increases salivary flow, remineralistion property, inhibit growth & metabolism of MS,
Different clinical trials showed different results. Most recent opinion on xylitol, it is not as effective as we were told before. We need a systematic review with meta-analysis on this subject to find out the truth. The following trial although on adults didn’t demonstrate significant caries reduction after using xylitol lozenges for 33 months.
Bader JD, and colleagues found that “Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries”
Bader JD, Vollmer WM, Shugars DA, Gilbert GH, Amaechi BT, Brown JP, Laws RL, Funkhouser KA, Makhija SK, Ritter AV, Leo MC.
Results from the Xylitol for Adult Caries Trial (X-ACT).
J Am Dent Assoc. 2013 Jan;144(1):21-30.
PMID: 23283923
Answer 3: Xylitol, a naturally occurring five-carbon sugar polyol, is a white crystalline carbohydrate known since a century ago. It has been widely studied during the last 40 years for its effect on dental caries. It is found naturally in fruit, vegetables, and berries and is artificially manufactured from xylan-rich plant materials such as birch and beechwood. Since a study conducted in Turku, Finland, evaluating the effectiveness of xylitol on dental plaque reduction in 1970, xylitol has been widely researched and globally accepted as a natural sweetener approved by the US Food and Drug Administration (FDA) and the American Academy of Pediatric Dentistry.
It has been observed that when all associated factors of dental caries, such as age, sex, race, number of teeth, and oral hygiene, were controlled, taste was found to be the only variable that was related to overall caries experience. In the recent past, sugar consumption has increased, especially in children and adolescents, to 120 pounds per person each year or 20 teaspoons of table sugar per day. This excessive consumption of sugar has led to negative health concerns like diabetes mellitus and dental caries and has increased awareness among the public and medical and dental professionals regarding the benefits of replacing sugar with nonsugar sweeteners. Hence, artificial sweeteners or noncaloric sweeteners are effective in reducing weight and such health disorders. However, an artificial sweetener is 300–400 times sweeter than table sugar, and a small amount of it can provide the same level of sweetness.
Sweeteners can be divided into nutritive and non-nutritive sweeteners. The nutritive sweeteners contain carbohydrates and provide energy. The non-nutritive sweeteners offer little or no energy when they are consumed. The US Department of Agriculture pattern for 2,000 kcal recommends no more than 32 g (8 tsp added sugars per day) or 6% of 2,000 kcal. The FDA regulates health claims on food labels, and the claim that sweeteners do not promote dental caries has been successfully approved for sugar alcohols, isomaltulose, erythritol, D-tagatose, and sucralose. Currently, more than 35 countries have approved the use of xylitol in foods, pharmaceuticals, and oral health products, principally in chewing gums, toothpastes, syrups, and confectioneries.
Habitual xylitol consumption may be defined as daily consumption of 5–7 g of xylitol at least three times a day. The recommended dose for dental caries prevention is 6–10 g/d. For those with temporomandibular joint dysfunction and who have difficulty in chewing, xylitol candy should be used instead of chewing gum. At high dosages, xylitol can cause diarrhea in children at 45 g/d and 100 g/d in adults. The amount tolerated varies with individual susceptibility and body weight. Most adults can tolerate 40 g/d. Xylitol reduces the levels of mutans streptococci (MS) in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death. It reduces the adhesion of these microorganisms to the teeth surface and also reduces their acid production potential. Xylitol, like any other sweetener, promotes mineralization by increasing the salivary flow when used as chewing gum or large xylitol pastille. The uniqueness of xylitol is that it is practically nonfermentable by oral bacteria. Also, there is a decrease in levels of MS, as well as the amount of plaque, when there is habitual consumption of xylitol.
Streptococcus mutans transports the sugar into the cell in an energy-consuming cycle that is responsible for growth inhibition. Xylitol is then converted to xylitol-5-phosphate via phosphoenolpyruvate: fructose phosphotransferase system by S. mutans resulting in development of intracellular vacuoles and cell membrane degradation. Unwittingly contributing to its own death, S. mutans then dephosphorylates xylitol-5-phosphate. The dephosphorylated molecule is then expelled from the cell. This expulsion occurs at an energy cost with no energy gained from xylitol metabolism. Thus, xylitol inhibits S. mutans growth essentially by starving the bacteria. Xylitol can inhibit the growth of harmful oral bacteria such as S. mutans, but its benefits do not stop in the oral cavity. Xylitol alcohol has been shown to impact growth of nasopharyngeal bacteria such as S. pneumonia and S. mitis, and hence has a role to play in nasopharyngeal pneumonia.
Please have a look at the following RG links and PDF attachment.
Article Xylitol in preventing dental caries: A systematic review and...
Article Weak evidence of caries reduction using xylitol-based lozeng...
Article The use of xylitol as a strategy for prevention of dental caries
