Non-Cochrane · intervention · PM33926448
A systematic review and meta-analysis of the role of sugar-free chewing gum on Streptococcus mutans.
Nasseripour Melanie, Newton Jonathon Timothy, Warburton Fiona, et al. · BMC oral health · 2021 · PubMed · doi:10.1186/s12903-021-01517-z
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
3
current version
GRADE rated
0
No studies
0
Included studies
14
linked below
No studies 0 · 0%Ungraded 3 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults and children (any age) who chew sugar-free gum | Adults and children (8 studies in adults, 5 in children); n=13 studies, 1335 participants |
| Intervention | Chewing of sugar-free gum (SFG; polyol-based, e.g. xylitol, sorbitol, maltitol) as the main intervention | Sugar-free gum, predominantly xylitol-containing (12/13 studies xylitol); chewed 2-5 times/day for 5-15 min |
| Comparison | Those who do not chew gum, who chew a control/placebo gum, or who receive alternatives such as probiotics or fluoride varnish | No gum (8 studies), placebo gum (2), control gum (1), fluoride varnish (1), probiotic (1) |
| Outcomes | Level of oral micro-organisms, specifically Streptococcus mutans (also adverse effects, acceptability and adherence) | Streptococcus mutans load reduced (any SFG: SMD -0.42, 95% CI -0.60 to -0.25; xylitol only: SMD -0.46, 95% CI -0.64 to -0.28); no adverse events reported |
| Study designs | Controlled trials (RCTs and non-randomised controlled trials) with adult and child participants | 13 controlled trials: 11 RCTs, 1 patient-preference non-randomised trial, 1 unspecified-design trial |
| Timing | Not specified | Follow-up 2 weeks to 18 months; final time point used in the analysis |
Search date: 1 January 1946 to 31 August 2020. Databases: Ovid MEDLINE; Ovid EMBASE; Ovid PsycINFO; Scopus; Web of Science; Allied and Complementary Medicine Database (AMED); Cochrane Central Register of Controlled Trials (CENTRAL); Open Grey; PROSPERO; Cochrane Library of Systematic Reviews
Questions and results
Sugar-free chewing gum (any polyol-based SFG; predominantly xylitol) vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish
Population: Adults and children (general population)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) Final/end-of-study time point (follow-up 2 weeks to 18 months) · Sensitivity analysis: baseline-to-endpoint correlation 0.95 for SFG arm 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. Source: Results (meta-analysis paragraph; correlation sensitivity analysis) · same question in other reviews | SMD -0.55 [-0.80, -0.30] | 13 studies · 1335 participants | Ungraded |
Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) Final/end-of-study time point (follow-up 2 weeks to 18 months) · Overall (vs all controls) Chewing sugar-free gum significantly reduced Streptococcus mutans load versus pooled controls (SMD -0.42, 95% CI -0.60 to -0.25; 13 controlled trials, I2 44%); certainty not formally graded. Source: Results (meta-analysis paragraph); Fig. 3 (forest plot, overall diamond); Abstract; Table 1 · same question in other reviews | SMD -0.42 [-0.60, -0.25] | 13 studies · 1335 participants | Ungraded |
Xylitol-only sugar-free chewing gum vs Pooled controls: no gum, placebo/control gum, probiotic, or fluoride varnish
Population: Adults and children (general population)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) Final/end-of-study time point (follow-up 2 weeks to 18 months) · Overall (vs all controls) 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. Source: Results (second meta-analysis, xylitol gum only); Abstract · same question in other reviews | SMD -0.46 [-0.64, -0.28] | 12 studies · 1295 participants | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Yes | Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 14
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Wang 2006 matched by author and year (probable) | 1 other review | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Al-Haboubi 2012 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Alamoudi 2012 / Hanno 2011 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Caglar 2007 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Campus 2009 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Ghasemi 2017 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Hanno 2011; Alamoudi 2012 Plasma and urine profiles of Delta9-tetrahydrocannabinol and its metabolites 11-hydroxy-Delta9-tetrahydrocannabinol and… PMID:20112012 | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Haresaku 2007 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Hildebrandt 2000 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Hildebrandt 2010 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Hoerman 1979 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Makinen 2005 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Seki 2011 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
| Thaweboon 2004 matched by author and year (probable) | this review only | Streptococcus mutans load in the oral cavity (saliva and/or dental plaque) | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Clinical Effects of Sugar Substitutes on Cariogenic Bacteria: A Systematic Review and Meta-Analysis. (2024) | 1 | 0.02 |