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

The science behind chewing sugarfree gum

Recent evidence

A trial carried out in Budapest, Hungary, and reported last year in the Journal of Dental Research, has strongly confirmed the benefits of chewing gum after meals. This study was not among a population with poor dental health who could be expected to show marked improvement with any intervention, but in a group of schoolchildren in a developed country with 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 in 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 in two ways, with or without incipient caries. A total of 547 completed the trial and were included in the final results. The findings were impressive, with an approximately 40% reduction in 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 in incremental caries compared with 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 in 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 in caries provides a pretty conclusive case for the use of sugarfree gum after meals as an adjunct to regular oral hygiene practice. The chewing time of at least 20 minutes was significant, as this gave long enough for almost all the soluble ingredients, ie flavours 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 in neutralising the plaque acids and remineralisation of early surface lesions.

The timing of chewing the gum was also important, taking place after each meal, in 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 carried out in areas of high caries incidence where there was sufficient disease for the effect of an agent or treatment to be clearly discerned, but Hungary is an industrialised nation with a moderate caries incidence. Between 1985 and 1996 the caries rate has slowly declined from 5.0 to 3.8 dmft in 12-year-olds, in parallel with those rates prevailing in other developed nations. This therefore gives a picture of the potential advantages of encouraging chewing in a typical European environment, where caries rates are moderate and adequate dental care and education are available. Such a marked improvement even in 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 in 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 in the caries rates associated with 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 in 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 in any practice. 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 in 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 in a bag or pocket. Wrigley EXTRA sugarfree gum is widely available in retail outlets and relatively cheap to buy, so incorporating chewing into a daily routine or even into a school programme, could be quite practical.

Chewing sugarfree gum has been proven to:

• Stimulate saliva

• Neutralise plaque acids

• Enhance remineralisation

• 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