The efficacy of an anti-gingivitis chewing gum

Innovations in Chewable Formulations: The Novelty and Applications of 3D Printing in Drug Product Design

Since their introduction, chewable dosage forms have gained traction due to their ability to facilitate swallowing, especially in paediatric, geriatric and dysphagia patients. Their benefits stretch beyond human use to also include veterinary applications, improving administration and palatability in different animal species. Despite their advantages, current chewable formulations do not account for individualised dosing and palatability preferences. In light of this, three-dimensional (3D) printing, and in particular the semi-solid extrusion technology, has been suggested as a novel manufacturing method for producing customised chewable dosage forms. This advanced approach offers flexibility for selecting patient-specific doses, excipients, and organoleptic properties, which are critical for ensuring efficacy, safety and adherence to the treatment. This review provides an overview of the latest advancements in chewable dosage forms for human and veterinary use, highlighting the motivations behind their use and covering formulation considerations, as well as regulatory aspects.

The comparative effect of propolis in two different vehicles; mouthwash and chewing-gum on plaque accumulation and gingival inflammation

Objective:

In general, chemical plaque agents have been used in mouthwashes, gels, and dentifrices. In some situations, application of mouthwashes and dentifrices can be difficult. Therefore, different approaches for oral health-care have been needed. The aim of this study was to evaluate the effect of propolis chewing-gum compared to propolis-containing mouthwash on gingival inflammation and plaque accumulation on patients that refrained from daily oral hygiene procedures for 5 days.

Materials and Methods:

10 college students with systemically healthy and very good oral hygiene and gingival health were included in this randomized, single-blind, crossover 5-day plaque regrowth with a 3-day washout period clinical study. After plaque scores were reduced to zero, participants were asked to refrain from oral hygiene procedures and allocated to either propolis mouthwash or chewing-gum group. Chewing-gum was performed after meals 3 times a day for 20 min mouthwash group was instructed to rinse mouthwash 2 times a day for 1 min. On day 5, the clinical periodontal measurements containing plaque and gingival indexes were taken from the participants.

Results:

The both plaque and gingival indexes of propolis mouthwash group were significantly lower than that of the propolis chewing-gum group (P = 0.005).

Conclusion:

It was demonstrated that the propolis mouthwash was more effective than the propolis chewing gum on the plaque inhibition and the gingival inflammation.

Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment

Oral diseases, such as dental caries and periodontal disease are directly linked with the ability of bacteria to form biofilm. The development of dental caries involves acidogenic and aciduric Gram-positive bacteria colonizing the supragingival biofilm (Streptococcus, Lactobacillus and Actinomycetes). Periodontal diseases have been linked to anaerobic Gram-negative bacteria forming a subgingival plaque (Porphyromonas gingivalis, Actinobacillus, Prevotella and Fusobacterium). Cells embedded in biofilm are up to 1000-fold more resistant to antibiotics compared to their planctonic ones. Several mechanisms have been proposed to explain biofilms drug resistance. Given the increased bacterial resistance to antibiotics currently used in dentistry, a great importance is given to natural compounds for the prevention of oral bacterial growth, adhesion and colonization. Over the past decade, interest in drugs derived from medicinal plants has markedly increased. It has been well documented that medicinal plants and natural compounds confer considerable antibacterial activity against various microorganisms including cariogenic and periodontal pathogens. This paper provides a review of the literature focusing on the studies on (i) biofilm in the oral cavity, (ii) drug resistance of bacterial biofilm and (iii) the potential use of plant extracts, essential oils and natural compounds as biofilm preventive agents in dentistry, involving their origin and their mechanism of biofilm inhibition.

The potential of dental-protective chewing gum in oral health interventions

BACKGROUND

The authors provide an overview of chewing gum as a delivery vehicle for dental-protective agents, highlighting xylitol and its potential application in caries-prevention programs for children.

