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Short-term germ-killing effect of sugar-sweetened cinnamon chewing gum on salivary anaerobes associated with halitosis
Abstract
The present study investigated the short-term germ-killing effect of sugar-sweetened cinnamon chewing gum on total and H2S-producing salivary anaerobes.
Fifteen healthy adult subjects were recruited in the double-blind, crossover clinical study. The three test chewing gums included: 1) sugared chewing gum containing cinnamic aldehyde and natural flavors (CinA+); 2) sugared chewing gum without cinnamic aldehyde but with natural flavors (CinA-); and 3) non-sugared chewing gum base (GB) without any flavors and without cinnamic aldehyde. A three-day "washout" period followed each treatment. Each subject chewed gum under supervision for 20 minutes at 60 chews/minute. Unstimulated whole saliva samples were collected before the subjects chewed the gum and at 20 minutes after expectoration of the gum. All saliva samples were serially diluted, plated on blood agar or agar plates that select for bacteria producing H2S, incubated anaerobically for three days, and enumerated for viable colony counts of total and H2S-producing salivary anaerobes.
Significant reductions in total salivary anaerobes (p < 0.01) and H2S-producing salivary anaerobes (p < 0.01) were observed 20 minutes after subjects chewed the CinA+ gum. The chewing of CinA- gum also significantly reduced total salivary anaerobes (p < 0.05) and H2S-producing salivary anaerobes (p < 0.05). However, no statistically significant difference in germ-killing effect was detected between the CinA+ and CinA- gums, although there was a numeric difference. The chewing of a gum base (GB) alone did not result in a significant reduction in the total or H2S-producing salivary anaerobes (p > 0.05).
The commercially available sugar-sweetened cinnamon chewing gum may benefit halitosis by reducing volatile sulfur compounds producing anaerobes in the oral cavity.
... Furthermore, Cinnamon exhibits fungicidal properties against both Candida glabatra and Candida tropicalis [98]. Cinnamon-containing chewing gum with cinnamon can reduce the concentration of volatile sulfur compounds in the mouth, which can aid in the treatment of halitosis cases [136]. An in vitro study for evaluating the antibacterial efficacy of Neem extract, Cinnamon extract in comparison to NaOCl as an irrigant against E. faecalis indicated that Cinnamon extract had the greatest reduction in colony-forming units (CFU) colonies. ...
... -endodontic irrigate solution. [98,136,317] 14 ...
Since the human population realized how important it was to maintain overall health and the weight of disease, they have been looking for therapeutic qualities in natural environments. The use of plants having medicinal qualities for the treatment and prevention of illnesses that may have an impact on general health is known as herbal medicine. There has been a noticeable increase in interest lately in the combination of synthetic contemporary medications and traditional herbal remedies. About 80% of people rely on it for healthcare, particularly in developing nations. One important aspect of overall health is said to be oral healthcare. The World Health Organization views oral health as a crucial component of overall health and well-being. Because they are more readily available, less expensive, and have fewer adverse effects than pharmaceutical treatments, using natural medicines to treat pathologic oro-dental disorders can make sense. The current evaluation of the literature sought to investigate the range and scope of the use of herbal products and their secondary metabolites in maintaining oral health, encompassing several oral healthcare domains such as halitosis, gingivitis, periodontitis, and other oral disorders. Therefore, there are many herbs discussed in this work and their mechanism in the treatment and improvement of many oral ailments. Besides, compounds that are useful in oral treatment with their natural sources and the cases where they can be used. To prevent any possible side effects or drug interactions, a doctor's consultation is necessary before using dental medicine. Although herbal therapy is safe and with minimum side effects, it is also strongly advised to do a more thorough preclinical and clinical evaluation before using herbal medicines officially.
... Abrasive microcapsules are an effective means of controlling halitosis II Shin et al. [36] 15 Bovine lactoferrin and lactoperoxidase Tablets Significantly greater number of patients with acceptable CH 3 SH scores when compared to control group II Zhu et al. [37] 15 Cinnamic aldehyde Sugared chewing gum Significant reductions in salivary anerobes III Iwamoto et al. [38] 20 Lactobacillus Salivarius with xylitol Tablet Significant reduction in oral hygiene parameters III Greenstein et al. [39] 123 ...
... [34] Zhu et al. showed that salivary anaerobes were significantly lower in subjects who chewed gum that contained cinnamic aldehyde. [37] While Iwamoto et al. showed a significant reduction in halitosis parameters in those subjects using lactobacillus salivarius with xylitol tablets [38] for 2 weeks. Greenstein et al. showed that oxidizing lozenges showed a significant reduction in malodor [39] of the dorsal surface of the tongue. ...
Halitosis is a common problem. There are many assessment methods in the literature as well as treatment modalities. The objective of this systematic review is to evaluate the level of evidence for each treatment modality of halitosis. Electronic databases were searched in a systematic method according to preferred reporting items for systematic reviews and meta-analyses guidelines. The review included human clinical trials with or without randomization and excluded case reports and case series. Only articles written in English were included in the review. Forty-three articles were included in this review. It was found that treatment modalities can be classified into chemical compounds in mouthwashes, chemical compounds in dentifrices, chemical compounds in other products, herbal products and combinations of chemical and physical methods. The level of evidence ranged from I to IV for each class. This review suggests that mouthwashes and dentifrices are the best ways to combat halitosis. There is currently insufficient amount of level I evidence to support the efficacy of herbal products or mechanical modifications to oral hygiene practices and there is a need for a greater number of randomized controlled trials to study the efficacy of these methods.
... A chewing gum containing natural cinnamon flavor and cinnamaldehyde was compared to one with natural cinnamon flavor but without cinnamaldehyde. Both chewing gums showed a significant reduction in H 2 S-producing bacteria [49] However, these results should be treated with caution, as the COHIP response is based on subjective perceptions. ...
