Xylitol is a carbohydrate derived from xylose, often obtained from birchbark. Now used as sweetener in many commercial products, it has been useful for consumers wanting to cut down on sugar consumption. Can chewing xylitol gum daily increase the efficacy of the existing caries-preventive measures now regularly used for 11- to 15-year-old children? The answer may be found in this study of nearly 400 children in Finland from 1982 through 1985. As the prevalence of dental caries decreases in industrialized nations like the United States, it simultaneously increases in developing nations and Third World countries. The decrease in the West is attributed to increased use of fluorides, but the increase in developing countries has been explained by an increase in the consumption of sugar. As this information continues to propel researchers to find sucrose substitutes, xylitol has been singled out as a proposed sucrose replacement. The question tackled by this study was: Can the daily use of chewing gum containing xylitol increase the efficacy of the existing caries-preventive measures now regularly used for 11- to 15-year-old children in most industrialized western countries?

Xylitol chewing gum in caries prevention: a field study in children

The effect of chewing gum containing xylitol on the incidence and progression of dental caries was tested in a sample of 274 children, aged eight and nine years, of low socio-economic status and high caries rate. They were divided into two experimental groups (15% and 65% xylitol chewing gum distributed three times a day at school) and one control group (without chewing gum). The three groups were exposed to the same basic preventive program. Children who chewed gum had a significantly lower net progression of decay (progressions-reversals) over a 24-month period than did the controls. Results for the two groups chewing gum were similar. Chewing xylitol gum had a beneficial effect on the caries process for all types of tooth surfaces, and especially for bucco-lingual surfaces. The two experimental groups had a DMF(S) increment of 2.24 surfaces, compared with 6.06 surfaces for the control group. For this indicator, there was no difference between the two experimental groups. Results for the plaque index were in agreement with those of the DMF(S) increment and the net progression of decay.

A 24-month Clinical Study of the Incidence and Progression of Dental Caries in Relation to Consumption of Chewing Gum Containing Xylitol in School Preventive Programs

Previous in situ and in vitro studies have demonstrated that the chewing of sucrose-free gum after eating reduces the development of dental caries. To investigate the extrapolation of these findings to the clinical setting, we conducted a two-year study on 547 schoolchildren in Budapest, Hungary. Subjects in the "Gum" group were instructed to chew one stick of a commercially available sorbitol-sweetened chewing gum for 20 minutes after meals, three times daily. The "Control" group was not provided with chewing gum. After two years, the "Gum" group exhibited a 38.7% reduction in incremental caries, excluding white spots, compared with the "Control" group. Including white spots, a corresponding 33.1% reduction was indicated. These results clearly suggest that even in a moderate caries population practicing normal oral hygiene, including the use of fluoride dentifrices, an after-meal gum-chewing regimen can significantly reduce the rate of caries development.

Effect of after-meal sucrose-free gum-chewing on clinical caries.

The purpose of the study was to assess the outcome of school‐based oral health education (OHE) and a sugar‐free chewing gum program on the oral health status of children in terms of reduced caries increment and gingival bleeding over a period of 2 years. Nine primary schools randomly chosen from one district were divided into three groups: OHE group (Group E), sugar‐free chewing gum in addition to OHE group (Group G), and the control group (Group C). All children of grade 1 (aged 6–7 years) were recruited (n = 1342). After 2 years, 1143 children remained in the study group at follow‐up. The overall drop‐out rate was about 15%. Data on dental caries and gingival bleeding were collected by clinical examination. The results showed that the mean increment of DMFS in Group G was 42% lower than in groups E and C (P < 0.05). The mean increments in F‐S were higher in Groups G and E than in Group C (P < 0.01). The gingival bleeding scores were statistically significant among the three groups. Compared to Group C, ...

Can school-based oral health education and a sugar-free chewing gum program improve oral health? Results from a two-year study in PR China.

The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14-20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6-11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSC, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p less than 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).

Collaborative WHO xylitol field studies in Hungary I. Three-year caries activity in institutionalized children

The consumption of sucrose and xylitol and the exposure to fluoride (F) were analyzed in a field study aimed at assessing the value of peroral xyfitol as a caries-preventive measure. The coverage of the general background referred to the conditions of 689 institutionalized children observed for a 3-year-period. The material in the dietary substudy consisted of 286 subjects aged 8–13 years. The intake and excretion of F was monitored at all institutions in a total of 380 children. The frequency of the consumption of sucrose was high, its intake increasing over the weekend in comparison with weekdays. The consumption of the xylitol-containing products did not reduce the frequency of sucrose intake. Varying and fluctuating levels of exposure to systemic F was registered, as also reflected in the urinary F/creatinine quotient.

Collaborative WHO xylitol field studies in Hungary II. General background and control of the dietary regimen

The carbohydrate to protein ratio of dental plaque was analyzed in a field study assessing the effect of partial substitution of dietary sucrose by xylitol (X group) in comparison with systemic fluoride (F group) and restorative treatment solely (C group). The biochemical analysis was supplemented by quantitative assessment of plaque through the visible plaque index (VPI). The present substudy was carried out cross-sectionally and longitudinally (n = 83) in initially 6- to 11-year-old children. Missing base-line values for the carbohydrate to protein ratio were partly compensated for through reexamination of the carbohydrate to protein ratio 15 months after termination of the trial. The latter series served as reference to indicate the base-line situation. A lower carbohydrate to protein ratio was measured in the X and F groups than in the C group. Improvement of the VPI values was obtained only in the X group. Our results suggest the potential value of parallel quantitative and qualitative assessment of plaque.

Palma Kertész

Papers

Collaborative WHO xylitol field studies in Hungary II. General background and control of the dietary regimen

Collaborative WHO xylitol field studies in Hungary. VI. Changes in the carbohydrate to protein ratio of dental plaque.