TYPES OF STUDIES REVIEWED

The authors reviewed selected clinical investigations and previous reviews associated with chewing gum containing substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol and their effects on reducing caries. They searched the MEDLINE database by using the key words "dental caries," "oral health," "calcium," "bicarbonate," "carbamide," "chlorhexidine," "fluoride" and "xylitol."

RESULTS

Chewing gum is being used as a delivery vehicle for substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol to improve oral health and reduce caries. These substances exhibit properties that are protective of the oral environment and mediate common oral diseases. The debate for advocating xylitol use in caries prevention is advancing; however, chewing gum use by young schoolchildren in the United States is hindered by choking hazard concerns and lack of specific xylitol dosing recommendations.

CLINICAL IMPLICATIONS

The use of chewing gum containing dental-protective substances, particularly xylitol, in caries-prevention programs can reduce the tooth decay epidemic. Chewing gum use by children in the school setting should be reconsidered.

Practical approaches of taste masking technologies in oral solid forms

In the pharmaceutical industry, taste masking techniques are applied to prevent active pharmaceutical ingredients exhibiting a bitter and unpleasant taste. The oral administration of bitter drugs through solid dosage forms requires an acceptable degree of palatability, patient tolerance and significant therapeutic value. In the recent years, enormous progress in taste masking technologies has given rise to novel strategies such as fast dissolving dosage forms, chewable tablets and coating of molten materials. Similarly, common technologies applying double coating layers, microencapsulation or even chemical modification have been employed to improve patient compliance. This review endeavours to present the practical technologies and platforms applied for taste masking and indicate the most interesting features of each approach.

Stability of Antimicrobial Decapeptide (KSL) and Its Analogues for Delivery in the Oral Cavity

PURPOSE

To investigate the stability of KSL, an antimicrobial decapeptide, and its analogues, in human saliva and simulated gastric fluid for delivery in the oral cavity.

MATERIALS AND METHODS

The degradation products of KSL in human saliva and simulated gastric fluid were separated by reversed-phase HPLC and their structures were identified by electrospray ionization-mass spectrometry. Analogues of KSL were synthesized by solid-phase synthesis procedure. Their enzymatic stabilities and antimicrobial activities were studied.

RESULTS

KSL was degraded by the peptide bond cleavages at Lys(6)-Val(7) in the human saliva and Phe(5)-Lys(6) in simulated gastric fluids. Three analogues of KSL were synthesized; the Lys(6) residue was either methylated (KSL-M), or replaced with Trp (KSL-W), or the d-form of Lys (KSL-D). The KSL analogues were much more stable than the native KSL, with the rank order of stability being KSL-D > KSL-W > KSL-M > KSL in human saliva. However, in simulated gastric fluid, while KSL-D was still stable, KSL-W was significantly degraded. In addition, KSL-D significantly lost the antimicrobial activity, whereas KSL-W completely preserved the activity against several oral bacteria. In a chewing gum formulation, KSL-W showed a more sustained release profile as compared with the native KSL.

CONCLUSION

This study suggests that KSL-W could be used as an antiplaque agent in a chewing gum formulation.

An efficacy and safety analysis of a chlorhexidine chewing gum in young orthodontic patients

AIM

The objective of the present study was to investigate the impact of a chlorhexidine (CHX) chewing gum in teenage orthodontic patients on plaque levels, gingival bleeding tendency and tooth staining.

MATERIALS AND METHODS

A randomized-controlled, double-blind, parallel study was conducted on 31 teenagers in fixed orthodontic therapy. Subjects of the CHX gum group were asked to continue their oral hygiene procedures in conjunction with chewing two pieces of a 5 mg CHX-containing chewing gum for 10 min. twice a day for 3 months. Subjects of the placebo gum group received the same instructions; however, using a CHX-free chewing gum. Plaque levels, gingival bleeding on probing and tooth staining were monitored at baseline and subsequently after 1-3 months.

