Influence of Maternal Xylitol Consumption on Acquisition of Mutans Streptococci by Infants

Abstract

Xylitol is effective as a non-cariogenic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) with impaired adhesion properties, i.e., they shed easily to saliva from plaque. One hundred sixty-nine mother-child pairs participated in a two-year study exploring whether the mothers' xylitol consumption could be used to prevent mother-child transmission of mutans streptococci. All mothers showed high salivary levels of mutans streptococci during pregnancy. The mothers in the xylitol group (n = 106) were requested to chew xylitol-sweetened gum (65% w/w) at least 2 or 3 times a day, starting three months after delivery. In the two control groups, the mothers received either chlorhexidine (n = 30) or fluoride (n = 33) varnish treatments at 6, 12, and 18 months after delivery. The children did not chew gum or receive varnish treatments. MS were assessed from the mothers' saliva at half-year intervals and from the children's plaque at the one- and two-year examinations. The MS were cultured on Mitis salivarius agars containing bacitracin. The salivary MS levels of the mothers remained high and not significantly different among the three study groups throughout the study. At two years of age, 9.7% of the children in the xylitol, 28.6% in the chlorhexidine, and 48.5% in the fluoride varnish group showed a detectable level of MS. In conclusion, therefore, habitual xylitol consumption by mothers was associated with a statistically significant reduction of the probability of mother-child transmission of MS assessed at two years of age. The effect was superior to that obtained with either chlorhexidine or fluoride varnish treatments performed as single applications at six-month intervals.

Xylitol and caries prevention — is it a magic bullet?

“…2 The 106 mothers randomly allocated to the first study group chewed xylitol gum at least two to three times a day, starting three months after the birth of their child. There were two other study groups: in one, thirty mothers received chlorhexidine varnish six, twelve and eighteen months after delivery; in the other, fluoride varnish was used at the same intervals.…”

“…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.…”

Dentists and Preventive Oral Health Care

“…For the first time, comprehensive Finnish "Turku Sugar Study" (Scheinin et al 1976) revealed an 85% decline in dental caries by total dietary substitution of sucrose with xylitol over a 2-year period. Xylitol also has been shown to reduce the vertical transmission of Streptococcus Mutans from mothers to children (Söderling et al 2000). Consequently, promotion of the use of xylitol-sweetened gum has been proposed as a caries-preventive measure in public health (Burt 2006, Honkala et al 1996, Virtanen et al 1996, Isokangas et al 1989.…”

Anticipatory Guidance in Pediatric Dentistry

“…[5]Also studies have revealed a reduction in the caries activity in children whose mothers used xylitol products [6,7] as xylitol significantly reduces the levels of mutans streptococci by disrupting the energy production processes leading to a futile energy consumption cycle and cell death. [6][7][8] Preterm infants and infants with very low birth weight experience a higher incidence of enamel (tooth) defects and enamel hypoplasia [9]. Periodontal disease has been linked to preterm labour [10].…”