Xylitol, Sweeteners, and Dental Caries

Author(s): Ly, K.A., Milgrom, P., Rothen, M.
Journal: Pediatric Dentistry
Volume (number): 28
Month, Year: 2006
Major topic: Provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions.
Type of Article: Review
Main Purpose:
Provide an overview of xylitol and other polyol sweeteners and dental caries for clinicians and to discuss current applications for dental practice and potential community-based public health interventions.
Findings:
• Sugar alcohols have been shown to be noncariogenic and reduce the level of strep mutans (SM) in plaque and saliva. Microorganisms do not readily metabolize xylitol into energy source so its consumption has minimal effect on plaque pH. Strep mutans expends energy to break down xylitol without yielding energy in return.
• Long term habitual consumption of xylitol can select for less virulent strains which are less capable of adhering to tooth surfaces.

Xylitol Dose and Frequency
• Not fully developed.

• Study at University of Washington concluded that MS levels were reduced with increasing doses of xylitol; effect leveling off between 6.88g to 10.32g per day.

• In a second study 10.32 g per day divided in 2,3, and 4 administrations demonstrated a linear response in decreasing levels of MS in plaque and saliva.

Children at High Risk for Caries
• One study in Belize showed children with high caries rates demonstrated arrest in 9-27% of lesions.

• Another study in Estonia showed a 33-59% reduction in tooth decay in the group using xylitol candy and 54% reduction in groups using xylitol gum.

• University of Washington produced and field tested xylitol-containing popsicles, gummy bears, puddings, and sorbet. They found children readily accepted such foods when offered as part of the daily diet.

• Study in Costa Rica involving 2,630 children between 8 and 10 years old compared NaF toothpaste with and without 10% xylitol. After 3 years of brushing twice a day study showed a 12% reduction in decayed / filled lesion surfaces (DFS) and DFS-buccal surfaces.




Pregnant Women and New Mothers
• Study looked at the effects of 100% xylitol gum, chlorhexidine varnish, and fluoride varnish on the inhibition of SM transmission to newborns through their mothers. SM levels were:
o 10% in xylitol mother group
o 29% chlorhexidine mother group
o 49% in the fluoride group
o At 6 years of age the xylitol group still had the lowest SM levels compared with the other two
Conclusions

1) 6 to 10g divided into to 3-5 consumption periods per day is needed to be effective
2) Clear labeling of xylitol content in products is needed
3) A ceiling effect appears beyond the 10g dose

Assessment of article
Good article. Very informative. Excellent tables