What are the potential negative effects of chewing gum on the body?

Potential Negative Effects of Chewing Gum

Chewing gum has minimal negative effects on the body when used appropriately, with the primary concerns being temporomandibular joint (TMJ) stress from excessive use, gastrointestinal symptoms from certain additives, and specific risks associated with nicotine-containing gum.

Dental and Oral Effects

Sugar-Free Gum

• Sugar-free gum does not cause dental caries and may actually reduce plaque accumulation, particularly on occlusal (chewing) surfaces, though it has minimal effect on smooth surfaces where gingivitis typically develops 1, 2
• Chewing gum produces transient bacteremia comparable to routine activities like tooth brushing and eating, which does not increase risk of infective endocarditis in most patients 3
• The cumulative bacteremia exposure from tooth brushing twice daily for one year is 154,000 times greater than from a single tooth extraction, indicating that gum chewing poses negligible infectious risk 3

Sugar-Containing Gum

• Sugar-containing gum increases caries risk through frequent sugar exposure, with a dose-response relationship between sugar intake and dental caries development 3
• However, even sugared gum can reduce plaque accumulation comparably to sugar-free gum during the chewing process itself 2

Gastrointestinal Effects

Nicotine Gum (FDA-Approved Medication)

• Common adverse effects include hiccups, heartburn, and nausea, particularly when pieces are used continuously one after another 4
• Users should not exceed 24 pieces per day and must avoid eating or drinking for 15 minutes before or during chewing 4
• Proper technique requires chewing slowly until tingling occurs, then parking the gum between cheek and gum for approximately 30 minutes 4

Sugar Alcohols (Xylitol)

• Xylitol-containing gum requires 3-5 times daily dosing throughout respiratory illness season to reduce acute otitis media risk by 25% 3
• Sporadic or as-needed use is not effective, and the gum must be used consistently 3

Temporomandibular and Mechanical Concerns

Physical Trauma Risk

• Chewing gum during sleep or physical activity increases risk of aspiration, particularly in young children 3
• Parents of infants or young children should be informed of aspiration and ingestion risks from gum and gum components 3

TMJ Considerations

• While not explicitly documented in the provided evidence, excessive chewing can theoretically stress the temporomandibular joint, though no specific guidelines address this concern in the evidence provided

Specific Clinical Contexts

Perioperative Use

• The American Society of Anesthesiologists conditionally suggests not delaying elective procedures in healthy adults who are chewing gum, based on very low-quality evidence 5
• Patients must remove gum before procedures begin 5
• Postoperatively, gum chewing accelerates bowel function recovery and is incorporated into Enhanced Recovery After Surgery protocols 5

Patients with Cardiac Conditions

• Lifelong antibiotic prophylaxis is not recommended to prevent infective endocarditis from bacteremias associated with routine activities like gum chewing 3
• Good oral hygiene and routine dental care are more important than antibiotic prophylaxis for reducing lifetime IE risk 3

Additive-Specific Concerns

Fluoride Content

• Enteral nutrition may provide up to 3 mg fluoride per day with 1500 kcal without toxicity 3
• Chronic fluoride toxicity presents with gastric complaints, anemia, osteomalacia, and dental problems, though this requires excessive exposure beyond normal gum use 3

Remineralizing Agents

• Gums containing calcium phosphates and remineralizing pastes are recommended for dental health maintenance without documented adverse effects 3

Key Clinical Recommendations

For routine use: Sugar-free gum poses minimal risk and may provide dental benefits through saliva stimulation and plaque reduction on occlusal surfaces 6, 1

For nicotine gum users: Follow FDA dosing guidelines strictly, use proper chewing technique, and monitor for gastrointestinal side effects 4

For special populations: Avoid gum in children under 2 years due to aspiration risk, and ensure removal before medical procedures 3, 5