**XYLITOL**

Xylitol is a natural sugar alcohol that sweetens without causing decay.
It actually inhibits caries formation. Below are some facts about
xylitol.

-   Xylitol is a naturally-occurring 5-carbon sweetener found in
    berries, fruits, vegetables, and mushrooms, etc., and is even
    produced in the human body. It is also known as pentose, pentitol,
    polyalcohol, and polyol.

-   The xylitol used in most products is produced from birch trees

-   Its taste is indistinguishable from sucrose and it is 40% less
    caloric

-   Slow absorption evokes low glycemic response

-   Mutans streptococci are unable to metabolize Xylitol. This prevents
    the bacteria from forming acids that cause caries.

-   Xylitol enhances remineralization

-   Xylitol is unique among the polyols because it inhibits the growth
    of mutans streptococci, thereby reducing caries susceptibility.
    Continued use of xylitol will help to reduce the number of bacteria
    in plaque

-   Xylitol is significantly more effective than other sugar substitutes
    in reducing the weight of plaque in the oral cavity. It also reduces
    the proportion of insoluble polysaccharides and increases the
    proportion of soluble polysaccharides present in plaque which
    results in plaque that is less adhesive.

-   Regular use (5 to 10 grams per day) has been shown to reduce caries
    by 30 to 85%

-   Works well in conjunction with fluorides

-   Lowers the rate of otitis media in children (gum by 40%, syrup by
    30%)

-   Xylitol is safe and approved by the FDA for use as a food additive
    in "sugar-free" products since 1993

-   It is safe to use for diabetics since it does not raise blood sugar
    levels

-   Xylitol comes in a crystal form which gives a strong, pleasant
    cooling sensation when dissolved in the mouth

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-   Xylitol gum is being used in Head Start programs as a preventive
    measure to help reduce caries formation

-   The US Army has found the evidence supporting Xylitol so compelling
    that it has added xylitol-containing chewing gum to all MREs and all
    base exchanges

-   Xylitol gum is effective when 3- 5 pieces (each containing 1.6 grams
    or more of xylitol) are chewed daily for 5 to 15 minutes

-   Xylitol gum can be purchased online and at health food stores such
    as Wild Oats, and Whole Foods

-   Xylitol causes GI laxative effects at very high doses (over 50 to 70
    grams per day)

The most fundamental difference between xylitol and other sweeteners is
that xylitol reduces the amount of plaque and the virulence of mutans
streptococci in plaque. Xylitol functions as a modulator of the oral
flora. Oral bacteria will not adapt to metabolize xylitol regardless of
the duration of its use, so its benefits continue while it's being
consumed and after Xylitol is no longer a part of daily use. This effect
has been shown to persist for at least five years.

A study published in the Journal of Dental Research (March 2000)
demonstrated significant reductions in the transmission of mutans
streptococci (MS) from mother to child as a direct result of the
consumption of chewing xylitol-containing chewing gum by their mothers.

Soderling E. et al; J Dent Res 2000 Mar; 79(3)882-7

-   169 mother-child pairs, 2 year study

-   All mothers had high S. mutans during pregnancy

-   Study group chewed 2-3 sticks of xylitol gum per day starting 3
    months after delivery

-   2 control groups, 1 treated with chlorhexidine and 1 treated with
    fluoride varnishes at 6, 12, and 18 months post delivery

-   At 2 years of age, 9.7% of the children of mothers in the xylitol
    group had detectable S. mutans levels compared with 28.6% in the
    chlorhexidine group and 48.5% in the varnish group

-   Appears to work by selecting for S. mutans with impaired adhesion
    properties

A follow-up study published in the Journal of Dental Research looked at
whether maternal consumption of sugar free chewing gum sweetened with
xylitol could reduce the risk of dental caries in their children.
Earlier published studies have demonstrated that prevention of
colonization by these bacteria in early childhood can lead to reduction
of dental decay and that mothers are the primary source of infection
with mutans streptococci. These bacteria are passed from mother to child
through everyday contacts such as kissing and tasting of food.

Isokangas P et al; J Dent Res 2000 Nov;79(11):1885-9

-   Follow-up of the same children in the previous study

-   Examined annually out to 5 years by double blinded examiner

-   dmf of xylitol group at 5 years was 70% of that in the fluoride or
    chlorhexidine group

In study in which xylitol was placed in a reservoir in the pacifiers of
one year old children (Aaltonen et al. Acta Odontol Scand. 2000 Dec;
58(6):285-92.), xylitol was shown to produce the following results:

-   Reduced mutans strep infection by 16%

-   Reduced caries to zero in test group (p\<0.001)

-   Reduced otitis media by 19% - 38%

IHS dental staff can easily implement a xylitol gum program by providing
the gum to post-natal mothers as an indirect preventive method (to
decrease the transmission of S. Mutans from mother to child) or by
providing the gum to a fixed group of children, such as Head Start,
working in collaboration with the Head Start teachers.

Additional information about Xylitol and its use in caries-prevention
programs can be found at the following links:

<http://www.aapd.org/media/Policies_Guidelines/P_Xylitol.pdf>

<http://www.xylitol.org/>

<http://jada.ada.org/cgi/reprint/137/2/190> (you will need to be an ADA
member to access this article)

**Xylitol Abbreviated Bibliography**

*To date, nearly 1,000 articles have been written on Xylitol. The
following are some directed to caries prevention research.*

Alanen P, et al. (2000). Sealants and xylitol chewing gum are equal in
caries prevention. Acta Odontol Scand. 58(6):279-84.

