Analia Veitz-Keenan DDS
There is limited evidence that supports the use of polyol-containing chewing gum as part of an oral hygiene program to prevent or reduce dental caries.
An extensive review of 19 studies supports the use of xylitol- and sorbitol-containing chewing gum to help prevent dental caries, but the results should be interpreted with caution.
Does the use of polyol containing chewing gum prevent caries development compared to no chewing gum?
The authors searched three major databases for peer-reviewed articles published in English between 1950 and 2008. The authors selected articles that reported dental caries outcomes for studies that compared polyol-containing gum to control gum.
The search identified 231 articles. After initial screening to eliminate duplicate and ineligible studies, the authors reviewed a total of 25 studies. Of that remaining total, the authors excluded 6 studies. The 19 included studies represented 14 study populations. The quality of the 6 included randomized clinical trials (RCT) was evaluated using the Jadad Scale with scores of 3 or higher representing low risk of bias. For nine controlled clinical trials (CCTs) and four cohort studies the U.S Preventive Service Task Force criteria were used. The authors performed meta-analyses for 4 groups of studies, 1) xylitol-containing gum versus no gum, 2) xylitol-sorbitol gum versus no gum, 3) sorbitol gum versus no gum, and 4) combination sorbitol-mannitol gum versus no gum. Xylitol, sorbitol, and xylitol/sorbitol combination gums were found to have significant preventive actions compared to no gum. Extensive sensitivity testing by study quality did not alter these principal findings. The data did not permit a dose-response analysis.
There is evidence that xylitol and sorbitol gum can be used as an adjunct for caries prevention. The authors suggested that because only 25% of the included studies were of good quality, more studies of rigorous design are needed to evaluate outcomes. The limited information about the duration of treatment and the variability of the measured outcomes suggest that the pooled results should be interpreted with care. The optimal dosage and relative polyol efficacy remains unknown.
Source of Funding:
Importance and Context:
New tools for prevention of caries, still a prevalent dental disease, are always well received especially if they are safe and easy to apply on school aged children. Practitioners need to be aware that there are some alternatives to prevent and to halt the progression of caries and those alternatives, if proven to be effective, can be recommended.
Strengths and Weaknesses of the Systematic Review:
The reviewers used appropriate methods to search and select studies. They described the limitations and the quality of each study. Heterogeneity between studies was assessed and an extensive sensitivity testing was performed. Although the data did not permit determination of optimal dose, the authors did perform an analysis of the association of total polyol consumption with prevented fraction.
Strengths and Weaknesses of the Evidence:
The evidence was weakened by the low quality of the available studies, the majority of which had unclear randomization, unaddressed confounding factors, and did not report dropouts nor reasons of subject withdrawals. Only 1 randomized controlled trial was of good quality. A meta-analysis was included in the review using the data from 13 studies, 5 RCTs and 8 CCTs. Six studies out of the original 19 included studies, were not used in these analyses because they were based on the same study populations. Also, all studies were relatively short-term with no data collected beyond 40 months. Additionally, all studies examined only child and adolescent populations.
Implications for Dental Practice:
The available evidence indicates that xylitol and sorbitol gum are effective in reducing the incidence of caries compared to no-gum use in school-aged children. Dosage questions remain to be answered. However, higher quality studies are needed to corroborate these findings, including studies examining adult populations.