RESULTS

Plaque levels significantly decreased from baseline at lingual/palatal sites in the placebo gum group. In the CHX gum group, a similar, yet non-significant trend was observed. At buccal sites, plaque levels remained unaffected in both groups. Gingival bleeding tendency significantly decreased in both groups, predominantly at lingual/palatal sites. There were no significant between-group differences in any of the efficacy parameters at any time point. However, the increase in staining was nearly five times higher in the CHX gum group.

CONCLUSIONS

There seems to be no indication for a CHX chewing gum in teenage orthodontic patients when used as an adjunct to normal oral hygiene practices.

A Systematic Review on the Effects of the Chlorhexidine Chip When Used as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis

BACKGROUND

Several local antimicrobial agents, such as a bioabsorbable chlorhexidine chip, have been developed to enhance the outcome of non-surgical periodontal therapy.

METHODS

Electronic (MEDLINE and Cochrane Oral Health Group Specialized Trials Register) and manual searches were performed to detect studies concerning the use of the chlorhexidine chip as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Only full-text randomized controlled trials published in English up to June 2005 were included.

RESULTS

Five studies were finally selected following independent screening by two reviewers. Due to considerable heterogeneity in study design, a qualitative data analysis was performed. Multicenter studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of mechanical debridement and repeated chlorhexidine chip administration in comparison to scaling and root planing alone. However, some recent studies failed to confirm the additional value of the chlorhexidine chip. A number of interstudy disparities with respect to methodological quality and study design may account for this lack of accordance.

CONCLUSIONS

The clinical and microbiological data currently available on the chlorhexidine chip are limited and conflicting. More research is needed to elucidate the additional value of the chlorhexidine chip when used as an adjunct to scaling and root planing.

The MediChew®technology platform

A few decades ago, chewing gum was rarely considered when industry searched for an applicable delivery vehicle for an active pharmaceutical substance. Yet, the 1980s and 1990s saw gum become the most successful nicotine delivery form; unawareness changed to cautious scepticism, and today the merits of chewing gum drug delivery technologies are generally appreciated. MediChew is the registered trademark of Fertin Pharma's medical chewing gum technology platform. Based on patent-protected technologies, it offers unique taste-masking possibilities and allows control of drug molecule release. Medical chewing gum products based on these technologies are specifically suitable for convenient administration on demand, for active substances providing a topical effect in the oral cavity and throat, and for systemic delivery of drug molecules that readily cross the oromucosal membranes.

A non-staining chlorhexidine mouthwash? Probably not: a study in vitro

BACKGROUND AND AIM

Tooth staining is a common side effect of chlorhexidine mouth rinses and caused by the interaction of the di-cationic antiseptic with dietary chromogens. A product is now available, which claims an anti-discolouration system (ADS) with one clinical study in support. This study in vitro aims to determine whether two ADS rinses do or do not bind dietary chromogens.

METHOD AND MATERIALS

Optically clear acrylic specimens were cycled through human saliva (2 min), one of the three chlorhexidine rinses (two ADS and a positive control) (2 min) or water and then soaked in tea (60 min). After each cycle the optical density (OD) of specimens were read on a UV/visible spectrophotometer. The exit point was the cycle at which OD was >2.0.

RESULTS

All three rinses exceeded OD 2 at 11 cycles and there was no significant difference in staining for the ADS rinses compared with the positive control rinse.

CONCLUSION

Based on extensive literature for the correlation of this test in vitro with chlorhexidine anti-plaque activity and propensity to stain in vivo these ADS rinses will have the same anti-plaque efficacy and potential to cause stain as established chlorhexidine rinse products.

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes

AIM

A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated.

METHODS

Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months.

RESULTS

In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum.

CONCLUSION

The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.

