Growth of plaque while chewing sucrose and sorbitol flavoured gum

Efficacy of chitosan-based chewing gum on reducing salivary S. mutans counts and salivary pH: a randomised clinical trial

OBJECTIVE

To determine chitosan-based chewing gum role on reducing salivary S. mutans counts and salivary pH.

MATERIALS AND METHODS

The present double-blind randomised clinical trial with the trial registration number of IRCT20190724044319N1 was conducted on 36 dental students. The volunteers were, randomly, divided into two groups (n = 18) including: G1: intervention group (chitosan chewing gum) and G2: control group (placebo chewing gum). Each participant was given eight pieces of the chewing gum, and was asked to chew each gum piece for 5 min and this was repeated for eight times. Their Saliva was collected before and after chewing gums and the number of S. mutans colonies and salivary pH were determined. Data were analysed using SPSS (ver.21) and independent student t test. p Value less than .05 was set as significant.

RESULTS

There was significant difference between two groups for the number of salivary S. mutans colonies (3.31*105  in the intervention group compared to 13.94*105 in the Control group) (p < .001). The salivary pH evaluation showed that salivary pH mean value in intervention group was not significant in compared with control group (p = .17). However, the chitosan chewing gum led to an increase in salivary pH by 0.17, which was statistically significant (p = .01).

CONCLUSION

Results of this study showed that chitosan chewing gum has a positive effect on the reduction of numbers of salivary S. mutans colonies but had no considerable effect on the increase of salivary pH.

The potential benefits of sugar-free chewing gum on the oral health and quality of life of older people living in the community: a randomized controlled trial

OBJECTIVES

To determine the effects of prescribing sugar-free chewing gum on the oral health and quality of life of dentate older people living in the community and attending for routine dental care.

METHODS

A randomized controlled trial was conducted on 186 older people who were not regular chewers of gum, (aged 60 years and over with ≥ 6 teeth) recruited from primary care clinics. Participants were randomly allocated to a gum-chewing group (chewing xylitol-containing gum twice a day for 15 min; n = 95) or a control group (no gum; n = 91). Both groups were examined at baseline and at the end of the study (6 months later). The primary outcome measure for the study was increased in stimulated saliva flow rate. Secondary measures included improvements in Plaque and Gingival Indices, and self-perceived change in oral health.

RESULTS

The retention rate for the study was 78.5% (n = 146 at follow-up); reported compliance with the protocol was 84% (ranged between 12% and 100%). There was no significant change in the saliva flow of the gum-chewing group (1.20-1.17 ml/min), while the control group experienced an increase in flow rate (1.06-1.32 ml/min; P = 0.001). The gum-chewing group, however, demonstrated significant improvement in Plaque and Gingival Index scores over the control group. For the Plaque Index, the mean scores (±SD) were 0.29 (±0.29) and 0.56 (±0.46) for the gum-chewing group and control groups, respectively (P < 0.001), at the second examination, which remained significant after controlling for age and saliva flow rate. For the Gingival Index, the scores were 0.73 (±0.30) and 0.92 (±0.32), respectively (P < 0.001), which persisted after controlling for age. A significantly higher proportion of participants in the gum-chewing group perceived that their oral health had improved during the study period in comparison with the control group (40% cf 21%; P = 0.016).

CONCLUSIONS

Prescription of sugar-free chewing gum to dentate older people living in the community and attending routine dental services was not associated with a significant increase in stimulated saliva flow. There were, however, significant improvements in Plaque and Gingival Index scores, and in self-perceived oral health.

The effect of chewing sugar-free gum on plaque regrowth at smooth and occlusal surfaces

BACKGROUND AND AIM

Chewing gum has the potential to provide oral health benefits including plaque control. The aim of this study was to determine the effects of chewing sugar free gum on plaque regrowth at buccal, lingual and occlusal surfaces of teeth.

METHOD AND MATERIALS

11 healthy and dentally-fit dental hygiene students participated in this randomised, single-blind crossover 4-day plaque regrowth study. From a zero plaque score on day 1, subjects suspended oral hygiene measures and either chewed gum or did not chew gum over 4 days. Gum chewing was one piece chewed for 30 min 4 x per day. On day 4, subjects were scored for plaque after disclosing from buccal, lingual and unrestored occlusal surfaces.

