Effect of Maltitol or Xylitol Sugars-Free Chewing Gums on Plaque Parameters Related to Dental Caries Development

Authors

• Berard M. - formerly with Roquette, Shanghai, China
• Guérin-Deremaux L. - Roquette Frères, Lestrem, France
• Lefranc-Millot C. - Roquette Frères, Lestrem, France
• Macioce V. - formerly with Roquette Frères, Lestrem, France
• Thabuis C. - Roquette Frères, Lestrem, France
• Wang X. - Tongji University, School of Stomatology, the affiliated stomatology hospital of Tongji University, China
• Wils D. - Roquette Frères, Lestrem, France
• Zhong B. - Tongji University, School of Stomatology, the affiliated stomatology hospital of Tongji University, China

In the present study, the impact of maltitol-containing chewing gums on the dental plaque was evaluated in children.

Introduction

Dental plaque and dental caries

Dental plaque is one of the three prerequisites for a caries lesion to develop, as shown in Figure 1 (1). It is a biofilm that adheres to teeth and consists of bacterial cells, bacterial wastes, salivary polymers, and other extracellular products. When plaque builds up, the microorganisms situated in the area of the biofilm nearest the tooth surface begin to ferment carbohydrates, producing demineralizing acids. Moreover, if a thick layer of plaque builds up on tooth enamel, the saliva is unable to penetrate the plaque to protect teeth through neutralization of acids or remineralization of the tooth surface.

Polyols and dental caries

Polyols are hydrogenated carbohydrates (also called sugar alcohols) used as sugar replacers. Unlike sugars, they are not fermented by the microorganisms present in the oral cavity and the dental plaque: they have all been tested and classified as hypo- or non-acidogenic.
Many studies have shown the oral health benefits of polyols-containing chewing gums (CG). The present study examined whether these benefits are due to the mere action of chewing, which increases salivary flow, or if the polyols themselves have a specific effect.

The different polyols

Three of the polyols most frequently used in sugars-free products are xylitol, maltitol, and sorbitol. Even though xylitol has been the most extensively studied regarding dental properties, it seems that chewing sugars-free CG three or more times daily for prolonged periods of time may reduce caries incidence irrespective of the type of sugar alcohol added (2). The present study focuses on maltitol and compares its effects to those of xylitol.

Materials and methods

Objectives

Primary objective:

Evaluation of the impact of SweetPearl™ maltitol chewing gum (CG) on saliva and plaque parameters to prevent dental caries. This poster focuses on plaque parameters, and results on saliva flow and composition are presented in another one (3).

Secondary objectives:

• Comparison of xylitol and maltitol CG effects
• Evaluation of the digestive tolerance of the CG

Study design

• Double controlled, double blind, parallel, randomized according to gender and baseline plaque
• index, single center
• Implementation in China
• Subjects: 240 children (4 x 60) - _ and _- 13 to 15 years
• Four groups (parallel study): Maltitol CG / Xylitol CG / Gum Base CG / No gum
• CG administration:
  o Five intakes per day (after main meals and before sleeping) chewed for 10 minutes during
  o 30 days
  o polyols CG: 2 pellets/intake (= 0.7g gum base); 57% xylitol or maltitol
  o Gum Base CG: 1 pellet/intake (= 0.7g gum base)
• One tooth brushing/day (in the morning or after the clinical examination)

Results

Plaque index

• The action of chewing had high importance in the reduction in plaque growth
• Longitudinal comparisons showed that maltitol was the only polyol to offer a significant reduction in plaque accumulation compared to the gum base

 

• The action of chewing played a role in the reduction in plaque insoluble glucans level.
• Polyols CG demonstrated a higher effect than Gum Base CG, according to both cross-sectional and longitudinal comparisons.
• Maltitol and xylitol CG induced similar effects.

Plaque pH

• Starting from Day 1 (Figure 3), the action of chewing had a high importance in the increase in plaque pH but polyols CG demonstrated a higher effect than Gum Base CG.
• Similar results were observed at Day 30 (data not shown), except at t=0min were the 3 gum groups displayed a significantly higher pH than the no gum one.

Increased plaque pH reflects a lesser amount of demineralizing acids.

Bacteria Concentration 

• Gum base CG lead to decreased concentrations of most bacteria species
• The amplitude of the decrease in bacteria concentrations was more important with polyols than with gum base
• Maltitol CG seemed to induce a stronger effect than xylitol on some bacteria species:

A. viscosus concentration was significantly lower in the maltitol group at Day 28, and maltitol was the only polyol to differentiate significantly from gum base as regards Lactobacillus concentrations.