Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program

Helen Whelton, Rose Kingston, Denis O'Mullane, Frederick Nilsson, Helen Whelton, Rose Kingston, Denis O'Mullane, Frederick Nilsson

Abstract

Background: In addition to its general and periodontal health effects smoking causes tooth staining. Smoking cessation support interventions with an added stain removal or tooth whitening effect may increase motivation to quit smoking. Oral health professionals are well placed to provide smoking cessation advice and support to patients. The objective of the present study was to evaluate the effect of Nicorette(®) Freshmint Gum used in a smoking cessation programme administered in a dental setting, on extrinsic stain and tooth shade among smokers.

Methods: An evaluator-blinded, randomized, 12-week parallel-group controlled trial was conducted among 200 daily smokers motivated to quit smoking. Participants were randomised to use either the Nicorette(®) Freshmint Gum or Nicorette(®) Microtab (tablet). Tooth staining and shade were rated using the modified Lobene Stain Index and the Vita(®) Shade Guide at baseline, weeks 2, 6 and 12. To maintain consistency with other whitening studies, the primary end-point was the mean change in stain index between baseline and week 6. Secondary variables included changes in stain measurements and tooth shade at the other time points the number of gums or tablets used per day and throughout the trial period; and the number of cigarettes smoked per day. Treatments were compared using analysis of covariance (ANCOVA), using treatment and nicotine dependence as factors and the corresponding baseline measurement as a covariate. Each comparison (modified intention-to-treat) was tested at the 0.05 level, two-sided. Within-treatment changes from baseline were compared using a paired t-test.

Results: At week 6, the gum-group experienced a reduction in mean stain scores whilst the tablet-group experienced an increase with mean changes of -0.14 and +0.12 respectively, (p = 0.005, ANCOVA). The change in mean tooth shade scores was statistically significantly greater in the gum-group than in the tablet group at 2 (p = 0.015), 6 (p = 0.011) and 12 weeks (p = 0.003) with greater lightening in the gum-group at each examination period.

Conclusion: These results support the efficacy of the tested nicotine replacement gum in stain reduction and shade lightening. These findings may help dentists to motivate those wishing to quit smoking using a nicotine replacement gum.

Trial registration: NCT01440985.

Figures

Figure 1
Figure 1
Flow of subjects through tooth stain removal study. The flow of subjects through the study is shown according to the CONSORT Statement. [16]

References

    1. Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2007;Issue 4 doi: 10.1002/14651858.CD000146.pub3. Art. No.: CD000146.
    1. Lee W, Pan P. In-vitro examination of the stain removal property of Nicorette Gums. Pfizer Consumer Healthcare Research Report RR111–0009. 2006.
    1. Mankodi SM, Conforti N, Berkowitz H. Efficacy of baking soda-containing chewing gum in removing natural tooth stain. Compend Contin Educ Dent. 2001;22(7A):29–32.
    1. Assev SJ, Stig S, Scheie AA. Carcinogenic traits in xylitol-resistant and xylitol-sensitive mutans streptococci. Oral Microbiol Immunol. 2002;17:95–99. doi: 10.1046/j.0902-0055.2001.00099.x.
    1. Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr. 2003;78:881S–892S.
    1. Bartizek RD, Walters P, Biesbrock AR. The prevention of induced stain using two levels of sodium hexametaphosphate in chewing gum. J Clin Dent. 2002;140:77–81.
    1. Can Trident White whiten teeth? Consum Rep. 2004;51 Editorial.
    1. Lobene RR. Effect of dentifrices on tooth stains with controlled brushing. J Am Dent Assoc. 1968;77(4):849–855.
    1. Macpherson LMD, Stephen KW, Joiner A. et al.Comparison of a conventional and modified tooth stain index. J. Clin. Periodontology. 2000;27:854–859. doi: 10.1034/j.1600-051x.2000.027011854.x.
    1. Özcan M, Kulak Y, Kazazoglu E. The efficacy of two prototype chewing gums for the removal of extrinsic tooth stain. Int Dent J. 2003;530:62–66.
    1. Soparkar P, Newman MB. Effects of a baking soda gum on extrinsic dental stain: results of a longitudinal 4-week assessment. Compend Contin Educ Dent. 2001a;22(7A):25–28.
    1. Soparkar P, Newman MB. A clinical investigation to evaluate reduction in dental stain provided by the once-daily use of a breath mint or chewing gum. Compend Contin Educ Dent. 2001b;22(7A):33–35.
    1. Yankell SL, Emling RC. Efficacy of chewing gum in preventing extrinsic tooth staining. J Clin Dent. 1997;80:169–172.
    1. ICH E6. Good Clinical Practice: Consolidated Guideline 1996. 1996. ; Accessed on 13 April, 2009.
    1. O'Brien WJ, Groh CL, Boenke KM. One-dimensional colour order system for dental shade guides. Dent Mater. 1989;5(6):371–4. doi: 10.1016/0109-5641(89)90102-4.
    1. Moher D, Schulz KF. Altman D for the CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001;285:1987–1991. doi: 10.1001/jama.285.15.1987.
    1. Fagerström KO, Schneider NG. Measuring nicotine dependence: a review of the Fagerström Tolerance Questionnaire. J Behav Med. 1989;12:159–182. doi: 10.1007/BF00846549.
    1. Jarvis MJ, Russell MAH, Saloojee Y. Expired air carbon monoxide: a simple breath test of tobacco smoke intake. BMJ. 1980;281(6238):484–485. doi: 10.1136/bmj.281.6238.484.
    1. Brothwell DJ. Should the use of smoking cessation products be promoted by dental offices: an evidence-based report. J Can Dent Assoc. 2001;67(3):149–155.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren