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US Army Fact Sheet on Xylitol: Xylitol the Army Facts

Ice Breakers gum has xylitol 7/06

The use of sorbitol- and xylitol-sweetened chewing gum in caries control – J Am Dent Assoc, Vol 137, No 2, 190-196. The author compared the caries-inhibitory action of sorbitol- and xylitol-sweetened chewing gum and assessed the role of these products in caries prevention. The author reviewed studies includingrandomized field trials with substantial numbers of participants and observational studies. He found studies through a MEDLINE search and by hand searching. When compared with sugar-sweetened gum, sorbitol-sweetened gum had low carcinogenicity when it was chewed no more than three times per day. Xylitol-sweetened gum was noncariogenic in all of the protocols tested. Some studies claimed that xylitol-sweetened gum had an anticariogenic effect, though these claims need further study. There also is good evidence that when mothers of infants and young children chew xylitol-sweetened gum, it will block transmission of mutans streptococci from mother to child. The evidence is strong enough to support the regular use of xylitol-sweetened gum as a way to prevent caries, andit can be promoted as a public-health preventive measure. Chewing xylitol-sweetened gum, especially for patients who like chewing gum, can be fitted readily into a regimen that includes frequent fluoride exposure, good oral hygiene and regular dental appointments. 4/06

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Xylitol is promoted in caries-preventive strategies, yet its effective dose range is unclear. This study determined the dose- response of mutans streptococci in plaque and unstimulated saliva to xylitol gum. Participants (n = 132) were randomized: controls (sorbitol/maltitol), or combinations giving xylitol 3.44 g/day 6.88 g/day , or 10.32 g/day . Groups chewed 3 pellets/4 times/d. Samples were taken at baseline, 5 wks, and 6 mos, and were cultured on modified Mitis Salivarius agar for mutans streptococci and on blood agar for total culturable flora. At 5 wks, mutans streptococci levels in plaque were 10x lower than baseline in G3 and G4 (P = 0.007/0.003). There were no differences in saliva. At 6 mos, mutans streptococci in plaque for G3 and G4 remained 10x lower than baseline (P = 0.007/0.04). Saliva for G3 and G4 was lower than baseline by 8 to 9x (P = 0.011/0.038). Xylitol at 6.44 g/day and 10.32 g/day reduces mutans streptococci in plaque at 5 wks, and in plaque and unstimulated saliva at 6 mos. A plateau effect is suggested between 6.44 g and 10.32 g xylitol/day.

Mutans Streptococci Dose Response to Xylitol Chewing Gum P. Milgrom, K.A. Ly, M.C. Roberts, M. Rothen, G. Mueller, and D.K. Yamaguchi, J Dent Res 85(2):177-181, 2006

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Recent studies report that subjects who chewed gum had fewer cavities than non gum chewers. Xylitol in chewing gum caused the GREATEST REDUCTION in cavities. The greatest reduction in cavities occurs when gum chewing is begun at least 1 year prior to the eruption of permanent teeth. The antimicrobial effect of xylitol on strep mutans. Children chewing xylitol gum had a greater reduction in the number of strep mutans than those children who were not gum chewers. Maximum effect of sugarless gum chewing occurs when it is chewed 3 time a day directly after meals.

Oral Care Report Vol. 13 No. 2,2003

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Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland.

The use of toothbrushes in daycare centers has been questioned because of the possibility of infections spreading through unsupervised brushing. Several field studies have demonstrated a caries-preventive effect of xylitol chewing gum–a measure that could be a practical way of taking care of oral hygiene during daycare hours without brushing. A community trial was conducted in total of 921 children. Oral health status in the xylitol group was a little bit better than in the control group. The use of xylitol can therefore be recommended, especially if the personnel do not have the possibility to supervise the brushing. Acta Odontol Scand. 2003 Dec;61(6):367-70. Kovari H, Pienihakkinen K, Alanen

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Remineralization effects of xylitol on demineralized enamel. We morphologically determined the effects of xylitol on the remineralization of artificially demineralized enamel. The samples were demineralized and then immersed in a remineralizing solution with or without 20% xylitol at 37 degrees C for 2 weeks. Samples immersed in a xylitol solution demonstrated less mineralization in the outer 10 microm of the outermost surface layers, but more mineralization in the middle and deep layerss. The MIP evaluation indicated that remineralization was more prominent in layers at depths of 50-60 microm in the xylitol samples than in the non-xylitol samples. These results indicate that xylitol can induce remineralization of deeper layers of demineralized enamel by facilitating Ca2+ movement and accessibility. Clinical Trial Randomized Controlled Trial PMID: 14960009 [PubMed - indexed for MEDLINE] J Electron Microsc (Tokyo). 2003;52(5):471-6.Miake Y, Saeki Y, Takahashi M, Yanagisawa T.

