American Journal of Advanced

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Original Article Medicated Gum- A Novel Drug Delivery System: An Updated Review Ritesh Kumar* 1, Pavitra Solanki 2 and Amrish Chandra 3

1Dr. K. N. Modi Institute of Pharmaceutical Education & Research, Modinagar, Uttar Pradesh, India 2Sanjay College of Pharmacy, Mathura, Uttar Pradesh, India 3Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India

Date of Receipt- 15/05/2014 ABSTRACT Date of Revision- 22/05/2014 Date of Acceptance- 27/05/2014 Chewing gums are mobile drug delivery systems. Unlike chewable tablets medicated gums are not supposed to be swallowed and may be removed from the site of application without resort to invasive means and medicated chewing gum MCG is solid, single dose preparation. As for as patient convenience is concerned it is discrete and easy administration without water promotes higher compliance. Since it can be taken anywhere, a chewing gum formulation is an excellent choice for acute medication. The advantages for children and for patients who find swallowing tablets difficult are obvious. The medicated chewing gums are solid, single dose preparations with a base consisting mainly of gums that are intended to be chewed, but Address for not swallowed. They contain one or more active substances, which Correspondence are released by chewing and are intended to be used for local Asst. Prof., Dr. K. N. treatment of mouth diseases or systemic delivery after absorption Modi Institute of through the buccal mucosa. This concept is supported by statements Pharmaceutical that chewing free gum can help reduce the risk of dental caries Education & Research (cavities). The objective of this systematic study is to appraise Modinagar- 201204, existing evidence concerning a possible therapeutic effect of sugar Uttar Pradesh, India. free chewing gum for patients. MCG represents the newest system with potential uses in pharmaceuticals, over the counter medicines Tel. +91-8755170024. and nutraceuticals. E-mail: ritesh_pharma @rediffmail.com Keywords : Chewing gums, Mobile drug delivery system, Dental caries, Mouth diseases, Saliva.

INTRODUCTION Medicated Chewing Gum (MCG) is for local treatment of mouth diseases or a novel drug delivery system containing systemic absorption through oral mucosa. masticatory with pharmacolo MCG is considered as vehicle or a drug gically active ingredient and intended to use delivery system to administer active

American Journal of Advanced Drug Delivery www.ajadd.co.uk Kumar et al______ISSN 2321-547X principles that can improve health and assurance that his/her masticatory needs will nutrition. MCG represents the newest be met. These are some of the international system with potential uses in terms which identify chewing gum (e.g. pharmaceuticals, over the counter medicines goma de mascara in Argentina; kaugummi and nutraceuticals 1. The drugs intended to in Austria; le chewing gum in France; ellk in act in oral cavity often have low water/saliva Arabian area; tskles in Greece; gamu in and chewing gum constitute a Japan, tyggegummi in Norway and heung valuable delivery system for such drugs. how chu in Taiwan). So it can be considered Medicated chewing gum is a solid or as an international habit among all countries semisolid which consists of one of the world (except in some countries and or more active ingredient (water soluble or in some religious communities where gum insoluble) incorporated in water insoluble chewing is still considered as bad manners base. Many scientific studies have explored or even forbidden e.g. Singapore & UAE). the role of chewing gum in promoting In 1987, gum products accounted for healthy teeth. Gum chewing is a common 550 million dollars in sales in the USA. habit in many countries 2. Chewing gum has Chewing gum provides new competitive been used for centuries to clean the mouth advantages over conventional drug delivery and freshen the breath. A MCG containing system. Several ingredients are now Acetyl Salicylic Acid was commercially incorporated in medicated chewing gum, introduced in 1928 3. In 1991, Chewing gum e.g. fluoride for prophylaxis of dental caries, was approved as a term for pharmaceutical chlorhexidine as local disinfectant, nicotine dosage form by the commission of European for cessation, aspirin as an Council. Approximately £80 to 100 million, analgesic, and caffeine as a stay alert 55% of it being sugar free gum. Seventy preparation. nine percent of the chewing gums sold in US market accounts for approx. 50% Switzerland are sugarfree, 70% of the of world market for medicated chewing consumers are teenagers, and girls chew gums. more gum than boys. Chewing gum was The medicated chewing gum consists initially sweetened with sugar, which of active ingredient in the core or on the contributed to dental caries. Today, surface of it. however, more than 50% of chewing gum sold in Europe is sweetened with sugar History of Medicated Chewing Gum substitutes (). Clinical evidence One thousand years ago, the Mayan shows that sugar substituted chewing gum Indians chewed from the sapodilla does not lead to caries, because the polyols tree in order to clean their teeth and freshen do not lead to a clinically relevant the breath 6,7 . Shortage of bases production of metabolic acids in dental during World War II enhanced development plaque. The objective of this systematic of the synthetic gum bases that are used literature review is to appraise existing today. evidence concerning a possible therapeutic/ The first patent for the production of anticarcinogenic effect of sugarfree chewing gum was filed in 1869 and was chewing gum for patients. MCG represents issued to Mr. W. F. Semple in Ohio under U. the newest system with potential uses in S. Patent No. 98,304. The first medical pharmaceuticals, over the counter medicines chewing gum, Aspergum®, was launched in and nutraceuticals 4,5 . A devoted gum chewer 1928 8,9 . This chewing gum contains the can confidently transverse the globe with the analgesic substance acetylsalicylic acid

