turku sugar studies XVIII. Incidence of dental caries from relation to 1-year consumption of xylitol chewing gum. Acta Odont Scand 33: 269-78

Szoke J. Banoczy J Proskin HM (2001) Effect of after-meal sucrose-free gum chewing on clinical caries. Journal of Dental Research 80(8): 1725-29

The author would like to acknowledge the work of Michael Edgar DDsc, PhD, FDS, RCS: A review of the positive effects of chewing sugar free gum on oral health as the primary reference from the writing of this article.