Objectives
Chewing gums containing antiseptics or other antimicrobial substances may be effective in reducing plaque and gingivitis. Therefore, the aim of this randomized placebo-controlled clinical trial was to investigate the efficacy of a novel antimicrobial chewing gum containing essential oils (cinnamon, lemon, peppermint) and extracts on reduction of dental plaque and gingivitis as well as on oral health-related quality of life (OHRQoL) in adolescent orthodontic patients.
Materials
52 patients (11-22 years of age) were randomly assigned to use a test chewing gum (COVIDGUM, Clevergum) or a commercially available control chewing gum over a period of 10 days. Approximal plaque index (API), papillary bleeding index (PBI) and an OHRQoL questionnaire for children (COHIP-G19) were assessed at baseline (BL), after 10 days (10d) and 30 days (30d). In addition, oral health and oral hygiene related questions of the COHIP-G19 questionnaire were evaluated separately in subscales at each timepoint. Data were analyzed using non-parametrical statistical procedures (α = 0.05).
Results
API and PBI decreased significantly over time from BL to 10d and from BL to 30d in both groups, without significant differences between the groups. In both groups, the COHIP-G19 score, oral health subscale and oral hygiene subscale decreased significantly over time. Regarding the oral hygiene subscale, the test group showed significantly better scores at 30d (p = 0.011).
Conclusion
Both chewing gums performed similarly effective in terms of reducing plaque accumulation and gingival inflammation and improving OHRQoL.
Clinical relevance
Chewing gums without antimicrobial ingredients may be sufficient to decrease plaque accumulation and gingival inflammation.
... Recent studies disclosed more health benefits of cinnamon-based chewing gums. Commercial sugar-sweetened cinnamon chewing gum has claimed to have the benefit of preventing halitosis by reducing volatile sulfur compounds producing anaerobes in the oral cavity (Zhu et al. 2011). Current chewing gum products are introduced with novel techniques such as multiple layers filled in cinnamon and its flavors (US patent application 2015/0264958A1). ...
... Recent studies disclosed more health benefits of cinnamon-based chewing gums. Commercial sugar-sweetened cinnamon chewing gum has claimed to have the benefit of preventing halitosis by reducing volatile sulfur compounds producing anaerobes in the oral cavity (Zhu et al. 2011). Current chewing gum products are introduced with novel techniques such as multiple layers filled in cinnamon and its flavors (Kabse et al. (2015) US patent application 0264958A1). ...
Cinnamon
Botany, Agronomy, Chemistry and
Industrial Applications
... Flavoring agents have been reported to possess antimicrobial activity [49,50]. We have previously found that cinnamon aldehyde suppressed growth of S. mutans and other oral bacteria [51]. Therefore, we anticipated that Black Tea with added cinnamon flavor may enhance inhibition against plaque bacteria. ...
Objectives: Polyphenols in edible berries and tea plant (Camellia sinensis) suppressed virulence factors of oral pathogens. We investigated if the commercially marketed plant polyphenols-containing beverages inhibited growth and biofilm formation of Streptococcus mutans and children’s dental plaque. Methods: Supragingival plaque collected from 16 children (7–11 years) were suspended in TSB for testing. Test beverages included 26 marketed packaged teas, ready-to-drink bottled raspberry flavored teas and cranberry juice cocktails with and without added sugars. Their effects on in vitro growth and biofilm formation of S. mutans and children’s plaque bacteria were determined after 24–48 h at 37 °C anaerobically in CDM with or without sucrose. Results: Brewed infusions from black, green and cinnamon or raspberry flavored teas bags inhibited growth and biofilm formation of children’s plaque bacteria. Compared to controls, bottled raspberry flavored teas and cranberry juice cocktails significantly inhibited growth and biofilm formation of test bacteria. Added sugar did not significantly impact the inhibition (p > 0.05). Biofilms formed in these beverages were loosely attached and easily dislodged from surfaces. Conclusions: Beverages rich in antimicrobial plant polyphenols reduce plaque adherence, may benefit oral health and are preferred over other sugary beverages. The concept of oral diseases prevention using natural foods/diet is innovative, practical and acceptable.
... Recent studies disclosed more health benefits of cinnamon-based chewing gums. Commercial sugar-sweetened cinnamon chewing gum has claimed to have the benefit of preventing halitosis by reducing volatile sulfur compounds producing anaerobes in the oral cavity (Zhu et al. 2011). Current chewing gum products are introduced with novel techniques such as multiple layers filled in cinnamon and its flavors (US patent application 2015/0264958A1). ...
True (Ceylon) cinnamon, a traditional spice, is used as a flavor enhancer in a variety of food products in many parts of the world. Today, the consumer is becoming increasingly health conscious and sophisticated, and the food and beverage market is more dynamic than ever and is shifting from synthetic to natural products with the advent of a burgeoning green economy. Ceylon cinnamon has unique organoleptic attributes, including exotic flavor, distinct aroma, and pungent taste with functional properties, such as antiaging, antidiabetic, anti-inflammatory, antifungal, antibacterial, antiflatulent, and analgesic uses. Therefore, it has found wide industrial applications, including food and beverage, nutraceutical, oral care, and packing industries. Cinnamon is used as an ingredient in a wide range of confectionaries. In the beverage industry, it is added to tea and alcoholic and ready-to-drink beverages. Among cinnamon-flavored beverages, cocktails, wine, tequila, and beer are popular and command an appreciable market. In view of its antibacterial, antifungal, and insect-repelling properties, cinnamon-impregnated food packaging material is used to extend shelf life of food products and to reduce their vulnerability to pest attack. Therefore, cinnamon shows great promise as an agro-industrial crop with a wide range of applications in the food and beverage industry through value addition and value creation.
