Data sources The following electronic databases were searched: MEDLINE, EMBASE, PsycoINFO, Scopis, WoS, AMED, CENTRAL Open alongside the Open Grey database and Cochrane Library of systematic reviews. In addition, reference lists of included studies and systematic reviews were searched.
Study selection Initial screening was undertaken by two independent reviewers against the PICO and inclusion/exclusion criteria. Discrepancies between reviewers were resolved by a third reviewer.
Data extraction and synthesis Data was extracted from included studies using a standardised form. Three summary measures were calculated: prevented fraction (PF); standardised mean difference (SMD); and standardised effect size (ES). Where concerns about incomplete data were encountered, authors were contacted to provide clarification; if data was not able to be completed, the study was excluded.
Results Following screening, 38 selected manuscripts explored the impact of sugar-free gum (SFG) across all aspects of oral health. From this, data was extracted from 12 studies with dental caries outcomes included; of these, eight explored xylitol gum as the intervention and were analysed separately. A significant reduction in caries incidence was found with the use of SFGs - PF of 28% (95%CI 7%-48%). In the eight trials that used xylitol-only gum as the basis of the intervention, the PF increased to 33% (95% CI 4%-61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included.
Conclusions The use of SFG was shown to have a significant, but tentative, effect in reducing the incidence of caries, compared to those who do not or use other sugar-free alternatives. The authors comment that a considerable degree of variability was noted between the trials reviewed. Further research is required in this field to provide robust empirical evidence.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 4 print issues and online access
$259.00 per year
only $64.75 per issue
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
Van Loveren C. Sugar alcohols: what is the evidence for caries-preventive and cariestherapeutic effects? Caries Res 2004; 38: 286-293.
Wessel SW, van der Mei H C, Maitra A, Dodds M W, Busscher H J. Potential benefits of chewing gum for the delivery of oral therapeutics and its possible role in oral healthcare. Expert Opin Drug Deliv 2016; 13: 1421-1431.
Claxton L, Taylor M, Kay E. Oral health promotion: the economic benefits to the NHS of increased use of sugarfree gum in the UK. Br Dent J 2016; 220: 121-127.
Alanen P, Isokangas P, Gutmann K. Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol 2000; 28: 218-224.
Szoke J, Banoczy J, Proskin H M. Effect of after-meal sucrose-free gum-chewing on clinical caries. J Dent Res 2001; 80: 1725-1729.
Machiulskiene V, Nyvad B, Baelum V. Caries preventive effect of sugar-substituted chewing gum. Community Dent Oral Epidemiol 2001; 29: 278-288.
Peng B, Petersen P E, Bian Z, Tai B, Jiang H. Can school-based oral health education and a sugar-free chewing gum programme improve oral health? Results from a two-year study in PR China. Acta Odontol Scand 2004; 62: 328-332.
About this article
Cite this article
Parker-Groves, D. Should dentists recommend sugar-free chewing gum to help prevent decay?. Evid Based Dent 21, 88 (2020). https://doi.org/10.1038/s41432-020-0110-x