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Title High Consumption of "Sugar Free" Chewing Gums Containing Sorbitol May Present A Small Cariogenic Risk, While Xylitol Gums Are Non-Cariogenic
Clinical Question In a healthy individual with a low to moderate caries risk, does the chewing of “sugar free” gums raise the risk of dental caries, as compared to no gum chewing?
Clinical Bottom Line Xylitol-sweetened gums have proven to be non-cariogenic and can be safely recommended to patients to prevent dental decay. Sorbitol-containing gums had low cariogenicity when chewed less than three times per day, but high or frequent sorbitol use may present a small cariogenic risk, especially to patients with low salivary flow rates.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19047666Deshpande/200814 study populations using xylitol, xylitol-sorbitol, and sorbitol gumsSystematic Review
Key resultsWhere PF represents the proportional reduction in dental caries between the experimental and the control groups, xylitol gum had a mean PF of 58.55%; xylitol-sorbitol blended gum had a mean PF of 52.82%; sorbitol gum had a mean PF of 20.01%; sorbitol mannitol blended gum had a mean PF of 10.71%, which was not clinically significant.
#2) 16521385Burt/2006Review of randomized field trials and observational studiesSystematic Review
Key resultsWhile xylitol is found to be non-cariogenic, sorbitol is considered a low-cariogenic sugar substitute. Chewing more than two sticks of sorbitol gum per day increases acid production, and bacteria can adapt to metabolize sorbitol when their sugar supply is limited. More trials are needed specific to the cariogenicity of sorbitol.
Evidence Search "Sorbitol"[Mesh] AND "Xylitol"[Mesh] AND "Dental Caries"[Mesh] AND "Chewing gum"[Mesh]
Comments on
The Evidence
Deshpande (2008) is a systematic review of 19 articles containing 14 different study populations meeting stringent selection criteria. They calculated a 95% confidence interval for the PF of each study using the formula PF= (XC − XE )/XC where XC is the mean increment in the control group and XE is the mean increment in the group with the polyol-containing chewing gum. Burt (2006) is a review of clinical trials and observational studies that examine carious outcomes related to gum-chewing. Although it meets our criteria for systematic review, it must be considered weaker evidence than Deshpande because its methods were so minimally described.
Applicability Due to the popularity of chewing gums among the general population, these results are particularly applicable in a general practice setting in educating patients on the benefits of choosing "sugar free" gums.
Specialty/Discipline (Public Health) (General Dentistry) (Restorative Dentistry) (Dental Hygiene)
Keywords Sorbitol, xylitol, chewing gum, dental caries
ID# 2275
Date of submission: 04/13/2012spacer
E-mail Boothe@livemail.uthscsa.edu
Author Matthew Boothe
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments and Evidence-Based Updates on the CAT
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by Aamna Zaidi and Gina Khong (San Antonio, Texas) on 11/28/2017
The PubMed database was searched for the above terms on 11/27/17. A study by Runnel in 2013 (PMID #24095985) was an RCT that found that the use of erythritol-containing candies was associated with reduced plaque growth and Strep mutans growth as compared to that of children who were given sorbitol and xylitol-containing candies. A second study by Soderling in 2015 (PMID #24663814) was also an RCT and showed that the short-term use of xylitol did reduce the Strep mutans counts but did not change the salivary microbial composition. These studies indicate that it might be beneficial to review other possibilities besides xylitol for reducing dental decay.

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