|Year : 2019 | Volume
| Issue : 1 | Page : 62-65
Medicated chewing gums - A novel targeted drug delivery
Nimesh Jain1, Manisha Jadhav2, Rajeshwari G Annigeri3, Pratik R Pipaliya4
1 Department of Oral Medicine and Radiology, College of Dental Sciences, Rau, Indore, Madhya Pradesh, India
2 Private Practitioner, Oral Medicine and Radiology, Dombivali, Maharashtra, India
3 Department of Oral Medicine and Radiology, College of Dental Sciences, Davangere, Karnataka, India
4 Private Practitioner, Oral Medicine and Radiology, Referral Hospital and Community Health Centre, Lodhika, Rajkot, Gujarat, India
|Date of Submission||29-Jun-2018|
|Date of Acceptance||14-Oct-2018|
|Date of Web Publication||23-Apr-2019|
Dr. Nimesh Jain
194, Alok Nagar, Kanadia Road, Indore - 452 016, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The potential of medicated chewing gum (MCG) for buccal delivery, fast onset of action makes it an attractive delivery form. It is considered as vehicle or a drug delivery system to administer active principles that can improve health and nutrition. Chewable tablets and chewing gum (CG) permit more rapid therapeutic action compared to per-oral dosage forms. Chewable tablets and CGs have been very well received by the parents for use in children with full dentition. MCG is feasible in local treatment of diseases of oral cavity as well as treatment of systemic conditions. This newer drug delivery system could be a boon in treating oral diseases as it is a non-invasive mode of drug delivery.
Keywords: Drug delivery, medicate chewing gum, noninvasive
|How to cite this article:|
Jain N, Jadhav M, Annigeri RG, Pipaliya PR. Medicated chewing gums - A novel targeted drug delivery. J Indian Acad Oral Med Radiol 2019;31:62-5
|How to cite this URL:|
Jain N, Jadhav M, Annigeri RG, Pipaliya PR. Medicated chewing gums - A novel targeted drug delivery. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2022 Oct 3];31:62-5. Available from: https://www.jiaomr.in/text.asp?2019/31/1/62/256887
Medicated chewing gum (MCG) is a novel drug delivery system containing masticatory gum base with pharmacologically active ingredient and intended to use for local treatment of mouth diseases or systemic absorption through oral mucosa. MCG is considered as vehicle or a drug delivery system to administer active principles that can improve health and nutrition.
Pharmacological active agents or drugs are formulated into variety of dosage form such as tablets, capsules, injectables, inhalers, ointments, etc., considering physicochemical, pharmacokinetic, pharmacodynamic parameters, and biopharmaceutical aspects of drugs. In addition to its confectionary role, chewing gum (CG) also has proven value as a delivery vehicle for pharmaceutical and nutraceutical ingredients.
Chewable tablets and CGs have been very well received by the parents for use in children with full dentition. Children in particular may consider CG as a more preferred method of drug administration compared with oral liquids and tablets. The use of MCG is feasible in local treatment of diseases of oral cavity as well as treatment of systemic conditions.
| Medicated Chewing Gum|| |
CG has been used for centuries to clean the mouth and freshen the breath. The first patent for the production of CG was filed in 1869 and was issued to Mr. W. F. Semple in Ohio under U. S. Patent No. 98,304. A MCG containing acetyl salicylic acid was commercially introduced in 1928.
In 1991, CG was approved as a term for pharmaceutical dosage form by the commission of European council.
MCGs are solid, single dose preparations with a base consisting mainly of gum that is intended to be chewed but not swallowed. They contain one or more active substances that are released by chewing and are intended to be used for local treatment of mouth diseases or systemic delivery after absorption through the buccal mucosa.
| Components of Medicated Chewing Gum|| |
CG is a mixture of natural or synthetic gums and resins, sweetened with sugar, corn syrup, artificial sweeteners, and may also contain coloring agents and flavor. The basic raw material for all CG is natural gum chicle, obtained from the sapodilla tree. Chicle is very expensive and difficult to procure therefore other natural gum or synthetic materials such as polyvinyl acetate and similar polymers can be used as gum base.
