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Xylitol Fact Sheet CDR N. Blaine Cook January 2000 Chemical makeup: A 5-carbon sugar alcohol (other names: pentose, pentitol, polyalcohol, polyol). It is isosweet to sucrose with about the same amount of calories. Source: Found in nature in many fruits, berries, and vegetables, and has always been a part of our diet. Extracted from the bark of birch trees for commercial use. General Dental Effects: Initial investigation began in Finland in the early 1970’s. Numerous studies over the past 25 years have suggest that a 5 - 10 gram daily consumption of xylitol in the form of gum can result in a 30 to 85% reduction in caries. Specific Effects: a. Anticariogenic effects b. Decreases oral levels of S. mutans. c. Decreases plaque formation d. Increases plaque pH e. Enhances remineralization Mode of Action: Xylitol is not metabolized by S. mutans. Xylitol is taken into the bacterial cell as xylitol-5-phosphate via the fructose phosphotransferase system. It accumulates intracellularly because most cells do not have sufficient amounts of xylitol-5-phosphate dehydrogenase. Xylitol-5-phosphate metabolites are dephosphorylated and expelled as xylitol. This energy consuming process is termed “the futile xylitol cycle.” It is also thought that xylitol competes with glycolysis by inhibiting glucose uptake and metabolism. Safety: Xylitol has been extensively tested and found to be a safe and effective dietary supplement in man. It occurs naturally in various berries, fruits, and vegetables. It is a normal intermediate in human carbohydrate metabolism. The only observed side effect has been gastrointestinal intolerance (laxative effect) at doses much higher than those needed to achieve dental benefits. Generally, 50 - 70 grams/day of xylitol are well tolerated by adults. The FDA approved xylitol in 1963 for special dietary purposes. Effective Dose: Patients should chew two pellets or one stick of the gum for 5 minutes three to five times per day which is equivalent to 6 to 10 grams of xylitol per day. Chewing for at least 5 minutes is recommended because that is when the concentration of xylitol in the saliva is greatest. Brand Name: Xylimax made by Fennobon Oy in Finland. Distributed by Bio Science, 2398 Alaska Avenue, Port Orchard, WA 98366; CLEN-DENT distributed by Advantage International USA, Inc., 4 Side Hill Road, Westport, CT 06880 Cost: Approximately 10¢ per piece including shipping. Xylitol January 2000 CDR N.B. Cook Availability: Sources of 100% Xylitol Sweetened Products Xylimax Chewing gum: Flavors – Peppermint, Fruit Bio Science 2398 Alaska Ave Port Orchard, WA 98366 Toll Free Order Line: 800-595-1089 FAX: 360-871-6178 Price: $8.00 for tub of 100 chiclet pieces + shipping Shipping: $2.00 for a single tub order, or the actual shipping costs for orders of two or more tubs (save on shipping when ordering in quantity). CLEN-DENT products: chewing gum, mints, and xylitol crystals. Products are 100% xyltiol sweetened. 100 Count CLEN-DENT xylitol gum (Wintermint) $9.95 100 Count CLEN-DENT xylitol gum (Spearmint) $9.95 100 Count CLEN-DENT xylitol gum (Fresh Fruit) $9.95 180 Count CLEN-DENT xylitol mints (Wintermint) $19.95 600 Count bulk bottles xylitol gum (Wintermint) $47.25 600 Count bulk bottles xylitol gum (Spearmint) $47.25 600 Count bulk bottles xylitol gum (Fresh Fruit) $47.25 1300 Count bulk bottles xylitol gum (Wintermint) $94.50 1300 Count bulk bottles xylitol gum (Spearmint) $94.50 1300 Count bulk bottles xylitol gum (Fresh Fruit) $94.50 2 lb. bulk bottles HEALTHY*SWEET (xylitol crystals) $24.95 3.63 lb. bulk bottles HEALTHY*SWEET (xylitol crystals) $39.95 Advantage International USA, Inc. 4 Side Hill Road Westport, CT 06880 203-226-8442 Xylitol January 2000 CDR N.B. Cook References: 1. Aguirre-Zero O, Zero DT, and Proskin HM: Effect of chewing xylitol chewing gum on salivary flow rate and the acidogenic potential of dental plaque. Caries Res, 1993; 27(1):55- 9. 2. Alanen P, et al. Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol 2000; 28(3):218-24. 