Efficacy and Tolerability of a Scutellaria lateriflora L. and Cistus × incanus L.-Based Chewing Gum on the Symptoms of Gingivitis: A Monocentric, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Preclinical studies have shown that the combination of Cistus × incanus L. and Scutellaria lateriflora L. extracts exerts beneficial effects on oral health against gingivitis. Thus, this study aimed to assess the tolerability of a chewing gum and its efficacy on gingivitis in a double-blind, placebo-controlled clinical trial. Enrolled subjects (n = 60, 18-70 years) were randomized to receive two chewing gums or a placebo daily for 3 months. At baseline (t0) and monthly (t1, t2, and t3) timepoints, the Quantitative Gingival Bleeding Index (QGBI), the Modified Gingival Index (MGI), and the Oral Health 15 items (OH-15)] were employed to assess potential improvements in gingivitis. Pain was self-quantified via the Visual Analogue Scale (VAS), and the Clinical Global Impression Scale for Severity of illness (CGI-S) helped in evaluating the oral general conditions. This study is listed on the ISRCTN registry. At t3, the QGBI, MGI, OH-15, VAS, and CGI-S values decreased in the treated but not in the placebo group (ß = 0.6 ± 0.1, t176 = 3.680, p < 0.001; ß = 0.87 ± 0.21, t115 = 4.263, p < 0.001; ß = 5.3 ± 2.5, t172 = 2.086, p = 0.038; ß = 3.16 ± 0.51, t88 = 6.253, p < 0.001; and ß = 1.09 ± 0.32, t83 = 3.419, p < 0.001, respectively). A significant improvement in gingival health occurred after a 3-month intervention with the chewing gums containing S. lateriflora and C. incanus extracts.

Strategies to reduce ileus after colorectal surgery: A qualitative umbrella review of the collective evidence.

BACKGROUND: Various strategies were proposed to reduce postoperative ileus after colorectal surgery. This umbrella review aimed to provide a comprehensive overview of current evidence on measures to reduce the incidence and severity of postoperative ileus after colorectal surgery. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic search was conducted in PubMed and Scopus to identify systematic reviews that assessed the efficacy of interventions used to prevent postoperative ileus after colorectal surgery. Data on study characteristics, interventions, and outcomes were summarized in a narrative manner. RESULTS: A total of 26 systematic reviews incorporating various strategies like early oral feeding, gum chewing, coffee consumption, medications, and acupuncture were included. Early oral feeding reduced postoperative ileus and accelerated bowel function return. The most assessed intervention was chewing gum, which was associated with a median reduction of postoperative ileus by 45% (range, 11%-59%) and shortening of the time to first flatus and time to defecation by a median of 11.9 and 17.7 hours, respectively. Coffee intake showed inconsistent results, with a median shortening of time to flatus and time to defecation by 1.32 and 14.45 hours, respectively. CONCLUSION: Early oral feeding, chewing gum, and alvimopan were the most commonly assessed and effective strategies for reducing postoperative ileus after colorectal surgery. Medications used to reduce postoperative ileus included alvimopan, intravenous lidocaine, dexamethasone, probiotics, and oral antibiotics. Intravenous dexamethasone and lidocaine and oral probiotics helped hasten bowel function return. Acupuncture positively impacted the recovery of bowel function.

Early absorption sources of caffeine can be a useful strategy for improving female table tennis players-specific performance.

