Chewing gum as treatment …?

PD Dr. Kristina Bertl, PhD MSc MBA

Patients with gingivitis are a regular feature of everyday clinical practice, and the most important step in their treatment is undoubtedly optimising their home oral hygiene in conjunction with a professional oral hygiene session. However, the question often arises of whether it might be possible to improve and increase patient outcomes and motivation further through other adjunctive therapies.

Chewing gum as treatment?

One simple method that would probably be quite popular with many patients and might prove beneficial is chewing sugar-free gum. A Finnish research group recently focused increased attention on the possible benefits of sugar-free chewing gum and published several systematic reviews, including a systematic review on the subject of sugar-free chewing gum and its effect on gingivitis (Söderling et al. 2022).

During the course of this systematic review, they identified seven publications; seven studies with information about xylitol and one study in each case with data on mannitol and sorbitol, but no study with any data about erythritol. In the various studies, participants chewed the gum between two and five times a day for between 5 and 15 minutes; so participants spent a total of between 15 and 50 minutes a day chewing gum.

Five of the seven studies on the effect of sugar-free xylitol gum found that chewing it had a significantly positive effect on gingival inflammation, in other words the group with xylitol gum saw a significant reduction in their gingival index scores. Sorbitol was found to have minor benefits in just one study, while mannitol was not found to have any additional positive effect.

In summary, chewing sugar-free xylitol gum could be considered as an adjunctive therapy for patients with gingivitis, however the data available to date is not yet conclusive and there are also some conflicting results. In addition to its positive effects in the treatment of gingivitis, xylitol was also found in other studies to have benefits in preventing caries (Söderling & Pienihäkkinen 2020) and in reducing plaque accumulation (Söderling & Pienihäkkinen 2022). With regard to other sugar alcohols, such as mannitol, sorbitol and erythritol, there is still too little data available or no data at all in order to be able to draw clinical conclusions.

References

1. Eva Söderling, Kaisu Pienihäkkinen, Ulvi Kahraman Gursoy. Effects of sugar-free polyol chewing gums on gingival inflammation: a systematic review. Clin Oral Investig. 2022 Dec;26(12):6881-6891. Eva Söderling, Kaisu Pienihäkkinen (2020) Effects of xylitol and eryth- ritol consumption on mutans streptococci and the oral microbiota: a systematic review. Acta Odontol Scand 78:599–608 Eva Söderling, Kaisu Pienihäkkinen (2022) Effects of xylitol chewing gum and candies on the accumulation of dental plaque: a system- atic review. Clin Oral Investig 26:119–129