Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

63 questions · 73 findings · 14 reviews · Dental caries

No studies found 1 · 1.4%GRADE not reported 69 · 94.5%Very low 1 · 1.4%Low 1 · 1.4%Moderate 1 · 1.4%High 0 · 0%

Sugary drinks/sweets consumption vs Not applicable (single-group prevalence)

Sugary drinks/sweets consumption prevalence (among children with caries) · Children with dental caries (deciduous and/or permanent dentition) in low- and middle-income countries

About 70% of children with caries in LMICs consumed sugary drinks/sweets (pooled prevalence 0.697, 95% CI 0.478 to 0.877; 7 studies; very high heterogeneity; not GRADE-rated).

1 finding from 1 review

Sugary drinks/sweets consumption vs Children without dental caries

Dental caries (association with sugary drinks/sweets consumption) · Children (deciduous and/or permanent dentition) in low- and middle-income countries

Sugary drinks/sweets consumption was associated with about twice the odds of dental caries in LMIC children (OR 2.04, 95% CI 1.59 to 2.60; 7 studies; not GRADE-rated).

1 finding from 1 review

Consumption of xylitol chewing gum by women (mothers) vs No chewing gum

Plaque · Adults and children (predominantly adults; one study in children), with natural dentition

Xylitol sugar-free gum significantly reduced plaque quantity versus no-gum/control (SMD -0.743, 95% CI -1.148 to -0.338), with high heterogeneity (I2 = 86.0%; ungraded).

1 finding from 1 review

Sugar consumption (higher sugar intake) vs No sugar consumption (lower/no intake)

Early childhood caries (ECC) · Preschool children (<6 years)

Higher sugar consumption is associated with early childhood caries in children under 6 years: pooled OR 1.59 (95% CI 1.50 to 1.68) from 9 cohort studies with no heterogeneity (I2=0%); the body of evidence was not GRADE-rated (ungraded).

1 finding from 1 review

High-frequency sugar consumption (three or more times daily) vs Low sugar intake (fewer than three times daily)

Early childhood caries experience (mean dmft) · Nigerian children with primary dentition (approximately 6 months to 5 years)

In primary dentition, high-frequency sugar consumption was associated with slightly higher, non-significant odds of caries (OR 1.13, 95% CI 0.23 to 5.44), with high heterogeneity (I2=83%; ungraded).

1 finding from 1 review

High-frequency sugar consumption (three or more times daily) vs Low sugar intake (fewer than three times daily)

Dental caries in permanent teeth · Nigerian individuals with permanent dentition (approximately 12 years and older)

In permanent dentition, high-frequency sugar consumption was associated with non-significant 15% higher odds of caries (OR 1.15, 95% CI 0.88 to 1.52), with no heterogeneity (I2=0%; ungraded).

1 finding from 1 review

High-frequency sugar consumption (three or more times daily) vs Low sugar intake (fewer than three times daily)

Dental caries prevalence · Nigerian individuals, including children and adults, with primary or permanent dentition

High-frequency sugar consumption was associated with 18% higher but non-significant odds of dental caries in Nigeria (OR 1.18, 95% CI 0.87 to 1.59; I2=36%; ungraded).

1 finding from 1 review

Gum chewing (sugar-free) vs No chewing gum

Plaque · Adults and children (predominantly adults; one study in children), with natural dentition

Sugar-free chewing gum significantly reduced plaque quantity versus no-gum/control (SMD -0.778, 95% CI -1.167 to -0.390), with high heterogeneity (I2 = 86.6%) and no GRADE rating (ungraded).

2 findings from 1 review

Xylitol-only sugar-free chewing gum vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish

Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) · Adults and children (general population)

Xylitol-only sugar-free gum significantly reduced Streptococcus mutans load versus pooled controls (SMD -0.46, 95% CI -0.64 to -0.28; 12 trials, I2 43%); certainty not formally graded.

1 finding from 1 review

Gum chewing (sugar-free) vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish

Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) · Adults and children (general population)

In a sensitivity analysis assuming a 0.95 baseline-to-endpoint correlation for the sugar-free gum arm, the effect remained significant (SMD -0.55, 95% CI -0.80 to -0.30; 13 trials, I2 73%); certainty not formally graded.

2 findings from 1 review

Xylitol (low-intensity sweetener/sugar alcohol) in food products (chewing gum, milk, candy, or tablets) vs Sorbitol (low-intensity sweetener)

Change in Mutans streptococci (MS) count in saliva · healthy people

Xylitol and sorbitol did not differ significantly for Mutans streptococci in saliva (SMD -0.16, 95% CI -0.44 to 0.12; 2 trials, P=.25); not GRADE-rated.

1 finding from 1 review

Xylitol (low-intensity sweetener/sugar alcohol) in food products (chewing gum, milk, candy, or tablets) vs no intervention

Change in Mutans streptococci (MS) count in dental plaque · healthy people

Xylitol significantly reduced Mutans streptococci in dental plaque compared with no treatment (SMD -0.73, 95% CI -1.09 to -0.37; 5 trials, I2=53%; not GRADE-rated).

1 finding from 1 review

Xylitol (low-intensity sweetener/sugar alcohol) in food products (chewing gum, milk, candy, or tablets) vs Sorbitol (low-intensity sweetener)

Change in Mutans streptococci (MS) count in dental plaque · healthy people

Xylitol reduced Mutans streptococci in dental plaque more than sorbitol (SMD -0.45, 95% CI -0.69 to -0.21; 4 trials, I2=7%); not GRADE-rated.

1 finding from 1 review

Gum chewing (sugar-free) vs No chewing gum

Self-reported thirst · Elderly (>60 years) and medically compromised adults with xerostomia / dry mouth

Gum chewing reduced self-reported thirst in most studies (6 of 7 positive, 1 no effect); not meta-analyzed.

1 finding from 1 review

Gum chewing (sugar-free) vs No chewing gum

Salivary flow rate · Elderly (>60 years) and medically compromised adults with xerostomia / dry mouth

Across 19 studies the effect of gum chewing on stimulated and/or unstimulated salivary flow rate was mixed (9 positive, 10 no effect); this broad outcome was not meta-analyzed.

1 finding from 1 review

Gum chewing (sugar-free) vs Within-subject before/after comparison of soft gum vs hard gum (no no-gum control)

Oral mucosal moisture · Elderly (>60 years) and medically compromised adults with xerostomia / dry mouth

One small study found that chewing hard (but not soft) gum increased oral mucosal moisture.

1 finding from 1 review

Gum chewing (sugar-free) vs No chewing gum

Salivary flow rate (unstimulated) · Elderly (>60 years) and medically compromised adults with xerostomia / dry mouth

In elderly and medically compromised people with xerostomia, chewing sugar-free gum daily for two or more weeks produces a small but statistically significant increase in unstimulated whole salivary flow rate versus no gum (SMD 0.44, 95% CI 0.22 to 0.66); certainty of evidence was not formally graded.

1 finding from 1 review

Gum chewing (sugar-free) vs No chewing gum

Dry mouth (xerostomia) · Elderly (>60 years) and medically compromised adults with xerostomia / dry mouth

Gum chewing was linked with improved self-reported xerostomia / dry mouth in most studies (12 of 17 positive, 5 no effect); heterogeneous instruments precluded meta-analysis.

1 finding from 1 review