... Recent studies disclosed more health benefits of cinnamon-based chewing gums. Commercial sugar-sweetened cinnamon chewing gum has claimed to have the benefit of preventing halitosis by reducing volatile sulfur compounds producing anaerobes in the oral cavity (Zhu et al. 2011). Current chewing gum products are introduced with novel techniques such as multiple layers filled in cinnamon and its flavors (Kabse et al. (2015) US patent application 0264958A1). ...
Sri Lanka is the market leader of Ceylon cinnamon with a 90% global market share. Cinnamon is one of the leading foreign exchange earners from among agricultural exports of Sri Lanka. The cinnamon extent of cultivation, production, and yield has only marginally increased over the past few decades despite high potential in the global market. However, the major competitive product cassia produced and exported predominantly by Indonesia, China, and Vietnam has contributed to the erosion of Ceylon cinnamon market share, notwithstanding warning from leading health agencies about its negative impact on health due to high content of coumarin. Ceylon cinnamon has the potential to become Sri Lanka’s number one foreign exchange earner from the agriculture sector by building on its competitive edge as the main true cinnamon supplier. Product and process innovation with a focus on compliance with food safety and quality requirements remains the most feasible and practical option to exploit the competitive edge of Ceylon cinnamon in the global marketplace. Marketing strategies should focus on product diversification, value addition, and brand recognition.
... Activity of CZ against fluconazole resistant and susceptible candida were studied in HIV infected patients having pseudo-membranous Candida, where 3 patients out of 5 showed improvements in their oral candidiasis [47]. The effects of sugared chewing gum containing cinnamic aldehyde and natural flavours from CZ on the short-term germ-killing effect on total and H 2 S-producing salivary anaerobes was investigated by Zhu, et al. [48]. Significant reductions in total salivary anaerobes and H 2 S-producing salivary anaerobes were observed 20 minutes after subjects chewed the gum. ...
Cinnamomum zeylanicum Blume or Ceylon cinnamon is a native medicinal and aromatic plant in Sri Lanka, which has been used extensively in treatment of various diseases in traditional systems of medicine in Asia. It is also a household remedy for primary care in aches, pains and certain other diseases. The claimed health benefits have been extensively tested using modern scientific methods to validate the health properties. It has been used clinically for treatment and management of diseases and in health foods, nutraceutical and cosmeceutical industries. The pharmacological properties tested and reported from C. zeylanicum bark, leaf and essential oils are discussed with special reference to antioxidant, anti-diabetic, antilipidemic, anticancer, anti-inflammatory, antiarthritic, immunomodulatory, antibiotic, antinociceptive, analgesic, cardioprotective, antihypertensive, gastroprotective, skin protection, skin whitening and anti-ageing properties, including clinical studies and toxicology.
... Cinnamaldehyde possesses a wide range of pharmacological functions. Studies have found that this compounds had antimicrobial, antiinflammatory, antioxidant, and antidiabetic properties (Zhu et al., 2011;Roth-Walter et al., 2014;Kawatra and Rajagopalan, 2015). Several studies have reported the effectiveness of cinnamon in treating HIV infected cells, cardiovascular disease and Parkinson's disease (Fink et al., 2009;Khasnavis and Pahan, 2012;Rao and Gan, 2014). ...
... Based on a review of high-evidence literature, it would seem that tongue brushing or scraping alone is not a satisfactory long-term solution for reducing intraoral malodour caused by tongue coating. 3,28,29,31,32,37 Masking or reducing halitosis can be achieved by using dentifrices, 15,38-41 chewing gums, [42][43][44][45][46][47] candies, 31,48 tablets, 49 including mucoadhesive types, 50 or lozenges 51,52 as vehicles for delivering therapeutic or cosmetic agents. Mouthrinses, however, have been the predominant mainstays for bad breath issues. ...
... Activity of CZ against fluconazole resistant and susceptible Candida were studied in HIV infected patients having pseudomembranous candidiasis, where three patients out of five showed improvements in oral candidiasis [19]. The effects of sugared chewing gum containing cinnamic aldehyde and natural flavours from CZ on the short-term germ-killing effect on total and hydrogen sulphide (H 2 S)-producing salivary anaerobes has been investigated [20]. Significant reductions in total salivary anaerobes and H 2 S-producing salivary anaerobes were observed 20 minutes after participants chewed the gum. ...
... Activity of CZ against fluconazole resistant and susceptible candida were studied in HIV infected patients having pseudo-membranous Candida, where 3 patients out of 5 showed improvements in their oral candidiasis [47]. The effects of sugared chewing gum containing cinnamic aldehyde and natural flavours from CZ on the short-term germ-killing effect on total and H 2 S-producing salivary anaerobes was investigated by Zhu, et al. [48]. Significant reductions in total salivary anaerobes and H 2 S-producing salivary anaerobes were observed 20 minutes after subjects chewed the gum. ...
In traditional medicine Cinnamon is considered a remedy for respiratory, digestive and gynaecological ailments. In-vitro and in-vivo studies from different parts of the world have demonstrated numerous beneficial medicinal effects of Cinnamomum zeylanicum (CZ). This paper aims to systematically review the scientific literature and provide a comprehensive summary on the potential medicinal benefits of CZ.
A comprehensive systematic review was conducted in the following databases; PubMed, Web of Science, SciVerse Scopus for studies published before 31st December 2012. The following keywords were used: "Cinnamomum zeylanicum", "Ceylon cinnamon", "True cinnamon" and "Sri Lankan cinnamon". To obtain additional data a manual search was performed using the reference lists of included articles.
The literature search identified the following number of articles in the respective databases; PubMed=54, Web of Science=76 and SciVerse Scopus=591. Thirteen additional articles were identified by searching reference lists. After removing duplicates the total number of articles included in the present review is 70. The beneficial health effects of CZ identified were; a) anti-microbial and anti-parasitic activity, b) lowering of blood glucose, blood pressure and serum cholesterol, c) anti-oxidant and free-radical scavenging properties, d) inhibition of tau aggregation and filament formation (hallmarks of Alzheimer's disease), e) inhibitory effects on osteoclastogenesis, f) anti-secretagogue and anti-gastric ulcer effects, g) anti-nociceptive and anti-inflammatory activity, h) wound healing properties and i) hepato-protective effects. The studies reported minimal toxic and adverse effects.
