The Benefits of Chewing Sugar Free Gum on Oral Health Author Short, Leonie Published 2008 Conference Title Dental and Oral Health Therapist Association Inaugural Conference, The Sea Change Copyright Statement The Author(s) 2008. The attached file is posted here with permission of the copyright owner for your personal use only. No further distribution permitted. For information about this conference please refer to the publisher's website or contact the author. Downloaded from http://hdl.handle.net/10072/24572 Link to published version http://www.dohtaq.com.au/upcomingevents/upcomingevents.html Griffith Research Online https://research-repository.griffith.edu.au
Contents The Benefits of Chewing Sugar free Gum on Oral Health Ms Leonie M. Short Senior Lecturer in Oral Health Therapy School of Dentistry and Oral Health, Griffith University Introduction Wider Context Scope of Practice Minimal Intervention Dentistry Caries Management System Dental Examination Oral Hygiene Behaviours Chewing Gum Main Protective Properties of Saliva The Effect of Chewing Gum Dental Bacterial Plaque Benefits of Sugar-free Chewing Gum Conclusion Introduction Dental therapy programs were originally developed for public sector services in countries within the Commonwealth United Kingdom, New Zealand, Hong Kong and South Africa (Nash et al., 2008b:61). The model was developed in New Zealand and now they operate in 53 countries (McKinnon et al., 2007:1478, Nash et al., 2008a:111) Research suggests that there are 14,441 dental therapists in the oral health workforce in countries such as Thailand (3,000), Malaysia (2,090), Australia (1,242), Nigeria (1,100), Great Britain (691), New Zealand (660), South Africa (411) and Netherlands (300) (Nash et al., 2008b:62). Introduction The most recent Australian data state that in 2005 there were 1,706 registered dental therapists, of whom 32 were registered dental hygienists and 207 were dual skilled oral health therapists (Australian Institute of Health and Welfare Dental Statistics and Research Unit, 2008b:1). For comparative reasons, there were 11,868 registered dentists in Australia in 2005 (Australian Institute of Health and Welfare Dental Statistics and Research Unit, 2008c:1).
Wider context Overlapping Domains in Dentistry Dental Specialist Therapist Hygienist Dentist Scope of Practice http://www.dentalboardnsw.org.au/app_cmslib/media/umlib/do uments/dentalpracticeact2001_regs.pdf Dental Practice Regulation 2004 under the Dental Practice Act 2001 6 Dental hygienist activities section 19 (e) simple prophylaxis, (f ) the topical application of sealants, fluoride solutions and medicaments, (g) the scaling of supra-gingival and sub-gingival calculus deposits from the teeth, Scope of Practice 7 Dental therapist activities section 19 (a) dental examination, (b) the cleaning and polishing of teeth and restorations, (c) the topical application of sealants, fluoride solutions and medicaments, (d) the removal of dental calculus not involving surgical techniques requiring incisions, This Scope of Practice is simplistic and outdated Minimal Intervention Dentistry (MID) Caries Management System
Minimal Intervention Dentistry (MID) The surgical approach to early surface lesion in enamel or dentine has been superseded by the biological or therapeutic approach which recognises that caries is an infectious disease (Tyas, et al. 2000:2 and 3) Alteration to oral environment (frequency of refined carbohydrate intake, optimum plaque control, optimum salivary flow, patient education) and application of agents (chlorhexidine and topical fluoride) (Tyas, et al. 2000:2) This is the scope of practice of Dental Therapists, Dental Hygienists and Oral Health Therapists in 53 countries around the world Caries Management System Saliva assessment plays a role in risk of caries (Evans, et al. 2008:85) When the ph drops below approximately 5.5, the sub-surface enamel or dentine will begin to demineralise. As the ph rises again, remineralisation may occur (Tyas, et al. 2000:2) GC's Saliva Testing kit and others (Tong, 2008) Tests of salivary secretion and composition Salivary secretion rate (volume), overall and for separate salivary glands pн Buffer capacity Viscosity Content of inorganic and organic components Dental examination The School of Dentistry and Oral Health at Griffith University considers the function of a dental examination to be too narrow in scope in that it focuses on dental caries per se instead of focussing on obtaining a thorough and comprehensive medical and dental history, undertaking a risk assessment which includes such factors as saliva testing, diet and nutrition analysis, smoking cessation and oral hygiene behaviours; oral pathology, referral for orthodontic assessment, a patient-centred approach to prevention of oral diseases and the promotion of optimal general and oral health.
