Acta Odontologica Scandinavica

ISSN: 0001-6357 (Print) 1502-3850 (Online) Journal homepage: http://www.tandfonline.com/loi/iode20

Effect on plaque of a xylitol-containing chewinggum: A pilot study Christian Mouton, Arje Scheinin & Kauko K. Mäkinen To cite this article: Christian Mouton, Arje Scheinin & Kauko K. Mäkinen (1975) Effect on plaque of a xylitol-containing chewing-gum: A pilot study, Acta Odontologica Scandinavica, 33:1, 27-31, DOI: 10.3109/00016357509004623 To link to this article: http://dx.doi.org/10.3109/00016357509004623

Published online: 02 Jul 2009.

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Date: 18 March 2016, At: 19:50

Effect on plaque of a xylitol-containing chewing-gum A pilot study CHRISTIAN MOUTON, ARJE SCHEININ & KAUKO K. MAKINEN

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Institute of Dentistry, University of Turku, Finland

Mouton, C., Scheinin, A. & Makinen, K. K. Effect on plaque of a xylitol-containing chewing-gum. A pilot study. Acta Odont. Scand. 33, 27-31, 1975. The effects on plaque induced by the use of xylitol- and sucrosecontaining chewing-gums were studied o n ten test-persons with neglected oral hygiene during two three-day periods. The chewing of three, as well as of ten pieces per day of a xylitol chewing-gum resulted in a significant reduction in the amount of plaque and in the decrease of activity of invertase-like enzymes in plaque extracellular phase, when compared to corresponding conditions where a sucrose-containing chewing-gum was used. Key-words: Dental plaque; xylitol; sucrose; chewing-gum; invertase C . Mouton, Universitd Louis Pasteur, Facultd de Chirurgie Dentaire, I , place de I'Hdpital, 67000 Strasbourg, France

The Turku sugar studies have shown that even a mild xylitol diet of short duration reduced the amount of dental plaque. At the same time chemical changes in the plaque took place, which might indicate a low cariogenicity of the material formed on the tooth surface (Scheinin & Makinen, 1971, 1972; Makinen & Scheinin, 1971, 1972). This communication describes a short-term clinical experiment on dental students using xylitol- or sucrosecontaining chewing-gum. The growth of plaque and the specific activity of invertase-like activity of the plaque extracellular phase were followed. MATERIALS A N D METHODS

Ten voluntary dental students were involved in the study which was formed by two separate phases. During the first Received for publication, September 9, 1974.

three-day-period the test persons used either three (five randomly selected test persons) or ten (five randomly selected test persons) pieces of a 72% sucrosecontaining chewing-gum (3 g per piece). The chewing-gum was advised to be used after meals. The chewing time was approximately 10 min. During the chewing period of three days the test persons refrained from brushing their teeth. Otherwise normal dietary habits were followed. The first three-day-period was terminated by plaque collecting, after which a normalization period of four days (with normal hygiene and no chewing-gum) followed. The second phase of the study was carried out as above, but using a 50% xylitol-containing product (2 g per piece). Plaque was collected from the teeth of the right side during a 2.5 min. period.

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28

CHRISTIAN MOUTON, ARJE SCHEININ

The plaque material obtained was immediately weighed, thus giving a plaque fresh weight (PFW). and suspended into cold (-7-4" C ) 0.9", sodium chloride solution. The mixture was stirred for 2 niin with a glass rod and centrifuged for 10 min 23500 ':, g at 4" C. The supernatant fluid resulting was analysed for protein and invertase-like activity. The reagents and chemical methods used in the study were in principle the same as mentioned in earlier papers (Sclwinin 8 Miikinen, 1972). The regior, 23-26. 33-36 of each test person was photographed according to the standardized method of Carisson & Egt'lberg. (1965). Prior to photographing, the region involved was stained with a Ii'(, phenolic fuchsin solution. The photographs obtained at the end of the two test periods were examined by projecting them sim~iltaneouslyi n an identical \yay against a white surface using two separate projectors. Consequently. two slides of the same subject were examined at the same time. Two dental students. not aware of the test consitions i n the photographs to be compared. were requested to deterniine whether the amount of plaque on the specified teeth (23-26, 33-36) i n one picture was the same. less, or more than on the corresponding teeth in the other picture.

