Mutans Streptococci Dose Response to Xylitol Chewing Gum

Department of Dental Public Health Sciences, Northwest/Alaska Center to Reduce Oral Health Disparities, University of Washington, Seattle, WA 98195 USA.
Journal of Dental Research (Impact Factor: 4.14). 03/2006; 85(2):177-81. DOI: 10.1177/154405910608500212
Source: PubMed


Xylitol is promoted in caries-preventive strategies, yet its effective dose range is unclear. This study determined the dose-response of mutans streptococci in plaque and unstimulated saliva to xylitol gum. Participants (n = 132) were randomized: controls (G1) (sorbitol/maltitol), or combinations giving xylitol 3.44 g/day (G2), 6.88 g/day (G3), or 10.32 g/day (G4). Groups chewed 3 pellets/4 times/d. Samples were taken at baseline, 5 wks, and 6 mos, and were cultured on modified Mitis Salivarius agar for mutans streptococci and on blood agar for total culturable flora. At 5 wks, mutans streptococci levels in plaque were 10x lower than baseline in G3 and G4 (P = 0.007/0.003). There were no differences in saliva. At 6 mos, mutans streptococci in plaque for G3 and G4 remained 10x lower than baseline (P = 0.007/0.04). Saliva for G3 and G4 was lower than baseline by 8 to 9x (P = 0.011/0.038). Xylitol at 6.44 g/day and 10.32 g/day reduces mutans streptococci in plaque at 5 wks, and in plaque and unstimulated saliva at 6 mos. A plateau effect is suggested between 6.44 g and 10.32 g xylitol/day.

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Available from: Marilyn C Roberts, Feb 15, 2014
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    • "Xylitol is a naturally occurring non-fermentable polyol used as a sugar substitute and is therefore considered a non-cariogenic sweetener (Maguire and Rugg-Gunn, 2003). Xylitol promotes remineralization by increasing salivary flow and inhibits bacterial growth and metabolism in the plaque biofilm (Ly et al., 2006; Milgrom et al., 2006; Söderling, 2009). Despite these favorable anti-cariogenic properties, the evidence for the clinical effectiveness of xylitol as a caries-preventive agent is controversial (Mäkinen, 1998; Scheie and Fejerskov, 1998). "
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    ABSTRACT: The Xylitol for Adult Caries Trial was a three-year, double-blind, multi-center, randomized clinical trial that evaluated the effectiveness of xylitol vs. placebo lozenges in the prevention of dental caries in caries-active adults. The purpose of this secondary analysis was to investigate whether xylitol lozenges had a differential effect on cumulative caries increments on different tooth surfaces. Participants (ages 21-80 yrs) with at least one follow-up visit (n = 620) were examined at baseline, 12, 24, and 33 months. Negative binomial and zero-inflated negative binomial regression models were used to estimate incidence rate ratios (IRR) for xylitol's differential effect on cumulative caries increments on root and coronal surfaces and, among coronal surfaces, on smooth (buccal and lingual), occlusal, and proximal surfaces. Participants in the xylitol arm developed 40% fewer root caries lesions (0.23 D2FS/year) than those in the placebo arm (0.38 D2FS/year; IRR = 0.60; 95% CI [0.44, 0.81]; p < .001). There was no statistically significant difference between xylitol and control participants in the incidence of smooth-surface caries (p = .100), occlusal-surface caries (p = .408), or proximal-surface caries (p = .159). Among these caries-active adults, xylitol appears to have a caries-preventive effect on root surfaces ( NCT00393055).
    Journal of dental research 04/2013; 92(6). DOI:10.1177/0022034513487211 · 4.14 Impact Factor
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    • "Studies have focused on its effect on MS. The majority of short-term (6 or fewer mos) studies with a daily xylitol dose of over 6 g have reported reduced oral MS levels (Loesche et al., 1984; Söderling et al., 1989; Ly et al., 2006; Milgrom et al., 2006; Holgerson et al., 2007). Very few studies have presented the long-term (over 12 mos) effect of xylitol use on MS and showed mixed results (Söderling et al., 2000; Mäkinen et al., 2008; Zhan et al., 2012a). "
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    ABSTRACT: The aim of the study was to investigate whether xylitol-wipe use in young children prevented caries by affecting bacterial virulence. In a double-blinded randomized controlled clinical trial, 44 mother-child pairs were randomized to xylitol-wipe or placebo-wipe groups. Salivary mutans streptococci levels were enumerated at baseline, 6 months, and one year. Ten mutans streptococci colonies were isolated and genotyped from each saliva sample. Genotype-colonization stability, xylitol sensitivity, and biofilm formation of these isolates were studied. Despite a significant reduction in new caries at one year in the xylitol-wipe group, no significant differences were found between the two groups in levels of mutans streptococci. Children in the xylitol-wipe group had significantly fewer retained genotypes (p = 0.06) and more transient genotypes of mutans streptococci (p = 0.05) than those in the placebo-wipe group. At one year, there was no significant difference in the prevalence of xylitol-resistant genotypes or in biofilm formation ability of mutans streptococci isolates between the two groups. The mechanism of the caries-preventive effect of xylitol-wipe use may be related to the stability of mutans streptococci colonization. Further studies with genomic characterization methods are needed to determine specific gene(s) that account for the caries-preventive effect of xylitol.
    Advances in dental research 09/2012; 24(2):117-22. DOI:10.1177/0022034512449835
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    • "The influence of xylitol on the control of risk factors and prevention of dental caries has already been assessed in several studies1,5-12,16-18,21-24,26. The outcomes of this strategy seem to depend on the detection of minimal salivary levels of that polyol along time28. "
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    ABSTRACT: The present study analyzed xylitol concentrations in artificial saliva over time after application of varnishes containing 10% and 20% xylitol. Fifteen bovine enamel specimens (8x4 mm) were randomly allocated to 3 groups (n=5/group), according to the type of varnish used: 10% xylitol, 20% xylitol and no xylitol (control). After varnish application (4 mg), specimens were immersed in vials containing 500 µL of artificial saliva. Saliva samples were collected in different times (1, 8, 12, 16, 24, 48 and 72 h) and xylitol concentrations were analyzed. Data were assessed by two-way repeated-measures ANOVA (p<0.05). Colorimetric analysis was not able to detect xylitol in saliva samples of the control group. Salivary xylitol concentrations were significantly higher up to 8 h after application of the 20% xylitol varnish. Thereafter, the 10% xylitol varnish released larger amounts of that polyol in artificial saliva. Despite the results in short-term, sustained xylitol releases could be obtained when the 10% xylitol varnish was used. These varnishes seem to be viable alternatives to increase salivary xylitol levels, and therefore, should be clinically tested to confirm their effectiveness.
    Journal of applied oral science: revista FOB 04/2012; 20(2):146-50. DOI:10.1590/S1678-77572012000200004 · 0.92 Impact Factor
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