Reviewed: Kimbrough C, Chun M, dela Roca G, Lau B. Pycnogenol^® chewing gum minimizes gingival bleeding and plaque formation. Phytomedicine 2002;9(5):410-3.

In Europe and the United States, Pycnogenol^® is available as a proprietary dietary supplement. This patented product, which has antioxidant activity, is made from phytochemicals extracted from the bark of the French maritime pine (Pinus pinaster Aiton, Pinaceae). The specific compounds in Pycnogenol include caffeic acid, gallic acid, oligomeric and monomeric procyanidins, and precursors of procyanidins.

Previous research has shown that the whole extract in Pycnogenol or its component fractions produce strong antioxidant effects in perfused organs in vitro, in in vivo models and humans. Studies have demonstrated that Pycnogenol protects against lipid oxidation, inflammatory disorders, and DNA damage induced by hydroxyl radicals. In addition, Pycnogenol alleviates symptoms of endometriosis and dysmenorrhea by decreasing menstrual cramps and abdominal pain. Research in mice showed that Pycnogenol improved immune function and memory. Pharmacological studies have shown that Pycnogenol decreases permeability of capillary walls. Pathologies involving leaky capillaries, chronic venous insufficiency, and diabetic retinopathy, have been successfully counteracted in various clinical studies with Pycnogenol.

The extract upon which Pycnogenol is based was reportedly first used by Native Americans in Quebec, Canada. Some historians suggest that they prepared a tea from the bark of a certain type of pine tree and offered this tea to the French explorer Jacques Cartier and his men, who were suffering from scurvy due to a lack of fruits and vegetables in winter. Symptoms included bleeding gums and loss of teeth. The explorers drank the tea, and within days their gums are reported to have stopped bleeding. This story has become part of the Pycnogenol storyline, although it is not historically possible to confirm its accuracy.

In this article, a double-blind study was used to evaluate the effect of a chewing gum containing Pycnogenol on plaque formation and gingival bleeding. The subjects were 40 dental students (20 men and 20 women) aged 22–35 years. The subjects were randomly assigned to chew either a sugar-free gum containing 5 mg Pycnogenol (prepared by Fennobon Oy, Karkkila, Finland) or a control gum without Pycnogenol (Trident^® Advantage Gum). For 14 days, each subject chewed six pieces of gum daily for at least 15 minutes per piece. Three pieces were chewed after meals and the remaining three were chewed at various times throughout the day.

Baseline measures of gingival bleeding and plaque were compared with post-treatment measures, which were obtained after the 14 days of chewing the Pycnogenol or control gums. Bleeding scores were determined by gently touching the sulcus (crevice between the gum and tooth surface) with a probe at four sites (facial, lingual, and interproximals) for 30 seconds each. If no bleeding occurred, a score of 0 was assigned. If any bleeding occurred, a score of 1 was assigned. The number of sites that bled was used as the sulcus bleeding index.

Plaque accumulation scores were also determined. A plaque-disclosing solution (basic fuchsin mouthwash) was applied to the teeth and amount of visible plaque was rated on a scale of 0 to 5, as follows: 0, no plaque; 1, separate flecks of plaque; 2, a thin, continuous band of plaque (up to 1 mm); 3, a band of plaque wider than 1 mm; 4, plaque covering at least one-third of the crown; and 5, plaque covering two-thirds or more of the crown.

For each subject, the bleeding and plaque scores were determined on a set of three teeth that were not brushed during the study. Subjects wore a removable acrylic stint over the three teeth while brushing, so that these teeth would not come into contact with the toothbrush. Compliance with the study protocol was excellent. The authors had chosen to enroll dental students because they would be more inclined to follow the study protocol without any difficulty.

The results showed that the mean bleeding index in the control group did not change significantly from baseline to post-treatment (1.55 plus/minus 0.10 and 1.54 plus/minus 0.08, respectively). However, in the Pycnogenol group, the bleeding index dropped significantly from baseline to post-treatment (1.59 plus/minus 0.15 and 0.71 plus/minus 0.14, respectively; P < 0.05). The plaque scores showed that plaque accumulation increased significantly from baseline to post-treatment in the control group (3.01 plus/minus 0.19 and 3.82 plus/minus 0.23, respectively; P < 0.05). In the Pycnogenol group, plaque scores were unchanged from baseline to post-treatment (2.95 plus/minus 0.23 and 2.93 plus/minus 0.33, respectively).

These findings indicate that chewing Pycnogenol gum can limit plaque accumulation and gingival bleeding. The authors had hypothesized that the potent antioxidants in Pycnogenol gum might minimize gingival inflammation, and the results supported this hypothesis. Subjects who used the Pycnogenol chewing gum had a greater than 50% reduction in gingival bleeding, whereas the control group had no change in bleeding scores from baseline to post-treatment. In addition, plaque accumulation increased significantly in control subjects, whereas it remained unchanged in the Pycnogenol group. "The data thus suggest that Pycnogenol is capable of minimizing the increased plaque accumulation normally observed in individuals who do not brush [their] teeth," the authors note.

Based on these results, the authors conclude that "for individuals who enjoy chewing gums, the addition of Pycnogenol to the gum may reduce the need for frequent tooth brushing and, at the same time, increase the benefits in maintaining gingival health." Regarding the dose of Pycnogenol used, each piece of gum contained 5 mg and therefore the daily dose obtained from 6 pieces was 30 mg. Plaque accumulation did not decrease in the Pycnogenol group, yet it increased in the control group, indicating that the Pycnogenol gum suppressed or prevented the increase that typically occurs when the teeth are not brushed. "It would be interesting to know whether doubling the concentration of Pycnogenol to 10 mg per gum may further increase its efficacy in minimizing gingival bleeding and plaque accumulation," the authors add. Perhaps that might be the subject of the next study.

—Christina Chase, MS, RD