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Studies have estimated that over 80% of all adults have experienced dental caries (Berger, 2009). Sealants may be effective in managing dental caries. However, controlling the consumption of sugary foods and undertaking habitual dental checkups are the most effective methods of managing oral health issues.
Although these approaches have been successful in reducing the effects of dental caries, dentists assert that dental caries can be effectively managed with the use of sugar-free chewing gum as shown by scientific study findings. The article focuses on the effect of sugar-free chewing gum on dental caries. It reviews available journal articles to draw comparative insights on the relationship between sugar-free chewing gum and dental caries.
Beneficial anticaries properties
The widespread use of chewing gum has driven interests among scholars to find its relationship with dental outcomes. The most relevant aspects of chewing gum are its ability to “integrate sugar substitutes and enhance long-lasting stimulation of salivary flow for protective purposes” (Edgar, 1998). In this regard, the focus has been using sugar substitutes, such as sorbitol and xylitol, in chewing gum for dental care (Edgar, 1998). Oral bacteria are unable to decompose xylitol, whereas they may ferment sorbitol gradually.
Consequently, xylitol is regarded as non-cariogenic. In this respect, chewing gum containing sorbitol sweeteners may not be effective in lowering the plaque pH. According to Edgar, effects of chewing sugar-free gum on the ability of “plaque to form acid from sucrose remain vague” (Edgar, 1998). However, the use of xylitol gum can reduce plaque acidogenicity between a period of two and three weeks because of its inhibitory effects on oral bacteria.
Generally, both sorbitol and xylitol provide the same benefits in oral care by enhancing enamel development within a short period. On this note, researchers have concluded that xylitol gum has beneficial anticaries properties that can help in oral care relative to sorbitol gum effects (Edgar, 1998; Mickenautsch, Leal, Yengopal, Bezerra and Cruvinel, 2007).
The most important properties of sugar-free chewing gum are that they contain sorbitol and xylitol, which are non-cariogenic as opposed to other sorts of sugar-based chewing gum. As a result, sugar-free chewing gum offers anticaries effects by stimulating saliva in the mouth. Moreover, xylitol contains antibacterial properties, which are critical in reducing caries in the mouth. Therefore, sugar-free chewing gum is effective in neutralizing and inhibiting the accumulation of food acid and acids that emanate from plaque.
Twetman recognized the impacts of adopting preventive approaches such as using sugar-free chewing gum on the oral health of toddlers, kids, teenagers, and adults (Twetman, 2009). He acknowledged gaps in current research but concluded that there were “adequate and consistent findings to show that the use of xylitol and sorbitol in chewing gum as part of normal oral hygiene to prevent dental caries” (Twetman, 2009) was highly encouraged.
Mickenautsch et al. (2007) have asserted that sugar-free chewing gum has a caries-reducing effect, which implies that chewing gum helps in reducing dental caries. At the same time, studies have suggested that the therapeutic or anti-cariogenic effect could facilitate healing of emerging carious lesions because of the enhanced salivary flow in the mouth.
It is imperative to note that the outcome could be enhanced by chewing the gum instantaneously after meals (Szöke, Bánóczy & Proskin, 2001). It works by inhibiting bacteria from metabolizing acid in the mouth. Hence, chewing sugar-free gum acts like a dose-response as one continues to chew gum during the day.
Some researchers noted that regular use of chewing gum sweetened with xylitol reduced chances of tooth decays (Isokangas, Söderling, Pienihäkkinen & Alanen, 2000). This study shows that xylitol is effective in managing oral caries, unlike other sugar-free sweeteners. It also indicates that the use of xylitol chewing gum reduces the chances of developing dental caries by 13% in men and 22% in women. Based on the above research, the use of sugar-free chewing gum lessens risks of developing dental caries.
Therefore, chewing gum is the most effective way of lessening rates of oral caries in adults and children. The above research has proved that the replacement of sugared gum with sugar-free gum could reduce the development of dental caries. Therefore, public health campaigns should promote the use of sugar-free chewing gum as a means of reducing dental caries.
Xerostomia and salivary flow
Xerostomia is a condition associated with a dry mouth, which could be permanent or temporary. It results from low salivary flow in the mouth. It is a distressing condition for many dental patients. This condition may facilitate the development of caries, teeth erosion, and oral periodontal challenges.
One major approach for managing xerostomia is chewing sugar-free gum. Sugar-free gum stimulates salivary flow in the mouth and reduces dryness of the mouth. Edgar noted that chewing gum enhanced the flow of a protective salivary function, particularly in individuals who had low rates of salivary flow (Edgar, 1998).
Another study also indicated that chewing sugar-free gum was an effective way of increasing salivary flow (Karami-Nogourani, Kowsari-Isfahan, and Hosseini-Beheshti, 2011). The increased flow was a response to “taste, stimuli and mechanical chewing” (Karami-Nogourani et al., 2011). These studies indicated that chewing sugar-free gum was a better option in combating xerostomia relative to other sugar-based gum.
