Antibacterial Effectiveness and Periodontal Actions of Sugar-Free Chewing Gums Derived From Alcohol or Vegetables in Patients with Fixed Orthodontic Treatment: A Systematic Review.

Aim: In patients with fixed orthodontic appliances, the effectiveness of mechanical cleaning is compromised due to difficulties in accessing all areas of the mouth.

Purpose: Aimed to evaluate the antimicrobial effectiveness and periodontal actions of sugar-free chewing gums in patients with fixed orthodontics through a systematic review of randomized clinical trials.

Materials and methods: A bibliographic search was conducted in digital databases for articles published up to 2024 in accordance with the PICO question. This review followed the PRISMA methodology and was registered in PROSPERO (CRD42023444472), while the Cochrane RoB 2 tool used to assess the risk of bias and GRADE employed to evaluate the certainty of evidence for each outcome.

Results: Five studies were included. A significant reduction Streptococcus mutans in saliva was observed in two studies (-17%-33% saliva, -20%-29% dental plaque, p<0.05), with xylitol gum and it's mixture with sorbitol exerting the best effect after one month of consumption (GRADE high). An effective decrease in the plaque index was observed in two studies of xylitol gum (-43% -47%, p<0.05) after one month of consumption, as well as studies of essential oil gum (10 days) and sorbitol gum (three months) (GRADE low). Chlorhexidine, sorbitol, and essential oil gums effectively reduce gingival bleeding, and xylitol gum increases the salivary pH, more than 50% presented a high risk of bias, and less than 25% were at low risk of bias (GRADE low).

Conclusion: The different types of chewing gum significantly improved the oral health of patients with fixed orthodontics, the quality of evidence suggests that chewing gums could decrease the level of SM in saliva (4:1 xylitol and sorbitol mix or xylitol). However, the heterogeneity of the studies limits the generalization to other outcomes which highlights the need for larger and longer clinical trials to confirm their efficacy.