Effect of xylitol versus sorbitol: A quantitative systematic review of clinical trials

Department of Community Dentistry, University of the Witwatersrand, Johannesburg, South Africa.
International Dental Journal (Impact Factor: 1.26). 08/2012; 62(4):175-88. DOI: 10.1111/j.1875-595X.2011.00113.x
Source: PubMed


This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol.
Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries-related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger's regression and funnel plotting were used to investigate risk for publication bias.
Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta-analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger's regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol.
The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.

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    • "Against this background, it can be assumed that xylitol would yield a higher anticaries effect than sorbitol and an at least similar effect than topical fluoride. Topical fluoride may be considered as the gold standard for preventing and treating tooth caries, owing to the accumulated evidence in support for its active anticaries effect [18] [19] [20] [21] [22] [23] [24] [25]. "
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    ABSTRACT: CONTEXT: Clinical knowledge, as any other type of knowledge, can be regarded as justified belief. The justification of belief follows two cognitive strategies: coherence of logic and correspondence of facts. PROBLEM: Coherence strategy has been traditionally favoured in the justification of beliefs concerning medical interventions throughout the centuries and is today still preferred by many clinicians as providing "logical sense" for or against the application of therapies, diagnostics or preventive measures. The use of correspondence strategy has only recently being emphasized within the medical field as evidence-based medicine (EBM). There is a risk that evidence from EBM, i.e. as appraised through systematic reviews, concerning clinical questions is ignored by clinicians, if no deeper logical integration of such evidence through coherence strategy is given. SUGGESTED SOLUTION: In order to explore how coherence strategy in regard to systematic review evidence may be applied, basic principles of formal logic were used on an example concerning systematic review evidence regarding the assumed active anticaries effect of xylitol. The example shows how a coherent Web-of-Beliefs (WoB) may be structured that way and how systematic review evidence may in turn serve as empirical support for such a coherent web-of-beliefs. The presented example also shows how strict logical coherence alone can be no guarantee for correctness of beliefs concerning medical interventions.
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    ABSTRACT: This demonstration programme tested topical use of xylitol as a possible oral health promoting regimen in infants at a Finnish Public Health Centre in 2002-2011. Parents (usually mothers) began once- or twice-daily administration of a 45% solution of xylitol (2.96 m) onto all available deciduous teeth of their children at the age of approximately 6-8 months. The treatment (xylitol swabbing), which continued till the age of approximately 36 months (total duration 26-28 months), was carried out using cotton swabs or a children's toothbrush; the approximate daily xylitol usage was 13.5 mg per each deciduous tooth. At the age of 7 years, caries data on the deciduous dentition of 80 children were compared with those obtained from similar, untreated children (n = 90). Xylitol swabbing resulted in a significant (P < 0.001) reduction in the incidence of enamel and dentine caries compared with the comparison subjects (relative risk 2.1 and 4.0, respectively; 95% confidence intervals 1.42-3.09 and 2.01-7.98, respectively). Similar findings were obtained when the children were 5 or 6 years old. The treatment reduced the need of tooth filling relative risk and 95% confidence intervals at 7 years: 11.86 and 6.36-22.10, respectively; P < 0.001). Compared with untreated subjects, the oral counts of mutans streptococci were reduced significantly (P < 0.001). Considerable improvement in dental health was accomplished in infants participating in a topical at-home xylitol administration experiment, which was offered to families in the area by the Public Health Centre as a supplement to standard oral health care. Caregiver assessment of the programme was mostly rated as high or satisfactory.
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