The aim of this study was to determine the effects of 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.

What did they do

Participants aged 60 years and over with a minimum of 6 natural teeth living independently in the community were randomised to either the test group (prescribed and provided with xylitol-containing chewing gum to use twice a day, for 15 min each time n =95 ), or control ( no gum n=91 ). Regular gum-chewers (those using chewing gum on a daily basis) were excluded along with those who had used antibiotics in the preceding 4 weeks. Participants  were examined at baseline  and at 6 months. The primary outcome was increase in stimulated saliva flow rate. Secondary measures included improvements in Plaque and Gingival Indices, and self perceived change in oral health.

What did they find

• The majority of the participants were female (63.4%) with a mean age of 70.2 years
• 146 participants were available for assessment at 6 months (75 in the test group and 71 in the control).
• Reported compliance with the protocol was 84% (range 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, demonstrated a significant improvement in Plaque and Gingival Index scores over the control group.
• A significantly higher proportion of participants in the gum-chewing group perceived that their oral health had improved during the study period compared with the control group
• No adverse events or side-effects attributed to gum-chewing were reported.

 What did they conclude

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.

Al-Haboubi M, Zoitopoulos L, Beighton D, Gallagher J. 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. Community Dent Oral Epidemiol. 2012 Apr 26. doi: 10.1111/j.1600-0528.2012.00685.x. [Epub ahead of print] PubMed PMID: 22533799.

Comment

In this trial there is an greater benefit for the control group than the test group for the main outcome of increased salivary flow. Considering gum-chewing is thought to exert its beneficial effects on oral health by stimulating salivary flow this seems surprising.  While the test group showed a significant improvement over the control group in relation to the secondary outcomes of Plaque and Gingival Index scores both groups had significant improvements over baseline which might suggest a ‘Hawthorne effect’ as noted by the authors.