Xylitol Chewing Gums and Caries Rates: A 40-month Cohort Study

Abstract

Abstract. Dental caries is a pandemic infectious disease which can affect the quality of life and consumes considerable health care resources. The chewing of xylitol, sorbitol, and even sugar gum has been suggested to reduce caries rates. No clinical study has simultaneously investigated the effectiveness of these gums when compared with a group receiving no chewing gum. A 40-month double-blind cohort study on the relationship between the use of chewing gum and dental caries was performed in 1989-1993 in Belize, Central America. One thousand two hundred and seventy-seven subjects (mean age, 10.2 years) were assigned to nine treatment groups: one control group (no supervised gum use), four xylitol groups (range of supervised xylitol consumption: 4.3 to 9.0 g/day), two xylitolsorbitol groups (range of supervised consumption of total polyols: 8.0 to 9.7 g/day), one sorbitol group (supervised consumption: 9.0 g/day), and one sucrose group (9.0 g/day). The gum use during school hours was supervised. Four calibrated dentists performed the caries registrations by means of a modified WHO procedure. The primary endpoint was the development of an unequivocal caries lesion on a non-cavitated tooth surface. Compared with the no-gum group, sucrose gum usage resulted in a marginal increase in the caries rate (relative risk, 1.20; 95% confidence interval, 0.96 to 1.49; p = 0.1128). Sorbitol gum significantly reduced caries rates (relative risk, 0.74; 95% confidence interval, 0.6 to 0.92; p = 0.0074). The four xylitol gums were most effective in reducing caries rates, the most effective agent being a 100% xylitol pellet gum (relative risk, 0.27; 95% confidence interval, 0.20 to 0.36; p = 0.0001). This gum was superior to any other gum (p < 0.01). The xylitolsorbitol mixtures were less effective than xylitol, but they still reduced caries rates significantly compared with the no-gum group. DMFS analyses were consistent with these condusions.The results suggest that systematic usage of polyol-based chewing gums reduces caries rates in young subjects, with xylitol gums being more effective than sorbitol gums.

Oral health habits amongst children in the United Kingdom in 2003

“…This appears to be effective in caries management in its own right by direct action on the oral microflora responsible for caries. 18,19 To what extent sugar free gum may have played a part in continued reductions in adolescent decay is completely unknown, but a relationship is feasible based on the extent of recent usage.…”

Xylitol and caries prevention — is it a magic bullet?

“…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. In two of these field trials, xylitol was given as several items of confectionery 17,21 while in other studies, xylitol was given in chewing gum only 20,23,27 and these studies will be considered later.…”

“…19 A series of double blind clinical studies carried out in Belize approximately 10 years ago were the first to provide direct comparisons between xylitol and sorbitol gums. 27,28,30,31 Before this study, trials of xylitol-containing gum had given superior results to trials of sorbitol-containing gums, but they had not been compared in the same trial. The trials investigated caries-preventive effects in primary teeth of younger children and permanent teeth of older children.…”

“…Since then, many clinical trials and field studies have indicated the dental benefit of chewing gum and other confectionery made with sorbitol, 84 hydrogenated glucose syrup, 85 as well as xylitol. 36 The majority of studies tested xylitol and results indicate that dental effects seemed to be greater with xylitol, but it was not until the Belize study 27,30 that sorbitol and xylitol were compared 'head to head'. The results showed clearly that xylitol in gum was superior to sorbitol, and that mixtures of xylitol and sorbitol were not as good as xylitol but were better than sorbitol alone.…”

“…The results showed clearly that xylitol in gum was superior to sorbitol, and that mixtures of xylitol and sorbitol were not as good as xylitol but were better than sorbitol alone. The results of the study in older children 27 (Table 4) recorded that, compared with the no gum control group, the relative risk for xylitol pellet gum used five times daily was 0.27 (ie a decreased risk of caries) and for sorbitol pellet gum used five times daily 0.74. These equate to 73% and 26% reduction in caries development respectively.…”