Chewing gum has always been criticized. Since childhood, adult figures have advised us to stop chewing gum to prevent damaging our teeth. However, chewing gum actually has benefits.
The big hero here is sugar-free gum. According to the American Dental Association, the only chewing gum that does no harm to your teeth is sugarless chewing gum. Whereas gum with real sugar can be terrible for dental care, sugar-free gum can actually do the opposite, preventing your teeth from developing cavities.
“First, it has proved possible to replace the ‘sugar’ in chewing gum with sugar substitutes, without diminishing its consumer appeal. Indeed the development of sugar-free gums with optimal taste characteristics has opened up new markets. The second characteristic is that all gums -sugared and unsugared- stimulate the saliva flow about 3–10 times higher than resting values. The stimulation of saliva leads to an increase in potentially protective properties. Both of these characteristics of chewing gum could be responsible for the non-cariogenicity of sugar-free chewing gums. Furthermore, if the gum chewing was to be carried out after meals and if the sugar substituted had beneficial properties, these actions could lead to a therapeutic, caries lowering action, and various other benefits.
The use of sugar-free gum provides a proven anticaries benefit, but other oral health effects are less clearly elucidated. Chewing sugar-free chewing gum promotes a strong flow of stimulated saliva, which helps to provide a number of dental benefits: first, the higher flow rate promotes more rapid oral clearance of sugars; second, the high pH and buffering capacity of the stimulated saliva help to neutralize plaque pH after a sugar challenge; and finally, studies have shown enhanced remineralization of early caries-like lesions and ultimately prospective clinical trials have shown reduced caries incidence in children chewing sugar-free gum.”1
“The oral cavity is home to over 250 microbial species and the dental hard tissue with its pits and fissures, and other inaccessible areas are the safe haven of these microbes. These species colonize the oral cavity in a methodical manner, from adhesion and succession to progression. Once the biofilms are formed, caries develop in those regions where they are allowed to mature and remain undisturbed for prolonged periods of time. Even among a plethora of microorganisms in the oral cavity, acidogenic organisms such as Streptococcus mutans have been found to play a major role in causing dental caries. These acidogenic organisms produce acid during metabolism of dietary carbohydrates. The acids thereby formed can dissolve the tooth mineral through a complex cycle of demineralization and remineralization and eventually take part in causing dental caries.”2
Recently, a sweetener called Xylitol has been found to provide sugar-free gum with a more pleasant flavor, which has helped those who are put off by artificial sweeteners like aspartame.
“Oral health benefits of xylitol
Xylitol decreases the incidence of dental caries by increasing salivary flow and pH and reducing the number of cariogenic (MS) and periodontopathic (Helicobacter pylori) bacteria, plaque levels, xerostomia, gingival inflammation, and erosion of teeth.
Xylitol is well tolerated by the human body as a sweetener, but its absorption rate in the small intestine is very slow. Excess xylitol is known to induce osmotic diarrhea, indicating there is an upper limit to its dosage that can be tolerated. Optimal inhibition of S. mutans growth by xylitol occurs with its total daily consumption of 5–6 g at a frequency of three or more times per day. The plaque samples of habitual xylitol users showed a significant reduction in plaque adhesiveness and insoluble extracellular polysaccharides produced by S. mutans when compared with those who did not consume xylitol at all.
Xylitol chewing gum
The predominant modality for xylitol delivery has been chewing gum. Chewing gum accelerates the processes of rinsing away acid and uptake of beneficial calcium phosphate molecules to remineralize tooth enamel. The recommended length of time for chewing after eating is approximately 20 minutes.”3
Adding Xylitol to chewing gum prevents Streptococcus from growing in your mouth and since these bacteria has been found to contribute to dental deterioration, eliminating its presence also reduces the chances of dental decay. Some research has indicated that it can be good enough to just rinse your mouth with fluoride toothpaste. This is because fluoride plays an active role in the re-mineralization process whereby the enamel is protected.
“The effective implementation of mechanical methods to reduce bacterial plaque and food debris, such as frequent brushing and flossing, are the main preventive defense method against decay, but there is a high degree of failure to carry out oral hygiene. There are multiple causes for this situation, such as educational and socio-economic level, beliefs and attitudes regarding personal and oral care, stressful life events, psychomotricity alteration, frequency of dental visits and age.
Therefore, it is necessary to have complementary preventive methods, which are inexpensive and easy to take on part of patients, to fight tooth decay. In order to do this, current dentistry has added a new alternative to preventive actions: the use of chewing gum. This product is culturally well accepted in various groups of the population and is easily adapted to people’s daily routines. It is a habit practiced regularly by a relatively high proportion of individuals in many countries and its use has increased in the last decade, being the most popular confectionery, selling hundreds of millions of units worldwide annually.
Historically, gum was sweetened with sugar (sucrose) and its use contributed to developing dental caries. But at the beginning of 1950, sugar-free varieties, sweetened with natural non cariogenic sweeteners were introduced into the market. These products have provided benefits for the oral health as they allow controlling plaque and reducing caries incidence. Additionally, gum can be used as a vehicle to provide therapeutic components for the oral cavity, which increases the benefits on oral health. using sugar-free chewing gum for preventing dental caries reported in literature.”4
Another amazing benefit of chewing sugar-free gum is that it increases the production of saliva, which has the capability to wash away pieces of food or bacteria remaining in the mouth after eating. Saliva is believed to neutralize acids and work as a protective element against dental deterioration.