3. Aminoff C, Vanninen E, and Doty TE: The occurrence, manufacture and properties of xylitol. In: Counsell JN, ed: Xylitol, Applied Science Publishers LTD:London, 1977, 1-9. 4. Assev S, Rölla G: Effects of xylitol/sorbitol combinations on bacerial growth and metabolism in Streptococcus sobrinus OMZ 176. APMIS (AMS), 1993; 101(12): 993-8. 5. Barmes D, Barnaud J, Khambonanda S, and Infirri JS: Field trials of preventive regimes in Thailand and French Polynesia. Int Dent J, 1985; 35: 66-72. 6. Birkhed D: Cariologic aspects of xylitol and its use in chewing gum: a review. Acta Odontol Scand, 1994; 52(2): 116-27. 7. Bowen WH, and Pearson SK: The effects of sucralose, xylitol, and sorbitol on remineralization of caries lesions in rats. J Dent Res, 1992; 71(5): 1166-8. 8. Cronin M, Gordon J, Reardon R, Balbo F: Three clinical trials comparing xylitol- and sorbitol-containing chewing gums for their effect on supragingival plaque accumulation. J Clin Dent, 1994; 5(4):106-9. 9. Cutress T, Howell PT, Finidori C, and Abdullah F: Caries preventive effect of high fluoride and xylitol containing dentifrices. ASDC J Dent Child, 1992; 59(4): 313-8. 10. Duckworth RM: The science behind caries prevention. Int Dent J, 1993; 43(6 Suppl 1): 529- 39. 11. Grenby TH, Bashaarat AH, and Gey KF: A clinical trial to compare the effects of xylitol and sucrose chewing-gums on dental plaque growth. Br Dent J, 1982; 152: 339-43. 12. Gustafsson BE, Quensel CE, Swenander Lanke L, Lundqvist C, Grahnén H, Bonow BE, and Krasse B: The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. The Vipeholm dental caries study. Acta Odontol Scand, 1954; 11: 232-64. 13. Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression with xylitol chewing gum. J Amer Dent Assoc 2000; 131(7):909-16. 14. Imfeld T: Efficacy of sweeteners and sugar substitutes in caries prevention. Caries Res, 1993; 27 (Suppl 1): 50-5. Xylitol January 2000 CDR N.B. Cook 15. Isogangas P, Mäkinen KK, Tiekso J, and Alanen P: Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program. Caries Res, 1993; 27(6): 495-8. 16. Isokangas P, Alanen P, Tiekso J, and Mäkinen KK: Xylitol chewing gum in caries prevention: a field study in children. J Am Dent Assoc, 1988; 117: 315-20. 17. Isokangas P, Tenovuo J, Söderling E, Männistö H, and Mäkinen KK: Dental caries and mutans streptococci in the proximal areas of molars affected by the habitual use of xylitol chewing gum. Caries Res, 1991; 25(6): 444-8. 18. Isotupa KP, Gunn S, Chen CY, Lopatin D, Mäkinen KK: Effect of polyol gums on dental plaque in orthodontic patients. Am J Orthod Dentofacial Orthop, 1995; 107(5):497-504. 19. Kandelman D, Bär A, and Hefti A: Collaborative WHO xylitol field study in French Polynesia. I. Baseline prevalence and 32-month caries increment. Caries Res, 1988; 22: 55- 62. 20. Mäkinen KK, Bennett CA, Hujoel PP, Isokangas PJ, Isotupa KP, Pape HR Jr, Mäkinen PL: Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res, 1995; 74(12):1904-13. 21. Mäkinen KK, Bennett CA, Isokangas P, Isotupa K, Pape HJ Jr, Hujoel PP and Mäkinen P-L: Caries-preventive effect of polyol-containing chewing gums. J Dental Res, 1993; 72(Spec Edition): 346 (abstract 1945). 22. Mäkinen KK, Mäkinen PL, Pape HR Jr, Allen P, Bennett CA, Isokangas PJ, Isotupa KP: Stabilisation of rampant caries: polyol gums and arrest of dentine caries in two long-term cohort studies in young subjects. Int Dent J, 1995; 45(1)(Supplement 1): 93- 107. 23. Mäkinen KK: A dietary procedure for preventing dental caries in young adults. J Am Coll Health, 1993; 41(4): 172-80. 24. Mäkinen KK: Dietary prevention of dental caries by xylitol--Clinical effectiveness and safety. J Appl Nutr, 1992; 44(1): 16-28 25. Manning RH, Edgar WM, and Agalamanyi EA: Effects of chewing gums sweetened with sorbitol or a sorbitol/xylitol mixture on the remineralization of human enamel lesions in situ. Caries Res, 1992; 26(2): 104-9. 26. Newbrun E: Preventing dental caries: Current and prospective strategies. J Am Dent Assoc, 1992; 123(5): 69-73. 