Oral hygiene measures and promotion: review and considerations

Current mechanical and chemotherapeutic approaches to oral hygiene aim to modify the oral microflora to promote healthy periodontal and dental tissues. Current oral hygiene measures, appropriately used and in conjunction with regular professional care, are capable of virtually preventing caries and most periodontal disease and maintaining oral health. Toothbrushing and flossing are most commonly used, although interdental brushes and wooden sticks can offer advantages in periodontally involved dentitions. Chewing sugar-free gums as a salivary stimulant is a promising caries-preventive measure. Despite new products and design modifications, mechanical measures require manual dexterity and cognitive ability. Chemotherapeutic supplementation of mechanical measures using dentifrices, mouthrinses, gels and chewing gums as delivery vehicles can improve oral hygiene. The list includes anticalculus, antibacterial and cariostatic agents. For the population at large to make effective use of these oral hygiene measures, oral hygiene promotion needs to be implemented. Considerations include the role of parents, school and the media for children and the workplace, social environments. nursing homes and trained carers for adults and the elderly. Community oral hygiene promotion must attempt to maximise opportunities for oral health for all and reduce inequalities by removing financial and other barriers. Oral health approaches should be tailored to lifestyles and abilities of children, adults and the elderly in order to enable them to make decisions to improve personal oral hygiene and oral health.

The effect of chewing sugar-free gum on plaque regrowth at smooth and occlusal surfaces

BACKGROUND AND AIM

Chewing gum has the potential to provide oral health benefits including plaque control. The aim of this study was to determine the effects of chewing sugar free gum on plaque regrowth at buccal, lingual and occlusal surfaces of teeth.

METHOD AND MATERIALS

11 healthy and dentally-fit dental hygiene students participated in this randomised, single-blind crossover 4-day plaque regrowth study. From a zero plaque score on day 1, subjects suspended oral hygiene measures and either chewed gum or did not chew gum over 4 days. Gum chewing was one piece chewed for 30 min 4 x per day. On day 4, subjects were scored for plaque after disclosing from buccal, lingual and unrestored occlusal surfaces.

RESULTS

There was no significant difference in smooth surface plaque scores between the treatments but significantly less plaque accumulated (44%) at occlusal surfaces during gum chewing compared to no gum chewing.

CONCLUSION

Chewing gum can reduce plaque accumulation at sites of predilection for caries but has little or no effect at sites of predilection for gingivitis.

Chewing gum--facts and fiction: a review of gum-chewing and oral health

The world market for chewing gum is estimated to be 560,000 tons per year, representing approximately US $5 billion. Some 374 billion pieces of chewing gum are sold worldwide every year, representing 187 billion hours of gum-chewing if each piece of gum is chewed for 30 minutes. Chewing gum can thus be expected to have an influence on oral health. The labeling of sugar-substituted chewing gum as "safe for teeth" or "tooth-friendly" has been proven beneficial to the informed consumer. Such claims are allowed for products having been shown in vivo not to depress plaque pH below 5.7, neither during nor for 30 minutes after the consumption. However, various chewing gum manufacturers have recently begun to make distinct health promotion claims, suggesting, e.g., reparative action or substitution for mechanical hygiene. The aim of this critical review--covering the effects of the physical properties of chewing gum and those of different ingredients both of conventional and of functional chewing gum--is to provide a set of guidelines for the interpretation of such claims and to assist oral health care professionals in counseling patients.

Attitudes of carers and the elderly occupants of residential homes to antimicrobial chewing gum as an aid to oral health

OBJECTIVE

The aim of this study was to investigate the attitudes of elderly residents to using an antimicrobial chewing gum as an aid to oral health, and the opinion of their carers on such a procedure.

DESIGN

A cross-sectional, multi-centre survey using a structured interview/questionnaire conducted with elderly residents and their carers.

SETTING

In January 1998, 9 residential/nursing homes were chosen at random from all the homes in West Hertfordshire, 207 residents were asked to chew two pieces of gum twice daily for 7 days.