&

KAUKO K. MAKINEN

period (13.94 mg) and the mean PFW of the xylitol period (8.64 mg) indicates an overall decrease of 38", in the amount of plaque. irrespective of the number of chewed pieces of chewing-gum. This Table I. Individurrl wiliies, means and standard der.iatioris, for plaque fresh w i g h t ( P F W ) in mg a d i/irertrise-lilce trctivit.y (IN.4) in /rmoles/(min nig protein) :I; 10' obtained f o r each trial ~~

Sucrose trial P F W INA

Cheuing 3 per day

~

Y

S.D. Cheuing 10 per day

Y

S.D.

16.0 10.0 19.6 18.8 23 9 17.66 5.13 14.5 12.7 11.6 7.3 5.0 10.22 3.94

53.8 44.0 24.7 25.3 37.9 37.14 12.45 23.6 27.1 22.6 9.7 8.5 18.30 8.57

0

THREE

A

TEN PIECES

Xylitol trial Sub-j. P F W INA

I 2

14.7 21.3 7.2 11.9 9.6 30.1 9.4 13.9 13.5 44.1 10.88 24.26 3.12 13.20 10.6 16.9 7.1 08.7 6.5 28.0 4.2 03.4 3.0 0.0 6.40 11.40 2.99 11.26

4 6

8

3 5 7 9 10

PIECES

PER

DAY

PER DAY

25

RESULTS

The values obtnined for plaque fresh ueight (PFW) and invertase-like activity ( I N A ) from each test person after the sucrose trial and the xylitol trial are shown in Table I. From Figs. 1 and 2 it can be seen that the least amount of plaque was formed diiriiig the xylitol period. Comparison beheen the mean PFW of the sucrose

SUCROSE

XYLiTOl

TRIAL

TRIAL

Fig. I . Individual changes i n Plaque Fresh Weight (PFW).

29

EFFECT O N PLAQUE OF A XYLITOL-CONTAINING CHEWING-GUM

20

r

1

Lo

a

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0

GROUP CHEWING IO/DAY

S SUCROSE TRIAL X

s x

s x

XYLITOL TRIAL

Fig. 2. Means and standard deviations of Plaque Fresh Weight for the two trials. Comparison between the sucrose and the xylitol trials: p < 0.025.

s x

decrease was statistically significant (p < 0.025, Wilcoxon-test for pair differences). As can be seen in F'g. 2, in both trials the niean PFW was lower (410/,) in the group chewing 10 pieces per day (p i 0.05, two-tailed U-test of MannWhitney) than in the group chewing 3 pieces per day. The invertase-like activity in the plaque extracellular phase was significantly lower after the xylitol trial than after use of the sucrose-containing product (p < 0.025, Wilcoxon-test for pair differences). A difference, however not significant, was found in the invertase activity between the groups chewing either 3 or 10 pieces per

day after the xylitol trial [24.26 and 11.40 pniole/(min x mg protein) x lo?, respectively], whereas a significant difference was found after the sucrose trial [37.14 and 18.30 pmole/(niin x mg protein) x lo2, respectively; p < 0.05, two-tailed U-test of Mann-Whitney]. Comparison between pictures froni the sucrose chewing period and the xylitol chewing period showed no marked difference (Table 11). More stained material was noticed after the sucrose trial on 32% of the teeth; more stained material was noticed after the xylitol trial on 24.5% of the teeth. No difference could be established on 43.596 of the teeth.

Table 11. Comparison between the photographs ta.'cen from each subject at the end of the sucrose and xylitol trials. Two examiners, not aware of the test conditions in the photographs to be compared, were requested to determine wether the amount of stained material on each tooth in one picture was the snme, less, or more than on the corresponding tooth in other picture Subjects Difference in Exthe amount of aminsteined material er

