Visual scoring of non cavitated caries lesions and clinical trial efficiency, testing xylitol in caries‐active adults

Abstract

Objectives To better understand the effectiveness of xylitol in caries prevention in adults, and to attempt improved clinical trial efficiency. Methods As part of the Xylitol for Adult Caries Trial (X-ACT), non-cavitated and cavitated caries lesions were assessed in subjects who were experiencing the disease. The trial was a test of the effectiveness of 5 grams/day of xylitol, consumed by dissolving in the mouth five 1 gram lozenges spaced across each day, compared with a sucralose placebo. For this analysis, seeking trial efficiency, 538 subjects aged 21–80, with complete data for four dental examinations were selected from the 691 randomized into the three year trial, conducted at three sites. Acceptable inter and intra examiner reliability before and during the trial was quantified using the kappa statistic. Results The mean annualized non-cavitated plus cavitated lesion transition scores in coronal and root surfaces, from sound to carious favoured xylitol over placebo, during the three cumulative periods of 12, 24, and 33 months, but these clinically and statistically non-significant differences declined in magnitude over time. Restricting the present assessment to those subjects with a higher baseline lifetime caries experience showed possible but inconsistent benefit. Conclusions There was no clear and clinically relevant preventive effect of xylitol on caries in adults with adequate fluoride exposure when non-cavitated plus cavitated lesions were assessed. This conformed to the X-ACT trial result assessing cavitated lesions. Including non-cavitated lesion assessment in this full scale, placebo controlled, multi site, randomized, double blinded clinical trial in adults experiencing dental caries, did not achieve added trial efficiency or demonstrate practical benefit of xylitol. Trial Registration ClinicalTrials.Gov NCT00393055

Applications of Raman Spectroscopy in Dentistry: Analysis of Tooth Structure

“…Current diagnostic methods can identify dental caries in advanced stages (3,32) where prevention can only stop the progression but cannot revert the destruction. Hence, early detection of dental caries and its prevention are necessary because early dental caries (incipient lesion) are noncavitated (33,34) and characterized by visible white spots when the enamel surface is dry.…”

The dynamic behavior of the early dental caries lesion in caries‐active adults and implications

“…The X‐ACT of Xylitol as a caries preventive showed no consistent, significant, or clinically meaningful benefit from xylitol, in caries‐active adult subjects living in fluoridated communities, over 91% of whom also used other fluorides. This was so when assessed for cavitated lesions and for noncavitated plus cavitated lesions of crown and root surfaces combined. Despite a significant xylitol effect on root caries assessed at the more advanced cavitated threshold (≥0.5 mm) , there were no significant differences in the distribution of profile types for root surface early lesions for xylitol versus placebo, from baseline, 12, or 24 months forward (data not shown).…”

“…Of 691 randomized trial subjects, 543 with complete data for all examinations at baseline, 12, 24, and 33 months were included in this analysis. They did not differ in demographics or personal oral health behaviors from the full complement .…”

“…Intra‐examiner reliability weighted kappa scores for distinguishing S versus D 1 versus D 2 scores for the full complement of the X‐ACT trial were: baseline 0.63, 12 months 0.84, 24 months 0.66, and 33 months 0.67. This trial was shown to be well calibrated for inter‐ and intra‐examiner visual assessments of noncavitated and cavitated caries lesions .…”

Effectiveness of Xylitol in Caries Prevention

“…A study based on a numerous group of adults aged 21-80, who received chewable tablets containing 1 g of xylitol over a period of 33 months, 5 times a day, showed a 40% reduction of root caries and a 10% reduction (statistically insignificant) of coronal caries compared to the placebo control group [31][32][33]. This data leads to the conclusion that the caries preventive effect of xylitol is mainly caused by its impact on dental plaque and cariogenic bacteria.…”