Shakhsi Niaee, M., Hedayatipanah, M., Torkzaban, P. and Mohammadi, T. (2024). A chewing gum containing ethylenediaminetetraaceticacid (EDTA), methyl sulfonyl methane (MSM) and xylitol works comparable to chlorehexidine mouthrinse. Scientific Reports, [online] 14(1). doi:https://doi.org/10.1038/s41598-024-79551-4.
Background
Dental plaque is a biofilm that forms on tooth surfaces and serves as an advantageous environment for pathogenic bacteria, contributing to periodontal disease and dental caries. Various methods exist for plaque control, including mechanical (e.g. brushing and flossing) and chemical approaches (e.g. mouthwashes); chlorhexidine (CHX) is considered to be the best option for chemical plaque control. However recent studies have also highlighted the potential of xylitol-containing chewing gums to reduce bacterial counts and enhance oral hygiene.
This study investigates a novel chewing gum containing xylitol, ethylenediaminetetraacetic acid (EDTA), and methylsulfonylmethane (MSM) and compares its efficacy in plaque control against chlorhexidine mouthwash.
Methods
This clinical trial employed a crossover design involving 24 patients diagnosed with gingivitis. Inclusion criteria: patients with no systemic diseases, no periodontal disease and an O’Leary plaque index greater than 50%. Exclusion Criteria: patients who had recently changed their oral hygiene routine, required additional procedures or had conditions requiring systemic medications. Each participant underwent scaling and root planing at the study’s onset to reduce their plaque index to below 20%. The chewing gum was formulated by heating a gum base and mixing it with the active ingredients (EDTA, MSM, xylitol) and flavouring agents, while the chlorhexidine mouthwash was a standard 0.12% commercial product.
Figure 1: Final samples of fabricated chewing gum
Patients were randomly assigned to two groups were as follows:
- Group 1: Used 0.12% chlorhexidine mouthwash twice daily for 14 days.
- Group 2: Used the novel chewing gum containing EDTA, MSM, and xylitol for 15 minutes twice daily for 14 days.
Figure 2: Allocation of patients to treatment groups
After a wash-out period of 14 days during which the participants did not use any method, the methods were switched between groups.
The primary outcomes measured were the O’Leary plaque index, gingival index, and sulcus bleeding index, recorded at baseline, after the first intervention, and after the second intervention.
Results
Statistical analyses were conducted using paired and independent t-tests to compare the efficacy of the treatments.
Statistical analysis revealed significant improvements in the O’Leary plaque index, gingival index, and sulcus bleeding index for Group 1 following the use of chlorhexidine, indicating its effectiveness. Group 2 showed no significant differences in plaque and gingival indices during the study periods of using the chewing gum and then the mouthwash.
Furthermore, independent t-tests indicated no significant differences in the plaque and gingival indices between both groups at any point in the study. Regression analyses confirmed that the type of treatment did not significantly influence any of the measured indices. This suggests that both treatments were similarly effective in controlling plaque and improving gingival health.
Conclusions
The findings suggest that the novel chewing gum is as effective as chlorhexidine mouthwash in reducing dental plaque and improving gingival health. Whilst it showed no advantage over mouthwash in terms of efficacy, given its accessibility, affordability, and lack of side effects typically associated with chlorhexidine (such as taste alteration and staining), this chewing gum could serve as a practical alternative for daily oral hygiene maintenance.
Further research regarding the long-term effects and efficacy of this chewing gum compared to other commercial products does need to be considered.
Research Summary Written By: Aaminah Patel, University of Manchester – BDS1