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Xylitol: A New Adjunct in Combating Early Childhood Caries
As most of us now know, dental caries is a transmissible infectious (that means we can “catch” it from someone else) disease caused by bacteria, primarily Streptococcus mutans (SM). When high amounts of carbohydrates or sugar is consumed, especially sucrose (common table sugar), SM bacteria increase in number and produce acids. These acids slowly weaken the protective tooth enamel. It takes over half an hour after sugar consumption for the pH of our mouth to be restored to a normal level. It is the frequency of these acid attacks which can eventually lead to decay.
Most children acquire the acid-producing bacteria from their mothers’ or caretakers’ by salivary contact (such as by kissing or shared eating utensils). The more bacteria a mother has in her saliva, and the more frequently her infant is exposed to her saliva, the higher rate of transmission of bacteria to her infant. Also, the younger an infant is in acquiring high levels of SM, the more severe the caries disease will be in his/her primary (baby) teeth. Of course, dietary and oral hygiene habits can contribute or hinder the progression of early childhood caries.
The Journal of Dental Research recently reported a reduction in children’s tooth decay as a result of a Xylitol (see our former article to see Xylitol: Nature’s Cavity Fighter) treatment given to only the mothers and not their children. The first group of mothers was given Xylitol during pregnancy and for the first 24 months post delivery in the form of gum that was chewed four times daily. There were two control groups. The second group of mothers received fluoride treatments (which strengthens tooth enamel but does not affect SM transmission). The third group received chlorhexidine at 6, 12, and 18 month intervals (chlorhexidine is a prescription-strength mouth rinse that reduces SM transmission).
The study clinically proved that the mothers’ habitual use of Xylitol chewing gum significantly reduced the transmission of SM from mother to child. Even though the children in this study did not chew or ingest Xylitol (nor did any of the children receive fluoride or chlorhexidine), the children from this group had a significant reduction of tooth decay when compared to the control groups. In fact, three years after the mothers stopped chewing the gum, the children still had a significant reduction in dental caries.
So how does chewing Xylitol help to reduce the occurrence of caries? It helps in several ways:
• It reduces plaque formation.
• It makes plaque less adhesive.
• It neutralizes plaque acids.
• It reduces the level of S. mutans.
• It stimulates saliva flow.
• It assists in the remineralization of tooth enamel.
There are several other benefits of Xylitol use. Although it is as sweet as table sugar, its initial use by the body does not require insulin, so it is a good sugar substitute for people with diabetes. It also inhibits the growth of pneumococci bacteria which is responsible for otitis media (ear infections). Research results have indicated that children who chew gum containing Xylitol or ingest Xylitol syrup have decreased frequency of infections, thus decreasing the need for prescribed antibiotics and prescriptions and fewer visits to the doctor. Xylitol’s sweet taste also stimulates salivary flow, which not only soothes dry mouth, but neutralizes acids produced by the fermentation of carbohydrates. This is a great advantage for some elderly patients who suffer from xerostomia (dry mouth) caused from medications, and inadequate oral hygiene due to decreased dexterity.
However, Xylitol is best known for its anticariogenic (anticavity) property. To achieve maximum results, chew gum with Xylitol listed as the first and only sugar in the ingredients. It must be chewed over a long length of time to gain the antimicrobial effect, and consistency and frequency are key elements as well. Research shows that 4-10 grams a day is enough. There is approximately 1 gram of Xylitol per gum or candy, so that means 4-10 pieces of gum need to be chewed each day. It is best to chew immediately after eating a meal or snack. Clear the mouth by rinsing with water first (if tooth brushing cannot be done), and then chew (or suck on a Xylitol candy) for five minutes. This should be done at least 3 and preferably 5 times a day. If Xylitol is only used once a day, or only occasionally, Xylitol may not be effective, regardless of the dose.
More than 15 grams a day does not show additional dental benefits. And, at high doses Xylitol can cause diarrhea at 45 grams per day for children and at 100 grams per day for adults. If chewing is a problem (because of partial dentures or TMJ dysfunction, for instance), then Xylitol candy should be used instead.
Xylitol is a wonderful adjunct to add to our arsenal in the fight against tooth decay, but it does NOT replace brushing and flossing. Daily good oral hygiene must be practiced. Additionally, don’t forget to eat healthy and cut back on consumption of sugary foods in order to achieve the best possible results. Regular check ups with your dentist are important and recommended as well.
Ashely D. and Barbieri S, The Use of Xylitol in Caries Prevention, Access, December 2005, p 24-27
Catt, D. and Fontana M., Xylitol Gains Ground against Cariogenic bacteria, Dimensions of Dental Hygiene, March 2007, p 24-26.
Hansen A., Xylitol: A Dental Phenomenon, Access, August 2006, p 24-26.
Stookey, G., Fighting Dental Decay Past, Present, & Future, Access, February 2006, p 12-16.
www.Dentist.net/xylitol-teeth.asp
www.xylitolnow.com/faq.html
www.xylitolinfo.com/cms/connect/xylitol/benefits/mother_child_study_II.htm
www.alternativemedicine.com
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