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Dental Caries (Cavities)
Xylitol is clinically proven to Fight Cavities

1: J Dent Educ 2001 Oct;65(10):1106-9 Related Articles, Books, LinkOut

The effect of non-cariogenic sweeteners on the prevention of dental caries: a review of the evidence.

Hayes C.

Harvard School of Dental Medicine, Boston, MA, USA. catherine_hayes@hms.harvard.edu

The role of sugar substitutes such as xylitol and sorbitol in the prevention of dental caries has been investigated in several clinical studies. The purpose of this report is to review the current published evidence regarding the relationship between sugar substitutes and dental caries. A literature search was conducted using MEDLINE and EMBASE and included studies published from 1966 to 2001. Studies that included human subjects and were published in English were included in this review. A total of fourteen clinical studies were reviewed that evaluated the effect of sorbitol or xylitol or the combination of both sugar substitutes on the incidence of dental caries. Most of the reports were of studies conducted with children outside of the United States. These studies demonstrated a consistent decrease in dental caries, ranging from 30 to 60 percent, among subjects using sugar substitutes as compared to subjects in a control group. These caries rate reductions were observed in subjects using xylitol or sorbitol as the sugar substitute in chewing gum or toothpaste. The highest caries reductions were observed in subjects using xylitol. These findings suggest that the replacement of sucrose with sorbitol and xylitol may significantly decrease the incidence of dental caries.

PMID: 11699985 [PubMed - indexed for MEDLINE]

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Acute Otitis Media (inner ear infection)
Xylitol is clinically proven to Fight and Reduce the occurance of Inner Ear Infection

A study published in the British Medical Journal, [BMJ 1996;313:1180-1183 (9 November)] , confirms that chewing gum sweetened with Xylitol can have a preventive effect against acute otitis media. The 1996 double blind randomised trial involved 336 preschool Finnish children (avg. 5 years of age) over a two month period.

Of the two groups tested, one chewed two pieces of xylitol sweetened gum 5 times a day after meals and snacks while the other did the same with sugar sweetened gum. [corresponds exactly with the amount and frequency suggested in other studies for optimum dental care] The pieces of gum were plain wrapped and numbered with neither group, parents or testers knowing until the end of the study which gum was xylitol and which was sucrose. "The chewing lasted until there was no taste left or for at least five minutes" the report stated. "The parents were asked to proceed with the normal dietary routines but to avoid the use of additional xylitol during the study."

Eleven day care nurseries in the city of Oulu took part in the study with most of the children having had problems with recurrent acute otitis media. Two children in the xylitol group experienced diarrhea, but no other adverse effects were noted among the xylitol users.

The study found:
• When given to children with recurrent otitis media in chewing gum xylitol reduced the occurrence of otitis media by about 40%
• The daily dose required is not known, but 8.4 g given daily in a chewing gum seems to be effective
• It also inhibits the growth of S pneumoniae

"We have previously found that xylitol inhibits the growth of S pneumoniae and S mutans" the doctors stated. "We suspected that the growth inhibiting effect of xylitol against pneumococci could reduce the pneumococcal carriage rates and also reduce the incidence of acute otitis media." The test proved them right.

Interestingly, in this day of worry concerning the overuse of antibiotics, when the medical records of each child's family doctor were reviewed, the sucrose group was prescribed antimicrobial drugs 60 times while the xylitol group was prescribed 34. Also interesting was the lack of difference in the laxative effect that overuse of polyols can cause. "Two children in our trial stopped using xylitol because of complaints of diarrhea. Yet the recorded number of episodes of diarrhea and the mean duration of diarrhea were similar in both groups."

The study further stated, "Our finding is best explained by the efficacy of xylitol in reducing the growth of S pneumoniae and thus preventing the attacks of acute otitis media caused by pneumococci. Pneumococci are the major cause of acute otitis media, causing about 30% or more of such attacks. A preceding viral infection is needed before the nasopharyngeal bacteria can rise to the middle ear and cause acute otitis media."

"The mean age of 5 years of the children in our study was older than that of most patients with acute otitis media as the peak incidence occurs at the age of 6-15 months. The children participating in our trial had to be able to chew gum without swallowing it, which resulted in the selection of older children."

PMID: 8916749

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Plaque
Xylitol is clinically proven to fight Plaque & Reduce the secretion of Plaque Acids
When it come to choosing a medical publication study that describes how xylitol fights plaque there are dozens to choose from. Studies by Kato Makinen on this limited subject alone are over a dozen. Here is an abstract from one in 1985 that briefly describes a combination of actions Makinen calls the "xylitol effect".

While the FDA has approved the use of a "does not promote tooth decay" health claim in labeling for all 8 polyols includinig Xylitol, it does not take into effect some of the unique anti-plaque and therefore cavity-fighting characteristics of Xylitol. For example, in their 1985 paper, Edgar WM & Dodds MW. showed that "Of the sugar alcohols, sorbitol, mannitol, maltitol and lactitol are all slowly fermented to acid by oral bacterial, and xylitol is virtually non-fermentable."

