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

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Abstract

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.

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Acknowledgements

The authors would like to thank GODeC Initiative (Global Observatory for Dental Care - https://wp.ufpel.edu.br/godec/en/home/) as this systematic review was conducted to answer a clinical question for a clinical practice guideline developed by GODeC and Brazilian Ministry of Health. FWMGM and AFM are members of the GODeC Initiavtive.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES). The authors self-funded the other part of the study. 

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Authors and Affiliations

  1. Graduate Program in Dentistry, Department of Periodontology, School of Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, Pelotas, RS, 457, Brazil

    Francisco Wilker Mustafa Gomes Muniz

  2. Post-graduate program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil

    Fabricio Batistin Zanatta

  3. Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil

    Mariana da Silva Muñoz & Francisco Hecktheuer Silva

  4. Graduate Program in Dentistry, University of Guarulhos, Guarulhos, Brazil

    Lilia Maia Aguiar

  5. Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil

    Anelise Fernandes Montagner

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  1. Francisco Wilker Mustafa Gomes Muniz
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Muniz, F.W.M.G., Zanatta, F.B., Muñoz, M.d. et al. Antiplaque and antigingivitis efficacy of medicated and non-medicated sugar-free chewing gum as adjuncts to toothbrushing: systematic review and network meta-analysis. Clin Oral Invest 26, 1155–1172 (2022). https://doi.org/10.1007/s00784-021-04264-1

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