Low-Dose Xylitol Chewing Gym Helps Prevent Dental Cavities

by | Jul 8, 2019 | 2017, Oral Health

Written by Angeline A. De Leon, Staff Writer. One-year use of chewing gums provided an effective means for preventing tooth decay in adults at high risk for developing cavities.

Dental caries, often referred to as tooth decay or dental cavities, involves the breakdown of teeth, typically triggered by the acids of bacteria and the presence of sugars 1. Recommended strategies for the prevention of caries include reducing sugar intake and the daily use of fluoride toothpaste 2,3. In more recent years, chewing sugar-free gum, which appears to increase saliva flow and improve buffering against plaque 4, has become another popular method for preventing dental cavities 2,5. Research suggests that xylitol, a sugar alcohol used as a substitute for sugar and a primary ingredient in sugar-free chewing gums, can reduce plaque and lower the prevalence of caries 6. Various studies confirm the non-cariogenic properties associated with xylitol 6,7.  However, while clinical effects have been observed with 3 to 8 g of daily xylitol intake, the optimal dosage of xylitol for caries prevention is still under debate and its long-term efficacy relatively unknown 8. Thus, in an exploratory trial published in Clinical Oral Investigation (2017), researchers examined the long-term effects of a low-dose xylitol-based chewing gum in a population of adults at high risk for caries.

A total of 130 high-caries-risk subjects (aged 30 to 45 years) (at least 12 natural teeth with 1-3 cavitated caries lesions and a salivary concentration of mutans streptococci [MS, bacteria species linked to caries] ≥ 105 CFU/mL saliva) were enrolled in a randomized placebo-controlled trial. Participants were randomly assigned to chew 2.5 g of either a polyol (sugar alcohol) or a xylitol chewing gum daily for 12 months. At baseline, after 6 and 12 months, and at 1-year follow-up, MS concentration in saliva was evaluated, inter-proximal plaque pH measured using pH indicator strips (area under the curve, AUC, calculated with pH 5.7 and 6.2 used as reference for enamel dissolution), and an International Caries Detection and Assessment System (ICDAS) index was calculated (caries lesions classified as initial, moderate, or extensive).

During the first 12 months of gum use, net caries increment (based on ICDAS score) was significantly reduced for the xylitol group vs. polyol group for initial caries lesions (p = 0.01) and for extensive caries lesions (p = 0.02). Over the total duration of the study (0-24 months), total caries experience was found to be significantly lower in the xylitol vs. polyol group (p = 0.01), and AUC at pH 5.7 was significantly lower for the xylitol group, relative to polyol (p = 0.02). In addition, researchers observed a statistically significant reduction in the concentration of salivary MS in the xylitol group (p = 0.01).

Based on findings, researchers conclude that the long-term use of low-dose xylitol can indeed effectively protect against dental caries. Xylitol significantly lowered caries increments, with effects not only apparent 1 year from the start of treatment, but persisting up to 24 months after baseline. The preventative action of xylitol was reflected in overall lower increment of caries experience, as well as in improvement of plaque pH (indicating improved plaque acidogenicity) and salivary concentration of MS (indicating regulation of cariogenic bacteria). A primary limitation noted by investigators is the inability to establish whether caries prevention in the study was mainly attributable to xylitol amount or frequency of gum chewing. Given that gum chewing in adult populations is relatively less common than in younger age groups, it would also be important for future studies to investigate whether other modes of xylitol intake which may be more generalizable to the average adult individual (e.g., exposure through diet or toothpaste) can be equally effective. Overall, however, xylitol appears to be an effective, long-lasting approach for the prevention of caries disease.

Source: Cocco F, Carta G, Cagetti MG, et al. The caries preventative effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults. Clin Oral Invest. 2017; 21: 2733-2740. DOI: 10.1007/s00784-017-2075-5.

© The Author(s) 2017. This article is published with open access at Springerlink.com

Click here to read the full text study.

Posted July 8, 2019.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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