Influence of Maternal Xylitol Consumption on Mother–Child Transmission of Mutans Streptococci: 6–Year Follow–Up

Abstract

Xylitol is effective as a noncariogenic or even cariostatic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) which shed easily into saliva from plaque. We have earlier shown that habitual xylitol consumption of mothers was associated with a statistically significant reduction in the probability of mother–child transmission of MS assessed at 2 years of age. The aim of the present study was to assess the children’s MS counts 1 and 4 years after the maternal xylitol consumption had been discontinued. At baseline, during pregnancy, all mothers (n = 195) showed high salivary levels of MS. The mothers were randomly assigned to xylitol, fluoride (F) and chlorhexidine (CHX) groups. In the xylitol group, the mothers chewed xylitol–sweetened gum, for 21 months, starting 3 months after delivery. In the two control groups, the mothers received CHX or F varnish treatments at 6, 12 and 18 months after delivery. At the 2–year examination, 169 mother–child pairs participated. At the 3–year and 6–year examinations, there were 159 and 147 children in the study, respectively. For children’s MS analyses, visible plaque was collected using toothpicks at the age of 3 and paraffin–stimulated saliva at the age of 6. The persons involved in the collection and analysis of the microbiological samples were blinded as to the study design and group. Both the plaque and salivary MS were cultured on Mitis salivarius agars containing bacitracin. In all groups, the colonization percentages increased during the follow–up. At the 3–year examination, the children’s risk of having MS colonization was 2.3–fold in the F group (95% CI 1.3–4.2) compared to the xylitol group. This difference was statistically significant. Even at 6 years of age, the salivary MS levels were significantly lower in the xylitol group than in the other groups (ANOVA, p<0.001). In conclusion, the earlier demonstrated, xylitol–associated reduction in the probability of mother–child transmission of MS was still found in the children’s MS counts at the age of 3 and 6 years.

Xylitol and caries prevention — is it a magic bullet?

“…12 One of the main purposes of this review is to summarize the evidence upon which these arguments rest. Other purposes of this review are to describe progress in the so-called 'mother and child' study 4 and to compare the effectiveness in caries prevention of xylitol with other bulk non-sugar sweeteners. The intense non-sugar sweeteners listed in Table 1 will not be discussed.…”

“…Follow-up studies have looked at the occurrence of dental decay in children as well as their plaque and salivary colonisation with mutans streptococci at three and six years of age. 3,4 There was a 74% reduction in dmft seen in the 5-year-olds whose mothers had used the xylitol around the period described as 'the discrete window of infectivity' 40 compared with children whose mothers had used chlorhexidine. There was a 71% reduction in dmft seen in the 5-year-olds whose mothers had used the xylitol compared with children whose mothers had used fluoride varnish.…”

“…2,4 Other evidence has shown that xylitol leads to a reduction in the quantity of plaque, possibly by interfering with mechanisms of adhesion between plaque organisms and the tooth's surface. [65][66][67][68] This is the most likely explanation for the reduced colonisation of mutans streptococci in the mouths of these children.…”

“…More recently, remarkable results have emerged from a trial where development of dental caries was much lower in children whose mothers had chewed xylitol gum when their children were young (beginning at three months of age) during the so-called 'discrete window of infectivity' from mother to child (between 19 -31 months of age), compared with control children. 2,3,4 For many years, many thousands of Finnish children have participated in caries preventive programmes which involved chewing xylitol gum in school. 5,6 Disposal of spent gum has been seen as a draw-back for such community programmes by public health authorities in many countries and it was of considerable interest that, in a recently published trial, the caries preventive effectiveness of chewing xylitol sweets was observed to be similar to that of xylitol chewing gum.…”

Role of Mothers in Prevention of Dental Caries: A Systematic Review

“…The other medication like Xylitol and chlorhexidine use reduces maternal oral bacterial load and reduce the vertical transmission of bacteria to infants when used late in pregnancy and in postpartum period. Both topical agents are considered safe in pregnancy and during breastfeeding [6]. The chewing gums containing high dose of Xylitol is found to have beneficial effects on reducing the plaque pH and MS saliva concentration [7].…”