Comprehensive oral health assessment The words comprehensive oral health assessment are preferred, especially for dually qualified oral health therapists, in terms of the links between general and oral health as well as a abroad assessment for disorders/diseases including coronal and root caries, gingivitis, dental erosion, periodontal disease, oral cancer, temporomandibular disorders and xerostomia. Oral hygiene behaviours Saliva testing Diet and nutrition analysis Soft drinks, sports drinks, coffee, guarana or energy drinks Smoking cessation Brushing Flossing Rinsing Chewing sugar-free gum Studies on chewing gum More than 2000 studies of the influence of chewing gum have been published worldwide More than 100 epidemiological studies have been conducted The benefits of the use of sugarfree chewing gum like ORBIT and EXTRA are recognized by the World Dental Federation (FDI) Medical aspects of the use of chewing gum Individual limitations are related to individual intolerance of separate components In general, chewing gum use is not associated with health threatening complications in adults and children There is a risk of aspiration in preschool children. Chewing gum is not recommended for children under 5 years.
Chewing sugar free gum Small lifestyle change Easy Cheap Convenient Anywhere and anytime I. Clearance II. Buffer properties III. Mineralising potential IV. Antibacterial and barrier properties I. Clearance Clearance is determined by the salivary flow rate (secretion volume per minute), and characterises the rate of dissolution and removal of sugars and acids from the oral cavity II. Buffer properties of saliva Buffer properties of saliva determine its ability to neutralise organic acids and to maintain neutral or slightly alkaline рн values
II. Buffer properties of saliva Buffer systems of saliva Bicarbonate buffer system is the principal buffer system in stimulated saliva Phosphate buffer system is the principal buffer system in unstimulated saliva II. Buffer properties of saliva Concentration of bicarbonates Unstimulated saliva 0.1 8.0 mmol/l Stimulated saliva - 4-40 mmol/l Concentration of phosphates Unstimulated saliva on average 6.0 mmol/l Stimulated saliva - on average 4.0 mmol/l D.B.Ferguson Oral Bioscience, Churchill Livingstone, 1999 III. Mineralising potential of saliva Saliva is supersaturated with main mineral ion components of apatite in tooth tissues (calcium, phosphates and fluorides) III. Mineralising potential of saliva Concentration of total calcium Unstimulated saliva 1.4 mmol/l Stimulated saliva 1.7 mmol/l Concentration of phosphate ions Unstimulated saliva 6.0 mmol/l Stimulated saliva 4.0 mmol/l D.B. Ferguson Oral Bioscience, Churchill Livingstone, 1999
D.B.Ferguson Oral Bioscience, Churchill Livingstone, 1999 III. Mineralising potential of saliva Calcium in saliva Free ions - 50% Complexes with other ions - 40% Complexes with proteins - 10% The effect of chewing gum on saliva composition and properties Stimulation of saliva secretion Increased рн and buffer capacity of saliva Increased super saturation of saliva by mineral ions Phosphates in saliva Free ions - 90% Organic phosphates - 10% Pyrophosphates - rare The effect of chewing gum on saliva composition and properties Influence of chewing gum on saliva secretion rate In the first minutes of gum chewing salivation rate is increased 10-12 times Throughout the period of gum chewing the salivary flow rate is 2-3 times higher than baseline level The effect of chewing gum on saliva composition and properties Influence of chewing gum on saliva рн The use of any chewing gum leads to a rise in salivary рн (after 10 minutes of chewing) A prolonged рн increase is maintained only when using sugar free chewing gums (163 publications over the period 1965 2000) 58 publications over the period 1965-2000
Dental bacterial plaque Dental bacterial plaque The term dental plaque refers to a bacterial biofilm consisting of colonies of microorganisms attached to the tooth pellicle and held together by a matrix of salivary glycoproteins and bacterial polysaccharides Staining of alpha-1,4-glucans of dental plaque by iodine- potassium iodide solution Dental bacterial plaque Mechanisms of formation Primary colonisation of the tooth pellicle surface by bacteria 1. Weak electrostatic interactions (Van der Waals forces, hydrogen bonds) 2. Strong carbohydrate bonds by means of polysaccharides Types of microorganisms: Streptococci (Str. sanguis) Actinomycetes Role of dental plaque in caries development Dental plaque formation is a physiological process Microbial colonisation of teeth is a part of the natural defenses of the oral cavity against exogenous pathogenic microorganisms A shift in the plaque microbiota towards a more pathogenic flora facilitates conditions for disease development