AJADD[2][3][2014]434-450 Kumar et al______ISSN 2321-547X known from Aspirin® tablets. Chewing gum arrival of a new chewing gum product, did not gain acceptance as a reliable drug FREEDENT, designed especially for denture delivery system until 1978, when nicotine wearers, which did not stick to most dentures chewing gum became available. Another as ordinary gums. commercially available medical chewing gum is dimenhydrinatecontaining chewing gum Merits of Medicated Chewing Gum 911 for . • Does not require water to swallow. Hence Chewing gum has an old and long it can be taken anywhere. history, in 50 AD; the Greeks sweetened their • Advantageous for patients having breath and cleansed their teeth by using difficulty in swallowing. mastiche, a resin from the bark of mastic tree. • Excellent for acute medication. (The English word "masticate" is derived • Counteracts dry mouth, prevents from the root word mastiche) At the candidiasis and caries. beginning of its history this product was not • Highly acceptable by children 10 . so much accepted by the public. gum, • Avoids first pass metabolism and thus which was manufactured in 1848, became the increases the bioavailability of drugs. first chewing gum product to be • Fast onset of action due to rapid release of manufactured commercially Called "STATE active ingredients in buccal cavity and OF MAINEPURE SPRUCE GUM." subsequent absorption in systemic However, its use was eventually replaced by circulation. paraffin, which is still being chewed in some • does not suffer from direct areas. contact with high concentrations of active The first patent for chewing gum, U.S. principles, thus reducing the risk of number 98,304 was filed on December 28, intolerance of gastric mucosa 11 . 1869 by Dr. William F. Sample, a dentist Fraction of product reaching the stomach from Mount Vernon, Ohio. This product, • is conveyed by saliva delivered consisting of liquorice and rubber dissolved in continuously and regularly. Duration of alcohol and naphtha, was initially intended to action is increased. be used as a dentifrice. In 1891, William Wrigley Jr., arrived in Chicago with $32 in • Aspirin, Dimenhydrinate and Caffeine cash with a desire to market his special shows faster absorption through MCG variety of soap. Eventually, he switched from than tablets. soap to baking sales and offered • Stimulates flow of saliva in the mouth. chewing gum premiums to merchants who • Neutralizes plaque acids that form in the became his customers. By 1892, when the mouth after eating fermentable premiums had become more popular than the carbohydrates. baking powder, Wrigley launched his first • Helps whiten teeth by reducing and 11 chewing gum products, LOTTA and preventing stains . VASSAR. A year later, he developed JUICY 1216 FRUIT, and shortly thereafter, WRIGLEY's Demerits of Medicated Chewing Gum SPEARMINT gum. Sugarless gum made its • Risk of over dosage with MCG compared debut in the early 1950s, generally used with chewable tablets or lozenges that can sorbital as a . The first brand be consumed in a to be marketed was HARVEY's followed by considerable number and within much TRIDENT and CAREFREE. In 1975, the shorter period of time. Wm. Wrigley Jr. Company introduced the • present in MCG formulation may cause flatulence and diarrhoea.

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• Additives in gum like flavouring agent, (2) The bicarbonate neutralizes and buffers Cinnamon can cause ulcers in oral cavity plaque acids; and liqorice cause hypertension. (3) The calcium and phosphate ions • Chlorhexidine oromucosal application is contribute to remineralization of early dental limited to short term use because of its caries lesions. Saliva also contains unpleasant taste and staining properties to antibacterial agents. teeth and tongue. Saliva alone is a powerful protector of • Prolong chewing on gum may result in the oral cavity and chewing gum is an pain in facial muscles. efficient and pleasant way to increase saliva without drugs. Increasing saliva in the mouth Problems Occurred During Manufacturing of is accomplished by the stimulation of flavors Chewing Gums 17 and the gustatory action of chewing.

• Generally the chewing gum will jam the 19 grinding machine, sticking to blades, Taste and Texture screens and other surfaces if the moisture To succeed in the market, the chewing level is not controlled. gum formulation must have a pleasant taste • Another problem associated with the and texture. Most active substances have an above methods is that the gum base is unpleasant, bitter or metallic taste. Since the heated to a fluid mass to facilitate mixing active substance will be released in the oral of other ingredients. Such elevated. cavity and remain there for a longer period of Temperatures can cause degradation of time than in the case with ordinary delivery heat sensitive compounds, including forms (usual chewing time is 10 to 20 active agents and flavors. minutes), unique expertise in taste definition, • In manufacturing of chewing gum, taste masking and taste modification are sometimes organic solvents are used to essential for the success of a medical chewing dissolve the active agents. It is dif