BACKGROUND: The consumption of fast absorption sources containing caffeine, such as caffeinated gum and coffee mouth rinsing, has been considered a practical nutritional strategy among athletes. Therefore, this study aimed to determine the effect of early absorption sources containing caffeine on the performance of female table tennis players. METHOD: Eighteen female table tennis players randomly participated in this randomized, double-blind, and crossover designed study. Before starting the test, the participants attended a familiarization session. In each test session, participants were randomly assigned to one of three conditions including chewing caffeinated gum (CG, n = 6), coffee mouth rinsing (CMR, n = 6) and placebo capsule (PLA, n = 6). All participants consumed caffeine with an average dose of ∼3 to 4.5 mg·kg-1. The one-week interval was considered a washout period for each condition. Each test session included measurement of functional, skill and cognitive tests. Skill tests included serve, forehand drive, backhand push and counter tests. The Cognitive function measured by color recognition test, and functional tests included agility, hand movement speed, the explosive power of the upper body and lower body, hand-eye coordination and hand grip strength tests. The collected data were analyzed (with SPSS Windows software) by repeated measure ANOVA analysis and Bonferroni post hoc test at P ≤ 0.05 level. RESULTS: The findings of the present study illustrated that CG and CMR increased significantly agility and reduced the amounts of errors in the cognitive test compared to PLA (p < 0.05), While there was no significant difference between CG and CMR (p > 0.05). Also, CG and CMR compared to PLA and CMR compared to CG rose significantly hand movement speed and movement speed (p < 0.05), and CMR compared to PLA increased significantly hand-eye coordination, isometric hand strength, service accuracy and forehand drive (p < 0.05). However, CG compared to PLA and CMR had no significant effect on hand-eye coordination, isometric hand strength, service accuracy and forehand drive (p > 0.05). In addition, CG and CMR enhanced significantly the explosive power of the lower body compared to PLA (p < 0.05), While there was no significant difference between CG and CMR (p > 0.05). Also, CG and CMR compared to PLA and CG compared to CMR had no significant effect on the explosive power of the upper body, backhand, and counter skills (p > 0.05). Furthermore, CG increased significantly accuracy in the service test compared to PLA (p < 0.05). CONCLUSION: According to the results, it seems that early absorption sources of caffeine (CMR and CG) are efficient strategies for improving the specific performance of female table tennis players. However, allegedly CMR and CG have a better effect on functional and cognitive tests compared to skill tests.

Effectiveness of plant-mediated synthesis of hydroxyapatite nano-particles impregnated in Pistachio oleogum resin on mineral contents of human teeth. An in-situ single-blind controlled study.

OBJECTIVES: This study aimed to synthesize and characterize an environmentally friendly nanohydroxyapatite (n-HA) and evaluate its impact on enamel mineral content when incorporated into a Pistachio oleo gum resin (Saqqez) bio-chewing gum for in-situ models. We compared the effects of this green nano-hydroxyapatite (G n-HA) with those of a commercially available synthetic nano-hydroxyapatite (S n-HA). METHODS: Various analytical techniques were employed including XRD, FESEM, FT-IR, EDX/SEM and TGA/DTA to characterize the crystallinity, size and composition of the G n-HA powder. Three chewing gum groups were formulated: (1) Saqqez gum containing 10% wt G n-HA, (2) Saqqez gum containing 10% wt S n-HA, and (3) pure Saqqez gum. In order to evaluate the impact of these chewing gums on enamel, intraoral appliances were fabricated, each containing six enamel specimens. Participants were instructed to chew the gums while wearing these appliances. The calcium (Ca+2) and phosphorus (P) levels in enamel specimens, both with and without exposure to an acid challenge, were quantified using EDX/SEM. FE-SEM was employed to capture the microstructure of the enamel surface. In terms of the statistical analysis, one-way ANOVA and Tukey's post hoc tests were utilized to compare the data, where the significance level (α) was set at 0.05. RESULTS: The characterization tests confirmed the successful synthesis of G n-HA. Furthermore, EDX/SEM analysis of the enamel specimens from the intraoral appliance revealed significant variations in calcium (Ca+2) content among the enamel specimens (P = 0.000). The S n-HA group, in particular, exhibited the highest Ca+2 content, while the pure Saqqez group displayed the lowest. Nonetheless, there was no statistically significant differences in phosphorus (P) content observed among the three groups (P = 0.27). CONCLUSIONS: Saqqez gum can be considered a wholesome natural chewing gum that serves, as a carrier for delivering remineralization agents to the tooth surfaces. This was evident in the groups containing n-HA, exhibiting elevated Ca+2 levels. It's noteworthy that G n-HA demonstrated less efficacy in enamel remineralization compared to S n-HA.

Gum Chewing and Coffee Consumption but not Caffeine Intake Improve Bowel Function after Gastrointestinal Surgery: a Systematic Review and Network Meta-analysis.

