- Email: [email protected]
Author's response from Dr. Ly
L E T T E R S
ed existence of a causative relationship between periodontal disease and heart disease. While the anticariogenic benefit of a normal, active saliva flow is unquestionable (and certainly no recent revelation), we have available very effective, proven means of controlling tooth decay with the appropriate use of fluorides, responsible dietary habits and conscientious oral hygiene practices. In my 36 years of dental practice, I’ve observed very effective control of dental caries when these factors are present, and there are no negative “side effects” from employing this regimen. The endorsement of gum chewing as a daytime activity for school-aged children in the guise of a “public health benefit” in Dr. Ly and colleagues’ article strains the credibility of the profession. Habitual gum chewing has deleterious effects, including increased occlusal enamel wear as with other parafunctional habits, and the exacerbation of temporomandibular joint (TMJ) pain. Often, when a person with TMJ pain ceases a habit of frequent gum chewing, symptoms are completely or at least dramatically improved. Another consideration is the unappealing prospect of a teacher facing a class of 30-odd adolescents gnashing on gum with the attendant noises and facial contortions. Educators clearly have enough impediments to their success for us to encourage another distraction. It is absurd to expect a teacher to monitor “the duration of the chewing and discarding.” Finally, just because a protocol reduces decay does not make it an infallible axiom of oral care. Full-mouth exodontia or 1166
JADA, Vol. 139
http://jada.ada.org
cessation of eating also reduces dental caries dramatically. Michael R. Pelczar, DDS Chestertown, Md.
Author’s response from Dr. Curro: Gum chewing as an adjunct to the use of medications has been proposed in the past. Chlorhexidine in gum has been shown to have efficacy equivalent to that in the mouthrinse. My article was written to expand the boundaries, yet unconsidered, for gum chewing. To be used as a medication, the drug in the gum would have to be controlled, While the anticariogenic benefit of a normal, active saliva flow is unquestionable, we have available very effective, proven means of controlling tooth decay with the appropriate use of fluorides, responsible dietary habits and conscientious oral hygiene practices. probably with a novel delivery system, and the chewing timed. The physiology is becoming very interesting, and my article describes that there may be secondary effects due to the chewing alone. “May be” is the operative phrase, which has to be demonstrated, as I state in the article, in a clinical study. Frederick A. Curro, DMD, PhD Clinical Professor Department of Oral and Maxillofacial Pathology, Radiology and Medicine and Director Pharmacotherapeutic Research Bluestone Center for Clinical Research College of Dentistry New York University
New York City
Author’s response from Dr. Ly: Dr. Pelczar rightly observes that there are a limited number of strategies for preventing and arresting tooth decay, each requiring either strict adherence to daily activities (such as brushing with fluoridated toothpaste) or access to professional services (such as the application of topical fluorides). Tooth decay is a persistent problem for some in our population, leading to unnecessary negative effects on the quality of life. Thus, the search for new approaches, or the adaptation of others, remains a priority. The medical use of chewing gum has been documented as successful in some countries,1-5 and it behooves us as professionals to consider this as part of our strategies for both individual patients and populations. Dr. Pelczar should be lauded for his attention to prevention in his practice. Kiet A. Ly, MD, MPH Acting Assistant Professor Department of Dental Public Health Sciences Northwest/Alaska Center to Reduce Oral Health Disparities University of Washington Seattle 1. Schneider NG, Cortner C, Justice M, et al. Preferences among five nicotine treatments based on information versus sampling. Nicotine Tob Res 2008;10(1):179-186. 2. Simons D, Brailsford SR, Kidd EA, Beighton D. The effect of medicated chewing gums on oral health in frail older people: a 1year clinical trial. J Am Geriatr Soc 2002; 50(8):1348-1353. 3. Richter P, Chaffin J. Army’s “look for xylitol first” program. Dent Assist 2004;73(2): 38-40. 4. Nordblad A, Suominen-Taipale L, Murtomaa H, Vartiainen E, Koskela K. Smart Habit Xylitol campaign, a new approach in oral health promotion. Community Dent Health 1995;12(4):230-234. 5. Kolahi J, Soolari A, Ghalayani P, Varshosaz J, Fazilaty M. Newly formulated chlorhexidine gluconate chewing gum that gives both anti-plaque effectiveness and an acceptable taste: a double blind, randomized, placebo-controlled trial. J Int Acad Periodontol 2008;10(2):38-44.