The available in-vitro and in-vivo evidence suggests that CZ has many beneficial health effects. However, since data on humans are sparse, randomized controlled trials in humans will be necessary to determine whether these effects have public health implications.
Herbal medicine has long been used to prevent and control disease, and it can minimize the potential side effects of chemical products. However, side effects from herbs do exist. Most of the challenges with herbal medicine revolves around inadequate information about the effect of herbs in the oral cavity, the mechanism of action, and potential side effects. There are several herbs described in this chapter have anti-inflammatory, anti-bacterial, anti-viral, anti-fungal in oral micro-organisms. It includes aloe vera, ginger, clove, cinnamon, garlic, neem, miswak, turmeric, tulsi, green tea, chamomile, fenugreek, anise plant, peppermint, bloodroot, caraway, eucalyptus, phyllanthus emblica, black seed, myrrh, rosemary, sage, and thyme; some may act as an alternative management option to current treatments for oral conditions such as caries prevention, gingivitis, periodontitis, oral burn, ulcers and inflammation, after extraction, dry mouth, pain reduction, anesthesia, intracanal medications, ill-fitting dentures, peri-implant mucositis and peri-implantitis. It can be used in several forms such as mouthwashes, toothpastes, topical agents or local drug delivery devices. However, more research is needed to understand their mechanisms and potential side effects.
A wide range of confectionery products have been formulated and commercialized as vehicles for delivering health actives. Advances in microencapsulation have allowed the design of carriers and devices which can accurately target a desired release site at a predetermined rate. One of the most important physiological variables is whether a person sucks or chews the dosage since systems designed to be chewed will invariably be sucked and vice versa by a proportion of consumers. Chewing gums have been used as reliable delivery vehicles for flavors, nutrients, oral care, and drug actives due to their non-invasive format, discreetness, and acceptability by consumers of various ages and cultures. Lozenges are sugar or sugar-free solid dosages formulated to deliver flavors and active substances such as antimicrobials, expectorants, analgesics, and other nutraceutical ingredients. Seamless capsules represent a class of delivery systems that can provide powerful impact, but has not yet realized its full potential.
Halitosis is a common complaint affecting the majority of the population. Mouthrinses containing cetylpyridinium chloride (CPC) have been used as oral hygiene aids to suppress oral malodor. Although the clinical efficacy of these mouthrinses has been well-documented, the mechanism whereby CPC reduces malodor is less-well-understood. We hypothesized that CPC suppresses expression of the genes (mgl and cdl) and enzymes responsible for methyl mercaptan (CH3SH) and hydrogen sulfide (H2S) production by oral anaerobes associated with halitosis. In this study, the mgl and cdl expression of Porphyromonas gingivalis and Fusobacterium nucleatum in the presence of CPC was investigated.
We used a microdilution method to determine the growth and production of volatile sulfur compounds (VSCs) by P. gingivalis W83 and F. nucleatum ATCC 10953 in respective media containing CPC (0.5μg/mL to 1.5μg/mL). For metabolic activity, we used an XTT {2,3-bis(2-methyloxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide} reduction assay. We used real-time RT-PCR and Western blotting to evaluate the effect of CPC at sub-MIC levels on mgl and cdl expression at the transcriptional and enzymatic levels.
CPC inhibited the growth of P. gingivalis and F. nucleatum at MICs of 3μg/mL and 2μg/mL, and at MBCs of 6μg/mL and 3μg/mL, respectively. Compared with untreated controls, CPC at 1.5μg/mL suppressed CH3SH production of P. gingivalis by 69.84%±2.88% and H2S production of F. nucleatum by 82.55%±8.36% (p<0.05) without affecting metabolic activity. Inhibition of mgl mRNA (81.58%±20.33%) and protein (39.15%±6.65%) expression in P. gingivalis and inhibition of cdl mRNA (61.76%±13.75%) and protein (64.34%±1.62%) expression in F. nucleatum were also noted (p<0.05).
CPC represents an effective agent for halitosis reduction by inhibiting the growth and suppressing the expression of specific genes related to VSC production in anaerobic periodontal pathogens.
The present article reviews the current knowledge of halitosis with particular emphasis upon the interplay of diet and disease of the gastrointestinal tract upon oral malodour.
Transient-altered breath smell usually reflects the effects of foodstuffs, whereas longstanding halitosis is almost always because of oral disease such as gingivitis or periodontitis. There is, however, increasing evidence that upper gastrointestinal tract disease may give rise to halitosis and that extracts of foodstuffs may be future therapeutic agents for the treatment of halitosis derived from the mouth or upper gastrointestinal tract.
There is some interplay between the halitosis and the gastrointestinal tract, and it is possible that the therapy of halitosis may be aided by investigations of the effects of foodstuffs upon bacteria that give rise to volatile sulphur compounds.
Many studies have shown the effects of chewing xylitol gum on mutans streptococci (MS) over short- and long-term periods in children; however, few studies have addressed long-term periods in adults. The objective of this investigation was to examine for 6 months the effects of chewing xylitol gum on MS in saliva and plaque in 127 adults (mean age 28.0 years). The participants were assigned to three groups according to gum type, in part taking preference for flavor into account and in part at random: xylitol (XYL), maltitol (MAL) and control (CR); 33, 34 and 27 subjects in each group, respectively, completed the trial. Daily gum use of the XYL and MAL groups was 7.9 and 7.1 g, respectively. MS levels, which declined significantly in saliva (p < 0.05) and plaque (p < 0.001) in the XYL group after 6 months, exhibited a significant increase in plaque in the MAL group (p < 0.001). Differences in relative changes of MS levels in plaque during the experimental period were significant between the XYL group and the CR (p < 0.05) and MAL groups (p < 0.001). Differences in relative change of amount of plaque during the experimental period were not statistically significant between the groups. The present study demonstrated that chewing xylitol gum for 6 months continued to inhibit the growth of mutans streptococci in adults.