BACKGROUND: Postoperative ileus is common after gastrointestinal surgery. This network meta-analysis aimed to compare the effectiveness of gum chewing and coffee and caffeine intake on ileus-related outcomes. METHODS: A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing noninvasive treatments for ileus after gastrointestinal surgery. The main analyses included random effects network meta-analyses using frequentist methods with simultaneous direct and indirect comparisons of time to first flatus, time to first defecation, and length of stay. Bayesian network meta-analysis using Markov chains was also used. RESULTS: A total of 32 RCTs comparing 4999 patients were included in this network meta-analysis. Time to flatus was reduced by gum chewing (mean difference compared to control (MD): -11 h, 95% confidence interval (95% CI) - 16 to - 5 h, P < 0.001). Time to defecation was reduced by gum chewing and coffee, with MDs of -18 h (95% CI - 23 to - 13 h, P < 0.001) and -13 h (95% CI - 24 to - 1 h, P < 0.001), respectively. Length of stay was reduced by coffee and gum chewing with MDs of - 1.5 days (95% CI: - 2.5 to - 0.6 days, P < 0.001) and - 0.9 days (95% CI: - 1.3 to - 0.4 days, P < 0.001), respectively. CONCLUSION: Coffee and gum chewing were proven to be effective noninvasive approaches for shortening the postoperative length of hospital stay and time to first defecation, especially in open gastrointestinal surgery; thus these actions should be recommended after gastrointestinal surgery.

Effects of caffeine chewing gum supplementation on exercise performance: A systematic review and meta-analysis.

The aim of this systematic review with meta-analysis was to determine the effect of caffeine gum (Caff-gum) on exercise performance-related outcomes. Several databases were searched for studies assessing the effect of Caff-gum in placebo-controlled protocols involving healthy adults. Random-effects meta-analyses using standardized mean differences (SMD) were performed to determine the effect of Caff-gum on exercise outcomes with several sub-analyses (training status, exercise type, timing and dose) for potential modifying factors. 14 studies were included, totalling 200 participants. There was a significant overall effect of Caff-gum compared to placebo (SMD = 0.21, 95%CI: 0.10-0.32; p = 0.001). Subgroup analysis showed improved performance for trained (SMD = 0.23, 95%CI: 0.08-0.37; p = 0.004), but not for untrained (SMD = 0.14, 95%CI: -0.02-0.29; p = 0.07) individuals. Caff-gum improved both endurance (SMD = 0.27, 95%CI: 0.12-0.42; p = 0.002) and strength/power (SMD = 0.20, 95%CI: 0.03-0.37; p = 0.03) performance outcomes. Caff-gum was ergogenic when consumed within 15 min prior to initiating exercise (SMD = 0.27, 95%CI: 0.07-0.4; p = 0.01), but not when provided >15 min prior (SMD = -0.48, 95%CI = -1.7-0.82; p = 0.25). There was no significant effect of Caff-gum with doses <3 mg/kg body mass (BM) (SMD = 0.20, 95%CI: -0.03-0.43; p = 0.07), but there was a significant effect when the dose was ≥3 mg/kg BM (SMD = 0.22, 95%CI: 0.07-0.37; p = 0.01). Caff-gum supplementation may be an effective ergogenic strategy for trained athletes involved in both endurance and strength/power exercise, using a recommended dose of ≥3 mg/kg BM consumed within 15 min of initiating exercise.HighlightsThis study determined the effect of Caff-gum on exercise performance, using a systematic review and meta-analysis. Fourteen studies, totalling 200 participants performing a variety of endurance and strength/power exercise tests were included. The relative Caff-gum dose ranged from 1.27-4.26 mg/kg BM and timing ranged from 120 min prior to exercise up to intra-test application.Caff-gum was shown to be an effective ergogenic aid for trained individuals involved in both endurance and strength/power exercise.Supplement dose and timing modified the efficacy of Caff-gum. Supplementation with Caff-gum was effective when provided in doses ≥3 mg/kg BM and within 15 min prior to initiating exercise.Trained endurance or strength/power athletes seeking to benefit from caffeine in the form of chewing gum should supplement within 15 min prior to initiating an exercise task, in doses ≥3 mg/kg BM.

Evaluation of Chemical, Biochemical and Anti-Microbial Effects of Salvadora persica and Moringa oleifera Extract to Produce Organic Disinfectant Products.

