The effects of added sugar in food on tooth decay are well known, prompting consumers to look for alternative sweeteners. Xylitol, a natural sugar alcohol, has been promoted as one healthy option.
The California Dental Association recommends using xylitol gum or mints 3 to 5 times a day for a total of 5 g to inhibit the growth of Streptococcus mutans, which causes cavities. Multiple studies also have found it effective in inducing remineralization of enamel.
Orthodontic appliances, though, offer additional challenges for oral hygiene. They create retentive areas for plaque, leading to greater decalcification and concentrations of S mutans. One recent study, then, examined how xylitol could combat these disadvantages. The research included 41 subjects undergoing orthodontic treatment with no active decay randomly divided into 3 groups.
The 13 patients in the first group consumed 6 pieces of xylitol gum each day, chewing 2 pieces with 1.0 g of xylitol each after breakfast, lunch, and dinner. The 13 patients in the second group consumed 12 mints each day, eating 4 pieces with 0.5 g of xylitol each after each meal. The third group, with 12 patients, took no xylitol at all.
Clinical exams were administered and plaque and saliva samples were collected at the baseline and at 3, 6, and 12 months. All of the subjects received oral hygiene instruction and were put on a 6-month cleaning and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the different approaches at reducing the risk of caries.
The xylitol groups did not experience any more reduction in plaque score, plaque S mutans counts, or salivary S mutans counts than the control group, nor did they show any lower values at any of the time points. The researchers note, though, that their subjects were not blinded and knew they were not receiving xylitol, perhaps prompting better home care. They also report some attrition in their limited sample during the 12-month follow-up period.
However, while xylitol did not show a clinical or bacterial benefit in patients with fixed orthodontic appliances, the oral hygiene instructions and 6-month topical fluoride application did reduce plaque scores and bacterial counts in all patients. Also, the chewing gum did not significantly increase the incidence of debonded brackets over the other groups.
The study, “Long-term Clinical and Bacterial Effects of Xylitol on Patients with Fixed Orthodontic Appliances,” was published in the October edition of Progress in Orthodontics.