Xylitol_ Sweeteners_ and Dental Caries

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					Xylitol, Sweeteners, and Dental Caries
Kiet A. Ly, Peter Milgrom, Marilynn Rothen

Xylitol is a sugar substitutes with sweetness equal to that of table sugar (sucrose), but
with 40% fewer calories. It is a member of the sugar alcohol or polyol family, which
includes other common dietary sweeteners such as sorbitol, mannitol, and maltitol.
Xylitol is produced commercially from birch trees and other hardwoods containing
xylan. Commercial xylitol is being produced from corn cobs and the waste of
sugarcane or other fibers. Its also can be found in small quantities in fruits and
vegetables and is produced as part of human metabolic processes. Xylitol has been
approved to be safe for use with children. polyols are absorbed slowly by the human
gastrointestinal tract which result in osmotic diarrhea if consumed in large quantities.

Xylitol sugar alcohols are proved to be non-cariogenic. Furthermore, studies have shown
that xylitol has a protective effect and reduce tooth decay in part by reducing the levels of Strep-
tococcus mutans in plaque and saliva and by reducing the level of lactic acid produced by these
bacteria. It's a bacteriostatic and its effect is achived through 3 ways: one is to exhaust
the bacteria by energy-consuming cycle and reduce its adhering capacity, the second
way in which xylitol is taken into the cell and exert direct toxic effect on the bacteria,
the third way in which xylitol specifically affects MS on the genetic level. Its
containing products have the potential to improve success in controlling rampant decay in the
primary dentition. A number of studies conducted among schoolchildren of various ages have
shown that consumption of gum containing xylitol reduces the extent of dental caries with a dose
of 10.32g per day divided into 2, 3,4 times per day and the result showed great
reduction in Streptococcus mutans .

In conclusion majority of studies showed the protective effect of xylitol on tooth
decay and the evidence is sufficient for clinicians to consider including xylitol-
containing products in their clinical armamentarium for the prevention of tooth decay
in high-risk populations.
Linear response of mutans streptococci to increasing frequency of
xylitol chewing gum use: a randomized controlled trial
Kiet A Ly, Peter Milgrom, Marilyn C Roberts, David K Yamaguchi, Marilynn Rothen, and Greg

Xylitol is a naturally occurring sugar substitute that has been shown to reduce the
level of mutans streptococci in plaque and saliva and to reduce tooth decay. It has
been suggested that the degree of reduction is dependent on both the amount and the
frequency of xylitol consumption. The aim of this study was to determine the
reduction in mutans streptococci levels in plaque and unstimulated saliva to
increasing frequency of xylitol gum use at a fixed total daily dose of 10.32 g over five
weeks. the total participants was (n=132) randomized to either active groups (10.32 g
,xylitol/day) and control (9.828 g sorbitol and 0.7 g maltitol/day). All groups chewed
12 pieces of gum per day. The control group chewed 4 times/day(F0) and active
groups chewed xylitol gum at a frequency of 2 times/day(F2), 3 times/day(F3), or 4
times/day(F4). The 12 gum pieces were evenly divided into the frequency assigned to
each group. Plaque and unstimulated saliva samples were taken at baseline and five-
weeks and were cultured on modified Mitis Salivarius agar for mutans streptococci

  The result showed no significant differences in mutans streptococci level among the
groups at baseline but at five-weeks, mutans streptococci levels in plaque and
unstimulated saliva showed a linear reduction with increasing frequency of xylitol
chewing gum use at the constant daily dose. Although the difference observed for the
group that chewed xylitol 2 times/day was consistent with the linear model, the
difference was not significant. In conclusion there was a linear reduction in mutans
streptococci levels in plaque and saliva with increasing frequency of xylitol gum use
at a constant daily dose but Reduction at a consumption frequency of 2 times per day
was small and consistent with the linear-response line but was not statistically
Xylitol as a caries preventive measure – an introduction to
past and present research
K. Sandahl, E. Sundling, C. Tegnesjö

The first clinical study was carried out by Peldyak and Mäkinen, 2002. This study was
Two parts to compare xylitol with sucrose considering their respective effect on
caries. The first part was a feeding study where sucrose was completely replaced with
xylitol, in all dietary products for two years. Compared to a sucrose consuming
control group, the xylitol group had a caries reduction by at least 85%. The Part two
of the Turku study was a gum trial where young adults were assigned to chew either
a xylitol or a sucrose gum which shows similar results to the first part.

Another study was done by Söderling and Isokangas (2000) to investigate the effects
of xylitol on the mother-child transmission of mutans streptococci. pregnant women
who all showed high salivary levels of MS were divided into three groups. Mothers in
one of the groups were requested to chew a xylitol gum 2 or 3 times per day starting 3
months after delivery and continuing until the child were 2 years old. The two other
groups received either a fluoride or a clorhexidin varnish treatment at six, twelve and
eighteen months after delivery. No treatment was given to the children. The children's
plaque levels of MS were then measured to determine the rate of colonisation.
Concerning the mothers, focus was on the salivary concentration due to the fact that
saliva is the potent Transmission medium. The result showed xylitol significantly
reduced the transmission of MS compared to the preventive treatments used in the
other groups. Xylitol appears to reduce adherence capacity of these bacteria which
contributes to a “false” high level of MS in the saliva.

- Sandahl.K , Sundling.E , Tegnesjö.C. Xylitol as a caries preventive measure – an
introduction to past and present research. Karolinska Institutet, Institute of
- Kiet et al(2005). Linear response of mutans streptococci to increasing
frequency of xylitol chewing gum use: a randomized controlled trial.
- Kiet et al (2006). Xylitol, Sweeteners, and Dental Caries.

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