Oral hygiene is one of the most influential and important issues in people's health. People have been using herbal components to maintain their oral hygiene for centuries. Oral cancer develops in the oral cavity, and its origin always lies in the growth of malignant epithelial tissue cells. Due to the spread of this cancer in Iran, we intend to measure the antibacterial effects of the combination of Salvadora persica and Moringa oleifera extracts. Cariogenic bacteria are one leading cause of oral cancer. We used this extract in mouthwash, toothpaste, and chewing gum, and we expect that it would reduce cell proliferation and be used in prevention and treatment. The new organic mouthwash, chewing gum, and toothpaste were designed and prepared using M. oleifera oil, S. persica, M. oleifera extract, the powder of S. persica wood, and M. oleifera leaves. With the use of herbal compounds in the preparation of these products, the quantity of essential chemical ingredients in the prepared samples was decreased. We examined the quality and stability of mouthwash, toothpaste, and chewing gum that indicated the standard level of each substance. Furthermore, we evaluated the antibacterial effects of our products, which indicated that our products can significantly reduce the total bacterial count. For the first time, a combination of S. persica and M. oleifera extract replaced chemicals in mouthwash, toothpaste, and chewing gum. Natural herbal ingredients with antimicrobial activity are effective in maintaining low bacterial counts in the mouth, and as a result, improving oral hygiene and health.

Development and evaluation of a chewing gum containing antimicrobial peptide GH12 for caries prevention.

The purpose of this study was to develop a chewing gum containing a novel antimicrobial peptide GH12 and evaluate its biocompatibility, antimicrobial activity, and caries-preventive effects in vivo and in vitro. GH12 chewing gum was developed using a conventional method and its extracts were prepared in artificial saliva. GH12 concentration in the extracts was determined by high-performance liquid chromatography; extracts were used for growth curve assay, time-kill assay, crystal violet staining assay, scanning electron microscopy, and Cell Counting Kit-8 assay. A rat caries model was established, and molars were treated topically with extracts for 5 weeks. Weight gain monitoring, hematoxylin-eosin staining, micro-computed tomography, and Keyes scoring were conducted. Significant inhibition of Streptococcus mutans growth and biofilm formation was observed. Extracts displayed low cytotoxicity against human gingival epithelial cells. No significant differences in weight gain or signs of harm to the mucosal tissues in any of the rats were observed. Keyes scores of caries lesions in the GH12 chewing gum group were lower than those of the negative control group. It was concluded that GH12 chewing gum showed good biocompatibility, antimicrobial activity, and caries-preventive effects, exhibiting great potential to prevent dental caries as an adjuvant to regular oral hygiene.

Chewing gum: alternative therapy to oxygen intolerance.

Rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare complex disorder associated with alterations in the endocrine system, autonomic nervous system, and respiratory system. Previously published case reports and studies have noted sleep-disordered breathing in patients with ROHHAD syndrome. Nocturnal respiratory manifestations, which if untreated early by respiratory support, may cause cardiorespiratory arrest and a life-threatening condition. More recently, it has been recognized that children with ROHHAD syndrome have central pauses during wakefulness associated with intermittent oxygen desaturations. We report novel findings of a child with ROHHAD syndrome displaying an irregular breathing pattern and significant central pauses associated with oxygen desaturations during wakefulness, whose respiratory status improved while chewing gum. This was used as an alternative to supplemental oxygen therapy. CITATION: Sunkonkit K, Selvadurai S, Yeh EA, Hamilton J, Narang I. Chewing gum: alternative therapy to oxygen intolerance. J Clin Sleep Med. 2022;18(6):1723-1726.

Effects of acute ingestion of caffeinated chewing gum on performance in elite judo athletes.

PURPOSE: Previous investigations have found positive effects of acute ingestion of capsules containing 4-to-9 mg of caffeine per kg of body mass on several aspects of judo performance. However, no previous investigation has tested the effectiveness of caffeinated chewing gum as the form of caffeine administration for judoists. The main goal of this study was to assess the effect of acute ingestion of a caffeinated chewing gum on the results of the special judo fitness test (SJFT). METHODS: Nine male elite judo athletes of the Polish national team (23.7 ± 4.4 years, body mass: 73.5 ± 7.4 kg) participated in a randomized, crossover, placebo-controlled and double-blind experiment. Participants were moderate caffeine consumers (3.1 mg/kg/day). Each athlete performed three identical experimental sessions after: (a) ingestion of two non-caffeinated chewing gums (P + P); (b) a caffeinated chewing gum and a placebo chewing gum (C + P; ~2.7 mg/kg); (c) two caffeinated chewing gums (C + C; ~5.4 mg/kg). Each gum was ingested 15 min before performing two Special Judo Fitness Test (SJFT) which were separated by 4 min of combat activity. RESULTS: The total number of throws was not different between P + P, C + P, and C + C (59.66 ± 4.15, 62.22 ± 4.32, 60.22 ± 4.08 throws, respectively; p = 0.41). A two-way repeated measures ANOVA indicated no significant substance × time interaction effect as well as no main effect of caffeine for SJFT performance, SJFT index, blood lactate concentration, heart rate or rating of perceived exertion. CONCLUSIONS: The results of the current study indicate that the use of caffeinated chewing gum in a dose up to 5.4 mg/kg of caffeine did not increase performance during repeated SJFTs.

