A systematic review and meta-analysis of the effects of mastication on sustained attention in healthy adults

Immediate and residual effects of functional chewing gum on sustained attention and mood

Objectives: Chewing gum has been shown to improve aspects of cognition and mood with sustained attention being particularly receptive to the effects of chewing. Chewing gum may also be a useful vehicle for administering functional ingredients. The herbal extract Rhodiola rosea and certain B-vitamins have previously been shown to improve aspects of cognition and subjective state, but their combined effects have not been studied to date.Methods: The current randomised, placebo-controlled, double-blind, balanced crossover study compared the effects of a functional gum containing Rhodiola rosea and B-vitamins to flavour-matched regular chewing gum and a flavour-matched placebo. Thirty-six healthy young participants completed measures of attention and mood at baseline, during chewing, and 1-h after chewing.Results: Chewing both functional and regular gum was shown to reduce errors on a digit vigilance task compared to placebo irrespective of whether measured during or after chewing. There were no benefits to adding functional ingredients to the gum.Discussion: Future chewing research should consider different formats of placebo. Sex differences in response to chewing and the impact of rate and intensity of chewing should also be explored.Trial registration: ClinicalTrials.gov identifier: NCT05544500.

DO ORAL CARE AND REHABILITATION IMPROVE COGNITIVE FUNCTION? A SYSTEMATIC REVIEW OF CLINICAL STUDIES

OBJECTIVES

An increasing number of studies have identified an association between oral health status and cognitive function. However, the effect of oral interventions, including oral health care, dental treatment and oral motor exercises, on cognitive function remains unclear. This systematic review examined whether oral interventions contribute to the long-term improvement of cognitive status.

METHODS

Four databases were searched (MEDLINE, Web of Science, Cochrane Library, and ICHUSHI Web) to identify randomized and nonrandomized controlled trial studies and prospective cohort studies from inception until 1 September 2023, published in English or Japanese. The Cochrane risk of bias tool for randomized controlled trials and the risk of bias assessment tool for nonrandomized studies were used to assess bias risk.

RESULTS

A total of 20 articles were included in the qualitative analysis; 13 articles were published in English, and 7 were published in Japanese. The implemented interventions were oral care in 8 studies, dental treatment in 8 studies, and oral motor exercise in 4 studies. One study found a significant effect on attention following oral care intervention. Some dental treatments influenced cognitive function, although a clear positive effect was not determined. In 1 study, attention and working memory improved in the chewing exercise group.

CONCLUSIONS

Several studies verified the improvement effects of oral interventions, such as oral care, dental treatment, and oral motor exercise, on cognitive function or impairment. However, there was still a lack of conclusive evidence that such an intervention clearly improved cognitive function. To clarify the effects of oral interventions on cognitive function, it is necessary to examine participants, interventions, and outcome measures in detail.

Effects of Chewing Gum on Nitric Oxide Metabolism, Markers of Cardiovascular Health and Neurocognitive Performance after a Nitrate-Rich Meal

OBJECTIVES

Cardiovascular and neurocognitive responses to chewing gum have been reported, but the mechanisms are not well understood. Chewing gum after a nitrate-rich meal may upregulate the reduction of oral nitrate to nitrite and increase nitric oxide (NO), a molecule important to cardiovascular and neurocognitive health. We aimed to explore effects of chewing gum after a nitrate-rich meal on nitrate metabolism (through the enterosalivary nitrate-nitrite-NO pathway), endothelial function, blood pressure (BP), neurocognitive performance, mood and anxiety.

METHODS

Twenty healthy men (n = 6) and women (n = 14) with a mean age of 48 years (range: 23-69) were recruited to a randomized controlled cross-over trial. After consumption of a nitrate-rich meal (180 mg of nitrate), we assessed the acute effects of chewing gum, compared to no gum chewing, on (i) salivary nitrate, nitrite and the nitrate reductase ratio (100 x [nitrite]/([nitrate] + [nitrite]); (ii) plasma nitrite, S-nitrosothiols and other nitroso species (RXNO); (iii) endothelial function (measured by flow mediated dilatation); (iv) BP; (v) neurocognitive performance; (vi) mood; and (vii) anxiety.