SUBJECTS

The participants, 148 women and 59 men, were aged between 53-100 years (mean age 82.23 +/- 9.62 years). 47 carers, all female, were involved in distributing and collecting the gum.

RESULTS

122 residents (58.9%) were edentulous and 85 (41%) of the participants were partially dentate. Of those with teeth 23 (27%) had 21 teeth or more. 73 (35.2%) residents found that chewing the gum was difficult with 37 (17.9%) of this group being unable to chew (P < 0.0001 for those residents with no teeth/dentures or dentures unopposed by teeth or other dentures). 32 (18.6%) subjects disliked the flavour of the gum. Of the 170 residents who chewed the gum 99 (57.2%) found it reduced oral dryness and 78 (45.1%) reported it made their mouth feel healthy. 34 (53.6%) of the dentate and 47 (40.9%) of the edentate residents wished to keep using the gum (P < 0.05). 35 (74.5%) of the carers found it easy to distribute the gum and 29 (61.7%) thought that chewing gum was an acceptable method of maintaining oral health for residents.

CONCLUSION

The antimicrobial gum investigated in this study was acceptable to many elderly occupants and their carers, significantly improving perceived oral health and oral dryness of residents.

Antibacterial agents in the control of supragingival plaque--a review

This review considers the main agents which have been used as antibacterial agents in mouthwashes and other vehicles to inhibit the growth of supragingival plaque. The agents discussed are bisguanide antiseptics, quaternary ammonium compounds, phenolic antiseptics, hexetidine, povidone iodine, triclosan, delmopinol, salifluor, metal ions, sanguinarine, propolis and oxygenating agents. The plaque inhibitory, anti-plaque and anti-gingivitis properties of these agents are considered along with their substantivity, safety and possible clinical usefulness. Clinical trials of these agents that have been published are also reported. The possible clinical uses of antiseptic mouthwashes are finally considered along with some advice about assessing manufacturers claims. Throughout this review the terms plaque inhibitory, anti-plaque and anti-gingivitis have been used according to the clarification of terminology suggested by the European Federation of Periodontology at its second workshop. This defines a plaque inhibitory effect as one reducing plaque to levels insufficient to prevent the development of gingivitis; an anti-plaque effect as one which produces a prolonged and profound reduction in plaque sufficient to prevent the development of gingivitis; and anti-gingivitis as an anti-inflammatory effect on the gingival health not necessarily mediated through an effect on plaque.

Evaluation of oral hygiene products: science is true; don't be misled by the facts

Most people in industrialized countries use oral hygiene products. When an oral health benefit is expected, it is important that sufficient scientific evidence exist to support such claims. Ideally, data should be cumulative derived from studies in vitro and in vivo. The data should be available to the profession for evaluation by publication in refereed scientific journals. Terms and phrases require clarification, and claims made by implication or derived by inference must be avoided. Similarity in products is not necessarily proof per se of efficacy. Studies in vitro and in vivo should follow the basic principles of scientific research. Studies must be ethical, avoid bias and be suitably controlled. A choice of controls will vary depending on whether an agent or a whole product is evaluated and the development stage of a formulation. Where appropriate, new products should be compared with products already available and used by the general public. Conformity with the guidelines for good clinical practice appears to be a useful way of validating studies and a valuable guide to the profession. Studies should be designed with sufficient power to detect statistically significant differences if these exist. However, consideration must be given to the clinical significance of statistically significant differences between formulations since these are not necessarily the same. Studies in vitro provide supportive data but extrapolation to clinical effect is difficult and even misleading, and such data should not stand alone as proof of efficacy of a product. Short-term studies in vivo provide useful information, particularly at the development stage. Ideally, however, products should be proved effective when used in the circumstances for which they are developed. Nevertheless, a variety of variable influence the outcome of home-use studies, and the influence of the variable cannot usually be calculated. Although rarely considered, the cost-benefit ratio of some oral hygiene products needs to be considered.