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Evening Times (Scotland)
December 9, 2002
Is giving parents chewing gum the best way to save their kid's teeth?
By John McCann
PARENTS in Glasgow could be given free chewing gum to protect their children's teeth in a bid to end a health "disaster".
Dental director Bob Broadfoot wants the city to introduce schemes to prevent children getting tooth decay instead of treating them once their teeth are rotten.
New figures show 64% of Glasgow pupils have at least one decayed tooth. But it is nearly 80% in the most deprived areas.
Dr Broadfoot said: "We have a public health disaster.
"More than half of Glasgow schoolchildren suffer from a preventable disease that can have fatal consequences or cause a lot of suffering."
Dr Broadfoot, dental director of the city's Primary Care Trust, said it had to take a medical approach, improving health, instead of a surg- ical one - removing or repairing teeth.
He said: "We do too much drilling and filling. We need to look more at prevention."
Tooth decay happens when bacteria, called streptococcus mutans, reaches high levels.
Babies are not born with it, but it can be passed on by contact including kissing and parents sucking a baby's "dummy" before putting it in the child's mouth, on shared cups or cutlery and even on toys.
But if parents chew gum containing artificial sweetener xylitol, the level of the bug in their mouths is reduced, preventing the bug being passed on and lowering the likelihood of decay in their children.
Dr Broadfoot wants parents to get free gum.
He said: "I don't know what it would cost, but it would be very effective."
The suggestion is included in Glasgow's recommendations to a national debate on children's teeth.
Dr Broadfoot is also recommending a scheme used in Swedish town Varmland, which cut the average number of rotten teeth among 12-year-olds from 6.5 to just one.
Health authorities offer advice on tooth brushing and a healthy diet when a baby's teeth first start to appear.
When children are five, the fissures in the surface of their teeth are sealed by dentists to prevent cavities and, when they are 12, their teeth are coated with a protective fluoride varnish to toughen and protect them. Dr Broadfoot said Glasgow does not have to wait for a national scheme.
He said: "I've spoken to chief executive Tom Divers at the health board and he acknowledges dental health has been neglected.
Dr Broadfoot was persuaded by the Primary Care Trust management team to include fluoride in water as one recommendation to the Scottish Executive.
But he admitted it would be unlikely to gain approval in the face of massive public opposition.
He said: "I don't want fluoride to hog the debate.
"There is a lot more we can do that is proven to be effective. I think we should be looking at the Swedish model.
"It may be more expensive but, if it's accepted and it works, then it's worth it."
A health board spokeswoman said: "Any such recommendation we receive will be considered by the board in due course."
Studies on the Cavity-Fighting effectiveness of Xylitol (a natural sugar): (back to top)
Alanen P, et al. (2000). Sealants and xylitol chewing gum are equal in caries prevention. Acta Odontol Scand. 58(6):279-84. (See abstract)
Alanen P, et al. (2000). Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol. 28(3):218-24. (See abstract)
Autio JT. (2002). Effect of xylitol chewing gum on salivary Streptococcus mutans in preschool children. ASDC J Dent Child. 69(1):81-6, 13. (See abstract)
Calamari SE, et al. (1997). Effects of xylitol, sorbitol and fluoride mouthrinses on glucose clearance in adolescents. Acta Odontol Latinoam.10(1):25-36. (See abstract)
Edgar WM. (1998). Sugar substitutes, chewing gum and dental caries--a review. Br Dent J. 184(1):29-32. (See abstract)
Gales MA, Nguyen TM. (2000). Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother. 34(1):98-100. (See abstract)
Hayes C. (2001). The effect of non-cariogenic sweeteners on the prevention of dental caries: a review of the evidence. J Dent Educ. 65(10):1106-9.(See abstract)
Hildebrandt GH, Sparks BS. (2000). Maintaining mutans streptococci suppression with xylitol chewing gum. J Am Dent Assoc. 131(7):909-16. (See abstract)
Honkala S, et al. (1999). Use of xylitol chewing gum among Finnish schoolchildren. Acta Odontol Scand. 57(6):306-9. (See abstract)
Hujoel PP, et al. (1999). The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention. J Dent Res. 78(3):797-803. (See abstract)
Isokangas P, et al. (2000). Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. J Dent Res. 79(11):1885-9. (See abstract)
Isogangas P, et al. (1993). Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program. Caries Res. 27(6):495-8. (See abstract)
Machiulskiene V, et al. (2001). Caries preventive effect of sugar-substituted chewing gum. Community Dent Oral Epidemiol. 20 29(4):278-88. (See abstract)
Makinen KK, et al. (1998). Physical, chemical, and histologic changes in dentin caries lesions of primary teeth induced by regular use of polyol chewing gums. Acta Odontol Scand. 56(3):148-56. (See abstract)
Makinen KK, et al. (1998). A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme. Caries Res. .32(2):107-12. (See abstract)
Makinen KK, et al. (1996). Conclusion and review of the Michigan Xylitol Programme (1986-1995) for the prevention of dental caries. Int Dent J. 46(1):22-34. (See abstract)
Makinen KK, et al. (1996). Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--an exploratory study. Spec Care Dentist. 16(3):104-15. (See abstract)
Petersson LG, et al. (1991). Caries-preventive effect of dentifrices containing various types and concentrations of fluorides and sugar alcohols. Caries Res. 25(1):74-9. (See abstract)
Rekola M. (1986). Changes in buccal white spots during 2-year consumption of dietary sucrose or xylitol. Acta Odontol Scand. 44(5):285-90. (See abstract)
Roberts MC, et al. (2002). How xylitol-containing products affect cariogenic bacteria. J Am Dent Assoc. 133(4):435-41. (See abstract)
Scheie AA, Fejerskov OB. (1998). Xylitol in caries prevention: what is the evidence for clinical efficacy? Oral Dis. 4(4):268-78. (See abstract)
Scheinin A, et al. (1993). Xylitol-induced changes of enamel microhardness paralleled by microradiographic observations. Acta Odontol Scand. 51(4):241-6. (See abstract)
Scheinin A, et al. (1985). Collaborative WHO xylitol field studies in Hungary. VII. Two-year caries incidence in 976 institutionalized children. Acta Odontol Scand. 43(6):381-7. (See abstract)
Simons D, et al. (2002). The effect of medicated chewing gums on oral health in frail older people: a 1-year clinical trial. J Am Geriatr Soc. 50(8):1348-53. (See abstract)
Simons D, et al. (1999). The effect of xylitol and chlorhexidine acetate/xylitol chewing gums on plaque accumulation and gingival inflammation. J Clin Periodontol. 26(6):388-91. (See abstract)
Soderling E, et al. (2000). Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 79(3):882-7. (See abstract)
Soderling E, et al. (1991). Long-term xylitol consumption and mutans streptococci in plaque and saliva. Caries Res. 25(2):153-7. (See abstract)
Soderling E, Scheinin A. (1991). Perspectives on xylitol-induced oral effects. Proc Finn Dent Soc. 87(2):217-29. (See abstract)
Steinberg LM, et al. (1992). Remineralizing potential, antiplaque and antigingivitis effects of xylitol and sorbitol sweetened chewing gum. Clin Prev Dent. 14(5):31-4. (See abstract)
Tanzer JM. (1995). Xylitol chewing gum and dental caries. Int Dent J. 45(1 Suppl 1):65-76. (See abstract)
Trahan L, et al. (1996). Emergence of multiple xylitol-resistant (fructose PTS-) mutants from human isolates of mutans streptococci during growth on dietary sugars in the presence of xylitol. J Dent Res. 75(11):1892-900. (See abstract)