Formulation of Medicated Chewing Gum Containing Sceletium tortuosum and Process Optimization Utilizing the SeDeM Diagram Expert System.

Sceletium tortuosum is one of the most promising medicinal plant species for treating anxiety and depression. Traditionally, aerial parts are chewed (masticatory herbal medicine) providing fast relief and rendering the masticatory route for delivery, ideal. This study intended formulating novel medicated chewing gum containing S. tortuosum to alleviate depression and anxiety. S. tortuosum extract was formulated into directly compressed medicated chewing gum (MCG) containing different Health-in-Gum® (HIG) bases through process optimization with the SeDeM Diagram Expert System. Physical properties of MCGs were characterized, and specialized drug release studies performed. According to the manufacturer, only HIG-03 was specifically developed for direct compression; however, the SeDeM System was successfully applied to all HIG-bases investigated. HIG-01 and HIG-04 are also considered useful in direct compression as no considerable differences in these MCG formulations' physical properties were recognized. Inclusion of a lubricant, however, is deemed essential, and MCG comprising HIG-01, most suited for direct compression. Dissolution experiments found only two alkaloids used as markers, mesembrine and mesembrenone, were released in quantifiable concentrations regardless formulation constituents. Novel directly compressed MCG-containing S. tortuosum extract was successfully formulated by which the biologically active phytochemicals of S. tortuosum can be scientifically delivered through the traditionally applied mastication method.

Investigação do potencial erosivo de gomas de mascar não convencionais / Investigation the erosive potential of unconventional chewing gums

Objetivo: mensurar o potencial erosivo de gomas de mascar não convencionais disponíveis no mercado brasileiro. Material e método: estudo experimental (in vitro) de caráter quantitativo. Foram adquiridos oito sabores de gomas de mascar: Poosh® (pinta língua); Plutonita® (abraço congelante, dentada ardente, baba de bruxa e língua ácida); e TNT® (sangue, lava e tumba). Para análise da acidez, foram realizadas leituras em triplicata do pH e acidez titulável (AT), utilizando um potenciômetro e eletrodo combinado de vidro em soluções obtidas após a maceração das gomas de mascar em água duplamente deionizada. Nas soluções com valores de pH inferiores a 5,5, foi mensurada a AT adicionando-se alíquotas de 100 µLNaOH 0,1 M, até alcançar pH 5,5. Os resultados foram submetidos à Análise de Variância (ANOVA). As comparações das médias de pH e acidez titulável foram realizadas pelo teste de Tukey, com um nível de 5% de significância (p<0,05). Resultados: os valores de pH variaram entre 2,4 (abraço congelante) e 3,5 (baba de bruxa), diferin-do significantemente do controle (água mineral/pH=6,2). Os valores de acidez titulável variaram entre 628µL de NaOH 0,1 M (sangue) e 10700µL de NaOH 0,1 M (abraço congelante). A goma de mascar sabor abraço congelante apresentou o pH mais baixo e a mais elevada acidez titulável, diferindo significantemente dos demais sabores. Conclusões: as gomas de mascar avaliadas são ácidas, mas diferem quanto ao seu potencial erosivo. Seu consumo abusivo pode constituir um fator de risco para erosão dental.(AU)

Objective: to measure the erosive potential of non- -conventional chewing gums available in the Brazilian market. Material and methods: this is an in vitro study using the following flavors of chewing gums from the Brazilian market: Poosh® (tongue cleaner); Plutonita® (freezing hug, burning bite, witch slime and acid tongue); TNT® (blood, lava and tomb). For acidity analysis, pH and titratable acidity (TA) readings were performed in triplicate using a potentiometer and combined glass electrode in solutions obtained after maceration of the chewing gums in double deionized water. In solutions with pH values below 5.5, the TA was measured by adding aliquots of 100 µL 0.1 M NaOH, until pH 5.5 was reached. The results were submitted to Analysis of Variance (ANOVA). Comparisons of pH and titratable acidity means were performed by Tukey test at a 5% significance level (p<0.05). Results: the pH values that ranged from 2.4 (freezing hug) to 3.5 (witch's slime) differed significantly from the control (mineral water/ pH=6.2). Titratable acidity values ranged from 628µL of 0.1 M NaOH (blood) to 10700µL of 0.1 M NaOH (freezing hug). The freezing hug flavor chewing gum had the lowest pH and the highest titratable acidity differing significantly from the other flavors. Conclusions: the evaluated chewing gums are acidic, but differ in their erosive potential. Their abusive consumption may constitute a risk factor for dental erosion.(AU)

Non-pharmacological interventions for the prevention of postoperative ileus after gynecologic cancer surgery.

