The Optimum Time to Initiate Habitual Xylitol Gum-chewing for Obtaining Long-term Caries Prevention

Abstract

Habitual xylitol gum-chewing may have a long-term preventive effect by reducing the caries risk for several years after the habitual chewing has ended. The goal of this report was (1) to determine if sorbitol and sorbitol/xylitol mixtures provide a long-term benefit, and (2) to determine which teeth benefit most from two-year habitual gum-chewing - those erupting before, during, or after habitual gum-chewing. Children, on average 6 years old, chewed gums sweetened with xylitol, sorbitol, or xylitol/sorbitol mixtures. There was a "no-gum" control group. Five years after the two-year program of habitual gum-chewing ended, 288 children were re-examined. Compared with the no-gum group, sorbitol gums had no significant long-term effect (relative risk [RR], 0.65; 95% confidence interval [c.i.], 0.39 to 1.07; p < 0.18). Xylitol gum and, to a lesser extent, xylitol/sorbitol gum had a long-term preventive effect. During the 5 years after habitual gum-chewing ended, xylitol gums reduced the caries risk 59% (RR, 0.41; 95% c.i., 0.23 to 0.75; p < 0.0034). Xylitol-sorbitol gums reduced the caries risk 44% (RR, 0.56; 95% c.i., 0.36 to 0.89; p < 0.02). The long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02). Teeth that erupted after 1 year of gum-chewing or after the two-year habitual gum use ended had long-term caries risk reductions of 93% (p < 0.0054) and 88% (p < 0.0004), respectively. Teeth that erupted before the gum-chewing started had no significant long-term prevention (p < 0.30). We concluded that for long-term caries-preventive effects to be maximized, habitual xylitol gum-chewing should be started at least one year before permanent teeth erupt.

Xylitol and caries prevention — is it a magic bullet?

“…The long-term effects of chewing sugarfree gum were demonstrated by Hujoel et al, 34 five years after the two year Belize chewing gum programme ended. In this blind follow-up study, xylitol gum had reduced the caries risk by 59% and sorbitol gum by 35%, compared with a no gum group.…”

Effect of dentifrices containing sorbitol, combination of xylitol and sorbitol on salivary Streptococcus mutans and Lactobacillus counts in 14-15 year old children: a randomized trial

“…20 The results are similar to those obtained by the clinical studies following the use of a xylitol and sorbitol mixture containing chewing gum. 12,13 Present study unique as hitherto no similar studies have been reported in literature. Results of this study showed combination of sorbitol and xylitol dentifrices was most effective against S. mutans and Lactobacillus, hence the use of it may be promoted further in the dentifrices which can make the dentifrice cost effective.…”

“…Study carried out by the Hujoell, Makinen on acid production in the oral cavity from sorbitol in the presence of xylitol in chewing gum containing sorbitol reduces acid production from sorbitol. 13 This may be explained by the following effects of xylitol as: Reduction of plaque and the number of microorganisms on the teeth which are a consequence of the toxic effect of xylitol-5-phosphate and inhibition of acid production from sorbitol due to competitive blocking of the phosphotransferase system due to structural similarities between xylitol and sorbitol. 17 Hence combination of xylitol and sorbitol can be effective.…”

Effectiveness of Xylitol in Caries Prevention

“…Hujoel et al [23] presented a long-term reduction of caries-risk as the result of xylitol chewing gum use. After administration to 6-year-old children for 2 years of chewing gum with xylitol, sorbitol or a mixture of xylitol and sorbitol, they found after 5 years a 59% reduction in caries risk in the xylitol group and 44% in the xylitol-sorbitol group.…”