Epigallocatechin gallate (EGCg), the main antimicrobial tea catechin, has been reported to inhibit growth and virulence factors of oral pathogens in vitro. Although the mechanism is unclear, the potential of EGCg in reducing halitosis caused by volatile sulfur compounds (VSCs) has been suggested. This study tested the hypothesis that EGCg reduces VSCs by suppressing mgl, the gene encoding L-methionine-α-deamino-γ-mercaptomethane-lyase, responsible for methyl mercaptan (CH₃SH) production by oral anaerobes. In this study, the effect of EGCg on in vitro growth, CH₃SH production, and mgl gene expression in P. gingivalis W83 was investigated. EGCg inhibited growth of P. gingivalis W83 (MIC = 97.5 µg/mL) and was bactericidal (MBC = 187.5 µg/mL). At sub-MIC levels, EGCg inhibited CH₃SH production, and mgl mRNA and protein expression (p < 0.05). We conclude that EGCg may represent a natural and alternative agent to the antimicrobial chemicals currently available for halitosis control.
The aim of the present study was to evaluate the effect of two chewing gums on the production of volatile sulfur-containing compounds (VSC) in vivo. Fourteen periodontally healthy participants (20-35 years old) were included in the test panel. Test gum 1 (TG1) contained sucrose and Test gum 2 (TG2) contained xylitol and zinc citrate. Two series of tests were conducted with a double-blind cross-over design. Following an overnight refrain from oral hygiene, VSC was measured before and at 5, 15, 30, 45 and 60 minutes of chewing the test gums. In the second series, VSC production was monitored prior to and up to 30 minutes after a rinse with cysteine 6 mM alone or after a rinse followed by chewing the test gums. For the first test, the results were analyzed by repeated measurements ANOVA for intra-group and paired sample t test for intergroup comparisons. In the second series, percent reduction of VSC was compared by Friedman and Wilcoxon tests (p < .05). The test gums did not differ in terms of VSC production, with values ranging from 146 ppb after 5 minutes to 86 ppb after 60 minutes. Similar reductions in VSC production following cysteine were observed for both test gums, with the largest reductions (71% to 52%) observed after 5 and 15 minutes. It can be concluded that VSC production is diminished after chewing gum and that the use of chewing gums reduces temporarily the VSC production enhanced by cysteine rinses.
To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients.
9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate > 33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles.
Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids.
The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.
The aim of this investigation was to study the effect of chewing sugared, sugar free or gum with therapeutic agents like urea or fluoride, on pH of dental plaque after a sucrose challenge using a microtouch method. The 20 subjects aged 8 to 10 years refrained from toothbrushing for 2 days. Resting plaque pH was recorded, followed by sucrose 10% (w/v) rinse for 3 min. After 5 min chewing gum was given and pH recorded at time points of 5, 10, 20, 30 min. Highest plaque pH was found with Endekay (urea) at all time points followed by fluoride chewing gum; Trident, and Wrigley's (p < 0.0001). Sucrose 10% w/v (control) showed the maximum drop in plaque pH when compared to the rest of the groups. The comparative evaluation has shown Endekay having maximum pH against the acidogenic challenge. Therefore the present study indicates that chewing gum containing therapeutic agents like urea may be recommended in high risk caries children.
The tongue bacterial microbiota of 50 individuals was identified and enumerated to group or genus level. Possible relationships between these data and the oral malodour status of each individual were explored. When subjects were grouped into low or high odour producers, significant increases in the total bacterial load and key bacterial groups, namely gram-negative anaerobes, which include Porphyromonas/Prevotella species and fusiforms, were related to high odour. However, on an individual basis the extensive variation between subjects reduced the correlation between bacterial groups and odour. Two phenotypic characteristics of the microbiota, volatile sulphur production and proteolytic activity, were also assessed. These were strongly associated with odour; in particular, the proportions of hydrogen sulphide producing organisms were significantly related to the odour levels of the individuals, despite the interpersonal variation. Thus it appears that it is the metabolic activity of the mixed microbiota rather than the bacterial load, or genus types present, that most contributes to oral malodour.
Chewing sugar-free gum has been shown to promote enamel remineralization. Manufacturers are now adding calcium to the gum in an approach to further promote enamel remineralization. The aim of this study was to compare the remineralization efficacy of four sugar-free chewing gums, two containing added calcium, utilizing a double-blind, randomized, crossover in situ model.
The sugar-free gums were: Trident Xtra Care, Orbit Professional, Orbit and Extra. Ten subjects wore removable palatal appliances with four human-enamel half-slab insets containing subsurface demineralized lesions. For four times a day for 14 consecutive days subjects chewed one of the chewing gums for 20min. After each treatment the enamel slabs were removed, paired with their respective demineralized control slabs, embedded, sectioned and mineral level determined by microradiography. After 1-week rest the subjects chewed another of the four gums and this was repeated until each subject had used the four gum products.
Chewing with Trident Xtra Care resulted in significantly higher remineralization (20.67+/-1.05%) than chewing with Orbit Professional (12.43+/-0.64%), Orbit (9.27+/-0.59%) or Extra (9.32+/-0.35%). The form of added calcium in Trident Xtra Care was CPP-ACP and that in Orbit Professional calcium carbonate with added citric acid/citrate for increased calcium solubility.
Although saliva analysis confirmed release of the citrate and calcium from the Orbit Professional gum the released calcium did not result in increased enamel remineralization over the normal sugar-free gums. These results highlight the importance of calcium ion bioavailability in the remineralization of enamel subsurface lesions in situ.