This study highlights Xylitol's plaque relationship along with some other little known facts of all polyols.
Here is the Makinen's abstract, the bullits and highlights I have added for clarity:

New biochemical aspects of sweeteners.

Makinen KK.

It has been customary to explain the dentally beneficial effects of xylitol and certain other polyols in terms of microbiological effects only. The almost complete nonfermentability of xylitol in human dental plaque does contribute to the promising clinical findings that have been obtained both in human and animal trials. The nonfermentability or very low fermentability of xylitol by dental plaque leads to a number of consequential phenomena of possible significance in oral biology. The following are associated with the consumption of xylitol:

• a decrease in the production of lactic acid;
• the formation of soluble extracellular polysaccharides which make plaque less adhesive;
• an increase in the general nitrogen metabolism of dental plaque, this resulting in increased transamination and proteolysis with enhancement of the pool of free amino acids and the possibility of ammonia formation. [ammonia formation is associated with low plaque levels]

When these effects are combined with the saliva-stimulating properties of xylitol (common to all sweet carbohydrates), the mechanism of the xylitol effect may be more adequately explained. A number of physicochemical facts have, however, received very little attention. They include the following: xylitol and other polyols:

• strongly protect proteins and enzymes from denaturation;
• seem to govern the precipitation reactions that occur in saliva or in saturated calcium phosphate solutions.

The former reactions may play a role in carbohydrate-induced wound healing and the maintenance of the integrity of the oral defense mechanisms. The latter reactions may manifest themselves in the inhibition of spontaneous precipitation of calcium phosphate; thus these polyols may mimic the function of innate inhibitors, statherin, for example. The total explanation of the xylitol effect may thus comprise aspects that are related both to microbiology and to physical chemistry.

PMID: 3922899

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Plaque, Tooth Decay, Remineralization
Xylitol is clinically proven to fight Plaque, Fight Cavities, Reduce the secretion of Plaque Acids, & Facilitates the Remineralization of Tooth Enamel

1: Int Dent J 1995 Feb;45(1 Suppl 1):65-76 Related Articles, Books, LinkOut

Xylitol chewing gum and dental caries.

Tanzer JM.

Department of Oral Diagnosis, University of Connecticut School of Dental Medicine, Farmington.

There is an extensive peer-reviewed literature on xylitol chewing gum as it pertains to effects on tooth decay in human subjects, on human dental plaque reduction, on inhibition of dental plaque acid production, on inhibition of the growth and metabolism of the mutans group of streptococci which are the prime causative agents of tooth decay, on reduction of tooth decay in experimental animals, and on xylitol's reported contribution to the remineralisation of teeth. The literature not only supports the conclusion that xylitol is non-cariogenic but it is now strongly suggestive that xylitol is caries inhibitory, that is, anti-cariogenic in human subjects, and it supplies reasonable mechanistic explanation(s).

Publication Types:
Review
Review, Tutorial

PMID: 7607747 [PubMed - indexed for MEDLINE]

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Dental Caries (Cavities)
Xylitol is clinically proven to Fight Cavities

1: Int Dent J 1996 Feb;46(1):22-34 Related Articles, Books, LinkOut

Conclusion and review of the Michigan Xylitol Programme (1986-1995) for the prevention of dental caries.

Makinen KK, Makinen PL, Pape HR Jr, Peldyak J, Hujoel P, Isotupa KP, Soderling E, Isokangas PJ, Allen P, Bennett C.

University of Michigan, School of Dentistry, Ann Arbor 48109-1078, USA.

The major results of the Michigan Xylitol Programme (1986-1995) are summarised. The Programme consisted of several clinical trials and laboratory investigations designed to study the usage of xylitol-containing saliva stimulants in the prevention of dental caries. The trials patients included young (initially 6 year olds) and adult or geriatric subjects who were given saliva stimulants (mostly chewing gum) for periods of two weeks to 56 months. A special rationale behind these studies was the need to further test the validity of the 'pentitol-hexitol theory' in the prevention of caries. This theory has maintained that pentitols (sugar alcohols with five hydroxyl groups, such as xylitol) may be cariologically more effective than hexitols (sugar alcohols with six hydroxyl groups, such as sorbitol). The accumulated clinical, sialochemical and microbiologic evidence suggests that xylitol, a natural carbohydrate sweetener of the pentitol type, is more effective in preventing dental caries than sorbitol, and cariologically safer than sorbitol, a natural carbohydrate of the hexitol type. Sorbitol was found to be significantly less cariogenic than sucrose. The Programme's results shed additional light on the cariologic and oral biologic effects of natural, dietary polyols, and suggest that the usage of xylitol chewing gum (and in some cases xylitol dragees) can be considered a valuable additional tool in caries prevention and in stabilisation of caries in all age groups.

PMID: 8744914 [PubMed - indexed for MEDLINE]

Excerts from the Xylitol Field Trials by John Peldyak

If you think melting glaciers are a problem - read this!