The effect of medicated, sugar-free chewing gum on plaque and clinical parameters of gingival inflammation: a systematic review.

Objective This study aimed to systematically review the present literature to establish the clinical effect of medicated, sugar-free chewing gum on plaque indices and parameters of gingival inflammation. Materials and methods MEDLINE-PubMed, Cochrane CENTRAL and EMBASE databases were searched up to April 2012 to identify appropriate studies. Included studies used an intervention of medicated, sugar-free chewing gum containing antimicrobial agents or herbal extracts compared with a control gum. Plaque and gingivitis scores were selected as outcome variables. Results Independent screening of 594 unique titles and abstracts identified 10 non-brushing and four brushing studies that met the eligibility criteria. Means and standard deviations were extracted. A sufficient number of studies evaluated chlorhexidine gum to perform a meta-analysis. Although this review provides evidence for the comparative effectiveness of chewing gums containing various ingredients, the results must be weighed carefully against the methods that were used to assess their outcomes. Conclusion Most of the chewing gums with antimicrobial agents or herbal extracts were shown to have a positive effect with respect to plaque and gingivitis scores. The most compelling evidence was provided for chewing gum containing chlorhexidine. Meta-analysis and individual results indicate a beneficial effect of chlorhexidine on plaque inhibition. However, GRADE evidence profile shows that the recommendation to use CHX-gum to reduce plaque scores in the absence of brushing is considered to be ‘weak’. Other ingredients with positive outcomes on plaque scores are eucalyptus, acacia, funoran, Pycnogenol and mastic. Limited data with respect to gingivitis scores were available, and the following agents showed a positive effect: magnolia, eucalyptus and CHX.