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Xylitol and dental caries: an overview

Xylitol is a naturally occurring, low-calorie sugar substitute with anticariogenic properties. Data from recent studies indicate that xylitol can reduce the occurrence of dental caries in young children, schoolchildren, and mothers, and in children via their mothers. Xylitol, a sugar alcohol, is derived mainly from birch and other hardwood trees. Short-term consumption of xylitol is associated with decreased Streptococcus mutans levels in saliva and plaque. Aside from decreasing dental caries, xylitol may also decrease the transmission of S. mutans from mothers to children. Commercial xylitol-containing products may be used to help control rampant decay in primary dentition. Studies of schoolchildren in Belize and Estonia, along with data from the University of Washington, indicate that xylitol gum, candy, ice pops, cookies, puddings, etc., in combination with other dental therapies, are associated with the arrest of carious lesions. PMID: 14700079 J Calif Dent Assoc. 2003 Mar;31(3):205-9.Lynch H, Milgrom P.

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In vitro testing of xylitol as an anticariogenic agent.

A number of studies involving xylitol chewing gum have demonstrated that xylitol is both noncariogenic and anticariogenic. The ability of xylitol to act as an anticariogenic agent most likely is due to its ability to be transported into caries-causing oral bacteria and inhibiting fermentation either by depleting the cell of high-energy phosphate or by poisoning the glycolytic system. In vitro tests were conducted to determine the concentration of xylitol required to inhibit the growth of three strains of oral streptococcus (S. mutans, S. salivarius, and S. sanguis). All three strains were inhibited significantly at xylitol concentrations of 12.5% and higher; however, only S. mutans was inhibited significantly at a xylitol concentration of 1.56%. Gen Dent. 2002 Jul-Aug;50(4):340-3. _Sahni PS, Gillespie MJ, Botto RW, Otsuka

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Maintaining Mutans Streptococci Suppression: With Xylitol Chewing Gum One strategy for treating dental caries is to suppress oral mutans streptococci, or MS, with chlorhexidine, or CHX, mouthrinse. Oral MS levels, however, tend to quickly return to baseline values without further intervention. In this clinical study, the authors evaluated the effect of xylitol chewing gum on MS regrowth. Subjects rinsed with 0.12 percent CHX gluconate mouthrinse twice daily for 14 days.Those in the test group chewed a commercial xylitol gum three times daily for a minimum of five minutes each time for three months. The placebo group subjects used a commercial sorbitol gum, and the control group subjects did not chew gum. After three months of gum chewing, the test group subjects had significantly lower salivary than did the placebo or control group subjects. Conclusions. Xylitol chewing gum appears to have the ability to prolong the effect of CHX therapy on oral MS. . [Maintaining Mutans Streptococci Suppression: With Xylitol Chewing Gum Hi= ldebrandt G.H., Sparks B.S. JADA The Journal of the American Dental Association, July 2000, vol. 131, no. 7,pp. 909-916]

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How XylitolContaining Products Affect Cariogenic Bacteria

The authors examined the effect of xylitol on levels of Streptococcus mutans and S. sobrinus. In the first study, 187 children received xylitol containing snacks in school for four weeks. The children’s salivary S. mutans levels remained stable before and after xylitol exposure. Bacteria from five of these children grew with 10 percent or less xylitol at baseline, while the bacteria from all seven children grew with 15 percent xylitol after exposure to the xylitol containing snacks, suggesting that the S. mutans increased in tolerance to xylitol during exposure. Overall, consumption of xylitol-containing snacks and candy did not reduce S. mutans levels. However, bacteria from five children and one adult became more xylitol tolerant. [How XylitolContaining Products Affect Cariogenic Bacteria Roberts M.C., Riedy C.A., Coldwell S.E., Nagahama S., Judge K., Lam M., Kaakko T., Castillo J.L., Milgrom P. JADA The Journal of the American Dental Association, April 2002, vol. 133, no. 4,pp. 435-441.]

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