Francisco Wilker Mustafa Gomes Muniz1, Fabricio Batistin Zanatta2, Mariana da Silva Muñoz3, Lilia Maia Aguiar4, Francisco Hecktheuer Silva3, Anelise Fernandes Montagner3. 1. Graduate Program in Dentistry, Department of Periodontology, School of Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, Pelotas, RS, 457, Brazil. wilkermustafa@gmail.com. 2. Post-graduate program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil. 3. Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil. 4. Graduate Program in Dentistry, University of Guarulhos, Guarulhos, Brazil.
Abstract
OBJECTIVE: This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing. MATERIAL AND METHODS: PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes. RESULTS: Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p > 0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes. CONCLUSION: SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence. CLINICAL RELEVANCE: There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis.
OBJECTIVE: This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing. MATERIAL AND METHODS: PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes. RESULTS: Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p > 0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes. CONCLUSION: SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence. CLINICAL RELEVANCE: There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis.
Authors: Maria Clotilde Carra; Laurent Detzen; Julia Kitzmann; Johan P Woelber; Christoph A Ramseier; Philippe Bouchard Journal: J Clin Periodontol Date: 2020-07 Impact factor: 8.728