Fluoride Chewing Gum

Fluoride Chewing Gum

PEP Topic 

Fluoride is the ionized form of fluorine. Fluoride is best known for its role in the prevention of tooth decay. It also has local antibacterial activity. Flouride chewing gum was examined for its efficacy related to development of mucositis in patients with cancer.

Effectiveness Not Established

Research Evidence Summaries

Gandemer, V., Le Deley, M., Dollfus, C., Auvrignon, A., Bonnaure-Mallet, M., Duval, M., … Schmitt, C. (2007). Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy. Journal of Pediatric Hematology/Oncology, 29, 86–94.

doi: 10.1097/MPH.0b013e318030a3e4

Intervention Characteristics/Basic Study Process:

Patients chewed five to six pieces of fluoride-containing, sugar-free gum, sweetened with xylitol per day for 20 minutes per piece from the first day of chemotherapy to three days after course of treatment. Both groups practiced standard oral care, consisting of brushing teeth with a soft toothbrush and rinsing with sodium bicarbonate rinse.

Sample Characteristics:

  • The study reported on 145 children ages 5–18 years. The gum group had 73 patients, and the control group had 72 patients.
  • All patients were scheduled to receive chemotherapy associated with at least a 30% rate of grade 3–4 oral mucositis according to the World Health Organization (WHO) oral mucositis grading scale.


The study was conducted between March 1999 and December 2002.

Study Design:

This was a randomized, controlled trial.

Measurement Instruments/Methods:

Researchers recorded the WHO grade of mucositis within first 21 days, time to development of grade 3–4 mucositis, incidence of any grade of mucositis, incidence of pain using a 70-point visual analogue scale, number of days of total parenteral nutrition, incidence of abdominal symptoms, and incidence of septicemia.


No significant differences were found between arms for severe mucositis endpoints.

Patients receiving less toxic regimens had a decrease in WHO grade 1–4 oral mucositis of 49% in the gum group and 72% in the control group (p = 0.03).


  • This study did not achieve adequate sample size according to power analysis.
  • Eight children discontinued using the gum because of nausea.
  • Chlorhexidine and fungizone were widely used in both arms.