Research published in the International Journal of Dental Hygiene by researchers at the Academic Center for Dentistry Amsterdam (ACTA) said that sugar free gum may improve dental health beyond proven effects such as helping tooth mineralization.
“The results of this study indicate that the use of two pieces of chewing gum sweetened with xylitol or maltitol has an inhibitory effect on gingivitis development,” said the researchers.
However, that was only found when regular tooth brushing was not performed and the study did not see any improvements in plaque and bleeding scores when participants brushed regularly.
“In the absence of brushing, chewing xylitol or maltitol gum provided a significant inhibitory effect on gingivitis scores compared to chewing gum base.”
Most chewing gums in the Western world are now sweetened with sugar alternatives, most commonly mixes of xylitol, sorbitol, mannitol and maltitol.
Sugar free gum has a series of approved health claims in the EU such as helps to maintain tooth mineralization, neutralizes plaque acids and reduces oral dryness, but no claim exists for gingivitis prevention.
In the current study, 220 participants were split into four groups: one chewing xylitol gum, one maltitol gum, one just a gum base and another chewing no gum. The xylitol gum was Roquette’s Xylisorb and the maltitol gum was also provided by Roquette through its SweetPearl brand.
The gum chewing groups chewed five times a day for 10 mins and the double-blind, randomized controlled study lasted for three weeks.
EFSA positive opinions on sugar-free gum
1. Helps neutralize plaque acids
2. Helps maintain tooth mineralization
3. Reduces oral dryness
4. SFG with carbamide neutralizes plaque acids more effectively
5. Xylitol-sweetened (100%) gum reduces the risk of caries in children
6. SFG with fluoride increases resistance of enamel to acid attacks and increases the rate of remineralization.
The participants were instructed not to brush their lower jaws but could maintain normal hygiene practices for their upper jaws. However, they were provided with a toothpaste with no anti-plaque or gingivitis agents.
The researchers measured bleeding on marginal probing (BOMP) and plaque scores at baseline and after the trial period.
BOMP scores in the lower jaw were similar for all groups at baseline. But after the study BOMP scores in the lower jaw increased to 0.26 for the sugar free gum groups, which was significantly lower than the gum base group (0.48) but not too dissimilar from the ‘no gum’ group (0.36).
The researchers observed no statistically significant difference in plaque scores among all the groups after the study.
Also, no significant differences were found between the maltitol and xylitol groups throughout the study.
An earlier systematic review found that sugar free gum provided a small reduction in plaque scores on top of tooth brushing, but it could not establish an effect with gingivitis scores. That review found no beneficial effect of chewing sugar free gum in the absence of tooth brushing.
Another study by the Faculty of Dentistry at the University of Antioquia, Colombia questioned the clinical benefits of sugar free chewing gum to prevent dental caries and gingivitis after a double-blind, randomized controlled trial. But a scientist from Mondelēz doubted the findings.
The latest study was performed with a grant from ACTA and was initiated by Roquette. The authors declared no conflict of interest.
Int J Dent Hygiene 12, 2014; 238–244.
‘Effects of sugar-free chewing gum sweetened with xylitol or maltitol on the development of gingivitis and plaque: a randomized clinical trial.’
Authors: Keukenmeester RS, Slot DE, Rosema NAM, Van Loveren C, Van der Weijden GA.