Effect of Xylitol-Containing Chewing Gums on Oral Microflora: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To assess the quality and effect of xylitol-containing chewing gums on oral microflora. Material and Methods: A systematic review was conducted utilizing a database from 2016 to 2023. The PICO question implemented through this research was “Does xylitol-containing chewing gums show any effect on oral microflora?”. A total of 372 articles were found, and after eliminating duplicates, 48 articles were retrieved. By applying inclusion and exclusion criteria, a total of 10 RCTs were identified. Quality assessment was done using the CONSORT checklist, and the Risk of Bias was assessed using the RoB 2 tool (A revised Cochrane risk-of-bias tool for randomized trials). Meta-analysis was performed using the Comprehensive Meta-analysis version 4 software for 4 RCTs. Results: A total of 1003 subjects who are aged between 3 and 63 years were included in the randomized trials with a follow-up period ranging from 2 days to 2 years. All the included studies have shown reduced mutans streptococci count after using xylitol chewing gums. On performing Meta-analysis, a significant difference was found between the experimental (xylitol) and control (Polyol) groups with a Standard Mean Difference (SMD) of -0.559, 95% Confidence Interval (CI): -0.860 to -0.258 (p=0.001). Conclusion: Regular use of xylitol chewing gum will reduce the count of mutans streptococci.