Postoperative ileus (POI) is characterized by impaired gastrointestinal motility after surgery. POI is a major concern for surgeons because it increases hospital stay, the cost of care, and postoperative morbidity in patients who have undergone extensive gynecological oncological surgery. Although several interventions have been proposed and investigated, no effective treatment for the prevention and management of POI has been established. The present review summarizes the current evidence on non-pharmacological interventions, including coffee consumption and chewing gum, used to prevent and treat POI. We obtained studies from MEDLINE, Cochrane Database of Systematic Reviews, ISI Web of Science, and SCOPUS databases.

Effects of acupressure, gum chewing and coffee consumption on the gastrointestinal system after caesarean section under spinal anaesthesia.

This study evaluated the efficacy and safety of postoperative acupressure in the recovery of the gastrointestinal system (GIS) after caesarean section. A total of 160 primipara pregnant women delivered by caesarean section under spinal anaesthesia were randomised into four groups: group 1 (those who received acupressure), group 2 (coffee was provided three times a day), group 3 (chewed sugar-free gum for 15 min with an interval of 4 h from the second postoperative hour), and group 4 (control group). The first gas outflow and defaecation times of the women were compared among the groups. The first flatus and defaecation exit times of the women in the acupressure group were statistically earlier than those of the other groups. No difference was found among the gum-chewing, coffee, and control groups. Acupressure is effective in reducing the flatus and defaecation exit times due to GIS inactivity after abdominal surgery including caesarean section.Impact statementWhat is already known about the topic. The slowing of gastrointestinal system (GIS) motility also occurs after caesarean section aside from other surgical operations. If normal GIS movements do not occur, then several problems, such as the negative increase in the duration of breastfeeding and the mother-baby attachment during the postpartum period, may arise. Therefore, the early onset of bowel functions is important in women who give birth by caesarean section.What do the results of this study add. In the postoperative period, spontaneous GIS motility can be achieved by applying acupressure. The effective use of acupressure in the postoperative period prevents the need for pharmacological methods to eliminate the discomfort caused by the decreased motility of the GIS in women in the postpartum period.What are the implications of these findings for clinical practice and further research. Acupressure, a non-invasive, easy-to-use, and cost-effective method, plays a role in preventing GIS immotility. Midwives or obstetricians should receive training on acupuncture or acupressure and should ensure that acupuncture or acupressure practices are converted into a protocol to be implemented in the postoperative period. With this transformation, the treatment methods to increase GIS motility and the reduced medication use can decrease the mother's and the newborn's duration of hospital stay and the cost of hospitalisation.

A full factorial experimental design to study the effect of flavoring agents on the mechanical properties of curcumin chewing gum tablets with high solids content.

Objective: Developing chewing gum tablets (CGTs) with high drug loads is a challenge due to the loss of mastication properties. We postulated that poor mastication properties of such gums could be improved by adjusting the concentration of liquid flavors to serve as plasticizers and consequently increase the flexibility of the elastomer in the gum base. To test this hypothesis, the objective of this work was to evaluate the effects of flavor type and concentration, and storage conditions on the textural properties of CGTs loaded with 20% curcumin (CUR) by weight.Methods: CGTs were made by directly compressing Health in Gum® base with CUR. The resultant CGTs were characterized by single and two bites textural tests to measure their yield strength, post-bite failure rate, and compressibility.Results: Flavor concentration (X2) had a significant impact on the masticatory properties of the chewing gums, which could be ascribed to the plasticizing effect of peppermint oil. Addition of liquid flavors and storage at low temperature (X4) produced CGTs with the desirable properties of low yield strength (Y1) and post-bite structural failure rate (Y2), and high compressibility (Y3). The effect of flavors however was negated at high temperatures, especially when flavored gums were stored for extended time at 50 °C. Flavor type (X1) on the other hand had no effect on the masticatory properties of the chewing gums.Conclusions: This study concluded that it is feasible to formulate CGTs with high solids content without negatively impacting their mechanical properties by controlling the concentration of liquid flavors.

