Professor Liz Kay argues that with a decline in the chewing of sugar-free gum, we must examine strategies to arrest the potential wider decline in dental health before we start feeling both the health and economic impacts.

An article in The Economist's 1843 magazine on the declining popularity of chewing gum is a source of nagging concern for me and, I am sure, many other dental practitioners.

In it, the author charts the gradual slide into obsolescence of a once-potent symbol of individuality and rebellion. Worldwide gum sales fell 14 per cent in 2020. This might be good news for pavements but, for those of us concerned with the health of the nation's teeth, the worry is that decreased chewing of sugar-free gum will have very negative consequences for our oral health.

According to the article, chewing gum has lost its cultural allure and is now considered uncool and outmoded, especially amongst the young. While I would not deign to second-guess The Economist on matters of culture and taste, I do take issue with the central claim it makes about chewing gum: that it is 'pointless'.

But before doing so, an important caveat: my comments relate to sugar-free chewing gum, not bubble gum which has a very different formulation and none of the oral health benefits described here. You would be hard pressed to find a dentist in favour of gum that contains sugar. Sugar-free gum is a different proposition, however. And contrary to what The Economist contests, it very much does have a point.

Happily, from a dental care perspective, the benefits of chewing sugar-free gum are already well-recognised. It helps protect your teeth and gums when it might not be possible to brush (e.g. between meals). Our teeth are most at risk from plaque and acid after we have eaten.

Chewing gum also stimulates the production of saliva, the mouth's natural defence against plaque acid. It takes the saliva about an hour to replace the minerals in our tooth enamel that are dissolved by the sugars contained in what we eat and drink. Chewing sugar-free gum for 20 minutes after eating or drinking increases the flow of saliva and helps replace the minerals more quickly.

A study by the Faculty of Dentistry at Kings College London in 2019 quantified the benefits. It found that people who chew sugar-free gum develop on average 28 per cent fewer cavities than people who don't. The equivalent figure for fluoride toothpastes is 24 per cent.

So, from an oral health perspective, there very much is 'a point' to chewing sugar-free gum.

But coming back to The Economist article, the question then becomes, how much of a risk to the nation's oral health does the decline in gum sales pose?

Some statistics help to put the question into context. Currently, one-in-three adults in the UK has tooth decay and around 35,000 children are admitted to hospital every year for tooth extractions under general anaesthetic on the NHS.

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Those numbers are stark enough, but they are being exacerbated by the effects of the Covid pandemic.

A survey by the Oral Health Foundation in June found that almost half of UK adults (45 per cent) have experienced delays to dental appointments or treatments in the last 12 months. This is more than any other health service including GP surgeries (30 per cent), hospital services (16 per cent) and mental health support (11 per cent). As many as 20 million dental appointments have been delayed or cancelled since March 2020.

Combined with an equally bleak funding outlook for NHS dental services, all of this points to a looming crisis in the nation's oral health.

So why the concern about the declining use of gum, which might seem a peripheral issue in the face of such grim statistics? The answer is it's an important weapon in the armoury of preventative measures that can prevent tooth decay and disease occurring in the first place.

The best strategy for good oral health, indeed good general health, is prevention. The mainstays of a good personal, oral health regime are brushing and flossing, plus regular visits to the dentist. But other measures make a big difference too, and these include a healthy diet of non-sugary foods and chewing.

The landmark National Food Strategy report published last month found that poor diet contributes to around 64,000 deaths every year in England and costs the economy an estimated £74 billion. A key recommendation was the introduction of a sugar and salt reformulation tax to encourage manufacturers to reduce sugar and salt levels in foods by reformulating recipes or reducing portion sizes.

What is good for the nation's waistline is also good for its teeth. It is worth repeating the headline stats again: one-in-three UK adults has tooth decay; 35,000 children undergo tooth extractions under anaesthetic every year. Shocking stuff.

Nor is tooth decay an equal opportunities disease: the toll falls heaviest on poorer households. A report from Public Health England in March revealed that, between 2008 and 2019, relative inequalities in the prevalence of tooth decay in 5-year-olds in England had gotten much worse.

This is shameful. And in the absence of significantly more funding for dentistry, which seems a distant prospect, we need to find innovative ways to protect children and lock in positive attitudes and behaviours towards our teeth.

From the simple and obvious like regular brushing, to the more ambitious and problematic like water fluoridation, preventative measures will save money and lives.

Simple, easy-to-access, non-prescriptive behavioural choices like chewing sugar-free gum can make a big difference. So while gum might have lost its cachet as a symbol of rebellion, my hope is the marketeers can highlight its oral health benefits instead, to the benefit of the nation's teeth but also the NHS and the public purse which otherwise bear the cost.

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