Antiplaque and antigingivitis efficacy of medicated and non-medicated sugar-free chewing gum as adjuncts to toothbrushing: systematic review and network meta-analysis.

OBJECTIVE: This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing. MATERIAL AND METHODS: PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes. RESULTS: Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p > 0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes. CONCLUSION: SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence. CLINICAL RELEVANCE: There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis.

Development and uniformity evaluation of low-dose medicated chewing gums prepared by compression method.

The aim of this work was to develop medicated chewing gums (MCGs) containing 10 mg of lysozyme hydrochloride (LH) and 20 mg of ascorbic acid (AsA) obtained by the compression method with Health in Gum® (HiG®) PWD 01 as a compressible gum base. Because of a low content of active ingredients, it was essential to choose the way of adding them to the tableting mass and evaluate their distribution homogeneity in the dosage units. The blends for compression were prepared by two methods: the first one was simple mixing of all components; the second one included the step of wet granulation of a three-component mixture - LH, sucralose and a taste additive. Flow properties of LH, AsA, HiG®, LH granules and blends for compression were studied. MCGs were evaluated according to Ph.Eur. 9.0 Chapters 2.9.5, 2.9.6 and 2.9.40. AsA and HiG® were characterized as free flowing, while LH had insufficient flow properties. Compared with a simple mixed blend, the granulation step allowed significantly improving flow properties of the final blend for compression. Unlike MCGs compressed from the simple mixed blend, MCGs prepared through the granulation step met Ph.Eur. 9.0 Chapter 2.9.40 requirements. The propriety of MCG preparation method involving the step of wet granulation also has been confirmed by mass and drug content uniformity tests.

The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults.

OBJECTIVES: The caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated. MATERIALS AND METHODS: In this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann-Whitney U test. RESULTS: The total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p < 0.01). CONCLUSIONS: Subjects using the low-dose xylitol chewing gum showed a significantly lower increment of initial and extensive caries lesions and overall a lower increment of caries experience. CLINICAL RELEVANCE: One-year use of chewing gums provides an effective means for the prevention of caries disease. TRIAL REGISTRATION NUMBER: NCT02310308.

In Vivo Release Kinetics and Antibacterial Activity of Novel Polyphenols-Enriched Chewing Gums.

Chewing gums may be particularly effective means for delivering and maintaining bioactive molecules, included in the gum formulation, able to have an anti-cariogenic effect. The purposes of this study were: to develop novel chewing gums containing quercetin (Qt); to evaluate their release using in vivo trial; finally, to test their in vivo antibacterial effect against oral Streptococcus mutans strains. A preliminary study was performed to produce new gums, enriched with the polyphenol quercetin. Then, a first in vivo experimental study was assessed to test the percentages of Qt released in the saliva of young volunteers. Moreover, a second clinical trial was performed to analyze the antibacterial capability of these enriched chewing gums against S. mutans strains after 14 days of daily consumption. The release analysis showed that a more effective release of Qt occurs in the first minutes of chewing, and it does not change saliva pH values. Moreover, Qt included in gums demonstrates an effective antibacterial activity, showing a reduction of the concentration of S. mutans strains in saliva samples, especially after 7 days. Qt included in experimental chewing gums could be efficiently released into the oral cavity and could promote an effective anti-caries concentration in volunteer's saliva, without changing salivary pH values.

Assessment of Oral Masticatory Muscle Activity With Different Chewing Gums: A Cross-Sectional Study Based on Electromyogram Analysis.

BACKGROUND: Facial muscles, particularly those involved in mastication, play a pivotal role in the chewing process. Despite their influence on chewing, these muscles undergo alterations during mastication. Examining the relationship between chewed substances and muscle activity can provide insights into various pathological processes and aid in the development of therapeutic chewing techniques. AIM: This study aimed to evaluate the impact of different commercially available chewing gums on the activity of key masticatory muscles. METHOD: Twenty-two participants were recruited for the study. They were instructed to chew four commercially available gums: group 1 comprised sugar gum with a strong flavor; group 2 included gum containing sorbitol; group 3 consisted of gum containing xylitol; and group 4 provided sugar gum with a mild flavor. Electromyogram (EMG) recordings were utilized to assess muscle activity. Various aspects of muscle activity, including chewing time, maximum muscle potential, and coordination between different muscles, were evaluated. Data tabulation and analysis were performed using IBM SPSS software version 23.0 (IBM Corp., Armonk, NY). RESULT: Analysis revealed that in terms of temporalis symmetry, group 2 exhibited the highest mean deviation, while for masseter symmetry, group 3 demonstrated the highest mean deviation. The total deviation for the temporalis and masseter muscles was 72.16% and 65.55%, respectively, indicating greater symmetry in the temporalis muscle. Additionally, group 3 displayed the highest mean deviation in both left and right-sided synergic activity of the muscles. The total deviation for the right and left sides was 64.34% and 65.67%, respectively. CONCLUSION: The findings suggest that sugar-free chewing gums elicit increased muscle activity compared to sugar-containing chewing gums. Furthermore, the utilization of calorie-free chewing gums with a firm texture was associated with better-coordinated muscle activity. These results provide valuable insights into the effects of different chewing gums on masticatory muscle function and coordination, which may have implications for therapeutic interventions and oral health management.

