Martínez-Pabón María C, Duque-Agudelo Lucas, Díaz-Gil Juan D, Isaza-Guzmán Diana M, Tobón-Arroyave Sergio I
POPCAD Research Group, Laboratory of Immunodetection and Bioanalysis, Faculty of Dentistry, University of Antioquia, Calle 64 No. 52-59, Medellín, Colombia.
Clin Oral Investig. 2014;18(2):589-98. doi: 10.1007/s00784-013-0989-0. Epub 2013 Apr 19.
The aim of this study was to compare the effect of two sugar-substituted chewing gums besides toothbrushing on different clinical, microbiological, and biochemical caries- and gingivitis-related variables.
The study was designed as a double-blind, randomized, controlled trial with three parallel arms. A total of 130 dental students, who volunteered after signing an informed consent, were randomly allocated to receive one of the following interventions: hexitol-sweetened gum containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), pentitol-sweetened gum containing no CPP-ACP, and control group with no gum. Subjects within the experimental groups chewed two gum pellets for 20 min three times a day after meals. The daily consumption level of both polyols was 6.0 g. Clinical examinations and salivary samplings were conducted at baseline and after 30 days of gum use. Pre- and post-intervention stimulated whole saliva samples were quantified for calcium/phosphate ionic concentration, total facultative bacterial load, Streptococcus mutans/Lactobacillus spp. counts, and Gram-negative percentage.
A statistically significant reduction in visible plaque score was displayed in the hexitol/CPP-ACP gum group after the intervention when compared with baseline, but the order of the effect was in the same order as the differences between the groups at baseline. A similar tendency was seen in both the pentitol/non-CPP-ACP gum and control groups regarding total salivary facultative bacterial load and S. mutans count, but median values of these parameters were more significantly reduced in the pentitol/non-CPP-ACP gum group in comparison with those of the control group. Alterations of salivary Lactobacillus spp. were demonstrated only in the pentitol/non-CPP-ACP gum group.
Although these findings might indicate that a 30-day protocol of daily chewing of pentitol-sweetened gum containing no CPP-ACP might have some a reducing effect on the salivary levels of facultative bacteria, S. mutans and Lactobacillus spp., there was only a marginal, if any, benefit from the chewing gums under study on some microbiological caries- and gingivitis-related variables.
Taking into account that for transferring results into clinically relevant conclusions the findings need to be strong and consistent, adhering to single significant differences appears not appropriate. Hence, the clinical significance of chewing gums as an adjunctive tool for daily oral care remained questionable.
本研究旨在比较除刷牙外两种含替代糖的口香糖对不同临床、微生物学和生物化学方面与龋齿及牙龈炎相关变量的影响。
本研究设计为一项双盲、随机、对照试验，设有三个平行组。共有130名牙科专业学生，在签署知情同意书后自愿参与，被随机分配接受以下干预措施之一：含酪蛋白磷酸肽 - 无定形磷酸钙（CPP - ACP）的己糖醇甜味口香糖、不含CPP - ACP的戊糖醇甜味口香糖以及无口香糖的对照组。实验组的受试者每天饭后咀嚼两粒口香糖，每次20分钟。两种多元醇的每日摄入量均为6.0克。在基线期以及使用口香糖30天后进行临床检查和唾液采样。干预前后的刺激全唾液样本用于量化钙/磷酸盐离子浓度、总兼性细菌载量、变形链球菌/乳酸杆菌属计数以及革兰氏阴性菌百分比。
与基线相比，干预后己糖醇/CPP - ACP口香糖组的可见菌斑评分有统计学意义的降低，但效果顺序与基线时各组间差异顺序相同。戊糖醇/不含CPP - ACP口香糖组和对照组在总唾液兼性细菌载量和变形链球菌计数方面呈现相似趋势，但与对照组相比，戊糖醇/不含CPP - ACP口香糖组这些参数的中位数降低更为显著。仅在戊糖醇/不含CPP - ACP口香糖组观察到唾液乳酸杆菌属的变化。
尽管这些发现可能表明，每日咀嚼不含CPP - ACP的戊糖醇甜味口香糖30天方案可能对兼性细菌、变形链球菌和乳酸杆菌属的唾液水平有一定降低作用，但在所研究的口香糖对一些与龋齿和牙龈炎相关的微生物学变量方面，仅存在边际益处（若有任何益处的话）。
考虑到要将结果转化为具有临床相关性的结论，研究结果需要有力且一致，仅依据单一显著差异似乎并不合适。因此，口香糖作为日常口腔护理辅助工具的临床意义仍存疑问。
