Avoiding caries with Xylitol (tooth sugar)

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Thanks to its anti-cariogenic characteristics, Xylitol, also called tooth sugar, is very effective in reducing the formation of plaque and the production of tooth-damaging acids – the two main causes of caries.

Experts have already known this sugar that protects teeth instead of damaging them, for 40 years. However, the broad public is hardly aware of the substance and its effective protection against caries even though almost 300 studies have been published addressing Xylitol and its effects on the development of caries.

Avoiding caries – Turku sugar studies


Back in the 1970s, Finnish scientists discovered the anti-cariogenic effect of Xylitol. Between 1972 and 1975, two clinical studies (known as Turku Sugar Studies [http://www.ncbi.nlm.nih.gov/pubmed/1067728] under the direction of Prof. Kauko K. Mäkinen) were conducted at the Turku University (Finland) which proved without a doubt that using Xylitol can significantly reduce caries. In the first study, three groups with a total of 115 probands were tested. While the first group exclusively got food sweetened with fructose, the second group got food sweetened with Xylitol instead. The third group got table sugar (saccharose) and served as a control group.

The DMFS index which indicates the exact number of decayed (D), missing (M) or filled (F) surfaces (S) of teeth, served as a reference. This index increased by 7.2 points in the saccharose group, by 3.8 points in the fructose group, and in the Xylitol group it remained unchanged. This translates into a highly significant decrease of caries of more than 85% in the group that got Xylitol, and into a decrease of at least 30% in the group that got fructose, compared to the saccharose group.

During the second Turku sugar study, 100 participants either got 7 g of Xylitol or 7 g of saccharose in the form of chewing gum over a period of one year. In the group of Xylitol testers, caries increase was 82% lower than in the group taking saccharose. Since both groups got chewing gum, the chewing effect did not have any impact on the final result.




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To date, there are almost 300 international studies that stress the benefit of Xylitol regarding the prevention of caries.

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Xylitol reduces the formation of plaque


The growth of the bacteria causing caries, such as streptococcus mutans, is inhibited. In part, these bacteria are not able to metabolize the sugar alcohol at all, and if they do, significantly less tooth-damaging acids are produced. The regular consumption also reduces the caries bacteria’s ability to stick to the surface of the teeth. Moreover, the regular consumption decreases the number of streptococci in the saliva and the plaque. The formation of damaging acids in the plaque can also be reduced by Xylitol. The daily consumption of 3.4 g of Xylitol over a period of four weeks already decreases the formation of plaque by one third. This is shown by a recent study of Swedish scientists. In order to reduce the production of acids, a daily intake of 6 g of Xylitol was necessary. In general, five to ten grams of Xylitol per day are considered an efficient dose. This can be achieved, for instance, by chewing six chewing gums – ideally directly after every meal – spread over the day. The reduction of bacteria inside the mouth has the appreciated side effect of decreasing bad breath that may exist, and preventing infections in the ear, nose and throat area like an inflammation of the middle ear for example.




Remineralisation with Xylitol


The remineralisation of enamel beginning to become carious is a natural anti-cariogenic effect. The saliva’s content of calcium, phosphate and fluoride has a remineralising effect on the dental surfaces, although this is a very slow process. Xylitol is also attributed a remineralising effect, but this mechanism is not completely clarified. An important clue for a remineralisation due to the influence of Xylitol was found in the Belize study. A re-hardening in 10-27% of the caries lesions (damages caused by caries) was observed. The Belize studies were conducted as an official program of the University of Michigan, and the participating dentists were from Finland, the USA and Belize.




