Xylitol for Teeth

Xylitol for Teeth: A Comprehensive Guide

Xylitol is a sugar alcohol that has been shown to have several benefits for dental health. It is often found in sugar-free gum, toothpaste, mouthwashes and candy, and can also be used as a sweetener in cooking and baking. Xylitol works in several ways to promote oral health which are reviewed in the following chapters.

Effects of Xylitol on Preventing Tooth Decay

Xylitol has been proposed in research to have various beneficial effects on caries prevention. In 2019, the latest review article on the subject was published, reviewing the xylitol studies conducted up to that point and the benefits of xylitol found in them (Lee et al., 2019). The literature review discussed six different beneficial effects of xylitol on teeth. The daily xylitol intake varied between 0.5 grams and about 20 grams per day, and the xylitol amounts used in different studies may partly affect the results obtained. There are also many studies in which xylitol may not have had any positive effects compared to a control group that did not use xylitol. It is therefore very important that in caries prevention, xylitol is still used in conjunction with a toothbrush, fluoride toothpaste and regular flossing (Kimari, 2019).

The prevention of caries
In addition to xylitol, the prevention of caries still involves the use of a toothbrush, fluoride toothpaste, and regular cleaning between the teeth.

1. Reduction of Streptococcus mutans bacteria and changes in bacterial flora

Regular use of xylitol has been found to reduce the amount of bacteria that predispose to decay in dental plaque. In particular, studies have focused on the reduction of Streptococcus mutans (S. mutans) bacteria in conjunction with regular xylitol use (Han et al., 2004). Many other bacteria in the mouth also produce enamel-erosive acids as well as S. mutans and thus contribute together with other microbes in the mouth to tooth decay (Kimari, 2019). However, S. mutans play a very important role in the initiation of enamel lesions, as they also secrete compounds other than acids that increase the caries potential of plaque in the early stages of enamel lesions. The microbial composition has also been observed to change on the tooth surface as caries develops and the bacterial composition and enamel lesions can develop through different mechanisms in different people even if there are no S. mutans bacteria in the mouth at all (Banas and Drake, 2018).

2. Xylitol reduces plaque

Regular use of xylitol has been found to reduce the amount of bacterial coating on the tooth surface, i.e. plaque (Lee et al., 2019). For example, regular use of xylitol (about 11 g per day) for two weeks has been shown to reduce plaque by about a third compared to a control group (Söderling et al., 1989).

3. Reduction of harmful acid production

Harmful acids for tooth enamel are formed in saliva and within the plaque layer. Xylitol use has been shown to reduce lactic acid production in the mouth and thus make the mouth more tooth-friendly (Twetman and Stecksén-Blicks, 2003). Tooth enamel calcium phosphate is known to dissolve when the pH of the tooth surface drops to about 5.5.

4. Reduced caries incidence

The incidence of caries is reduced by about 35–60% compared to the control group when children used 5 grams of xylitol per day (Alanen et al., 2000).

5. Strengthening tooth remineralization

Xylitol use has been found to increase tooth remineralization, i.e. the re-hardening of tooth enamel. At the same time as the amount of plaque decreases, tooth mineralization has also been found to improve with regular use of xylitol.

6. Transmission of Streptococcus mutans microbes to a child's mouth

Regular use of xylitol by the mother reduces the transmission of harmful S. mutans microbes to the child's mouth. The newborn baby's oral microbial flora develops and S. mutans infection is usually acquired from the parents. S. mutans in the saliva or plaque of children of mothers who used xylitol were significantly lower than in the control groups. Based on these studies, it would probably also be good for fathers to use xylitol products for the well-being of their own and their family's teeth.

Why is xylitol effective in caries prevention?

Xylitol has been shown to accumulate inside the S. mutans cell membrane into the cytoplasm and inhibit the metabolism of S. mutans bacteria, thereby inhibiting the nutrient intake of S. mutans bacteria. This is an effective mechanism to reduce the amount of S. mutans bacteria.

Xylitol has also been shown to increase saliva secretion. Increased saliva neutralizes acidic compounds in the mouth and at the same time dilutes the acids in the mouth. A neutral acid-base balance in the mouth prevents tooth enamel from dissolving. In addition, the molecular structure of xylitol allows for the formation of a complex with calcium. Bonding with calcium allows the dissolution of tooth enamel to stop/slow down of enamel dissolution and, in part, enables the remineralization of tooth enamel. Xylitol has also been observed to alter the composition of saliva (amino acid composition), thereby improving saliva buffering capacity and enhancing the inhibitory effect on saliva bacterial growth (Lee et al., 2019).

Works Cited

Alanen P, Isokangas P and Gutmann K (2000) Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol, 28, 3, 218-224.

Banas JA and Drake DR (2018) Are the mutans streptococci still considered relevant to understanding the microbial etiology of dental caries? BMC Oral Health 18, 3–8.

Ebisawa M, Hayashi N, and Sugisaki S. (2013) A national questionnaire survey for immediate allergy due to sweeteners, such as erythritol. Arerugi; 62:4, Japaninkielinen.

Han SK, Choi YH, Son EY, Song KB, Kim YG, Nam SH (2004) Prevention of dental caries gum in pre-school children during 12-months. J Korean Acad Pediatr Dent 31(2):159-168.

Kimari L (2019) Mutans streptokokit – kariesjoukkueen tuhoisat, arvoitukselliset tähtipelaajat. Suomen Hammaslääkärilehti 3/2019.

Lee Y-E, Kim J-H, Cho M-J, Song K-B and Choi Y-H (2019) Effect of xylitol on dental caries prevention : a literature review J Korean Soc Dent Hyg 19(4):449-465.

Loh W and Tang MLK (2018) The Epidemiology of Food Allergy in the Global Context. Int J Environ Res Public Health18;15(9):2043

Okamoto K, Kagami M, Kawai M, Mori Y, Yamawaki K, Nakajima Y, Kondo Y and Tsuge I (2019) Anaphylaxis to xylitol diagnosed by skin prick test and basophil activation test, Allergol.Int. 68(1):130-131.

Söderling E, Mäkinen KK, Chen CY, Pape HR Jr, Loesche W and Mäkinen PL (1989) Effect of sorbitol, xylitol, and xylitol/sorbitol chewing gums on dental plaque. Caries Res 23, 5, 378-384.

Twetman S and Stecksén-Blicks C (2003) Effect of xylitol-containing chewing gums on lactic acid production in dental plaque from caries active pre-school children. Oral Health Prev Dent 1, 3, 195-199.

Valls EF and Malo-Cerisuelo AI (2021). The First Register in Europe of Allergic Urticaria and Anaphylaxis Caused by Erythritol. Revista de Medicina Clínica 05(02):e15052105019.

Yunginger, J. W., Jones, R. T., Hirohito, K., Katsuhiko, S., Hefle, S. L. & Taylor, S. L. (2001). Allergic reactions after ingestion of erythritol-containing foods and beverages. J Allergy Clin Immunol, 108, 650.

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