Impact of Compression Force on Mechanical, Textural, Release and Chewing Perception Properties of Compressible Medicated Chewing Gums.

Medicated chewing gums (MCGs) represent a beneficial platform for realizing drugs intended for dental prophylaxis and treatment. The present study aimed to investigate the impact of compression force on the mechanical, textural, release, and chewing perception characteristics of compressible MCGs with the combination of lysozyme hydrochloride (LH) and ascorbic acid (AsA). Four batches of MCGs were obtained on a laboratory single-punch tablet machine applying different forces, i.e., 5, 7, 10, and 15 kN, and evaluated by their geometrical parameters, mechanical resistance, surface and internal structure characteristics, texture profile, release behavior, and perception attributes during mastication. It was found that increasing compression force slightly affected resistance to crushing and friability of MCGs, but resulted in surface smoothing and formation of a thicker layer with highly compacted particle arrangement. According to the texture analysis, increasing compression force led to harder and more adhesive gums, indicating possible difficulties in chewing and, therefore, impairment of their consumer properties. Lower compression forces were also found to be preferable in terms of better drug release from the obtained chewing gums. The volunteers' assessment showed that an increase of compression force led to significantly raising the initial hardness and crumbliness as well as to decreasing the rate of the integral gum mass formation during mastication, which may negatively affect perceptive sensations when using MCGs. Based on the results obtained, the optimal compressing force was selected to be 7 kN, which allows obtaining MCGs with good organoleptic, mechanical, textural, and release properties.

Medicated Chewing Gums: Recent Patents and Patented Technology Platforms.

The reason that the oral route attained such acceptance may be ascribed to its affluence of administration. Over the years, patient convenience- oriented exploration in the area of drug delivery has introduced potential innovative medicine delivery systems. The elegant drug delivery system is an amalgamation of science and dexterity with therapeutic prospect and presentability. It involves the administration of medications in a groundbreaking fashion with the assistance of cosmetics, wearable devices and oral drug delivery system which can also be used for ornamental purposes. Out of which, therapeutic chewing gum offers a highly suitable and amenable technique of dosing medications comprising children and elderlies. It is a potentially convenient means of administering medications either locally or systematically via the oral cavity. It bids innumerable gains over conventional drug delivery methods. Moreover, medicinal chewing gums involve the dynamic and constant masticatory actions for drug release. Currently, enriched expertise has made it promising to advance and fabricate medicated chewing gum with predefined properties and it could be a marketable triumph in the future. Apprehending this, several investigators and pharmaceutical companies are now engaged in developing innovative practices vis-à-vis medicated chewing gums by filing several patents in this area. The present manuscript also delivers a gestalt of various patented technology platforms based on different methods/ mechanisms employed for the preparation of medicated chewing gums.

Gum Sensor: A Stretchable, Wearable, and Foldable Sensor Based on Carbon Nanotube/Chewing Gum Membrane.

Presented in this work is a novel and facile approach to fabricate an elastic, attachable, and cost-efficient carbon nanotube (CNT)-based strain gauge which can be efficiently used as bodily motion sensors. An innovative and unique method is introduced to align CNTs without external excitations or any complicated procedure. In this design, CNTs are aligned and distributed uniformly on the entire chewing gum by multiple stretching and folding technique. The current sensor is demonstrated to be a linear strain sensor for at least strains up to 200% and can detect strains as high as 530% with a high sensitivity ranging from 12 to 25 and high durability. The gum sensor has been used as bodily motion sensors, and outstanding results are achieved; the sensitivity is quite high, capable of tracing slow breathing. Since the gum sensor can be patterned into various forms, it has wide applications in miniaturized sensors and biochips. Interestingly, we revealed that our gum sensor has the ability to monitor humidity changes with high sensitivity and fast resistance response capable of monitoring human breathing.

Evaluation of the Antimicrobial Effectiveness and the Effect of Dosage and Frequency of Sugar-free Chewing Gums on Streptococcus mutans Count: An in vivo Microbiological Study.

The aim of the present study was to evaluate the antimicrobial efficacy of sugar-free chewing gums and also to assess the effect of dosage and frequency of intake of sugar-free gums on Streptococcus mutans count. Method : The sample consisted of 30 subjects, divided into two groups AI and AII. Each group consisted of 15 subjects. Group AI chewed two sugar-free chewing gum, twice daily for 20 minutes (Total four gums daily) and group AII chewed two sugar-free chewing gum, four times daily for 20 minutes (Total eight gums daily) and saliva sample was collected and agar plates were inoculated for Streptococcus mutans colony count. The study was carried for a week's time and saliva samples collected were baseline, day 1 morning and evening, day 4 evening, day 7 morning and evening. Results : After the gum was chewed, it was observed that the colony count started to reduce when compared with baseline in both the groups. The fall in Streptococcus mutans count was statistically highly significant with p < 0.001 in both the groups. When comparing between group AI (dosage 4 gums daily) and group AII (dosage 8 gums daily), the fall in Streptococcus mutans count for both the groups was not statistically significant with p > 0.05. It was concluded that there was reduction in the level of salivary Streptococcus mutans, but was not statistically significant by increasing the dosage and frequency of intake of sugar-free chewing gums. Therefore, we recommend that dosage of sugar-free chewing gums can be restricted to four gums instead of eight gums per day.