The objective of the study was to determine quantitatively the effect on the potential for in situ remineralization of artificial caries-like lesions in human enamel when sugar-free gum containing mainly sorbitol as sweetener was chewed after meals and snacks. Artificial white-spot lesions were created in extracted human premolars and divided into three parts. One part was used as reference and the other two worn consecutively for two 21-day periods by 10 volunteers in a cast silver band cemented on lower molar teeth and covered with gauze to promote plaque formation. During the experimental periods, the subjects used fluoridated toothpaste twice daily, and consumed three meals (breakfast, lunch, and dinner) and two snacks (selected from chocolate bar, raisins, chocolate wafer, and iced cupcake). Sorbitol gum was chewed for 20 min immediately after each meal or snack during one of the experimental periods. The three parts of the enamel lesions were then sectioned (congruent to 80 microns) and examined together by means of quantitative microradiography and by polarized light microscopy. All estimates of mineral content indicated that significant remineralization occurred and was approximately doubled with gum-chewing. It is suggested that sorbitol gum stimulates salivation, which is responsible for the significantly enhanced remineralization, thus contributing to a therapeutic, caries-preventive effect. Because the gum was chewed immediately after meals and snacks, inhibition of demineralization may also have occurred.
Inter-related determinants of oral malodor were measured over a three-hour period in 30 human subjects after mouthwash treatments. Re-odoration was important to mouthwash activity for 30 min. At post-treatment times of 60-180 min, the anti-odor activity of the product is due solely to its anti-microbial action.
On two occasions, 12 adults collected unstimulated saliva and then eight samples of saliva over a 20-min period while chewing 3 g of either Wrigley's Spearmint sucrose-containing gum (SCG) or sugar-free gum (SFG) at 70 chews/min. The flow rates peaked initially, then fell with duration of stimulation. With the SFG they were slightly but significantly higher than with the SCG after 4 min of chewing. The sum of the concentrations of cations minus the sum of the concentrations of anions was not significantly different from zero for saliva elicited by the SCG. However, for unstimulated saliva and that elicited by SFG, there was a slight positive anion balance. A second series of saliva collections with SCG and SFG was made by the same 12 participants and these samples were analysed for lactate. For these collections the flow rates with SCG were not significantly less than with the SFG. The lactate concentration in saliva elicited by SCG peaked at 1.82 mmol/l in samples collected over 8-15 min, whereas samples of saliva elicited by SFG had a mean lactate concentration of 0.21 mmol/l. Of the lactate formed during the metabolism of sucrose by the oral bacteria, only 2% or less appeared to be derived from the metabolism of micro-organisms free in saliva, the balance presumably being formed in dental plaque and entering the saliva by diffusion. All saliva samples were supersaturated with respect to hydroxyapatite but stimulated saliva was significantly more supersaturated than unstimulated saliva.(ABSTRACT TRUNCATED AT 250 WORDS)
Halitosis, or bad breath, is a clinical problem for many people. In the majority of cases the problem has been shown to originate in the oral cavity. All conditions that favour the retention of anaerobic, mainly gram-negative, bacteria will predispose for the development of bad breath. In addition to periodontal pockets, the most important retention site is the dorsum of the tongue with its numerous papillae. The bacteria metabolize sulphur-containing amino acids to yield the volatile sulphur-containing compounds hydrogen sulphide and methylmercaptane. These substances have an offensive odour in very low concentrations. The sulphur compounds may also damage the surrounding tissue directly, and thereby contribute to the initiation and development of periodontal disease. During the night and between meals the conditions are optimal for odour production. The importance of regular meals is therefore emphasized. To supplement conventional oral hygienic measures the patients are advised to brush their tongue. The use of oral care products which contain metal ions, especially zinc, will inhibit odour formation because of the affinity of the metal ion to sulphur. It is also possible to measure the level of volatile sulphur-containing compounds in the air in the mouth directly by means of a portable sulphide monitor. Dentists and physicians are both advised to discuss the problem of halitosis with their patients, since this should be regarded as an important aspect of the patient's health.
Volatile sulfur-containing compounds (VSC) are known to constitute the major component of halitosis. Aqueous solutions of zinc salts have been shown to reduce the levels of VSC produced orally. The aim of the present study was to examine whether zinc could be made available in the oral cavity and inhibit VSC production when delivered by a chewing gum. VSC measurements were carried out on the 'morning breath' of 11 test subjects and re-examined after the use of test solutions containing 0.02% zinc chloride, 0.2% chlorhexidine, or water or the use of chewing gums containing 2 mg, 0.5 mg, or 0 mg zinc acetate. The results showed that similar amounts of zinc in mouthrinses or chewing gum had the same effect, with a reduction of the oral VSC of 45%. Chewing gum thus seems to be a viable alternative for delivering zinc to reduce VSC levels in the oral cavity.
The main purpose of the study was to examine the anti-malodor properties of oxidizing lozenges, as compared to breath mints and chewing gum. Healthy, young adult volunteers (N = 123; mean age 24.5 years) were measured for oral malodor-related parameters (whole mouth odor measured by 2 judges; tongue dorsum posterior odor using the spoon test; volatile sulphide levels; salivary levels of cadaverine and putrescine; and 2 versions of an oral rinse test) on the first afternoon of the study. They were then assigned randomly to one of 6 groups (2 brands of breath mints, chewing gum with no active ingredients, regular and full-strength oxidizing lozenges, and a no-treatment control), and instructed to employ the treatment before bedtime, the next morning, and in the early afternoon 3 hours prior to measurements, which were carried out 24 hours following baseline measurements. Volunteers also estimated the level of their own whole mouth and tongue odors at baseline and post-treatment. The data showed that, among treatments, only the full-strength oxidizing lozenge significantly reduced tongue dorsum malodor, as determined by the spoon test. The full-strength lozenge also yielded a significant increase in the modified oral rinse test, presumably due, at least in part, to residual oxidizing activity retained in the oral cavity. Self-estimations of whole mouth and tongue malodor by volunteers were significantly correlated with corresponding-judge assessments, suggesting some degree of objectivity in assessing one's own oral malodor.
