RESUMEN
Habitual xylitol gum-chewing may have a long-term preventive effect by reducing the caries risk for several years after the habitual chewing has ended. The goal of this report was (1) to determine if sorbitol and sorbitol/xylitol mixtures provide a long-term benefit, and (2) to determine which teeth benefit most from two-year habitual gum-chewing - those erupting before, during, or after habitual gum-chewing. Children, on average 6 years old, chewed gums sweetened with xylitol, sorbitol, or xylitol/sorbitol mixtures. There was a "no-gum" control group. Five years after the two-year program of habitual gum-chewing ended, 288 children were re-examined. Compared with the no-gum group, sorbitol gums had no significant long-term effect (relative risk [RR], 0.65; 95% confidence interval [c.i.], 0.39 to 1.07; p < 0.18). Xylitol gum and, to a lesser extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5 years after habitual gum-chewing ended, xylitol gums reduced the caries risk 59% (RR, 0.41; 95% c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums reduced the caries risk 44% (RR, 0.56; 95% c.i., 0.36 to 0.89; p < 0.02). The long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02). Teeth that erupted after 1 year of gum-chewing or after the two-year habitual gum use ended had long-term caries risk reductions of 93% (p < 0.0054) and 88% (p < 0.0004), respectively. Teeth that erupted before the gum-chewing started had no significant long-term prevention (p < 0.30). We concluded that for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt.
Asunto(s)
Goma de Mascar , Caries Dental/prevención & control , Belice/epidemiología , Goma de Mascar/estadística & datos numéricos , Distribución de Chi-Cuadrado , Niño , Estudios de Cohortes , Índice CPO , Caries Dental/epidemiología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Riesgo , Sorbitol/uso terapéutico , Factores de Tiempo , Erupción Dental , Xilitol/uso terapéuticoRESUMEN
A previous caries trial (Belize studies) involved the usage of sucrose chewing-gum for a period of 40 months in one group of initially 10-year-old subjects in an environment of high sugar consumption, high caries activity, and limited access to restorative care. After the termination of the 40-month supervised sucrose gum usage, the 109 subjects of the original sucrose group retrieved at the endpoint of the original trial were invited to participate in a xylitol chewing-gum programme (involving the usage of the '100% pellet-shaped formular') for 16 months. The average daily consumption level of xylitol was up to 14 g per subject, normally used in seven daily chewing episodes. Although most subjects used chewing-gum at schools and received their gum portions from a school official, gum chewing during these 16 months was mostly unsupervised. After 16 months, 83 subjects (76%; mean age 14.9 years) were retrieved. The caries status of these subjects was examined by the same calibrated, blinded examiners as in the original trial. To mask the examiners, 141 similar non-participating subjects were recruited from the same school classes and were examined in a random order with the gum-using subjects, according to the same standard routine. The intensified xylitol gum usage for 16 months was associated with a reduction of the mean DMFS score from 10.9 (at 40 months) to 9.3 (at 56 months, p = 0.0013) and a reduction in caries rate from 20.1 caries onsets per 1,000 surface-years (40-month period average rate) to 10.2 caries onsets per 1,000 surface-years. The reduction in DMFS score resulted mostly from the change in the D component of the index and possibly reflected a stabilisation of the caries process and rehardening of some caries lesions to a non-progressive carious state.
Asunto(s)
Goma de Mascar , Caries Dental/terapia , Remineralización Dental/métodos , Xilitol/administración & dosificación , Adolescente , Belice/epidemiología , Índice CPO , Caries Dental/epidemiología , Caries Dental/etiología , Humanos , Incidencia , Método Simple Ciego , Sacarosa/efectos adversosRESUMEN
The effect of 2-year chewing-gum use on the caries rates of primary teeth was studied in a combined school and home program in a sample of 510 initially 6-year-old subjects with high caries experience, low availability of fluoride, and difficult access to dental care. The gum, formed into either sticks or pellets, comprised either xylitol, sorbitol, or mixtures thereof. The gum was chewed for 5 min under supervision five times a day during the school year, and for variable times during nonschool days. Seven groups were studied. One group received no gum; two xylitol gum groups received either pellet or stick gum as did, two sorbitol gum groups, and two groups received either of two types of xylitol/sorbitol pellet gum. The response variable was the development of a frank carious lesion detectable by physical loss of enamel and probable extension to the dentin for those surfaces of primary teeth that were not cavitated at baseline. Caries rates associated with the use of each of the gum types were compared to the caries rates in the no-gum group. The usage of all polyol gums resulted in a significant decrease of the caries onset rate (p < 0.05). The caries onset risk for a primary surface in the xylitol pellet and the sorbitol pellet groups was 35 and 44% of that in the no-gum group (relative risk, 0.35; 95% confidence interval, 0.21-0.59; relative risk, 0.44; 95% confidence interval, 0.30-0.63, respectively). The caries onset risk in the xylitol stick gum group was 53% of that in the no-gum group (relative risk, 0.53; 95% confidence interval, 0.39-0.72), which was marginally (p = 0.1520) lower than in the sorbitol stick gum group (relative risk, 0.70; 95% confidence interval, 0.52-0.94). The usage of both xylitol/sorbitol mixtures in pellet form was associated with a caries onset rate comparable with the usage of the xylitol stick gum. The largest caries risk reduction was observed in the group receiving xylitol pellet gum.