RESULTS

There was no significant difference in smooth surface plaque scores between the treatments but significantly less plaque accumulated (44%) at occlusal surfaces during gum chewing compared to no gum chewing.

CONCLUSION

Chewing gum can reduce plaque accumulation at sites of predilection for caries but has little or no effect at sites of predilection for gingivitis.

Chewing gum--facts and fiction: a review of gum-chewing and oral health

The world market for chewing gum is estimated to be 560,000 tons per year, representing approximately US $5 billion. Some 374 billion pieces of chewing gum are sold worldwide every year, representing 187 billion hours of gum-chewing if each piece of gum is chewed for 30 minutes. Chewing gum can thus be expected to have an influence on oral health. The labeling of sugar-substituted chewing gum as "safe for teeth" or "tooth-friendly" has been proven beneficial to the informed consumer. Such claims are allowed for products having been shown in vivo not to depress plaque pH below 5.7, neither during nor for 30 minutes after the consumption. However, various chewing gum manufacturers have recently begun to make distinct health promotion claims, suggesting, e.g., reparative action or substitution for mechanical hygiene. The aim of this critical review--covering the effects of the physical properties of chewing gum and those of different ingredients both of conventional and of functional chewing gum--is to provide a set of guidelines for the interpretation of such claims and to assist oral health care professionals in counseling patients.

The efficacy of an anti-gingivitis chewing gum

Chlorhexidine is a well-established agent used for the control of supragingival plaque but is not without disadvantages, such as tooth staining, which limits its clinical applications to short-term use. This clinical trial studied the clinical effectiveness and stain-forming potential of chlorhexidine in a chewing gum base. Subjects (151) were screened for baseline plaque and gingival indices before receiving a dental prophylaxis and randomized into 3 treatment groups: group 1 chewed 2 pieces of chlorhexidine diacetate gum for 10 min 2x a day (total daily chlorhexidine = 20 mg), group 2 chewed 2 pieces of placebo gum for 10 min 2x a day and group 3 rinsed with 10 ml of 0.2% chlorhexidine gluconate mouthwash for 1 min 2x per day (total daily chlorhexidine = 40 mg). Plaque, gingivitis and stain evaluations were made at 4 and 8 weeks. Plaque and bleeding scores were significantly lower at 4 and 8 weeks in the chlorhexidine gum group compared to the placebo gum group and similar at 8 weeks to the rinse group. Stain intensity at week 8 was significantly less for the chlorhexidine gum than rinse. The staining measured by extent was also less with the chlorhexidine gum than the rinse, but the difference was not significant at week 4. At week 8, stain extent was significantly lower in the chlorhexidine gum group than chlorhexidine rinse. In conclusion, the results of this study demonstrate that this chlorhexidine chewing gum used with normal tooth cleaning provides similar adjunctive benefits to oral hygiene and gingival health as a 0.2% chlorhexidine rinse.

Comparability and discriminating power of 4 plaque quantifications

This study was designed for analysis of the discriminating power of 4 different quantifications of supragingival plaque: (1) plaque wet weight (PWW); (2) the plaque index (PlI); (3) the PLQ index measuring the coronal extension of plaque; (4) the area % of stained plaque. Different quantities of plaque were produced by adding chlorhexidine acetate (CHX), hydrogen peroxide (H2O2), or sucrose to experimental chewing gums. Total mean scores of 12 subjects in each of 3 test groups revealed that chewing of CHX gum resulted in the lowest plaque scores with all 4 quantifications and that the highest scores were recorded for the PWW or PlI of the sucrose gum users. Chewing of the H2O2 gum produced as much plaque as the sucrose gum when evaluated according to the PLQ index and exceeded the sucrose gum scores when evaluated according to the area % index. The PWW discriminated best between low, medium and high plaque scores after chewing of both CHX, H2O2 and sucrose gums. PlI scores 1 and 3 remained stable whereas the frequency of PlI score 0 strongly decreased and that of score 2 strongly increased when going from gums producing low (CHX) and medium (H2O2) to large (sucrose) amounts of plaque. The PLQ index discriminated well between low and medium but poorly between medium and large amounts of plaque. The area % index functioned well when subjects with low (CHX) and medium (H2O2) plaque scores were subgrouped into those with < 30%, 30-70% or > 70% of their tooth surfaces covered with stained plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of dietary sucrose on plaque extension rate in man