Chewing gum may act as a masking or a therapeutic agent against the different chemical compounds that are responsible for oral malodor. An open-label exploratory study investigated the effect of mastication and aromatic components of chewing gum on reducing oral volatile sulfur compounds.
Twelve dental students (5 males and 7 females) acted as their own controls. Toothbrushing stopped 12 hours before observations. Measurements included organoleptic and volatile sulfur compound scores and the pH of the anterior and posterior zones of the dorsal tongue. Measurements were made at 9 AM and 12 PM on 1 day for 3 successive weeks; week 1, no gum (control); week 2, test gum; week 3, unsweetened gum base. This open-label study was then completed by an observer-blind study, according to the same schedule; the recorded measurement was the plaque index.
The pH, volatile sulfur compounds, and organoleptic scores were similar for all groups. The pH was more basic in the posterior part than in the anterior zone of the dorsal tongue, irrespective of time and presence or absence of chewing gum. In addition, the volatile sulfur compound score rose transiently immediately after the test gum, and the organoleptic score fell in the first hour only after the test gum. The two chewing gum groups seemed to have a greater reduction in plaque index than did the control (no gum) group.
Chewing gum may have a valuable mechanical role in cleaning dental surfaces, and the test gum may temporarily control bad breath. After 3 hours, similar volatile sulfur compound scores were observed for subjects who chewed either test or unsweetened gum base and control subjects.
Six healthy dentate individuals collected a 5-min sample of unstimulated whole saliva (UWS) and dilutions were plated out on blood agar and grown anaerobically for 48 h. The output of bacteria into saliva (counts/min) was calculated as the product of counts/ml and ml/min. The individuals repeated the collections at intervals of up to 7 h after (1) rinsing with water, (2) eating a meal plus tooth brushing, (3) a thorough dental prophylaxis, or (4) tongue brushing and scraping. They also collected saliva at intervals while chewing gum for 20 min, as did 10 individuals who chewed gum for 2 h. The original six individuals also collected UWS under "drooling" (no oral movements) and "spitting" conditions. Six edentulous individuals not wearing their dentures collected UWS before and after a water rinse. With the four oral hygiene procedures, bacterial outputs fell initially and then rose again, but a repeated-measures ANOVA revealed no significant differences in the effects of the four procedures. Gum chewing caused initial marked increases in the outputs of bacterial and epithelial cells, but these fell with time and reached a plateau after about 10 min at outputs above those in UWS. Samples collected by spitting contained up to 14 times more bacteria than those collected by drooling. Bacterial output by edentulous individuals did not differ from that in those with teeth. It is concluded that bacteria from the teeth and gingival crevices normally make only a small contribution to those in saliva, that various oral hygiene procedures have similar effects on bacterial output into saliva, and that saliva collection conditions should be standardized and specified.
Published research indicates that regular use of toothpaste containing sodium bicarbonate is effective in reducing volatile sulfur compounds (VSCs) and oral malodor. Gaffar initially reported on the use of sodium bicarbonate as an agent to affect VSCs, indicating that sodium bicarbonate had the potential to alter the VSCs to nonvolatile compounds. Chewing gum would also be suspected of providing benefits in controlling oral malodor through its claimed ability to mechanically aid in the removal of dental plaque. Based on the length of chewing time, the opportunity exists for chewing gum to reach places in the mouth that might be missed during brushing. This activity could contribute to reductions in the amount of viable plaque mass that could produce VSCs.
Tongue brushing and mouth rinsing are basic treatment measures for halitosis, and as such are categorised as treatment needs (TN)-1. Although TN-1 is used for treatment of physiologic halitosis treatment, pseudo-, extra oral pathologic or halitophobic patients must also be managed with TN-1 as well as other treatments. Since the origin of physiological halitosis is mainly the dorso-posterior region of the tongue, tongue cleaning is more effective than mouth rinsing. However, practitioners should always instruct their patients on how to brush their tongues to prevent harmful effects. Another approach using a chlorhexidine mouthwash is most effective in reducing oral malodour. However, chlorhexidine should not be used routinely; therefore, zinc-containing mouthwashes have been recommended for use. People can also use chewing gum to reduce oral malodour. Surprisingly, however, it has been noted that sugarless chewing gum increased methyl mercaptan, one of the principal components of oral malodour. Mint did not reduce the concentration of methyl mercaptan either, although these products are widely used for their ability to mask oral malodour. There is a need for the development of a novel food or chewing gum that could considerably reduce VSC levels in mouth air to complement TN-1.
Halitosis is a common problem. Its aetiology is multifactorial, but oral malodour is usually caused by microbial metabolism from the tongue, saliva or dental plaque. Mouthwashes are only effective against halitosis caused by intraoral factors. The principal causative agents of oral malodour are volatile sulphide compounds (VSCs), including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Data suggest that oral VSC levels correlate with the depth of periodontal pockets. Trials have shown that both mechanical oral care and mouthwash use can reduce halitosis levels. The majority of studies involving mouthwashes have investigated chlorhexidine and essential oil mouthwashes, although comparative studies are sparse.
