Antimicrobial Effectiveness of Chlorhexidine Chewing Gums on Streptococcus Mutans Counts– An in vivo Microbiological Study

The aim of the present study was to evaluate the antimicrobial efficacy of Chlorhexidine chewing gums and to assess the effect of dosage and frequency of intake of Chlorhexidine gums on Streptococcus mutans(SM) count. Method: The sample consisted of 30 subjects, divided into two groups AI & AII. Each group consisted of 15 subjects. Group AI chewed 2 Chlorhexidine Chewing gum X Twice Daily for 20 minutes (Total = 4 gums Daily) & Group AII chewed 2 Chlorhexidine Chewing gum X Four times daily for 20 minutes (Total = 8 gums Daily) & saliva sample was collected & agar plates were inoculated for SM colony count. The study was carried for a week’s time and salivary sample collected were Baseline, Day 1 morning and evening, Day 4 evening, Day7 morning and evening. Results: After the gum was chewed, it was observed that the colony count started to decrease when compared with baseline in both the groups. The fall in SM count was statistically highly significant with p < 0.001 in both the groups. When comparing between Group AI (Dosage 20mg daily) and Group AII (Dosage 40mg daily), the fall in SM count for both the groups was not statistically significant with p-value > 0.05. It was concluded that there was reduction in the level of Salivary SM, but was not statistically significant, by increasing the dosage and frequency of intake of Chlorhexidine containing gums. Conclusions: We recommend that dosage of Chlorhexidine containing chewing gums can be restricted to four gums instead of eight gums per day.

Chlorhexidine, Chewing gums, Streptococcus mutans, children.

1. Rassing MR. Chewing gum as a drug delivery system. Adv Drug Delivery Rev. 13: 89–121, 1994.

2. Cloys LA, Christen AG, Christen JA. The development and History of chewing gum. Bull Hist Dent, 40: 57–65, 1992.

3. Commission of the European Communities: CPMP list of allowed terms for pharmaceutical dosage form, route of administration, container, closure and administration devices, III / 3593 / 91 (1991).

4. Edgar WM, Geddes DAM. Chewing gum and Dental Health. Br Dent J, 168: 173–177, 1990.

5. Thomas Imfeld. Chlorhexidine-containing chewing gum: A clinical documentation Schweiz Monatsschr Zahnmed, 116: 476–483, 2006.

6. Keyes PH: The infectious and transmissible nature of experimental dental caries: Findings and Implications. Arch Oral Biol, 1: 304–20, 1960.

7. Simons D, Brailsford SR, Kidd EAM, Beighton D. The Effect of medicated chewing gums on oral health in frail older people: A 1year clinical Trail. J Am Geriatr Soc, 50: 1348–1353, 2002.

8. Ainamo J, Nominen A, Westerlund U. Optimal dosage of chlorhexidine acetate in chewing gum. J Clin Periodontol, 17: 729–733, 1990.

9. Smith AJ, Moran J, Dangler LV, Leight RS, Addy M. The efficacy of an antigingivitis chewing gum. J Clin Periodontol, 23: 19–23, 1996.

10. Georg Tellefsen, Greg Larsen et al. Use of chlorhexidine chewing gum significantly reduces dental plaque formation compared to use of similar xylitol and sorbitol products. J Periodontol, 67: 181–183, 1996.

11. Anderson M.H.: Chlorhexidine: How useful is it in combating the bacterial challenge and Dental caries? Canadian Dental Association Journal, 31: 211–216, 2003.

12. Glass RL,ed: The First international conference on the declining prevalence of Dental caries. J Dent Res 61 (Special issue): 1301–1383, 1982.

13. Bowden GHW. Which bacteria are cariogenic in man? In markers of high and low risk groups and individuals for dental caries (ed. Johnson NW); Cambridge University press; 266–286, 1991.

14. Loesche W.J. Role of Streptococcus mutans in human dental decay. Microbiol Rev, 50: 353–380, 1986.

15. Van Houte J, Jordan HV, Laraway R, Kent R, Soparkar PM, De Paola PF. Association of microbial flora of dental plaque & saliva with human root-surface caries. J Dent Res, 69: 1463–8, 1990.

16. Cronin M, Gordon J, Rearden R, Balbo F. Three clinical trials comparing xylitol and sorbitol containing gums for their effect on supragingival plaque accumulation. J Clin Dentistry, 5: 106–109, 1994.

17. Emilson CG, Westergren G. Effect of Chlorhexidine on the relative proportions of Streptococcus mutans and Streptococcus Sanguis in hamster plaque. Scand J Dent Res, 87: 288–95, 1979.

18. Emilson CG. Effect of Chlorhexidine gel treatment on Streptococcus mutans population in human saliva and dental plaque. Scand J Dent Res, 89: 239–246, 1981.

19. Jones CG. Chlorhexidine: Is it still the gold Standard? Periodontology, 2000, 15: 55–62, 1997.

20. Hugo WB, Longworth AR, Some aspects of mode of action of Chlorhexidine. J Pharm Pharmacol, 16: 655–662, 1964.

21. Longworth AR. In “The inhibition and Destruction of microbial cells” Ed. W.B. Hugo Academic press, London: 95: 1971.

22. Persson RE, Truelove EL, LeResche L, Robinovitch MR. Therapeutic effects of daily or weekly chlorhexidine rinsing on oral health of a geriatric population. Oral Surg Oral Med Oral Pathol, 72: 184–191, 1991.

23. Kozai K, Wang DS, Sandham HJ, Phillips HI. Changes in strains of mutans streptococci induced by treatment with chlorhexidine varnish. J Dent Res, 70, 1252–1257, 1991.

24. Lindquist B, Edwards S, Torell P, Krasse B. Effects of different carriers preventive measures in children highly infected with mutans streptococci. Scand J Dent Res, 97: 330–337, 1989.

25. Hildebrandt GH. Effect of repeated treatment with sustained-release chlorhexidine mouth guards on salivary levels of mutans Streptococci. Caries Res, 30: 445–53, 1996.

26. Jukka A, Hossein Etemadzadeh. Prevention of plaque growth with chewing gum containing Chlorhexidine acetate. J Clin Periodontol, 14: 524–527, 1987.

27. Niklaus P. Lang, Michel C. Brecx. Chlorhexidine digluconate – an agent for chemical plaque control & prevention of gingival inflammation. J Periodontol Res Supplement: 74–89, 1986.

28. Simons D, Kidd EAM, Beighton D, Jones B. The effect of chlorhexidine/xylitol chewing gum on cariogenic salivary microflora: A clinical trial in elderly patients. Caries Res, 31: 91–96, 1997.

29. Loe H. Schiott R. The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. J Periodont Res, 5: 79–83, 1970.