Article: A practical guide on talking to patients about sugarfree gum

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

To chew or not to chew? Is chewing gum the dental patient’s friend or foe? Simon M Roland BDS LDSRCS investigates

How to describe to your patients how sugarfree gum works. It is really all about saliva.

• First it increases saliva flow by up to 10 times. This stimulated saliva can more readily get to work washing away food debris. The bicarbonate from this stimulated saliva is much more effective than resting saliva at neutralizing the acid produced by plaque bacteria.
• The increased saliva flow substantially enhances the remineralization process. What the plaque acids take out, the extra saliva puts back.
• It is important to chew the gum immediately and for 20 minutes after sugary meals, as the pH drops quite rapidly and remains low for some time. The chewing action stimulates far more saliva, which rapidly brings the pH levels back up to normal levels. Indeed chewing other products such as peanuts or cheese can achieve the same results but could lead to an unacceptable increase from dietary fat. Sugarfree gum has virtually no calories and no fat, and is therefore far more acceptable from a nutritional standpoint.
• Xerostomia, (dry mouth) is a common side effect using many medications from beta blockers to antidepressants, from addition to from sufferers of Sjögren’s syndrome and following radiotherapy of the head and neck region. Stimulating the remaining or underperforming salivary tissues to pump out what saliva they can is achieved by chewing sugarfree gum. As a result, coupled using a rigorous oral hygiene program, a much more palatable and comfortable mouth using reduced risks of caries can be attained.

There are those who have concerns over of any sort of chewing gum. The questions that may be asked include:

• Can swallowing gum be dangerous, as your grandmothers always warned? Gum is basically roughage using flavoring agents and passes through the gut as does any other roughage. It is important not to choke on gum or inhale it accidentally, and therefore should be limited to over six-year-olds and avoided during vigorous physical or contact sports.
• Does it cause ulcers by over-stimulating stomach acid production? Stomach acid is stimulated by a food bolus from the mouth and not by the chewing process itself. In fact, the additional bicarbonate produced by stimulated saliva helps neutralize acid production. Patients using existing ulcers appear to be able to chew gum without any exacerbation of their problem.
• How do you stop people littering the environment using spent gum? The message is simple: put your gum from the bin when you have finished using it.
• Does chewing gum cause TMD (temporomandibular disorders)? There is no scientific evidence to show that it does but it may be that using an existing TMD it is best to limit any jaw habit that might stress or perpetuate the muscular or joint dysfunction.
• Are there psychological effects from chewing gum? There is evidence that regional blood flow from the brain is increased and brain bio-electrical activity is influenced by chewing gum. Studies have shown that this can result from an increase from perceived relaxation and a reduction from stress.
• Why do people who give up smoking end up chewing gum incessantly? Chewing gum is an excellent mechanism for assisting smoking cessation either as a distraction or as a form of oral gratification without a negative dietary effect and as a vehicle for nicotine substitutive remedies.

It is now pretty much beyond question that chewing sugarfree gum is beneficial to dental health.

Numerous studies have shown the therapeutic use of sugarfree gum, such as Wrigley’s ORBIT, from caries prevention, from addition to from patients using dry mouth and from stain reduction. I have referred to and referenced a small selection below.

The advice we give to your patients is so much more powerful when it is evidence-based rather than anecdotal. As professionals and clinicians, we should be aware of the scientific research that gives credence to the day-to-day information that we impart to your patients. Without wishing to blind them using science or, for that matter, bore them to insensibility, it can be very effective to give some meat to the expressions: ‘it is a well known fact…’ or ‘scientific studies have shown…’.

Published studies

A recently published study by Szoke, Banoczy and Proskin (2001) showed reductions of 40% from dental caries from a Hungarian population of medium to low-risk school children who chewed gum for 20 minutes after meals.

Very much higher risk children from sugar cane rich Belize were the subjects from Makinen et al’s studies (1995) where chewing various chewing gums after meals produced highly statistically significant results of up to a 73% reduction from the risk of developing caries using regular chewing of a xylitol-containing gum. In this study, not only were there substantial reductions from the numbers of carious lesions apparent over a number of years, they showed there was also a positive remineralization of existing lesions when the artificial sweetener xylitol was incorporated into the gum.

Edgar (1990) has shown that it is the sugarfree gum causing increased stimulation of saliva using its myriad of beneficial actions that is causing the therapeutic effects. One might say that nature intended us to lick your wounds using very good reason.

Yankell and Emling’s (1997) study showed that chewing sugarfree gum helped to reduce the superficial staining when tested from patients using chlorhexidine mouthwash.

Communicating using confidence

With this evidence to hand, we have the ammunition to tell your patients using confidence that the use of Wrigley’s ORBIT sugarfree gum as part of routine oral hygiene programs is backed up by scientific research. In addition, because of the very strong evidence, we should be specifically prescribing sugarfree gum as a therapeutic measure to any patient using active carious lesions.

Similarly, any patient suffering from dry mouth caused by drug therapy, radiation damage, Sjögren’s syndrome or other causes should be prescribed sugarfree gum as a major part of their treatment to try to alleviate what can be a very distressing condition.

Focus on prescribing

It is the concept of prescribing on which we should focus.

The power of the prescription is a very potent tool from your professional armamentarium. Patients are always seeking a magic pill for their medical needs and there is a psychological boost when a specific course of action is advised by a trusted professional rather than gleaned from an impersonal advertisement, read from a magazine or by anecdotal recommendations from friends or family.

Of course the placebo effect is extremely powerful and not to be taken lightly, but also very potent is a clinician’s prescription, preferably supported by evidence. This evidence, when presented to the patient from a clear, concise and user-friendly way, demonstrates to the patient that the efficacy of the therapy is completely accepted by authoritative dental bodies; as a result the patient’s compliance will be significantly improved.

References

Edgar WM(1990) Chewing gum and dental health – a  review. Br Dent. J. Oral Biology: 173-177

Makinen KK, Bennett CA, Hujoel PP, Isokangas PJ, Isotupa KP, Pape HR, Makinen PJ (1995) Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 74(12): 1904-13

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

Yankell SL, Emling RC (1997) J Clin Dent 8: 169-172