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Overall, most studies reviewed in this article have shown that chewing sugar-free gum has oral health benefits and could reduce dental caries. This suggests that people who chew sugar-free gum may have low rates of dental caries relative to others who chew sugar-sweetened gum or who do not chew any gum.
A controversial finding
While all journal articles used in this study have demonstrated beneficial effects of chewing sugar-free gum on oral dental caries, a recent study by Martínez-Pabón, Duque-Agudelo, Díaz-Gil, Isaza-Guzmán, & Tobón-Arroyave (2014) questioned such conclusions.
The researchers acknowledged that chewing of pentitol-sweetened gum containing no CPP-ACP for a period of 30 days could reduce some effects of salivary on facultative bacteria, but they asserted that “there was only a marginal, if any, benefit from the chewing gum under study on some microbiological caries- and gingivitis-related variables” (Martínez-Pabón et al., 2014). In other words, the authors demonstrated that the results were not strong and consistent.
Therefore, there was no significance evidence to show that chewing sugar-free gum as a method of enhancing oral health care was effective, but it remained questionable (Martínez-Pabón et al., 2014). This new evidence will set a precedent for future research on the relationship between sugar-free chewing gum and dental caries.
From these studies, one can argue that sugar-free chewing gum may have positive outcomes in oral health care because of increased salivary flow and the presence of sorbitol and xylitol, which help in fighting plaque. However, this observation may only be valid under theoretical perspectives.
One must acknowledge that most researchers have indeed demonstrated beneficial outcomes of chewing sugar-free gum in oral health care. However, it is imperative to recognize that chewing sugar-free gum is just an adjunctive method of improving oral health care and fighting dental caries. Hence, it does not substitute regular dental hygiene involving brushing of teeth regularly with fluoride toothpaste.
Despite a recent study that questioned such beneficial outcomes of chewing sugar-free gum to reduce dental caries, oral care experts continue to advice individuals that chewing sugar-free gum can help in reducing dental caries, particularly instantaneously after meals. Also, individuals with xerostomia could also benefit from increased chewing of sugar-free gum, which stimulates salivary flow. Thus, it is necessary to consider chewing sugar-free gum as a component of oral health care.
Scientific evidence suggests that chewing sugar-free gum could lead to low rates of dental caries because it contains sugar substitutes such as sorbitol and xylitol, which improve dental care. This evidence is relevant to the public and applicable to people who can chew gum because dental caries starts from childhood. Therefore, people should chew sugar-free chewing gum to help in fighting dental caries.
Sugar-free chewing gum does not only inhibit the growth of plaque but also hinders enamel demineralization. Using sugar-free chewing gum containing xylitol for a long time leads to the development of xylitol-resistant cells. Dentists have noted that early mitigation measures to prevent the development of dental caries in children are useful in reducing tooth decay.
On the other hand, people must note that chewing sugar-free gum should not replace regular brushing of teeth with fluoride toothpaste. Also, they must also continue with regular visits to dentists, flossing, and taking balanced meals to ensure optimal oral health care. Besides, a new study questions the effectiveness of chewing sugar-free gum to supplement oral health care.
Berger, V. W. (2009). Chewing Gum and Caries. Journal of the American Dental Association, 140(6), 638-640.
Edgar, W. M. (1998). Sugar substitutes, chewing gum and dental caries–a review. British Dental Journal, 184(1), 29-32.
Isokangas, P., Söderling, E., Pienihäkkinen, K., & Alanen, P. (2000). Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. Journal of Dental Research, 79(11), 1885-9.
Karami-Nogourani, M., Kowsari-Isfahan, R., and Hosseini-Beheshti, M. (2011). The effect of chewing gum’s flavor on salivary flow rate and pH. Dental Research Journal, 8(Suppl1), S71–S75.
Martínez-Pabón, M. C., Duque-Agudelo, L., Díaz-Gil, J. D., Isaza-Guzmán, D. M., & Tobón-Arroyave, S. I. (2014). Comparison of the effect of two sugar-substituted chewing gums on different caries- and gingivitis-related variables: a double-blind, randomized, controlled clinical trial. Clin Oral Investigations, 18(2), 589-98. doi: 10.1007/s00784-013-0989-0.
Mickenautsch, S., Leal, S. C., Yengopal, V., Bezerra, A. C., and Cruvinel, V. (2007). Sugar-free chewing gum and dental caries: a systematic review. Journal of Applied Oral Science, 15(2), 83-8.
Szöke, J., Bánóczy, J., & Proskin, H. M. (2001). Effect of after-meal sucrose-free gum- chewing on clinical caries. Journal of Dental Research, 80(8), 1725-9.
Twetman, S. (2009). Consistent evidence to support the use of xylitol- and sorbitol- containing chewing gum to prevent dental caries. Evidence-Based Dentistry, 10, 10–11. doi:10.1038/sj.ebd.6400626.