Xylitol Use in the Prevention of Dental Caries
Teeth Remineralized After Use of Xylitol
Xylitol as Effective as a Dental Sealant
Xylitol Reduces Plaque
Study Shows Children had 70% Fewer Cavities When Their Mother's Chewed Xylitol Gum
Xylitol Can Reduce Ear Infections in Children

The effect of non-cariogenic sweeteners on the prevention of dental caries: a review of the evidence.

Hayes C., J Dent Educ 2001 Oct;65(10):1106-9

Harvard School of Dental Medicine, Boston, MA, USA.

The role of sugar substitutes such as xylitol and sorbitol in the prevention of dental caries has been investigated in several clinical studies. The purpose of this report is to review the current published evidence regarding the relationship between sugar substitutes and dental caries. A literature search was conducted using MEDLINE and EMBASE and included studies published from 1966 to 2001. Studies that included human subjects and were published in English were included in this review. A total of fourteen clinical studies were reviewed that evaluated the effect of sorbitol or xylitol or the combination of both sugar substitutes on the incidence of dental caries. Most of the reports were of studies conducted with children outside of the United States. These studies demonstrated a consistent decrease in dental caries, ranging from 30 to 60 percent, among subjects using sugar substitutes as compared to subjects in a control group. These caries rate reductions were observed in subjects using xylitol or sorbitol as the sugar substitute in chewing gum or toothpaste. The highest caries reductions were observed in subjects using xylitol. These findings suggest that the replacement of sucrose with sorbitol and xylitol may significantly decrease the incidence of dental caries.

PMID: 11699985 [PubMed - in process]

Extensive dentin caries were "totally rehardened (remineralized)" after use of xylitol/sorbitol gum.

Acta Odontol Scand 1998 Jun;56(3):148-56 Related Articles, Books, LinkOut Physical, chemical, and histologic changes in dentin caries lesions of primary teeth induced by regular use of polyol chewing gums. Makinen KK, Chiego DJ Jr, Allen P, Bennett C, Isotupa KP, Tiekso J, Makinen PL. Institute of Dentistry, University of Turku, Finland.

A previous clinical trial showed that long-term use of saliva-stimulating polyol (xylitol and sorbitol) chewing gums was associated with arrest of dental caries in young subjects. After a 20-22-month intervention (when the subjects were 8 years old), a total of 23 primary teeth with extensive dentin caries lesions whose surface in clinical examination was found to be totally rehardened (remineralized) could be removed because the teeth were near their physiologic exfoliation time. These teeth were subjected to histologic, microhardness, and electron microscopic tests. The majority of the specimens had been remineralized from the surface by a non-cellular-mediated process within the remaining collapsed, organic extracellular matrix associated with the remaining dentinal surface. Many of the underlying dentinal tubules were filled with a matrix that had been subsequently mineralized. Dental microanalyses showed that the topmost (outer) 20-microm-thick rehardened layer of the lesions exhibited the highest Ca:P ratio, which leveled off at a depth of approximately 150 microm. The rehardened surface layer (normally <0.1 mm in thickness) was significantly (P < 0.001) harder than sound dentin and nearly as hard as sound enamel. Although the main source of the mineral present in the rehardened layer was most likely of salivary origin, some extracellular remineralization was probably mediated by odontoblasts. The results complete the dinical diagnoses of the original trial and suggest that regular use of polyol chewing gums may induce changes in dentin caries lesions, which in histologic and physiochemical studies show typical characteristics of rehardening and mineralization. PMID: 9688223 [PubMed - indexed for MEDLINE]

Xylitol is as effective as a dental sealant

Acta Odontol Scand 2000 Dec;58(6):279-84

Sealants and xylitol chewing gum are equal in caries prevention.

Alanen P, Holsti ML, Pienihakkinen K.

Institute of Dentistry, University of Turku, Finland.

Sealants and xylitol have been demonstrated to prevent dental decay, but their effect has never been compared in the same study. Regular use of xylitol chewing gum during 2 or 3 school years was compared with application of occlusal sealants in a randomized study. The reliability of the clinical observations was controlled by examining the presence of dental decay in the same teeth from bitewing radiographs in a blind study. After 5 years, no statistically significant differences between the sealant and xylitol groups were found. The results were in line with the results from separate studies with sealants or xylitol. There were no great differences between the costs of the measures. The selection between the compared preventive measures has to be made on the basis of practical aspects such as caries occurrence, availability of personnel and other resources, opportunity costs, cooperation with schools, and other local conditions.

Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 11196404 [PubMed - indexed for MEDLINE]
 

Xylitol reduces plaque

Caries Res 2001 Mar-Apr;35(2):129-35

Comparison of erythritol and xylitol saliva stimulants in the control of dental plaque and mutans streptococci.

Makinen KK, Isotupa KP, Kivilompolo T, Makinen PL, Toivanen J, Soderling E.

International Institute for Preventive Dentistry, Institute of Dentistry, University of Turku, Finland.

The effect of 2-month usage of saliva-stimulating pastils containing either erythritol or xylitol was studied in a cohort of 30 subjects assigned to the respective polyol groups (n = 15). The daily consumption level of both polyols was 5.2 g, used in 5 daily chewing episodes. The mean weight of total plaque mass (collectable during a standard period of 3 min from all available tooth surfaces) was reduced significantly in the xylitol-group, while no such effect was observed in the erythritol-group. This reduction in plaque mass was accompanied by a significant reduction in the turbidity readings (A(660)) of aqueous plaque suspensions; no such effect was observed in the erythritol-group. However, plaque protein levels did not differ between baseline and endpoint in either polyol group. The plaque and salivary levels of Streptococcus mutans and plaque levels of total streptococci were reduced significantly in the xylitol-group, while no such effect was detected in the erythritol-group. However, either polyol regimen had no effect on plaque levels of S. sobrinus. The results suggest that systematic use of xylitol-containing saliva stimulants may be more effective in controlling some oral-hygiene-related and caries-associated parameters than similar use of erythritol-containing products. The results also speak for a special relationship between xylitol and S. mutans. However, owing to the great potential of erythritol as a caries-reducing agent -- based on the tetritol nature of erythritol -- the present laboratory results should be considered preliminary and subject to verifying clinical studies. Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 11275673 [PubMed - indexed for MEDLINE]

Young children had 70% fewer cavities when their mothers chewed xylitol-gum, even though the children themselves did not chew the gum.

:J Dent Res 2000 Nov;79(11):1885-9 Related Articles, Books

Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age.

Isokangas P, Soderling E, Pienihakkinen K, Alanen P.

Ylivieska Health Care Center, University of Turku, Finland.

Studies have shown that prevention of mutans streptococci (MS) colonization in early childhood can lead to prevention of dental decay. In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels, regular maternal use of xylitol chewing gum resulted in a statistically significant reduction in MS colonization in their children's teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment. The children did not chew gum or receive varnish treatments. For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS. Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each child's age at the first caries attack in the primary dentition. In children at the age of 5 years, the dentinal caries (dmf) in the xylitol group was reduced by about 70% as compared with that in the fluoride or chlorhexidine group. We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child.

Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 11145360 [PubMed - indexed for MEDLINE]
 

Xylitol can reduce some ear infections and can inhibit viruses and bacteria.

Vaccine 2000 Dec 8;19 Suppl 1:S144-7 Related Articles, Books, LinkOut Xylitol in preventing acute otitis media. Uhari M, Tapiainen T, Kontiokari T. Department of Paediatrics, University of Oulu, FIN-90220 Oulu, Finland. matti.uhari@oulu.fi

Xylitol is a polyol sugar alcohol and is referred to as birch sugar, because it can be produced from birch. Natural sources of xylitol include plums, strawberries, raspberries and rowan berries. Xylitol inhibits the growth of Streptococcus pneumoniae and it inhibits the attachment of both pneumococci and Haemophilus influenzae on the nasopharyngeal cells. In two clinical trials xylitol was found efficient to prevent the development of acute otitis media with a daily dose of 8.4-10 g of xylitol given in five divided doses. The efficacy in these 2-3 months follow-up trials was approximately 40% when chewing gum was used and approximately 30% with xylitol syrup. The need to use antimicrobials reduced markedly when using xylitol. In a high-risk group of children with tympanostomy tubes xylitol was ineffective in preventing otitis. Xylitol appears to be an attractive alternative to prevent acute otitis media. A more practical frequency of doses should be found before its use can be widely recommended. Publication Types: Review Review, Tutorial PMID: 11163479 [PubMed - indexed for MEDLINE]