RESULTS

Consumption of the nitrate-rich meal resulted in a significant increase in markers of nitrate metabolism. A significantly higher peak flow mediated dilatation was observed with chewing compared to no chewing (baseline adjusted mean difference: 1.10%, 95% CI: 0.06, 2.14; p = 0.038) after the nitrate-rich meal. A significant small increase in systolic BP, diastolic BP and heart rate were observed with chewing compared to no chewing after the nitrate-rich meal. The study did not observe increased oral reduction of nitrate to nitrite and NO, or improvements in neurocognitive performance, mood or anxiety with chewing compared to no chewing.

CONCLUSION

Chewing gum after a nitrate-rich meal resulted in an acute improvement in endothelial function and a small increase in BP but did not result in acute effects on neurocognitive function, mood or anxiety.

Measuring attention and vigilance in the laboratory vs. online: The split-half reliability of the ANTI-Vea

Over the past few years, there has been growing interest in using online methods for collecting data from large samples. However, only a few studies have administered online behavioral tasks to assess attention outside the lab. In the present study, we assessed the classic attentional functions and two vigilance components using two versions of the Attentional Networks Test for Interactions and Vigilance-executive and arousal vigilance components (ANTI-Vea): (1) a standard version, performed under typical experimental conditions (n = 314), and (2) an online version, completed outside the lab (n = 303). Both versions were equally effective in assessing (1) the main effects and interactions of phasic alertness, orienting, and executive control, and (2) the executive (i.e., a decline in the ability to detect infrequent critical signals) and the arousal (i.e., a progressive slowness and variability in responses to stimuli from the environment) vigilance decrement across time on task. Responses were generally slower in the online than in the standard version. Importantly, the split-half reliability observed for both tasks was (1) higher for executive control (~.67) than for phasic alertness and orienting (< .40), as observed in previous versions of the task, and (2) between .71 and .99 for the executive and arousal vigilance measures. We expect the present study will be of interest to researchers aiming to assess attentional functions with a valid and reliable method that, importantly, is publicly available on an open website ( https://www.ugr.es/~neurocog/ANTI/ ) and is easy to use in applied contexts.

The effect of masticatory behaviour on generalized attention in heathy volunteers

AIM

As our society ages, the number of people living with dementia also steadily increases. Some work has focused on masticatory behaviour as a form of daily health care that could help prevent cognitive impairment and dementia. However, it is not yet clear how masticatory behaviour influences various cognitive functions. Therefore, the purpose of this study was to examine the effect of masticatory behaviour on the decline of generalized attention, an important cognitive function.

METHODS

Participants were 35 healthy, dentulous individuals without stomatognathic abnormalities (24 men, 11 women; mean age: 56.8 ± 4.8 years). All participants completed three interventions: mastication, foot-stepping, and none (control). Pre- and post-intervention measures of generalized attention were measured by using neuropsychological tests to examine general attention; the results were then compared. Simultaneously, during the generalized attention task, the functional activity of the prefrontal cortex was observed on functional near-infrared spectroscopy.

RESULTS

Response time of generalized attention improved in both the masticatory and foot-stepping interventions. There was a transient increase in oxyhaemoglobin activity in the right and left prefrontal cortices in the masticatory intervention.

CONCLUSIONS

Masticatory behaviour may be involved in a partial improvement of generalized attention and may induce prefrontal cortex activity in middle-aged and older adults.

Effects of Chewing Training on Orofacial and Cognitive Function in Healthy Individuals: A Systematic Review

Background: There is some evidence showing significant correlations between acute chewing gum and orofacial function, and between acute chewing gum and cognitive function; however, as far as we are aware, little is known about the chronic effects of chewing gum training on cognitive and orofacial functions in healthy adults. Objectives: To evaluate the chronic effects of chewing gum training on orofacial and cognitive functions in healthy adults. Method: Searches of the electronic databases PubMed, Scopus, BVS, CENTRAL, Scopus, and Google Scholar were conducted from inception to 14 January 2020. The inclusion criteria used were: clinical trial or randomized controlled trial lasting a minimum of four weeks, chewing gum intervention in at least one arm of the study, presence of a non-exercise control group, study population consisting of healthy adults, study outcomes consisting of orofacial function and/or cognitive function. Results: Starting from 5973 sources, a total of six articles met the inclusion criteria, and they were subjected to a systematic review. The main findings were that chewing gum training improved some variables related to orofacial function. No clear effect of chewing gum training on cognitive function was found. Conclusions: Chronic chewing gum training has an unclear positive effect on specific variables related to orofacial and cognitive function in healthy adults.