Non-Cochrane · intervention · PM35434703
A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum on Plaque Quantity in the Oral Cavity.
Nasseripour Melanie, Newton Jonathon Timothy, Warburton Fiona, et al. · Frontiers in oral health · 2022 · PubMed · doi:10.3389/froh.2022.845921
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
4
current version
GRADE rated
0
No studies
0
Included studies
8
linked below
No studies 0 · 0%Ungraded 4 · 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 who chew sugar-free gum | Adults and children across 8 studies (predominantly adults; one pediatric study, Kandelman) |
| Intervention | Chewing of sugar-free gum (SFG) as the main intervention; polyols (xylitol, sorbitol, maltitol) qualify as sugar-free | Sugar-free gum (xylitol, sorbitol, maltitol); xylitol-containing gums predominated |
| Comparison | Those who do not chew SFG, do not chew gum, or use alternatives such as probiotics or fluoride varnish | No gum / no chewing (one study used a gum-base / no-active-ingredient control) |
| Outcomes | Plaque quantity (increase or decrease) | Plaque quantity measured by plaque index or plaque weight |
| Study designs | Trials including RCTs, crossover, pre-post, pre-post one-arm, post-only, and any design with a comparative arm (crossover required >=7-day washout) | 7 RCTs and 1 non-randomized controlled clinical trial (8 studies) |
| Timing | Not specified (primary research published 1946-2020) | Follow-up 4 days to 2 years; only 2 of 8 studies extended beyond 6 months |
Search date: Primary research published 1 January 1946 to 31 August 2020. Databases: Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Scopus, Web of Science, AMED, Cochrane CENTRAL, OpenGray; also searched PROSPERO and the Cochrane library of systematic reviews and reference lists of included studies
Questions and results
Sugar-free chewing gum (any polyol: xylitol, sorbitol, or maltitol), chewed regularly vs No sugar-free gum / no chewing gum (or gum-base control); no chewing
Population: Adults and children (predominantly adults; one study in children), with natural dentition
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque quantity (plaque index or plaque weight) End of study (last reported time point; study durations 4 days to 2 years) 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). Source: Results (para 2); Table 4; Figure 3; Abstract · same question in other reviews | SMD -0.778 [-1.167, -0.390] | 7 studies | Ungraded |
Plaque quantity (plaque index or plaque weight) End of study (last reported time point; study durations 4 days to 2 years) · Sensitivity analysis (pre-post correlation set to 0.95 for the SFG group) A sensitivity analysis assuming a 0.95 pre-post correlation for the SFG group gave a larger reduction in plaque quantity (SMD -1.098, 95% CI -1.539 to -0.656; I2 = 89.73%; ungraded). Source: Results (para 2); Abstract · same question in other reviews | SMD -1.098 [-1.539, -0.656] | 7 studies | Ungraded |
Xylitol sugar-free chewing gum vs No sugar-free gum / no chewing gum (or gum-base control); no chewing
Population: Adults and children (predominantly adults; one study in children), with natural dentition
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque quantity (plaque index or plaque weight) End of study (last reported time point; study durations 4 days to 2 years) 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). Source: Results (para 2); Table 5; Figure 4; Abstract · same question in other reviews | SMD -0.743 [-1.148, -0.338] | 7 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | No adverse events reported | 8 studies | 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 | Partial Yes | no |
| 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 8
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Al-Haboubi 2012 The potential benefits of sugar‐free chewing gum on the oral health and quality of life of older people living in the community: a… DOI:10.1111/j.1600-0528.2012.00685.x | 1 other review | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Haresaku 2007 Long-Term Effect of Xylitol Gum Use on Mutans Streptococci in Adults DOI:10.1159/000099318 | 1 other review | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Kandelman 1990 A 24-month Clinical Study of the Incidence and Progression of Dental Caries in Relation to Consumption of Chewing Gum Containing Xylitol… DOI:10.1177/00220345900690111201 | this review only | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Keukenmeester 2014 Effects of sugar‐free chewing gum sweetened with xylitol or maltitol on the development of gingivitis and plaque: <i>a randomized clinical… DOI:10.1111/idh.12071 | this review only | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Mouton 1975 Effect of a xylitol chewing gum on plaque quantity and quality DOI:10.3109/00016357509004630 | this review only | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Saheer 2019 DOI:10.4103/ijdr.ijdr_247_17 | this review only | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Simons 2001 The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes. A… DOI:10.1034/j.1600-051x.2001.281104.x | this review only | Plaque quantity (plaque index or plaque weight) | not extracted yet | not extracted yet |
| Wang 2006 Effects of xylitol in chewing gum on dental plaque and Streptococcus mutans DOI:10.38212/2224-6614.2504 | this review only | Plaque quantity (plaque index or plaque weight) | 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).