Did you know that chewing gums can promote dental health?
Chewing gum has been a part of human culture since ancient times, evolving from natural substances to the wide variety of flavors and types available today. While often considered a means for freshening breath or as a distraction from hunger or boredom, chewing gum also holds potential benefits for dental health. This blog post delves into the relationship between chewing gums, specifically sugar-free varieties, and their impact on dental health.The Historical Context of Chewing Gum
The tradition of chewing gum dates back thousands of years (1), with evidence at an archeological site in
Sweden, where lumps of birch bark tar with tooth impressions of children and adolescents, dating back 9,000 years, have been found . This suggests that early forms were derived from birch bark tar and other natural substances. The ancient
Greeks seemed to have chewed on a similar substance, known as mastic, from which the word “mastication” likely derives.
Native American Indians and Inuit chewed gum from spruce trees, a custom adopted by the
Europeans who settled in New England. In
India, the precursor for chewing gums was betel nuts; while in
China it was ginseng, and
early settlers in USA preferred tobacco leaves. These ancient practices laid the groundwork for the modern chewing gum industry, which now offers products ranging from sugar-laden options to those sweetened with non-cariogenic polyols like xylitol.
Chewing gums can be divided into three types (2):
- Sugar containing chewing gums
- Sugar free chewing gums
- Functional chewing gums
Let us delve deeper into each of these and see which one has what effects on the oral health.
Monosaccharides and disaccharides are used in sugar-containing chewing gum. These fermentable carbohydrates can be metabolized by oral bacteria. The bacteria (particularly
S. mutans and
Lactobacillus spp.) in turn produce dental biofilm and acid, which can lead to
enamel demineralization and caries. (3). Hence, sugar containing gums are best avoided for oral health enhancement. The potential cariogenicity of sugar-containing gum depends on the physical consistency, oral retention time of the gum, the frequency with which it is chewed, and the sequence of consumption (for instance, chewing sugar-containing gum before eating foods that reduce acid production will be less cariogenic than the reverse)
As defined by the Food and Drug Administration (FDA), a food substance can be labeled as “sugar-free” if it contains less than 0.5 g of sugars per serving. (4) In place of sugar, these gums use high-intensity sweeteners such as
- aspartame
- acesulfame-K
- neotame
- saccharin
- sucralose or
- stevia. (5)
They also may be sweetened with sugar alcohols such as
- erythritol,
- isomalt,
- maltitol
- mannitol
- sorbitol, or
- xylitol. (5)
One of the primary ways in which sugar-free chewing gum promotes oral health is through the stimulation of saliva production. Chewing triggers mechanical action and taste receptors in the mouth, leading to increased salivary flow. Simply chewing unsweetened, unflavored chewing gum base
stimulates the salivary flow rate by 10-12 times that of the unstimulated rate. Saliva plays a crucial role in diluting and neutralizing acids produced by plaque bacteria on teeth surfaces. These acids can lead to enamel erosion and cavities over time. Furthermore, saliva contains calcium and phosphate ions that contribute to the remineralization process of tooth enamel. Clinical trials have found decreased caries incidence in subjects who chewed sugar-free gum for 20 minutes after meals. (6)
Sugar-free gums are often sweetened with polyols such as xylitol, sorbitol, mannitol, or maltitol. Unlike sugars that can be fermented by oral bacteria into acids, these sweeteners do not serve as a food source for bacteria and are therefore considered noncariogenic.
Xylitol, in particular, has been shown in clinical studies to significantly reduce Streptococcus mutans load in the mouth—a key contributor to dental caries. (6)
In addition to traditional benefits associated with dental health, certain "functional" chewing gums are designed with added health benefits. Functional chewing gum is the term given to chewing gum said to have function instead of or in addition to that of traditional chewing gum.
Nicotine-containing gums are among are first-line pharmacologic therapies to assist with smoking cessation programs. (7)
- Aspirin-containing gum have been sold as an over-the-counter (OTC) product for pain relief
- Caffeine-containing gums available OTC that claim to boost energy and athletic performance. (8)
For addressing xerostomia induced by medications or nonsurgical cancer therapies, systematic reviews (9) include both sugar-free lozenges or chewing gum among the recommended interventions.
Oral mucositis is characterized by ulcerative and erosive lesions that occur in the oral mucosa after radiotherapy or high-dose chemotherapy. Chewing gums may help in these conditions since it increases salivary production; however it is not found to be very effective for prevention of oral mucositis in pediatric cancer patients.
Functional gums post abdominal surgeries
A number of systematic reviews published in recent years have indicated that chewing gum may positively affect postoperative ileus, enhancing surgical recovery following various types of surgical interventions (e.g., colorectal, gastrointestinal, gynecologic, and urological) (10-12)
Chewing sugar-free gum represents an easy yet effective adjunct to daily oral hygiene practices aimed at maintaining dental health. By stimulating saliva production, it helps neutralize harmful acids and provides minerals necessary for remineralizing tooth enamel. When used alongside regular brushing and flossing routines, sugar-free gum stands out as more than just a breath freshener—it's an ally in promoting overall oral health, especially when used as functional chewing gums
