National Smile Month, which ended June 16, 2022, has been running along broadly the same lines for nearly half a century. The first event, ‘Smile ’77’, was a week-long campaign in the West Midlands. The poet Pam Ayres wrote I Wish I'd Looked After Me Teeth especially for the event (subsequently voted 'Top 10’ in a BBC poll of the Nation's 100 Favourite poems).

To people of my father’s age (I’m 24), it was a much-needed reminder to brush twice a day and visit the dentist.

The same advice still holds 45 years on; and the longevity of the event underlines the importance of oral health in the context of overall public health. But what’s particularly interesting for public health watchers like me, is how the messaging has changed over the period.

Smile '77 majored on ‘brushing', whereas today’s campaign is much broader in focus and, in keeping with the times, underpinned by a strong commitment to social justice.

As the website says, "National Smile Month 2022 is all about shining a light on inequalities within oral health […] Your age, wealth, level of education and where you live all determine how healthy, or unhealthy, your mouth might be”. It then lists the grim consequences for the unfortunate (tooth decay, gum disease and mouth cancer) and sets out ways in which a healthy mouth can be made more affordable.

This last point is particularly important in the midst of a cost-of-living crisis with NHS dental appointments in very short supply.

A constant over the 45 years has been the importance accorded to preventative measures. The obvious ones have featured throughout: brushing, flossing, avoiding sugary food and drink. But one is a relative newcomer — the regular use of sugar-free chewing gum.

No-one was talking about the health benefits of gum back in 1977. But they are now and the benefits are many and varied, extending well beyond the mouth.

The oral health benefits of sugar-free gum are already well-established: it stimulates saliva which clears the mouth and prevents the build-up of the plaque. Research by the Faculty of Dentistry at King’s College London in 2019 found that people who regularly chew develop 28 per cent fewer cavities than those who do not.

Less well known, however, are the systemic, whole-body benefits of chewing gum. And some of them are quite surprising to say the least.

According to the Oral Health Foundation (the body behind National Smile Month), plaque contains many types of bacteria which can cause infections linked with problems in other parts of the body. The list of linked diseases is staggering: heart disease, stroke, diabetes, preterm birth, respiratory disease, even dementia.

A 2022 study of over 10,000 pregnant women in Malawi, reported in the New Scientist, connected oral health with improved maternity outcomes. One group of women was asked to chew xylitol-based sugar-free gum (SFG) for 10 minutes once or twice a day; another control group was asked not to.

The SFG-chewing group experienced a 24 per cent reduction in the overall rate of preterm delivery, resulting in considerably fewer babies born below a healthy birth weight.

There are also surprising cardio and geriatric benefits.

A 2018 Japanese study presented at the European Congress on Obesity and reported in The New Yorker magazine, looked at the "effects of gum chewing while walking on physical and physiological functions”. It found that people who chew gum while walking expend more energy than non-chewing walkers. Older men in particular walk faster and farther while chewing gum.

And why bother even standing up? A study into “The Energy Expended in Gum Chewing”, reported in the New England Journal of Medicine, found that seated adults used 19 per cent more energy when they were given sugar-free gum to chew. If you did nothing but chew gum all day for a year you could lose 11 pounds, according to the author.

Another study presented to a 2021 conference of the US Society of Thoracic Surgeons, looked at a range of post-operative procedures that facilitate patient recovery. It showed that gum chewing had had ameliorative effects on cardiac surgery patients.

Chewers presented demonstrably fewer instances of ileus, the lack of normal intestinal muscle contractions that leads to build-up and potential blockage. In other words, gum had “kick-started” the digestive tract.

National Smile Month rightly confines itself primarily to oral health and the prevention of tooth decay and gum disease. But it is becoming ever more apparent that there is more to oral health than just a healthy smile (important though that is).

The significance of the oral biome and 'the mouth as a gateway’ is a relatively nascent science, but one that warrants further and deeper research. How long before Pam Eyres or her successors are writing poems for ‘Healthy Mouth Month’?

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