The aim of this study was to determine the plaque extension rate following both a sucrose restricted and a sucrose supplemented diet. Eighteen female students, 19-32 yr of age, volunteered to participate in the study. The experiment comprised two periods, with each consisting of five consecutive days of no oral hygiene. The diet during one experimental period was composed of typical Swedish food with no addition of sucrose. The diet during the other experimental period was identical except for the daily addition of 100 g sucrose. Plaque was assessed after 24 h, 72 h, and 120 h with the aid of photographs which were evaluated photogrammetrically. The results showed a mean plaque extension rate of 0.32% per hour during the period with no additional sucrose and 0.36% per hour with sucrose addition. The difference was not statistically significant. The results suggest that moderate amounts of sucrose added to normal diet do not influence the plaque extension rate.

Plaque-growth inhibiting effect of chewing gum containing urea hydrogen peroxide

The plaque-reducing effect of a chewing gum containing hydrogen peroxide was assessed. 12 dental hygienist students participated in a double-blind 3 x randomly crossed-over study. During the 4-day test periods, from Monday to Friday, no oral hygiene measures were allowed other than chewing 2 pieces of gum for approximately 10 min 5 x daily. The 800 mg pieces of gum were V6+regular (V6+) containing 0.4 g sorbitol and 6.3 mg hydrogen peroxide, V6 placebo gum (PLAC) containing 0.45 g sorbitol and no hydrogen peroxide, and only the gum base (GB) as a negative control. The quantity of plaque was assessed using the plaque index and the visible plaque index, and by scraping "all" plaque off the teeth in half the mouth during 2.5 min for determination of plaque wet weight. With all 3 measurements, chewing of the hydrogen peroxide-releasing gum (V6+) resulted in significantly lower plaque increments, from Monday to Friday, than chewing of the gum base (P less than 0.05). Chewing of the V6 placebo gum (PLAC) resulted in plaque scores which differed from neither those recorded after use of the hydrogen peroxide releasing (V6+) nor the placebo (GB) gums. The observed plaque-growth inhibiting effect of the hydrogen peroxide-releasing chewing gum in the present study was found to be of limited clinical significance.

Further in vivo studies on the plaque-inhibiting effect of chlorhexidine and its binding mechanisms

The aim of the present study was to investigate the relative importance of chemical groups in the oral cavity which bind chlorhexidine of clinical significance. This was performed by clinical experiments where a test panel of 11 individuals rinsed with chlorhexidine at pH 7, pH 5.5, and pH 3. Rinsing with 0.02 M EDTA was performed prior to the chlorhexidine rinse, because this procedure has been shown to enhance the antibacterial effect of chlorhexidine in vitro. However, pre-rinses with EDTA did not increase the clinical effect of chlorhexidine. Bacteriologic tests showed comparable antibacterial effect of chlorhexidine at pH 7 and pH 3. Mouthrinses of pH 7 and pH 5.5 had comparable plaque-inhibiting effects, whereas the effect of a rinse of pH 3 was not different from that of the placebo. This finding is interpreted to suggest that primary phosphate (pK about 2) is an important receptor site for chlorhexidine, whereas secondary phosphate (pK = 7.0) is of negligible importance. Previous studies have clearly shown that phosphate binds chlorhexidine. The lack of clinical effect at pH 3 is probably due to precipitation of salivary proteins by hydrogen ions, making primary phosphate groups unavailable for interaction with chlorhexidine.

The distribution of plaque and gingivitis and the influence of toothbrushing hand in a group of South Wales 11-12 year-old children

Numerous factors may affect the distribution of plaque and gingivitis in any individuals mouth. Of considerable importance must be the oral hygiene habits of each person, which will be influenced by compliance and dexterity with tooth cleaning methods. The pattern of gingivitis seen at a young age may, with time, reflect the eventual distribution of attachment loss. This in part, could explain the considerable variation in chronic periodontal disease seen between individuals and at different sites within the same mouth. This study reports the baseline data for the distribution of plaque and gingivitis in 1105, 11-12-year-old children in South Wales. The children were selected by disproportionate stratified random sampling and examined by a multidisciplinary group with the long-term aim of evaluating the importance of malocclusion to dental health and psychosocial variables. Toothbrushing frequency had a very low but significant correlation with the distribution of plaque and gingivitis, accounting therefore for only a small % of the variance in the group. For the total group and right-handed toothbrushers, buccal plaque and gingivitis was significantly increased on right contralateral teeth. No specific pattern for plaque and gingivitis distribution by side was seen for 100 left-handed toothbrushers. Plaque and gingivitis also showed significant differences dependent upon arch, tooth number, and surface. The population is being followed at 4-year intervals to monitor the pattern of periodontal disease with time and correlate changes with these baseline findings.

