Effectiveness Of Chewing Gum In Dental Hygiene: A Systematic Review Of Clinical Trials

Abstract

Background: Oral diseases remain a major global public health concern, disproportionately affecting vulnerable populations. While toothbrushing and flossing are recognized as foundational practices for maintaining oral hygiene, compliance is often limited by behavioral, physical, and socioeconomic factors. Consequently, there is growing interest in adjunctive approaches such as therapeutic chewing gums to enhance oral health outcomes.

Objective: This systematic review evaluates the clinical effectiveness of chewing gum, particularly formulations containing xylitol, fluoride, or other functional agents, in reducing dental plaque, preventing caries, modulating oral microbiota, stimulating salivary flow, and improving oral pH buffering.

Methods: Following PRISMA 2020 guidelines, a comprehensive literature search was conducted across PubMed, Scopus, and Web of Science for studies published between January 2000 and December 2024. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and quasi-experimental studies involving chewing gum as an intervention were included. Data extraction and risk of bias assessment were independently performed by two reviewers. Outcomes analyzed included plaque index scores, caries incidence, microbial changes, salivary flow rate, and secondary benefits such as xerostomia relief.

Results: Thirty clinical trials met the inclusion criteria. Xylitol gum demonstrated the most consistent benefits, showing significant reductions in Streptococcus mutans levels, plaque indices (up to 38%), and caries incidence (up to 70%). Fluoride gums primarily contributed to enamel remineralization, while sorbitol and placebo gums exhibited limited antimicrobial effects. Chewing gum was also associated with increased salivary flow (up to 1.8 mL/min) and improved oral pH buffering. Secondary outcomes included subjective improvements in breath freshness and dry mouth symptoms.

Conclusion: Chewing gum, particularly xylitol-based formulations, can serve as an effective adjunct to conventional oral hygiene practices. Its benefits are especially relevant in pediatric and high-caries-risk populations. Further large-scale, standardized clinical trials are warranted to strengthen the evidence base and inform public health recommendations.