Alanen P, et al. (2000). Xylitol candies in caries prevention: results
of a field study in Estonian children. Community Dent Oral Epidemiol.
28(3):218-24.

Autio JT. (2002). Effect of xylitol chewing gum on salivary
Streptococcus mutans in preschool children. ASDC J Dent Child.
69(1):81-6, 13.

Calamari SE, et al. (1997). Effects of xylitol, sorbitol and fluoride
mouthrinses on glucose clearance in adolescents. Acta Odontol
Latinoam.l0(1):25-36.

Edgar WM. (1998). Sugar substitutes, chewing gum and dental caries\--a
review. Br Dent J. 184(1):29-32.

Gales MA, Nguyen TM. (2000). Sorbitol compared with xylitol in
prevention of dental caries. Ann Pharmacother. 34(1):98-100.

Hayes C. (2001). The effect of non-cariogenic sweeteners on the
prevention of dental caries: a review of the evidence. J Dent Educ.
65(10):1106-9.

Hildebrandt GH, Sparks BS. (2000). Maintaining mutans streptococci
suppression with xylitol chewing gum. J Am Dent Assoc. 131(7):909-16.

Honkala S, et al. (1999). Use of xylitol chewing gum among Finnish
schoolchildren. Acta Odontol Scand. 57(6):306-9.

Hujoel PP, et al. (1999). The optimum time to initiate habitual xylitol
gum-chewing for obtaining long-term caries prevention. J Dent Res.
78(3):797-803.

Isokangas P, et al. (2000). Occurrence of dental decay in children after
maternal consumption of xylitol chewing gum, a follow-up from 0 to 5
years of age. J Dent Res. 79(11):1885-9.

Isogangas P, et al. (1993). 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. 27(6):495-8.

Machiulskiene V, et al. (2001). Caries preventive effect of
sugar-substituted chewing gum. Community Dent Oral Epidemiol. 20
29(4):278-88.

Makinen KK, et al. (1998). Physical, chemical, and histologic changes in
dentin caries lesions of primary teeth induced by regular use of polyol
chewing gums. Acta Odontol Scand. 56(3):148-56.

Makinen KK, et al. (1998). A descriptive report of the effects of a
16-month xylitol chewing-gum programme subsequent to a 40-month sucrose
gum programme. Caries Res. .32(2):107-12.

Makinen KK, et al. (1996). Conclusion and review of the Michigan Xylitol
Programme (1986-1995) for the prevention of dental caries. Int Dent J.
46(1):22­34.

Makinen KK, et al. (1996). Polyol-combinant saliva stimulants and oral
health in Veterans Affairs patients\--an exploratory study. Spec Care
Dentist. 16(3):104-15.

Petersson LG, et al. (1991). Caries-preventive effect of dentifrices
containing various types and concentrations of fluorides and sugar
alcohols. Caries Res. 25(1):74-9.

Rekola M. (1986). Changes in buccal white spots during 2-year
consumption of dietary sucrose or xylitol. Acta Odontol Scand.
44(5):285-90.

Roberts MC, et al. (2002). How xylitol-containing products affect
cariogenic bacteria. J Am Dent Assoc. 133(4):435-41.

Scheie AA, Fejerskov OB. (1998). Xylitol in caries prevention: what is
the evidence for clinical efficacy? Oral Dis. 4(4):268-78.

Scheinin A, et al. (1993). Xylitol-induced changes of enamel
microhardness paralleled by microradiographic observations. Acta Odontol
Scand. 51(4):241-6.

Scheinin A, et al. (1985). Collaborative WHO xylitol field studies in
Hungary. VII. Two-year caries incidence in 976 institutionalized
children. Acta Odontol Scand. 43(6):381-7.

Simons D, et al. (2002). The effect of medicated chewing gums on oral
health in frail older people: a 1-year clinical trial. J Am Geriatr Soc.
50(8):1348-53.

Simons D, et al. (1999). The effect of xylitol and chlorhexidine
acetate/xylitol chewing gums on plaque accumulation and gingival
inflammation. J Clin Periodontol. 26(6):388-91.

Soderling E, et al. (2000). Influence of maternal xylitol consumption on
acquisition of mutans streptococci by infants. J Dent Res. 79(3):882-7.

Soderling E, et al. (1991). Long-term xylitol consumption and mutans
streptococci in plaque and saliva. Caries Res. 25(2):153-7.

Soderling E, Scheinin A. (1991). Perspectives on xylitol-induced oral
effects. Proc Finn Dent Soc. 87(2):217-29.

Tanzer JM. (1995). Xylitol chewing gum and dental caries. Int Dent J.
45(1 Suppl 1):65-76.

Trahan L, et al. (1996). Emergence of multiple xylitol-resistant
(fructose PTS-) mutants from human isolates of mutans streptococci
during growth on dietary sugars in the presence of xylitol. J Dent Res.
75(11):1892-900.

Yanagisawa T, Miake Y, Saeki Y, Takahashi M. (2003) Remineralization in
enamel caries and restoration of carious lesions by enhanced
remineralization induced by saliva and xylitol. Dent in Japan, vol
39:208-215.