27. Nuuja MC, Meurman JH, Murtomaa H, and Pesonen T: Effect of chewable antiplaque preparation on plaque and gingival index scores in military academy cadets during their two- week winter camp. Mil Med, 1993; 158(7): 438-40. Xylitol January 2000 CDR N.B. Cook 28. Nuuja T, Meurman JH, and Torkko H: Xylitol and the bactericidal effect of chlorhexidine and fluoride on Streptococcus mutans and Streptococcus sanguis. Acta Odontol Scand, 1993; 51(2): 109-14. 29. Park KK: Current Cariology: Lecture notes for Advanced Preventive Dentistry. Indiana University School of Dentistry, 1992. 30. Passon C: Xylitol: a sugar that fights tooth decay. J Colo Dent Assoc, 1993; 71(3): 19-23. 31. Plüss EM: Effect on plaque growth of xylitol and sucrose-containing chewing gums. J Clin Periodontol, 1978; 5: 35-40. 32. Scheinin A, Bánóczy J, Szöke J, Esztári I, Pienihäkkinen K, Scheinin U, Tiekso J, Zimmermann P, and Hadas E: Collaborative WHO xylitol field studies in Hungary. I. Three-year caries activity in institutionalized children. Acta Odontol Scand, 1985; 43: 327- 47. 33. Scheinin A, Mäkinen KK, Tammisalo E, and Rekola M: Turku sugar studies. XVIII. Incidence of dental caries in relation to 1-year consumption of sucrose and xylitol chewing gum. Acta Odont Scand, 1975; 269-78. Reprented, 1975; Suppl. 70:307-16. 34. Scheinin A, Pienihäkkinen K, Tiekso J, Bánóczy J, Szöke J, Esztári I, Zimmermann P, and Hadas E: Collaborative WHO xylitol field studies in Hungary. VII. Two-year caries incidence in 976 institutionalized children. Acta Odontol Scand, 1985; 43: 381-87. 35. Scheinin A, Söderling E, Scheinin U, Glass RL, and Kallio ML: Xylitol-induced changes of enamel microhardness paralleled by microradiographic observations. Acta Odontol Scand, 1993; 51(4): 241-6. 36. Scheinin A: Dental caries, sugars and xylitol. Ann Med, 1993; 25(6): 519-21. 37. Sintes JL, Escalante C, Stewart B, McCool JJ, Garcia L, Volpe AR, Triol C: Enhanced anticaries efficacy of a 0.243% sodium fluoride/10% xylitol/silica dentifrice: 3-year clinical results. Am J Dent, 1995; 8(5):231-5. 38. Soderling E, et al. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res 2000; 79(3):882-7. 39. Söderling E, Isokangas P, Tenovuo J, Mustakallio S, and Mäkinen KK: Long-term xylitol consumption and mutans streptococci in plaque and saliva. Caries Res, 1991; 25: 153-7. 40. Söderling E, Mäkinen, Chen C-Y, Pape HR Jr, Loesche W, and Mäkinen P-L: Effect of sorbitol, xylitol, and xylitol/sorbitol chewing gums on dental plaque. Caries Res, 1989; 23: 378-84. 41. Steinberg LM, Odusola F, and Mandel ID: Remineralizing potential, antiplaque and antigingivitis effects of xylitol and sorbitol sweetened chewing gum. Clin Prev Dent, 1992; 14(5): 31-4. Xylitol January 2000 CDR N.B. Cook 42. Svanberg M and Birkhed D: Effect of dentifrices containing either xylitol and glycerol or sorbitol on mutans streptocci in saliva. Caries Res, 1991; 25(6): 449-53. 43. Tanzer JM: Xylitol chewing gum and dental caries. Int Dent J, 1995; 45(1)(Supplement 1):65-76. 44. Topitsoglou F, Birkhed D, Larsson L-Å, and Frostell G: Effect of chewing gums containing xylitol, sorbitol or a mixture of xylitol and sorbitol on plaque formation, pH changes and acid production in human dental plaque. Caries Res, 1983; 17: 369-78. 45. Trahan L, Söderling E, Dréan M-F, Chevrier M-C, and Isokangas P: Effect of xylitol consumption on the plaque-saliva distribution of mutans streptococci and the occurrence and long-term survival of xylitol-resistant strains. J Dent Res, 1992; 71(11): 1785-91. 46. Trahan L: Xylitol: a review of its action on mutans streptococci and dental plaque--its clinical significance. Int Dent J, 1995; 45(1)(Supplement 1):77-92. 47. Waaler SM: Evidence for xylitol 5-P production in human dental plaque. Scand J Dent Res, 1992; 100(4): 204-6. 48. Wennerholm K, Arends J, Birkhed D, Ruben J, Emilson CG, and Dijkman AG: Effect of xylitol and sorbitol in chewing-gums on mutans streptococci, plaque pH and mineral loss of enamel. Caries Res, 1994; 28(1): 48-54.
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