September 2008
Copyright © 2008 American Dental Association. All rights reserved.
ed existence of a causative relationship between periodontal disease and heart disease. While the anticariogenic benefit of a normal, active saliva flow is unquestionable (and certainly no recent revelation), we have available very effective, proven means of controlling tooth decay with the appropriate use of fluorides, responsible dietary habits and conscientious oral hygiene practices. In my 36 years of dental practice, I’ve observed very effective control of dental caries when these factors are present, and there are no negative “side effects” from employing this regimen. The endorsement of gum chewing as a daytime activity for school-aged children in the guise of a “public health benefit” in Dr. Ly and colleagues’ article strains the credibility of the profession. Habitual gum chewing has deleterious effects, including increased occlusal enamel wear as with other parafunctional habits, and the exacerbation of temporomandibular joint (TMJ) pain. Often, when a person with TMJ pain ceases a habit of frequent gum chewing, symptoms are completely or at least dramatically improved. Another consideration is the unappealing prospect of a teacher facing a class of 30-odd adolescents gnashing on gum with the attendant noises and facial contortions. Educators clearly have enough impediments to their success for us to encourage another distraction. It is absurd to expect a teacher to monitor “the duration of the chewing and discarding.” Finally, just because a protocol reduces decay does not make it an infallible axiom of oral care. Full-mouth exodontia or 1166
JADA, Vol. 139
http://jada.ada.org
cessation of eating also reduces dental caries dramatically. Michael R. Pelczar, DDS Chestertown, Md.
Author’s response from Dr. Curro: Gum chewing as an adjunct to the use of medications has been proposed in the past. Chlorhexidine in gum has been shown to have efficacy equivalent to that in the mouthrinse. My article was written to expand the boundaries, yet unconsidered, for gum chewing. To be used as a medication, the drug in the gum would have to be controlled, While the anticariogenic benefit of a normal, active saliva flow is unquestionable, we have available very effective, proven means of controlling tooth decay with the appropriate use of fluorides, responsible dietary habits and conscientious oral hygiene practices. probably with a novel delivery system, and the chewing timed. The physiology is becoming very interesting, and my article describes that there may be secondary effects due to the chewing alone. “May be” is the operative phrase, which has to be demonstrated, as I state in the article, in a clinical study. Frederick A. Curro, DMD, PhD Clinical Professor Department of Oral and Maxillofacial Pathology, Radiology and Medicine and Director Pharmacotherapeutic Research Bluestone Center for Clinical Research College of Dentistry New York University
New York City
Author’s response from Dr. Ly: Dr. Pelczar rightly observes that there are a limited number of strategies for preventing and arresting tooth decay, each requiring either strict adherence to daily activities (such as brushing with fluoridated toothpaste) or access to professional services (such as the application of topical fluorides). Tooth decay is a persistent problem for some in our population, leading to unnecessary negative effects on the quality of life. Thus, the search for new approaches, or the adaptation of others, remains a priority. The medical use of chewing gum has been documented as successful in some countries,1-5 and it behooves us as professionals to consider this as part of our strategies for both individual patients and populations. Dr. Pelczar should be lauded for his attention to prevention in his practice. Kiet A. Ly, MD, MPH Acting Assistant Professor Department of Dental Public Health Sciences Northwest/Alaska Center to Reduce Oral Health Disparities University of Washington Seattle 1. Schneider NG, Cortner C, Justice M, et al. Preferences among five nicotine treatments based on information versus sampling. Nicotine Tob Res 2008;10(1):179-186. 2. Simons D, Brailsford SR, Kidd EA, Beighton D. The effect of medicated chewing gums on oral health in frail older people: a 1year clinical trial. J Am Geriatr Soc 2002; 50(8):1348-1353. 3. Richter P, Chaffin J. Army’s “look for xylitol first” program. Dent Assist 2004;73(2): 38-40. 4. Nordblad A, Suominen-Taipale L, Murtomaa H, Vartiainen E, Koskela K. Smart Habit Xylitol campaign, a new approach in oral health promotion. Community Dent Health 1995;12(4):230-234. 5. Kolahi J, Soolari A, Ghalayani P, Varshosaz J, Fazilaty M. Newly formulated chlorhexidine gluconate chewing gum that gives both anti-plaque effectiveness and an acceptable taste: a double blind, randomized, placebo-controlled trial. J Int Acad Periodontol 2008;10(2):38-44.
September 2008
Copyright © 2008 American Dental Association. All rights reserved.