Avoiding caries in children


In addition to one’s own teeth, Xylitol can also protect the teeth of babies and toddlers. Mothers can drastically reduce the caries risk of their own children by simply chewing Xylitol-containing chewing gums. This is because the interior of a newborn’s mouth is absolutely sterile at first. Bacteria that facilitate caries get to the children’s mouth through the mother’s saliva. They are transmitted when kissing or sharing the same cutlery, for example. If the mother reduces the streptococcal concentration in her saliva, this automatically lowers the risk of transmitting bacteria. This was shown by a Finnish mother-child-study by Söderling et al. in 2000, where 195 mothers of newborns participated (source: “Journal of Dental Research”, vol. 79 (3), p. 882 to 887). After giving birth, 120 women chewed Xylitol-containing chewing gum four times a day from the third to the 24th month, while the remaining testers received enamel varnish treatment during the same period of time, either with fluoride to strengthen the enamel, or with chlorine hexidine to reduce the bacteria concentration. Out of the Xylitol group, 9.7% of the children had streptococcus mutans colonisations at the age of two, while 28.6% of the children of the chlorine hexidine group and 48.5% of the fluoride children showed those colonisations.

The same children were examined at the age of five again. That test showed that the children of the Xylitol group had 70% less damage caused by caries than the other children (source: “Journal of Dental Research”, vol. 79 (11), p. 1885-1889). The result of this mother-child-study proves without a doubt the great use of Xylitol to effectively avoid caries in babies and children.




Informing pregnant women better


Almost no pregnant woman knows about the effects of Xylitol, although the studies’ results turned out to be very positive. Professor Dr. med. dent. Christian Hirsch (German Society for Pediatric Dentistry / University Medical Centre Leipzig) also confirms the studies’ creditableness. However, the target group for this preventive action is hardly reached. Hirsch considers the broad distribution of information as reasonable so that as many children as possible can benefit from Xylitol and its effects. Unfortunately, Xylitol-containing products are expensive.




Just as sweet as table sugar


There is hardly any difference in the sweetening power of table sugar – also called saccharose – and Xylitol. However, the calorific value of Xylitol is approximately 40% lower than that of saccharose – that means 40% less calories. Nummerically, Xylitol has 2.4 kcal/g compared to saccharose with a calorie content of 4.0 kcal/g. Like menthol, the substance has a cooling effect in the mouth because it draws heat from its surroundings.




Xylitol as an alternative for diabetics


Since Xylitol is metabolised independently of insulin, it is also suitable for diabetics. Xylitol occurs as an intermediate in the body when metabolising glucose, which means that the liver produces around 5 to 15 grams of Xylitol every day. Thus, an intake of greater quantities is also possible since the human body can tolerate it very well. Just a laxative effect can occur when taking excessive doses. At the beginning, 20 g as a single dose and a daily total intake of 50 to 70 g of Xylitol maximum are considered the upper limit. Once the human body has adapted to the “new sugar” over a certain period of time, there is no problem in taking 200 g a day.




Editor’s recommendations


The daily consumption of Xylitol as an addition to the oral hygiene is recommended especially for people with a high caries risk as well as for mothers of newborns. A daily intake of approximately 6 g of Xylitol is recommended, ideally divided into at least three units. Optimally, you brush your teeth in the morning and in the evening, and take Xylitol directly after your other meals. Even better would be to also remember the Xylitol-containing chewing gum after eating small snacks. In general, chewing gums are to be preferred to bonbons and pastilles containing Xylitol. Besides stimulating the salivation which goes along with a flushing effect of the teeth, the adherence of plaque (tooth deposit) is also impeded due to the mechanical chewing process.




Study results for sorbitol


All these anti-cariogenic qualities do not apply to sorbitol, a sugar alcohol that is often found in so-called chewing gums for dental hygiene! Quite the opposite! A study (Wennerholm et al., 1994) reaches the conclusion: habitual consumption of sorbitol can even increase the number of streptococcus mutans in the plaque. The reason: Xylitol is not metabolised by oral bacteria and no long-term adaption takes place either. Sorbitol, on the other hand, can be fermented increasingly well over time, while even raising the number of streptococcus mutans bacteria (Kalfas et al., 1990). (Additional source: Prof. Kauko Mäkinen, University of Turku, Finland: “The use of Xylitol for caries prevention”, p. 38:) “In summary, it’s fair to say that laboratory experiments and clinical studies have shown that sorbitol stimulates the growth of different types of streptococcus mutans although the production of acid out of sorbitol can usually be low.







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