Systematic review of natural and miscellaneous agents, for the management of oral mucositis in cancer patients and clinical practice guidelines - part 2: honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents.

OBJECTIVE: To update the clinical practice guidelines for the management of oral mucositis (OM) that were developed by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). This part focuses on honey, herbal compounds, saliva stimulants, probiotics, and miscellaneous agents. METHODS: A systematic review was conducted by the Mucositis Study Group of MASCC/ISOO. The body of evidence for each intervention, in each clinical setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, one of the following guidelines were determined: Recommendation, Suggestion, No Guideline Possible. RESULTS: A total of 78 papers were identified within the scope of this section, of which 49 were included in this review and merged with nine publications that were reported in the previous guidelines update. A new Suggestion was made for honey (combined topical and systemic delivery) for the prevention of OM in head and neck cancer patients receiving radiotherapy with or without chemotherapy. A new Suggestion clarified that chewing gum is not effective for the prevention of OM in pediatric patients with hematological or solid cancer treated with chemotherapy. No guideline was possible for other interventions. CONCLUSIONS: Numerous natural products and herbal remedies were studied for the management of OM. Of the agents reviewed in this systematic review, a guideline in favor was made for honey (combined topical and systemic), while a guideline against was made for chewing gum. Additional research is warranted to clarify the potential of other interventions.

Interventions for managing halitosis.

BACKGROUND: Halitosis or bad breath is a symptom in which a noticeably unpleasant breath odour is present due to an underlying oral or systemic disease. 50% to 60% of the world population has experienced this problem which can lead to social stigma and loss of self-confidence. Multiple interventions have been tried to control halitosis ranging from mouthwashes and toothpastes to lasers. This new Cochrane Review incorporates Cochrane Reviews previously published on tongue scraping and mouthrinses for halitosis. OBJECTIVES: The objectives of this review were to assess the effects of various interventions used to control halitosis due to oral diseases only. We excluded studies including patients with halitosis secondary to systemic disease and halitosis-masking interventions. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 April 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3) in the Cochrane Library (searched 8 April 2019), MEDLINE Ovid (1946 to 8 April 2019), and Embase Ovid (1980 to 8 April 2019). We also searched LILACS BIREME (1982 to 19 April 2019), the National Database of Indian Medical Journals (1985 to 19 April 2019), OpenGrey (1992 to 19 April 2019), and CINAHL EBSCO (1937 to 19 April 2019). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (8 April 2019), the World Health Organization International Clinical Trials Registry Platform (8 April 2019), the ISRCTN Registry (19 April 2019), the Clinical Trials Registry - India (19 April 2019), were searched for ongoing trials. We also searched the cross-references of included studies and systematic reviews published on the topic. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) which involved adults over the age of 16, and any intervention for managing halitosis compared to another or placebo, or no intervention. The active interventions or controls were administered over a minimum of one week and with no upper time limit. We excluded quasi-randomised trials, trials comparing the results for less than one week follow-up, and studies including advanced periodontitis. DATA COLLECTION AND ANALYSIS: Two pairs of review authors independently selected trials, extracted data, and assessed risk of bias. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 44 trials in the review with 1809 participants comparing an intervention with a placebo or a control. The age of participants ranged from 17 to 77 years. Most of the trials reported on short-term follow-up (ranging from one week to four weeks). Only one trial reported long-term follow-up (three months). Three studies were at low overall risk of bias, 16 at high overall risk of bias, and the remaining 25 at unclear overall risk of bias. We compared different types of interventions which were categorised as mechanical debridement, chewing gums, systemic deodorising agents, topical agents, toothpastes, mouthrinse/mouthwash, tablets, and combination methods. Mechanical debridement: for mechanical tongue cleaning versus no tongue cleaning, the evidence was very uncertain for the outcome dentist-reported organoleptic test (OLT) scores (MD -0.20, 95% CI -0.34 to -0.07; 2 trials, 46 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Chewing gums: for 0.6% eucalyptus chewing gum versus placebo chewing gum, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.10, 95% CI -0.31 to 0.11; 1 trial, 65 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Systemic deodorising agents: for 1000 mg champignon versus placebo, the evidence was very uncertain for the outcome patient-reported visual analogue scale (VAS) scores (MD -1.07, 95% CI -14.51 to 12.37; 1 trial, 40 participants; very low-certainty evidence). No data were reported for dentist-reported OLT score or adverse events. Topical agents: for hinokitiol gel versus placebo gel, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.27, 95% CI -1.26 to 0.72; 1 trial, 18 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Toothpastes: for 0.3% triclosan toothpaste versus control toothpaste, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -3.48, 95% CI -3.77 to -3.19; 1 trial, 81 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Mouthrinse/mouthwash: for mouthwash containing chlorhexidine and zinc acetate versus placebo mouthwash, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.20, 95% CI -0.58 to 0.18; 1 trial, 44 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Tablets: no data were reported on key outcomes for this comparison. Combination methods: for brushing plus cetylpyridium mouthwash versus brushing, the evidence was uncertain for the outcome dentist-reported OLT scores (MD -0.48, 95% CI -0.72 to -0.24; 1 trial, 70 participants; low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. AUTHORS' CONCLUSIONS: We found low- to very low-certainty evidence to support the effectiveness of interventions for managing halitosis compared to placebo or control for the OLT and patient-reported outcomes tested. We were unable to draw any conclusions regarding the superiority of any intervention or concentration. Well-planned RCTs need to be conducted by standardising the interventions and concentrations.