“Saliva has a cleansing effect on the teeth. Normally, 700– 800 ml of saliva is secreted per day. Caries activity increases as the viscosity of the saliva increases. Eating fibrous food and chewing vigorously increases salivation, which helps in digestion as well as improves cleansing of the teeth. The quantity as well as composition, pH, viscosity and buffering capacity of the saliva plays a role in dental caries.
- Quantity: Reduced salivary secretion as found in xerostomia and salivary gland aplasia gives rise to increased caries activity.
- Composition: Inorganic—fluoride, chloride, sodium, magnesium, potassium, iron, calcium and phosphorus are inversely related to caries. Organic—ammonia retards plaque formation and neutralizes the acid.
- pH: A neutral or alkaline pH can neutralize acids formed by the action of microorganisms on carbohydrate food substances.
- Antibacterial factors: Saliva contains enzymes such as lactoperoxidase, lypozyme, lactoferrin and immunoglobulin (Ig)A, which can inhibit plaque bacteria.”5
Last but not least, sugar-free gum discourages plaque formation. However, it is important to be sure that the American Dental Association has approved the gum you choose, because some options contain other substances like sorbitol, a sugar substitute that does not provide the same protective effect on teeth compared to Xylitol.
“The effect of sugar substitutes on changes in caries rates has been evaluated in several observational studies as well as clinical trials, with results consistently demonstrating a protective effect of xylitol on caries incidence. Sorbitol also was shown to decrease caries rates compared to controls; however, the reductions in caries rates were greatest when xylitol was the sugar substitute. Some limitations of previous studies include the lack of radiographs in caries diagnosis, high loss to follow-up, and potential confounding and bias due to the nature of long-term community intervention studies.”6
“Consequently, xylitol use actually prevents cavities, while other sugars promote cavities. Xylitol is also much sweeter than sorbitol. Although xylitol is tolerated well even in large servings, very sensitive individuals may need to adapt to higher intakes. An adaptive increase in the activity levels of an enzyme (a polyol dehydrogenase) greatly increases the rate of xylitol absorption in a few days. This is not the case with sorbitol. Xylitol is slowly absorbed and metabolized, resulting in negligent changes in insulin. It also has 40% fewer calories than ordinary sugar. Xylitol dissolves quickly and produces a cooling sensation in the mouth. It is a true sugar replacement, having the physiologic advantage of a pleasant taste and sweetness equal to sugar with no aftertaste. It can easily be used to replace sucrose (table sugar) in the diet.”7
You should chew the gum for about 20 to 30 minutes after eating to take advantage of its benefits. Keep in mind that continuous chewing for long periods can strain the jaw and neck muscles, causing pain and discomfort.
We have nothing to lose by chewing sugar-free gum, the disadvantages are quite minimal. Caution should be taken with smaller children as there is a risk of them swallowing it. According to research, gum does in fact help prevent cavities. With this said, it is important to highlight that continuous brushing and flossing of teeth are the best way to maintain a good dental hygiene.
(1) Aravinth, H., Ganapathy, D., & Jain, A. R. (2018). Role of chewing gum in oral hygiene maintenance. Drug Invention Today, 10. Available online at https://www.researchgate.net/publication/330353649_Role_of_chewing_gum_in_oral_hygiene_maintenance
(2) Kaur, K., Nekkanti, S., Madiyal, M., & Choudhary, P. (2018). Effect of chewing gums containing probiotics and xylitol on oral health in children: A randomized controlled trial. Journal of International Oral Health, 10(5), 237. Available online at http://www.jioh.org/article.asp?issn=0976-7428;year=2018;volume=10;issue=5;spage=237;epage=243;aulast=Kaur
(3) Nayak, P. A., Nayak, U. A., & Khandelwal, V. (2014). The effect of xylitol on dental caries and oral flora. Clinical, cosmetic and investigational dentistry, 6, 89. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232036/
(4) Matthews, F. (2015). Use of sugar-free gum as complement in the prevention of dental caries. Narrative review. Journal of Oral Research, 4(2), 129-136. Available online at https://pdfs.semanticscholar.org/c07d/844aaa9c3bdc4c8be1cdf7694bc83fa6b551.pdf
(5) http://screening.iarc.fr/doc/Commision_on_Macroeconomic_and_Health_Bg_P2_Oral_and_dental_diseases.pdf Available online at http://screening.iarc.fr/doc/Commision_on_Macroeconomic_and_Health_Bg_P2_Oral_and_dental_diseases.pdf
(6) Hayes, C. (2001). The effect of non-cariogenic sweeteners on the prevention of dental caries: a review of the evidence. Journal of dental education, 65(10), 1106-1109. Available online at https://www.essentialnutrition.com.br/media/artigos/xylitol/Artigo-4.pdf
(7) Pierini, C., & CNC, C. (2001). Xylitol: A sweet alternative. History, 5, 6. Available online at https://www.iprogressivemed.com/misc/xylitol_a_sweet_alternative.pdf