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      SUGAR-FREE CHEWING GUM AND DENTAL CARIES – A SYSTEMATIC REVIEW

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          Abstract

          Objective:

          To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients.

          Method:

          9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles.

          Results:

          Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids.

          Conclusion:

          The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.

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          Most cited references77

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          A systematic review of the performance of methods for identifying carious lesions.

          This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessment of visual, visual/tactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to support generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces.
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            Xylitol chewing gums and caries rates: a 40-month cohort study.

            Dental caries is a pandemic infectious disease which can affect the quality of life and consumes considerable health care resources. The chewing of xylitol, sorbitol, and even sugar gum has been suggested to reduce caries rates. No clinical study has simultaneously investigated the effectiveness of these gums when compared with a group receiving no chewing gum. A 40-month double-blind cohort study on the relationship between the use of chewing gum and dental caries was performed in 1989-1993 in Belize, Central America. One thousand two hundred and seventy-seven subjects (mean age, 10.2 years) were assigned to nine treatment groups: one control group (no supervised gum use), four xylitol groups (range of supervised xylitol consumption: 4.3 to 9.0 g/day), two xylitol-sorbitol groups (range of supervised consumption of total polyols: 8.0 to 9.7 g/day), one sorbitol group (supervised consumption: 9.0 g/day). The gum use during school hours was supervised. Four calibrated dentists performed the caries registrations by means of a modified WHO procedure. The primary endpoint was the development of an unequivocal caries lesion on a non-cavitated tooth surface. Compared with the no-gum group, sucrose gum usage resulted in a marginal increase in the caries rate (relative risk, 1.20; 95% confidence interval,0.96 to 1.49; p = 0.1128). Sorbitol gum significantly reduced caries rates (relative risk 0.74; 95% confidence interval, 0.6 to 0.92 ; p = 0.0074). The four xylitol gums were most effective in reducing caries rates, the most effective agent being a 100% xylitol pellet gum (relative risk, 0.27; 95% confidence interval, 0.20 to 0.36; p = 0.0001). This gum was superior to any other gum (p < 0.01). The xylitol-sorbitol mixtures were less effective than xylitol, but they reduced caries rates significantly compared with the no-gum group. DMFS analyses were consistent with these conclusions. The results suggest that systematic usage of polyol-based chewing gums reduces caries rates in young subjects, with xylitol gums being more effective than sorbitol gums.
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              Caries preventive effect of sugar-substituted chewing gum.

              The aim of this 3-year community intervention trial was to determine the caries preventive effect of sugar-substituted chewing gum among Lithuanian school children, and to assess compliance with the instructions for gum use. A total of 602 children, aged 9-14 years, from 28 school classes in five secondary schools in Kaunas, Lithuania, were given a baseline clinical and radiographic caries examination. The schools were randomly allocated to receive one of the following interventions: sorbitol/carbamide gum; sorbitol gum; xylitol gum; control gum; and no gum. Children in the four active intervention groups were asked to chew at least five pieces of gum per day, preferably after meals. The children were reexamined clinically after 1, 2 and 3 years, and radiographically after 3 years. Self-reported compliance was monitored anonymously four times during the study. A total of 432 children were available at the 3-year clinical follow-up examination. The crude mean 3-year caries increments (DMFS--all stages of lesion formation) were 11.8 for the sorbitol/carbamide gum group; 9.0 for the sorbitol gum group; 8.1 for the xylitol gum group; 8.3 for the control gum group; and 12.4 for the no gum group. The adjusted 3-year caries increments were statistically significantly lower in the sorbitol gum group, the xylitol gum group and the control gum group than in the no gum group, whereas no statistically significant difference was seen between the no gum group and the sorbitol/carbamide gum group. Adjusted 3-year caries increments in the xylitol gum group and the sorbitol gum group did not differ statistically significantly from the caries increments in the control gum group. Compliance with the study protocol was better in School C (xylitol gum) than in the other schools. In all schools, compliance decreased over time. The results indicate that the caries preventive effect of chewing sugar-free gum is related to the chewing process itself rather than being an effect of gum sweeteners or additives, such as polyols and carbamide.
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                Author and article information

                Journal
                J Appl Oral Sci
                J Appl Oral Sci
                Journal of Applied Oral Science
                Faculdade de Odontologia de Bauru da Universidade de São Paulo (Bauru )
                1678-7757
                1678-7765
                April 2007
                April 2007
                : 15
                : 2
                : 83-88
                Affiliations
                [1 ]BDS, Division of Public Oral Health, University of the Witwatersrand, Johannesburg, South Africa
                [2 ]PhD, University of Brasília, DF, Brazil
                [3 ]MChD, Division of Public Oral Health, University of the Witwatersrand, Johannesburg, South Africa
                [4 ]PhD, School of Dentistry, Catholic University of Brasilia, DF, Brazil
                [5 ]MS, in private practice in Brasilia, DF, Brazil
                Author notes
                Corresponding address: S Mickenautsch, BDS - Division of Public Oral Health - University Of The Witwatersrand - P.O. Box 2779 Houghton/Johannesburg - 2041 - South Africa - Phone: 27 11 717 2594 - Fax: 27 11 717 2625 - e-mail: neem@ 123456global.co.za
                Article
                S1678-77572007000200002
                10.1590/S1678-77572007000200002
                4327235
                19089107
                13dc6c6e-d545-44ee-929c-078b576167f0

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 March 2007
                : 16 April 2007
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 45, Pages: 6
                Categories
                Review

                sugar free,chewing gum,caries,xylitol,sorbitol,remineralisation
                sugar free, chewing gum, caries, xylitol, sorbitol, remineralisation

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