A clinical procedure was developed to examine the effects of short-term and extended use of a triclosan/copolymer dentifrice and a commercial fluoride dentifrice on oral bacteria, including those producing hydrogen sulfide. Healthy adults volunteered for this double-blind, crossover design clinical study and provided saliva samples for culturing on enriched and indicator media to enumerate all salivary bacteria and those producing hydrogen sulfide (odorigenic), respectively. Subjects brushed with an assigned dentifrice for 7 d and were sampled on day 8 to assess the long-term effects on bacteria. Extended use of the triclosan/copolymer dentifrice resulted in a 49% and 66% reduction of salivary and odorigenic bacteria, respectively, compared with the fluoride dentifrice. To examine short-term effects, subjects subsequently brushed with their assigned dentifrice and were sampled at 2 h and 4 h post-brushing. At 2 h and 4 h post-brushing, the triclosan/copolymer dentifrice resulted in a 62% and 52% decrease for salivary bacteria and 79% and 72% decrease for odorigenic bacteria, respectively, vs. the fluoride dentifrice. The results indicate a significant decrease of all salivary bacteria and hydrogen sulfide-producing odorigenic bacteria following use of the triclosan/copolymer dentifrice and explain previous results on the efficacy of this dentifrice on oral malodor.
Two studies were conducted to determine the antimicrobial effect of rinsing with an essential oil-containing mouth rinse 12 h after a single rinse and 12 h after 2 weeks of twice daily rinsing, during the daytime and overnight. Materials and
These studies utilized a randomized, double-blind, controlled crossover design. Following baseline sampling of bacteria from supragingival plaque and the dorsum of the tongue, subjects began twice-daily rinsing with either an essential oil mouth rinse containing 0.09% zinc chloride (Tartar Control Listerine Antiseptic) or a negative control rinse. Bacterial sampling was repeated 12 h after the first rinse, and again 12 h after the final rinse 14 days later. The sampling schedule was adjusted according to whether the study was investigating daytime or overnight activity. Samples were plated on Schaedlers medium (total anaerobes), Schaedlers Nalidixic/Vancomycin medium (Gram-negative anaerobes), and OOPS medium (volatile sulphur compound (VSC)-producing organisms). Inter-group log10 transformed colony-forming units/ml counts from samples of supragingival plaque and tongue swabs on each of the three media were compared by analysis of covariance.
The mean bacterial counts in subjects using the essential oil mouth rinse were significantly lower (p< or =0.005) than mean counts in subjects using the control rinse in all the comparisons, i.e., tongue and supragingival plaque samples on each of three media at two sampling periods in the daytime and overnight study, respectively. Mean bacterial count percent reductions for plaque samples ranged from 56.3 to 95.3; percent reductions for tongue samples ranged from 61.1 to 96.1. There was a trend to higher reductions after 14 days' rinsing than after the initial rinse.
Rinsing with the essential oil mouth rinse can have long-lasting effects in reducing anaerobic bacteria overall as well as Gram-negative anaerobes and VSC-producing bacteria. The significant reductions in numbers of these bacteria produced by the essential oil mouth rinse, both in plaque and on the dorsum of the tongue, can play a key role in explaining the essential oil mouth rinse's effectiveness in reducing supragingival plaque and gingivitis as well as its effectiveness in controlling intrinsic oral malodor over prolonged periods.
The aim of this study was to investigate the effect of a fixed daily dose of xylitol on mutans streptococci in saliva and the amount of visible dental plaque. A second aim was to explore if the possible effects differed between children with and without caries experience.
The study was designed as a double-blind randomized controlled trial with two parallel arms. All pupils (n=149) in grades 1-6 in a comprehensive school in northern Sweden were invited, and 128 children (mean age=12.7 years) consented to participate. The children were stratified as having caries experience (DMFS/dmfs>or=1) or not before the random allocation to a test or control group. The control group (A) was given two pellets containing sorbitol and maltitol three times daily for 4 weeks, and the test group (B) received corresponding pellets with xylitol as single sweetener (total dose=6.18 g day). Clinical scoring and saliva samples were collected at baseline and immediately after the test period. The outcome measures were visible plaque index, salivary mutans streptococci counts and salivary lactic acid production.
The amount of visible plaque was significantly reduced in both groups after 4 weeks (P<0.05). Likewise, the sucrose-induced lactic acid formation in saliva diminished in both groups (P<0.05). The proportion of mutans streptococci decreased significantly in the test group compared to baseline, but not in the control group (P<0.05). The alterations in the test group seemed most prominent among children without previous caries experience.
The results suggest that chewing gum with xylitol or sorbitol/maltitol can reduce the amount of dental plaque and acid production in saliva in schoolchildren, but only the xylitol-containing gum may also interfere with the microbial composition.
Flavors and natural botanic extracts are often used in chewing gum and compressed mints for breath freshening and relief of oral malodor. The oral malodor is a result of bacterial putrification of proteinaceous materials from food or saliva. In this study, magnolia bark extract (MBE) and its two main components, magnolol and honokiol, were evaluated by the minimum inhibition concentration (MIC) test. The inhibitory effect of MBE mint was further evaluated by a kill-time assay study. In addition, an in vivo study was performed on nine healthy volunteers postlunch. Saliva samples were taken before and after subjects consumed mints and gum, with and without MBE. Listerine mouthwash was included as a positive control. The testing results indicated that MBE and its two main constituents demonstrated a strong germ-kill effect against bacteria responsible for halitosis and also Streptococcus mutans, bacteria involved in dental caries formation. The MIC of magnolol, honokiol, and MBE on Porphyromonas gingivalis, Fusobacterium nucleatum, and S. mutans ranged from 8 to 31 microg/mL. Kill-time assay results indicated that mints containing 0.2% MBE reduced more than 99.9% of three oral bacteria within 5 min of treatment. The in vivo study demonstrated that MBE containing mints reduced total salivary bacteria by 61.6% at 30 min and 33.8% at 60 min postconsumption. In comparison, the flavorless mint reduced total salivary bacteria by 3.6% at 30 min and increased total bacteria by 47.9% at 60 min. The MBE containing chewing gum reduced total salivary bacteria by 43.0% at 40 min, while placebo gum reduced total salivary bacteria by 18.0%. In conclusion, MBE demonstrated a significant antibacterial activity against organisms responsible for oral malodor and can be incorporated in compressed mints and chewing gum for improved breath-freshening benefits.