Early childhood caries (ECC), a severe deterioration of infants’ teeth due to bacterial infection, is a major global public health concern and its prevalence is rising, mostly within poor populations. Children with ECC are three times more likely than children without ECC to develop tooth decay in their permanent teeth, and ECC has a negative effect on oral health in general.1
Xylitol Acts as an Antibacterial Agent
Xylitol, a five-carbon sugar alcohol commonly used as a sweetener in foods, gum, and oral health products,2 reduces plaque formation and bacterial adherence by exerting a selective antibacterial action against mutans streptococci, the main bacterial species in human tooth decay.1 However, the concentrations of xylitol in these products are generally too low to have anticariogenic effects.
Efficacy of Xylitol Shown in a Randomized Clinical Trial
A study by Milgrom and colleagues was the first to assess the efficacy of xylitol pediatric topical syrup in the reduction of the incidence of tooth decay.1 Children at high risk for ECC, aged from 15 to 25 months, were followed for 12 months in a double-blind randomized clinical trial. A total of 94 children were randomized to one of three groups, two active groups each receiving oral xylitol (8 g/day) divided into 2 or 3 doses, and a control group receiving a single subtherapeutic dose of 2.67 g xylitol. Dose frequency was controlled by dummy doses of sorbitol, a polyol sweetener which has not demonstrated protective effects against caries.
The number of decayed teeth was evaluated and results are shown in the table. Compared to the control group, significantly fewer decayed teeth were observed in the xylitol-2X group and the xylitol-3X group (51.6% vs. 24.25% vs. 40.6%, respectively). There was no significant difference between xylitol treatment groups (p-value = 0.22).
The results of this trial suggest that exposure to xylitol (8 g/day) in a twice-daily topical syrup during primary tooth eruption prevents up to 70% of tooth decay. Dividing 8 g xylitol into 3 doses daily did not significantly change the efficacy of treatment.3,4 The results confirm the position of the National Institutes of Health and the American Academy of Pediatric Dentistry supporting the importance of xylitol for the prevention of dental carries.1
Adverse Effects and Long-Term Consequences
The most common adverse events of xylitol, such as loose stools and diarrhea, are those most frequently seen after the consumption of polyol sweeteners. There is no published evidence of long-term negative consequences related to the consumption of a specific sweetener during childhood. However, xylitol-based products have been widely available for many years and consumed in several countries with no undesirable effects noted so far.
Xylitol as a Public Health Measure
Xylitol syrup could potentially be a cost-effective measure for the prevention of ECC, especially in high-risk populations. However, further studies are required to establish xylitol effectiveness in real life practice before it can be recommended as a public health measure.
