Xylitol, Sweeteners, and Dental Caries
Author(s): Ly, et al.
Resident: Cho
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2006. 28. 154-263.
Major topic: Xylitol, Dental Caries
Minor topic: Sweeteners
Type of Article: Conference Paper/Report
Main Purpose: The main purpose of this article was to provide an overview of xylitol and other sweeteners and how they affect the risk of dental caries.
Findings:
Xylitol, sorbitol, mannitol, and maltitol are all part of the sugar alcohol (polyol) family. These products are widely used in chewing gums, candies, and toothpastes and advertised as “sugar-free” products. Sugar alcohols are shown to be noncariogenic. In addition, xylitol has shown to reduce tooth decay by reducing the levels of Streptococcus mutans in plaque and saliva and by reducing the level of lactic acid produced by these bacteria. The main side effect associated with these products is osmotic diarrhea, which occurs when it is consumed large quantities (4 to 5 times greater than the amount to prevent dental caries).
- Participants in groups consuming 100% xylitol had greater reductions in caries or S. Mutans levels that those that consumed a combination of xylitol and sorbitol. Those that consumed xylitol and sorbitol had a greater reduction of caries that those who consumed 100% sorbitol.
- At a University of Washington, Seattle study, participants were put in 4 groups and given 12 pellets of xylitol gums to be divided evenly into four doses per day with varying levels of xylitol. MS levels were reduced with increasing doses of xylitol, with the effect leveling off between 6.88g/day and 10.32g/day.
- In an intensive xylitol chewing gum study, it was found that chewing a maximum of 14g/day of xylitol was not significantly different from chewing 10g/day upon analysis of DMFS scores.
- Two retrospective studies showed that xylitol use is associated with greater reduction in caries and suggested that a frequency of less than 3 times per day may not be effective.
- Study of 3 to 6 year olds comparing xylitol chewing gum and tooth-brushing using fluoridated toothpaste was conducted. Children brushed once after lunch or chewed xylitol gum 3 times each day during daycare hours. The children brushed as they normally would at home. The xylitol gum group had a better oral health status than the group that brushed after lunch.
- In Finland, a study was conducted with a group of mothers who had high S. Mutans levels. They were treated with either chlorhexidine varnish, fluoride varnish, or 100% xylitol gum. The children of mothers treated with xylitol had the lowest levels of S. Mutans.
Key points/Summary:
1. Xylitol content in products should be labeled so that consumers can make informed decisions to use these products for the prevention of tooth decay.
2. Recommendations of efficacious dose and frequency of xylitol use should be more clearly stated.
3. The effective daily dose of xylitol is 6 to 10g.
4. The effective frequency of consumption of xylitol is 3 to 5 times per day.
5. The effectiveness of xylitol is greater the higher the frequency and the higher the dose of xylitol.
6. There is a ceiling effect for the dose of xylitol, which is 10g per day.
Assessment of Article:
This article was informative. I was surprised by the amount of xylitol that needed to be consumed in order to have an effect on dental caries. Perhaps xylitol-containing products should be promoted to wean children off sugary snacks.