Typically CG comprises two parts
- Water insoluble chewable gum base portion
- Water-soluble bulk portion.
| Manufacturing Processes|| |
Different methods employed for the manufacturing of CG, can be broadly classified into three main classes namely
- Conventional/traditional method (Melting)
- Freezing, grinding, and tableting method
- Direct compression method.
| Factors Affecting Release of Active Ingredient|| |
- Contact Time: The local or systemic effect is dependent on time of contact of MCG in oral cavity. In clinical trial, chewing time of 30 min was considered close to ordinary use
- Physicochemical properties of active ingredient: Physicochemical properties of active ingredient plays very important role in release of drug from MCG. The saliva soluble ingredients will be immediately released within few minutes, whereas lipid soluble drugs are released first into the gum base and then released slowly
- Inter individual variability: The chewing frequency and chewing intensity that affect the drug release from MCG may vary from person to person. In-vitro study prescribed by European Pharmacopoeia suggests 60 cycles per minute chewing rate for proper release of active ingredient
- Formulation factor: Composition and amount of gum base affect rate of release of active ingredient. If lipophilic fraction of gum is increased, the release rate is decreased.
| Therapeutic Uses of Medicated Chewing Gum|| |
- The use of sugar free gum to counteract dental caries by stimulation of saliva secretion has led to a more widespread use and acceptance of gums. It has been proved that chewing non-MCGs increases plaque pH, stimulates saliva flow, and decrease decay. Prevention and cure of oral disease are obvious targets for CG formulations. It can control the release rate of active substances providing a prolonged local effect,,
- Fluoride containing gums have been useful in preventing dental caries in children and in adults with xerostomia
- MCGs containing chlorhexidine (CHX) for treatment of gingivitis and plaque have been available. The use of MCG in the treatment of oral infections has also been reported. CHX CG offers numerous flexibility in its formulation as it gives less staining of the teeth and is distributed evenly in the oral cavity. The bitter taste of CHX can be masked quite well in a CG formulation,
- For systemic effect in conditions such as Vitamin C deficiency, pain and fever alertness, motion sickness, as well as for local effect in the conditions such as plaque acid neutralization, fresh breath, disinfection, anticaries, antiplaque, antifungal, and antibacterial are available,
- Obesity- Active substances such as chromium, guaran, and caffeine are proved to be efficient in treating obesity. Chromium is claimed to reduce craving for food because of an improved blood-glucose balance. Caffeine and guaran stimulate lipolysis and have a thermogenic effect (increased energy expenditure) and reduce feeling of hunger,
- In addition, gums are available for smoking cessation.
| Merits Of Medicated Chewing Gum|| |
- Excellent for acute medication
- Water is not required to take this medication. Therefore, it can be taken anywhere, and hence, high patient compliance
- It need not be swallowed. Therefore, it can be a boon for patient with dysphagia
- Helps preventing dry mouth candidiasis and caries
- Highly acceptable by children
- Increases the bioavailability of drugs by avoiding first pass metabolism
- Fast onset because of the rapid release of active ingredients in buccal cavity and subsequent absorption in systemic circulation
- Gum does not reach the stomach. Hence, gastro intestinal tract (GIT) suffers less from the effects of excipients
- Stomach does not suffer from direct contact with high concentrations of active principles, thus reducing the risk of intolerance of gastric mucosa
- Fraction of product reaching the stomach is conveyed by saliva delivered continuously and regularly. Therefore, duration of action is increased
- Aspirin, dimenhydrinate, and caffeine show faster absorption through MCG than tablets
- Gives local effect
- Increase the rate of saliva secretion. Stimulated saliva has a buffering capacity. Therefore, may help in reducing acidity of gastric fluid.
| Demerits of Medicated Chewing Gums|| |
- Control over drug dosage is not sufficient. The risk of over dosage with MCGs compared with chewable tablets or lozenges that can be consumed in a considerable number and within much shorter period of time
- Sorbitol present in MCG formulation may cause flatulence and diarrhea
- Additives in gum such as flavoring agent, cinnamon, can cause ulcers in oral cavity and licorice causes hypertension
- CHX oromucosal application is limited to short-term use because of its unpleasant taste and staining properties to teeth and tongue
- CGs have been shown to adhere to different degrees to enamel dentures and fillers
- Prolong chewing on gum may result in pain in facial muscles and earache in children.
| Literature Overview|| |
Literature shows few studies conducted in designing and testing the properties of these MCGs.