Investigating release kinetics of phenolics from defatted wheat germ incorporated chewing gums.

BACKGROUND: Wheat germ (WG) is a valuable by-product of the commercial milling industry and is used as a functional ingredient in various foods. Therefore, in this study, it is aimed to utilize defatted wheat germ (DWG) (1%, 3%, 5%, 10%) in chewing gum formulation, which is a different food matrix besides the conventional structures, and investigate the release kinetics of phenolics from DWG incorporated chewing gums with a new centrifugation method. RESULTS: According to the results, it was observed that DWG was a good source of total phenolics (2254.15 mg GAE kg-1 ). Based on the results obtained from texture profile and sensory analyses, DWG addition did not cause any reverse effect on the chewing gum texture. Centrifugation method was used to indirectly simulate the physical effects of the chewing process. In particular, after 5 min of chewing and centrifugation, phenolic release levels were 59.07% and 59.41%, respectively. The model used in the previous studies showed a better correlation than Korsmeyer-Peppas model for ABTS (2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulphonic acid), CUPRAC (cupric ion reducing antioxidant capacity), and DPPH (2,2-diphenyl-1-picrylhydrazyl) assay results. CONCLUSION: The results showed that phenolics release from gum base polymer matrix might be dominated by erosion of matrix due to chewing action. Similar phenolic release kinetics were obtained by centrifugation and chewing methods. Therefore, centrifuge equipment can be used to simulate the chewing forces acting on the gum when optimization is performed. © 2019 Society of Chemical Industry.

Whitening Efficacy of Chewing Gum Containing Sodium Metaphosphate on Coffee Stain: Placebo-controlled, Double-blind In Situ Examination.

This study aimed to evaluate the ability of chewing gum containing sodium metaphosphate (SMP) to remove coffee stains from enamel in situ. This was a double-blind (subjects, evaluators), parallel-group, crossover, randomized clinical trial with 30 healthy adult volunteers. Each participant held an appliance with a hydroxyapatite (HA) pellet on the lower lingual side of his or her mouth for two hours to allow pellicle formation. The appliances were subsequently immersed in coffee solution at 37°C for 48 hours. The color of the HA pellet before and after coffee immersion was measured using a spectrophotometer. The participant set the appliance and chewed two pieces of test gum, which contained 7.5 mg of SMP per piece, or control gum without SMP. Each cycle included five minutes of exposure to chewing gum, after which the appliances were placed in 100% relative humidity at room temperature for a 30-minute incubation. This cycle was repeated five times for each gum type. The color of the HA pellet was measured after each chewing cycle using the spectrophotometer. In addition, ΔE* values, which indicate the change in pellet color after each chewing cycle compared with after coffee immersion, were calculated. Data were analyzed using the paired t-test with Bonferroni adjustment to compare ΔE* values of control and test gum after each chewing cycle. The ΔE* values of test gum were significantly higher than those of control gum after all chewing cycles, excluding the first cycle (p<0.05). This finding indicates that test gum containing SMP was more effective at removing coffee stains from the HA pellet than control gum. We conclude that chewing gum containing SMP can effectively remove coffee stains from HA pellets. Thus, SMP is a promising agent to be further explored in tooth-cleaning studies.