Effects of folate mouthwash on experimental gingivitis in man

Although the experimental gingivitis model has been used extensively since 1965, some doubts exist concerning the nature of the tissue response in this model. Accordingly, the present study was designed to determine whether or not experimental gingivitis responded to 0.1% folate mouthwash (MW) in a similar manner to that already reported for established gingivitis. 20 male dental students took part in a double blind cross-over study which involved two 3-week experimental periods with random allocation to folate or placebo MW. The experimental site was the lower anterior area and 24 points of gingival examination were made at baseline and weeks 1, 2 and 3. Inflammation was assessed by presence or absence of colour change, and bleeding being slight, profuse or absent when gingivae were stroked with a blunt probe. A plaque sample was evaluated using dark field microscopy, and dry weight of accumulated plaque was measured at the end of each experimental period. Folate MW did not appear to have any statistically significant effects on accumulated plaque, or clinical signs of experimental gingivitis in this study. The different response of experimental gingivitis to folate MW, compared with the response of established gingivitis already reported, further suggests that experimental gingivitis may not represent an authentic replica of the cellular and immunological responses occurring in established gingivitis.

Effects of sugared and sugar-free chewing gum on the accumulation of plaque and debris on the teeth

The aim of this study was to determine the effects of sugar-free and sugar-containing gums on plaque formation, established plaque and salivary debris. Plaque accumulating during three 5-day periods was recorded in a group of 10 students who, in the absence of normal oral hygiene methods, chewed sugar-free or sugar-containing chewing gum or did not chew gum. In a second group of 10 students the effect of chewing the two types of gum on 3-day accumulations of plaque was recorded. Finally, the wet weight of liquorice debris present in saliva with and without gum chewing, was recorded. During the no chewing periods distinct and significant differences in the amounts of plaque accumulating at different sites were apparent. Both types of chewing gum significantly and comparably reduced plaque accumulation during the 5-day period. The chewing gums also significantly reduced established plaque on many tooth surfaces. Salivary debris was significantly reduced by 50% after chewing gum. It was noted that plaque removal occurred primarily from sites remote from the gingival margin and interdental areas and therefore it was concluded that the observed effects of chewing gum on plaque would not be reflected in a reduction in gingival inflammation.

A mastication device designed for the evaluation of chewing gums

A mechanical device designed to simulate the human mastication of chewing gum was used to evaluate the enamel polish, dentin abrasion, and reduction in enamel solubility produced by several commercial gums, as well as experimental gums incorporated with various additives. The results demonstrated that this mastication device was suitable for evaluating in vitro the physical and chemical effects of chewing gums on teeth.

Plaque growth while chewing sorbitol and xylitol simultaneously with sucrose flavored gum

In a recent study, sorbitol flavored chewing gum was found neither to increase nor decrease the normal rate of plaque formation, whereas high plaque scores were obtained with sucrose gum during 4 days of no mechanical tooth cleaning. The aim of the present study was to see if chewing sorbitol or xylitol flavored gum together with sucrose gum would affect the growth rate of plaque and whether chewing of xylitol flavored gum could reduce the amount of already formed plaque. Twenty-seven dental students refrained from mechanical oral hygiene measures from Monday to Friday morning for 3 weeks. The students were randomly divided into three groups. A three time crossed-over double-blind approach was used. During each test period one group chewed a combination of one piece sorbitol and one piece sucrose flavored gum five times per day, the second group correspondingly chewed xylitol and sucrose flavored gum, while the third group served as a no hygiene control group. After each test period the students in the control group chewed one piece of xylitol gum every 15 minutes for 2.5 hours. The participants started out each week with clean teeth and were at the end of each test period scored for visible plaque on the facial, mesial and lingual surfaces of their teeth. There was somewhat more plaque after 4 days of chewing sucrose-sorbitol and sucrose-xylitol gum combinations than after no oral hygiene alone. There was no difference between the two test treatments. The 2.5-hour chewing of xylitol flavored gum after the no oral hygiene period did not result in a reduction of the 4-day-old plaque.