Xylitol candies in caries prevention: results of a field study in Estonian children

Abstract

All field studies have unequivocally reported significant reductions in dental caries occurrence associated with the use of chewing gum containing xylitol. No other xylitol products besides chewing gum have so far been tested in field trials. A 5-year follow-up study with 2- or 3-year xylitol consumption periods began in Estonia in 1994 with 740 10-year-old children in 12 schools at baseline examinations. For the study, 3 clusters each including 3-5 schools were formed on the basis of baseline caries experience. The products were used under the supervision of the teachers 3 times per day during school days but not during weekends or during the 3-month summer holiday. The daily dose of xylitol was 5 g in all groups. The children were examined every year in September by two experienced clinicians. Dental caries was recorded according to WHO criteria. After 3 years, all xylitol groups showed a highly significant 35%-60% reduction in caries incident, compared with the corresponding control groups. The differences between candies, between candies and chewing gum, and between 2- and 3-year users in the xylitol groups were non-systematic, indicating no trends between the groups. The results suggest that not only xylitol chewing gum but also xylitol candies are effective in caries prevention, and that a school-based delivery system seems to offer a practical way to distribute and control the use of the xylitol products.

Xylitol and caries prevention — is it a magic bullet?

“…1,7, Field trials differ from clinical trials in that they may have no particular control group; the study may not be blind or there may be no special selection or supervision of participants. Even with these intrinsic weaknesses, field trials are important as they allow the effectiveness and acceptability of preventive agents or methods previously shown in a clinical trial to be effective, to be evaluated in a particular setting.…”

“…Two such studies have been undertakenone short-term plaque study in habitual xylitol consumers showed a xylitol-specific effect 51 and the other study -a 3 year community intervention trial 35 -did not, although this study did have some problems in its design which may have been reflected in the results. Of some relevance is the Estonian xylitol trial, 7 which compared the dental effects of xylitol in candy and chewing gum form. Although sucking the candy stimulated salivary flow, the results suggested that the xylitol was active in caries prevention, as well as the form of the vehicle used (ie chewing gum or sucking candy).…”

“…7 The subjects of the study were children aged ten years who were given two pieces of gum or two candies three times a day on school days. A double blind design was possible between the use of the two candies, but not between candy and gum use.…”

“…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. 7 Because of these recent events, it was thought to be useful to summarise the evidence concerning 'is xylitol a magic bullet? ' Xylitol is one of a number of non-sugar sweeteners permitted for use in foods.…”

Are sugar-free confections really beneficial for dental health?

“…Furthermore, lower doses of xylitol have also been shown to be efficient in caries prevention. 23,24 The most commonly used polyol in several sugar-free chewing gums in the United States, however, is sorbitol. This is mainly due to its low cost compared to xylitol.…”