More after sucrose trial More after xylitol trial No difference

1

2

3

I

5

8 6

I1

I I1 I I1 No I observation I1 Individual and total number of teeth

4

8 5

4 4 2

3

2 2

16

8 7

1

2

1

1

16

16

16

5 4 3 4

9

6

7

8

3 4

2 1 1 1 5 6

7 6

1 2

4 1 4 7

16

16

16

5 3

16

Total

4 7

1 16

10

o/

/0

24 24 48 32 22 I5 37 24.5 2 3 0 1 3 6 6 6 4 3 . 5 2 4 5 9

16

160

160

30

CHRISTIAN MOUTON, A R J E SCIIEININ

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DISCUSSION

The gravimetric results showed that the use of a xylitol-containing chewing-gun1 noticeably reduced (38; L,) the aniount of plaque formed during a neglected oral hygiene period of three days, when compared to the use of a corresponding sucrose containing product. The use of ten pieces of gum per day was seen to be more effective than the use of only three. However, the possible effect one could expect from the use of xylitol-containing chewinggum was weakened by the fact that less plaque was also observed after the sucrose trial in the group chewing ten pieces per day than in the group chewing three. According to Curlssoiz & Egelberg, (1965), owing to an increased sucrose consumption one might have expected a larger amount of plaque to be formed. A possible explanation might be found in the plaqueremoving capacity of chening per se; an increased friction on the tooth-surface would correspond to an increased removal of plaque. It is, however, not likely that such a procedure could produce a 41"" decrease in the amount of plaque as observed in the present study. Furthermore, available information indicates a relative (Rirthe & V d k , 1972) or an uiilike (Bratthull et al.. 1973) ability of gum chewing to remove plaque. More likely, it appears that the observed discrepancy might be caused by the involvement of high plaque-formers i n the group chewing 3 pieces per day and of low plaqueformers in the group chewing 10 pieces per day. The results obtained from visual estimation of the variations in the amount of stained material cannot be so clearly established. One may assume that such a visuaI method deals only with a particular aspect of the dynamics of dental plaque,

&

KAUKO K. M A K I N E N

i.e. its extension. Consequently, special attention should be paid, in further studies. to the specific problem of plaque indices, and ascertain their reliability in assessing the growth of dental plaque. As earlier stated (Makinen & Scheinin, 1971), the term ))invertase))has also in the present study included other enzymes acting on sucrose (for example, transglycosylase activity in the formation of polysaccharides). This trivial name has been used for practical reasons, because the 3.5 dinitrosalisylic acid method involved has been particularly exploited in the assay of invertare in the literature. The actual involvement of true invertase w-ill be elucidated later by chromatographic methods. However, the forniation of xeducing sugars from sucrose was clearly higher after the use of the sucrosecontaining chewing-gum than after that of the xylitol-containing product. This may be an indication of induction of sucrose-ut ilizing enzymes in the sucrose group or of the actual increase in the number of bacterial cells capable of producing the enzymes involved. In earlier papers (Mukinen & Scheicin, 1972; Mukinen, 1972) it was suggested that the determination of plaque or salivary invertase-like activity could be exploited as a specific test for the cariogenic properties of the plaque samples mentioned. All later results, including the present one, have supported this idea. The plaque-reducing capability of xylitol has also been shown earlier (Scheinin & Makineiz, 1971, 1972), and it was established that of all the natural sugars tested, xylitol consumption accompanied the least aniount of plaque. The results of this study indicate that the inclusion of xylitol in a chewing-gum may form an inexpensive means to contribute to other nieasures i n the control of dental plaque

EFFECT ON PLAQUE OF A XYLITOL-CONTAINING CHEWING-GUM

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formation. This may also give reasons for positive anticipation as regards the reduction of caries. Acknowledgements. The authors express their thanks to Mrs. Irma Rintanen, Leila Saarinen and Christina Tuominen for their valuable technical assistance. The first author acknowledges the research fellowship through the Finnish-French scientific exchange program, and the financial aid through the Ministry of Education in Finland, the Emil Aaltonen Foundation and the Nutritional Research Foundation of Finnish Sugar Co. Ltd. REFERENCES

Bratthall et al., 1973. Gor tuggummi tanderna rena? Tandlak. tidn. 65, 582-584 Carisson, J. & Egeiberg, J . 1965. EfTect of diet o n early plaque formation in man. Odont. Revy 16, 112-125

31

Makinen, K . K . 1912. The role of sucrose and other sugars in the development of dental caries: A review. Int. Dent. J. 22, 363-386 Makinen, K . K . & Scheinin, A . 1971. The effect of the consumption of various sugars o n the activity of plaque and salivary enzymes. Int. Dent. J. 21, 331-339 Makinen, K . K . & Scheinin, A . 1972. The effect of various sugars and sugar mictures o n the activity and formation of enzymes of dental plaque and oral fluid. Acta Odont. Scand. 30, 259-275 Rierhe, P . & Volk, B. 1972. Kaugummi und Plaque. Dtsch. zahnarztl. Z. 27, 261-267 Scheinin, A . & Makinen, K . K . 1971. The effect of various sugars o n the formation and chemical composition of dental plaque. Int. Dent. J. 21, 302-321 Scheinin, A . & Makinen, K. K . 1972. Etfect of sugars and sugar mixtures o n dental plaque. Acta Odont. Scand. 30, 235-257

Effect on plaque of a xylitol-containing chewing-gum. A pilot study.

The effects on plaque induced by the use of xylitol- and sucrose-containing chewing-gums were studied on ten test-persons with neglected oral hygiene ...
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