Asunto(s)
Cariostáticos/uso terapéutico , Goma de Mascar , Caries Dental/prevención & control , Sorbitol/uso terapéutico , Xilitol/uso terapéutico , Belice/epidemiología , Niño , Estudios de Cohortes , Caries Dental/epidemiología , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Incidencia , Masculino , Análisis de Regresión , Riesgo , Diente PrimarioRESUMEN
Dental caries is a pandemic infectious disease which can affect the quality of life and consumes considerable health care resources. The chewing of xylitol, sorbitol, and even sugar gum has been suggested to reduce caries rates. No clinical study has simultaneously investigated the effectiveness of these gums when compared with a group receiving no chewing gum. A 40-month double-blind cohort study on the relationship between the use of chewing gum and dental caries was performed in 1989-1993 in Belize, Central America. One thousand two hundred and seventy-seven subjects (mean age, 10.2 years) were assigned to nine treatment groups: one control group (no supervised gum use), four xylitol groups (range of supervised xylitol consumption: 4.3 to 9.0 g/day), two xylitol-sorbitol groups (range of supervised consumption of total polyols: 8.0 to 9.7 g/day), one sorbitol group (supervised consumption: 9.0 g/day). The gum use during school hours was supervised. Four calibrated dentists performed the caries registrations by means of a modified WHO procedure. The primary endpoint was the development of an unequivocal caries lesion on a non-cavitated tooth surface. Compared with the no-gum group, sucrose gum usage resulted in a marginal increase in the caries rate (relative risk, 1.20; 95% confidence interval,0.96 to 1.49; p = 0.1128). Sorbitol gum significantly reduced caries rates (relative risk 0.74; 95% confidence interval, 0.6 to 0.92 ; p = 0.0074). The four xylitol gums were most effective in reducing caries rates, the most effective agent being a 100% xylitol pellet gum (relative risk, 0.27; 95% confidence interval, 0.20 to 0.36; p = 0.0001). This gum was superior to any other gum (p < 0.01). The xylitol-sorbitol mixtures were less effective than xylitol, but they reduced caries rates significantly compared with the no-gum group. DMFS analyses were consistent with these conclusions. The results suggest that systematic usage of polyol-based chewing gums reduces caries rates in young subjects, with xylitol gums being more effective than sorbitol gums.
Asunto(s)
Goma de Mascar , Caries Dental/prevención & control , Edulcorantes/uso terapéutico , Xilitol/uso terapéutico , Belice/epidemiología , Distribución de Chi-Cuadrado , Niño , Estudios de Cohortes , Índice CPO , Caries Dental/epidemiología , Pruebas de Actividad de Caries Dental , Método Doble Ciego , Femenino , Humanos , Incidencia , Masculino , Variaciones Dependientes del Observador , Distribución de Poisson , Análisis de Regresión , Factores de Riesgo , Sorbitol/uso terapéutico , Sacarosa , Alcoholes del Azúcar/uso terapéuticoRESUMEN
The purpose of this paper is to report clinical observations on the stabilisation of dentine caries in two chewing gum studies carried out in young subjects. One study focused on the permanent dentition of 1,277 initially 10-year old subjects, while the other study was carried out on 510 initially 6-year old subjects and focused on the primary dentition. In both trials, several chewing gum formulas containing dietary polyols (xylitol and sorbitol, or their combinations) were used for up to 40 months (10-year olds) or up to 24 months (6-year olds). The daily consumption level of both polyols was up to 10.7 g per subject, used normally in 5-minute chewing episodes 3 to 5 times per day. Supervised chewing in schools lasted 5 min per episode, and for variable times during non-school days. Rehardening of dentine caries lesions was observed clinically by experienced, blinded examiners using sharp dental explorers and fibre optic light. After 40 months (permanent dentition) or after 18 months (primary dentition), rehardening (caries arrest) generally occurred more frequently in subjects who used polyol gums than in subjects who did not receive gum as part of the programmes, or who received sucrose gum. Arrest or non-progression of dentine caries was most frequently observed in subjects who used 100 per cent xylitol gums or mixtures of xylitol and sorbitol, but the differences between gums were not consistently significant. However, the usage of 100 per cent xylitol pellet-shaped gum was more frequently associated with arrest of dentine caries than other treatments. These results and previous studies suggest that high-xylitol chewing gum usage can retard or arrest even rampant dentine caries in conditions where effective restoration and prevention programmes have not been instituted, and can also provide additional protection against further caries development during full implementation of restorative procedures by holding the lesion in a non-progressive condition.