The effect of chewing gum on the composition and properties of dental plaque Influence of chewing gum on dental plaque рн Increase in minimal рн value after sugar load Reducing period of рн decrease after sugar load Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) Recently, in a randomised, controlled, double-blind caries trial, Morgan et al. (2008) showed that CPP-ACP in a sugar-free gum significantly slowed the progression of caries in an optimally fluoridated environment (Reynolds et al. 2008: 346, Morgan et al. 2008). 71 publications over the period 1965-2000 Role of chewing gum in prophylaxis and treatment of halitosis Stimulation of saliva secretion Mechanical cleaning of the oral cavity to remove microflora Antibacterial action of therapeutic and preventive additives Flavours contained in chewing gum conceal or temporarily reduce halitosis The benefits of sugar free chewing gum on oral health Use of chewing gum stimulates saliva secretion and improves protective neutralising properties of saliva including those in functional xerostomia Sugar free chewing gum has no cariogenic potential Regular use of sugarfree chewing gum may be a promising additional method for caries prophylaxis, particularly in patients with high risk of caries development and with xerostomia
Conclusion A dental examination is much more than detecting and treating the symptoms or consequences of dental caries A comprehensive oral health assessment is more in line with contemporary standards Professional advice about oral hygiene behaviours is crucial for a patient-centred approach to prevention of oral diseases, and the promotion of optimal general and oral health. This includes proven, accessible and cost-effective measures such as chewing sugar-free gum. Questions? References Australian Institute of Health and Welfare Dental Statistics and Research Unit, A. (2008b) Dental Therapist Labour Force in Australia, 2005. Adelaide, Australian Institute of Health and Welfare Dental Statistics and Research Unit, (AIHWDSRU) Australian Institute of Health and Welfare Dental Statistics and Research Unit, A. (2008c) Dentist Labour Force in Australia, 2005. Adelaide, Australian Institute of Health and Welfare Dental Statistics and Research Unit, (AIHWDSRU) References Dental Practice Regulation 2004 under the Dental Practice Act 2001 http://www.dentalboardnsw.org.au/app_cmslib/media/umlib/d ocuments/dentalpracticeact2001_regs.pdf Evans, R.W., Pakdaman, A., Dennison, P.J. and Howe, E.L.C. (2008) The Caries Management System: An Evidence-based Preventive Strategy for Dental Practitioners. Application for Adults. Australian Dental Journal, 53, 83-92. McKinnon, M., Luke, G., Bresch, J., Moss, M. & W., V. R. (2007) Emerging allied dental workforce models: considerations for academic dental institutions. Journal of Dental Education, 71, 1476-1491
References Morgan, M.V., Adams, G.G., Bailey, D.L., Tsao, C.E., et al. (2008) The Anticariogenic Effect of Sugar-Free Gum Containing CPP-ACP Nanocomplexes on Approximal Caries Determined Using Digital Bitewing Radiography, Caries Research, 42 (3), 171-184 Nash, D., Ruotoistenmaki, J., Argentier, A., Barna, S., Behbehani, J., Berthold, P., Catalanotto, F., Chidzonga, M., Goldblatt, L., Jaafar, N., Kikwilu, E., Konoo, T., Kouzmina, E., Lindh, C., Mathu-Muju, K., Mumghamba, E., Nik Hussein, N., Phantumvanit, P., Runnel, R., Shaw, H., Forna, N., Orliaguet, T. & Honkala, E. (2008a) Profile of the oral healthcare team in countries with emerging economies. European Journal of Dental Education, 12, 111-119 References Nash, D. A., Friedman, J. W., Kardos, T. B., Kardos, R. L., Schwarz, E., Satur, J., Berg, D. G., Nasruddin, J., Mumghamba, E. G., Davenport, E. S. & Nagel, R. (2008b) Dental therapists: a global perspective. International Dental Journal, 58, 61-70 Reynolds, E.C., Cai, F., Cochrane, N.J., Shen, P., Walker, G.D., Morgan, M.V., and Reynolds, C. (2008) Fluoride and casein phosphopeptide-amorphous calcium phosphate, Journal of Dental Research, 87 (4), 344-348. References Tong, D.T. 2008 Salivary diagnostics: Enhancing disease detection and making medicine better, European Journal of Dental Education, 12 (Suppl. 1), 22-29.