title: The effect of medicated, sugar-free chewing gum on plaque and clinical parameters of gingival inflammation: a systematic review.
abstract: OBJECTIVE
  This study aimed to systematically review the present literature to establish the clinical effect of medicated, sugar-free chewing gum on plaque indices and parameters of gingival inflammation.
  
  
  METHODS
  MEDLINE-PubMed, Cochrane CENTRAL and EMBASE databases were searched up to April 2012 to identify appropriate studies. Included studies used an intervention of medicated, sugar-free chewing gum containing antimicrobial agents or herbal extracts compared with a control gum. Plaque and gingivitis scores were selected as outcome variables.
  
  
  RESULTS
  Independent screening of 594 unique titles and abstracts identified 10 non-brushing and four brushing studies that met the eligibility criteria. Means and standard deviations were extracted. A sufficient number of studies evaluated chlorhexidine gum to perform a meta-analysis. Although this review provides evidence for the comparative effectiveness of chewing gums containing various ingredients, the results must be weighed carefully against the methods that were used to assess their outcomes.
  
  
  CONCLUSIONS
  Most of the chewing gums with antimicrobial agents or herbal extracts were shown to have a positive effect with respect to plaque and gingivitis scores. The most compelling evidence was provided for chewing gum containing chlorhexidine. Meta-analysis and individual results indicate a beneficial effect of chlorhexidine on plaque inhibition. However, GRADE evidence profile shows that the recommendation to use CHX-gum to reduce plaque scores in the absence of brushing is considered to be 'weak'. Other ingredients with positive outcomes on plaque scores are eucalyptus, acacia, funoran, Pycnogenol and mastic. Limited data with respect to gingivitis scores were available, and the following agents showed a positive effect: magnolia, eucalyptus and CHX.
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Keukenmeester
authors.forename: D E
authors.initials: DE
authors.lastname: Slot
authors.forename: M S
authors.initials: MS
authors.lastname: Putt
authors.forename: G A
authors.initials: GA
authors.lastname: Van der Weijden
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002638:Chewing Gum; D002710:Chlorhexidine / Q000008:administration & dosage; D003773:Dental Plaque / Q000517:prevention & control*; D003774:Dental Plaque Index; D005891:Gingivitis / Q000517:prevention & control*; D006801:Humans; D010512:Periodontal Index; D008517:Phytotherapy / Q000379:methods*; D010936:Plant Extracts / Q000008:administration & dosage*; D013549:Sweetening Agents
chemical_list: D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local; D002638:Chewing Gum; D010936:Plant Extracts; D013549:Sweetening Agents; D002710:Chlorhexidine
keywords: chewing gum; gingival inflammation; meta-analysis; plaque; systematic review