A study was conducted to assess the anti-plaque effect of CHX in CG on 12 dental hygiene students. Three types of CG were used; each CG measured 0.80gm. One containing 5 mg CHX acetate, one containing 5 mg CHX acetate in addition with hydrogen peroxide (H2O2) and third one was used as control with neither CHX acetate and H2O2 and only flavouring agent as base. During the 4-day test periods, no other oral hygiene measures were allowed than chewing 2 pieces of gum at the time for approximately 10 min, 5 times daily.
At the beginning and at the end of each test period, the quantity of plaque was assessed using the plaque index, plaque wet weight, and the area of plaque on the tooth surface as criteria. It was concluded that use of both the CHX gum and the gum-containing CHX in addition to the H2O2 releasing agent had an excellent plaque growth inhibiting effect during the 4-day test periods but also that the CHX gum had unpleasant taste.
Later in a study in 2008, the researchers prepared a new formulation of CHX gluconate CG that gave both anti-plaque effectiveness and an acceptable taste.
A systematic review was conducted by Keukenmeester RS et al. from MEDLINE-PubMed, Cochrane-CENTRAL, and EMBASE databases to check the effect of sugar-free CG on plaque and clinical parameters of gingival inflammation. It was concluded that the use of sugar-free CG as an adjunct to tooth brushing provides a small but significant reduction in plaque scores. Chewing sugar-free gum showed no significant effect on gingivitis scores. In the absence of brushing, no effect on plaque and gingivitis scores could be established.
In another study, the researchers proved that the use of CHX CG significantly reduced dental plaque formation compared to the use of similar xylitol and sorbitol products in a double-blind three-treatment crossover design employing a 6-day trial period without mechanical oral hygiene measures.
Further, studies are under progress to check if the use of xylitol CG in mothers may delay the transmission of Streptococcus mutans infants.
| Smoking Cessation|| |
CG formulation containing nicotine, lobeline, and silver acetate has been clinically tested as aids to smoking cessation. It is a therapeutic agent intended to help smokers break the psychological habit of smoking by reducing the nicotine withdrawal symptoms normally experienced when smoking is stopped.
The optimal dosage form is selected according to the following table:
Directions for use:
- One piece of gum should be chewed until the taste becomes strong
- The CG should be rested between the gum and cheek
- When the taste fades, chewing should commence again
- The chewing routine should be repeated for 30 min.
Normally, treatment should continue for at least for 3 months. After three months, the user should gradually cut down the number of pieces chewed each day until they have stopped using the product. Treatment should be discontinued when the dose has been reduced to 1–2 pieces of gum per day. Nicotine gum is sugar free.
| Oral Candidiasis|| |
Fungal infections have become major causes of morbidity and mortality among immunocompromised patients. Oral candidiasis is a fungal infection caused by the opportunistic pathogen named Candida albicans. Conventional available treatments for oral candidiasis include topical antifungal azoles such as miconazole. Although increase of resistant microorganisms to conventional treatment is becoming a challenge, researchers are trying to identify potential drugs and alternatives treatments with better and improved therapeutic effects and fewer adverse effects. Studies are being done to develop a MCG with a combination of essential oils as active substances for the effective treatment of oral candidiasis.
| Other Oromucosal Lesions and Conditions|| |
Studies are being conducted to formulate aloe vera CGs to treat oromucosal lesions such as oral lichen planus, ulcers, and abscesses caused by cancer chemotherapy and mucositis caused by radiotherapy.
| Safety Aspect|| |
Over usage of the CGs can lead to pain in the masticatory muscles, and if overused over a longer period of time can lead to hypertrophy of the muscles. MCG like other drugs should be carefully taken under the supervision of the physician and kept away from the reach of children.
| Conclusion|| |
CG not only offers clinical benefits but also is an attractive, discrete, and efficient drug delivery system. A few decades ago, the only treatment for some disease was surgical procedure but now more and more disease can be treated with novel drug delivery systems. In general, it takes time for a new drug delivery system to establish itself in the market and gain acceptance by patients. However, CG is believed to manifest its position as a convenient and advantageous drug delivery system as it meets the high quality standards of pharmaceutical industry and can be formulated to obtain different release profiles of active substances.
The potential of MCG for buccal delivery, fast onset of action, and the opportunity for product-line extension makes it an attractive delivery form. Reformulation of an existing product is required for patent protection, additional patient benefits, and conservation of revenues.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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