Recent research has documented the oral health benefits of chewing sugar-free gum. Saliva stimulation generated by chewing sugar-free gum helps in the management of dental caries by neutralizing plaque acids. However, the benefits may also extend beyond caries prevention. When combined with dietary management, improved oral care, and the use of desensitizing agents, the use of sugar-free gum could potentially be a useful adjunct in the prevention of acid erosion, tooth wear and dentine hypersensitivity, which in recent years have become widespread oral health concerns.
Dentine hypersensitivity is defined as “a pain arising from exposed dentine in response to stimuli, typically thermal, evaporative, tactile, osmotic or chemical, which cannot be ascribed to any other form of dental defect or pathology” and satisfies all the criteria to be classified as a true pain symptom.1 Dentine hypersensitivity affects people of all ages around the world, with exact incidence rates varying between different populations and statistical investigation methods. Recently, for example, the results of The Epidemiology Study on Non-Carious Cervical Lesions and Associated Risk Factors (ESCARCEL) highlighted the growing prevalence of dentine hypersensitivity, as well as erosive tooth wear. The ESCARCEL study showed that one-third (29.4%) of young European adults have erosive tooth wear and 41.9% demonstrate dentine hypersensitivity.2
The increasing prevalence of dentine hypersensitivity is thought to be due to the longevity of healthy dentition and more frequent daily dietary acid challenges to the tooth surface. ESCARCEL looked at tooth wear risk factors and found that those with frequent acidic food intake had higher levels of damage.2 Adherence to modern lifestyles including consumption of diets rich in acidic food such as fruits, juices, tea and carbonated drinks is a likely contributor to the prevalence of the condition. Moreover, eating habits are changing from three square meals a day to more frequent snacking, which exposes teeth to sugar and acids more often and increases the risk of decay.
An important part of the clinical management of dentine hypersensitivity is the identification and treatment of the causative factors. By removing the aetiological factors, the condition can be prevented from occurring or recurring. Aetiological factors include incorrect tooth brushing technique, poor oral hygiene, gingival recession and exogenous/endogenous non-bacterial acids.3
Prevention and management interventions of dentine hypersensitivity and erosive tooth wear thus often revolve around dietary counselling, including avoidance of acidic foods and drinks, particularly between meals and last thing at night when salivary flow rate is at its lowest during sleep. Reviewing oral hygiene aids and tooth brushing techniques also address abrasive loss of tooth surface and exposure of dentine or root surfaces. When treatment and pain control is necessary, home desensitizing treatments can be advised along with in-surgery treatments as required.
For all patients, it is essential that any diagnosis of dental erosion be made early, because once dissolution has started, non-carious cervical lesions will continue to progress and worsen.
The role of sugar-free gum
Sugar-free gum can serve as a complement to these interventions. Saliva stimulation from chewing sugar-free gum may help in the management of erosion by increasing the rate of clearance of acidic food or drink from the mouth compared with not chewing sugar-free gum during the initial 15 minutes after eating.4 The chewing of sugar-free gum stimulates saliva production which can last up to 2 hours.5,6 Moreover, it helps remove 95% of food debris and sugar in two minutes.7 The increased levels of bicarbonate and calcium ions in stimulated saliva also aid in a more rapid remineralization of the enamel surface following an acid challenge.8,9 10
By increasing the oral clearance rate of acid substances which may help reduce acid erosion of tooth surfaces, we hypothesise that this could ultimately reduce dentine hypersensitivity that occurs secondary to this phenomenon. Currently only one, uncontrolled, study has shown an effect of gum in mitigating tooth sensitivity11, so further work is required to confirm this effect.
Chewing sugar-free gum is a particularly appealing and effective intervention because patients can use it on the go. Moreover, it exemplifies the minimal intervention and management approaches that will define preventive dental care in the 21st century, which is a win for financial and infrastructural healthcare resource management, and above all, a win for patients’ health.
By Dr. Michael Kelly, Senior Principal Scientist and Regulatory Affairs at Wrigley
