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The Effect of Non-Cariogenic Sweeteners on the Prevention of Dental Caries: A Review of the Evidence
Abstract
The role of sugar substitutes such as xylitol and sorbitol in the prevention of dental caries has been investigated in several clinical studies. The purpose of this report is to review the current published evidence regarding the relationship between sugar substitutes and dental caries. A literature search was conducted using MEDLINE and EMBASE and included studies published from 1966 to 2001. Studies that included human subjects and were published in English were included in this review. A total of fourteen clinical studies were reviewed that evaluated the effect of sorbitol or xylitol or the combination of both sugar substitutes on the incidence of dental caries. Most of the reports were of studies conducted with children outside of the United States. These studies demonstrated a consistent decrease in dental caries, ranging from 30 to 60 percent, among subjects using sugar substitutes as compared to subjects in a control group. These caries rate reductions were observed in subjects using xylitol or sorbitol as the sugar substitute in chewing gum or toothpaste. The highest caries reductions were observed in subjects using xylitol. These findings suggest that the replacement of sucrose with sorbitol and xylitol may significantly decrease the incidence of dental caries.
... [35] Sorbitol is considered non-cariogenic in nature, although acid formation in the bacterial plaque can occur during metabolism by an oral microorganism, it is very slow. [28,34,[36][37][38] Sorbitol is particularly useful in chewable tablets due to its pleasant sweet taste and cooling sensation. It is used as a vehicle in sugar-free formulations in liquid preparations. ...
... [24] Xylitol is cariostatic and has anticariogenic properties which help in the prevention of dental caries. [32,36,39,40] It is sweet as sucrose and is found in fruits, such as plums and berries and in vegetables. [12] None of the predominant bacteria of dental plaque produces acid from xylitol, and its presence reduces acid production from glucose in dental plaque in vivo. ...
... [43] Aspartame is a dipeptide of aspartic acid and a methyl ester of phenylalanine. [36] It is 160-220 times sweeter than sucrose, and produces a limited glycemic response. [14] Due to the fact that aspartame is a source of phenylalanine, [44] the major consideration in the use of aspartame is in those children with autosomal recessive phenylketonuria. ...
Sweetened oral medications are widely used for children to facilitate compliance. A variety of natural and artificial sweeteners are used in these drug formulations to augment the sweetness and thereby palatability of the product. There is growing concern among dentists about the increased consumption of sugars in these medications by children, especially those who are chronically ill as it may contribute to diabetes mellitus, dental erosion, and dental caries. This literature review provides information about the sweetener content and cariogenic potential of commonly prescribed pediatric oral medications that are used for managing acute and chronic conditions in children and measures for oral health prevention.
... Xylitol is also safe for diabetics because it stimulates much less insulin release than a comparable quantity of table sugar [1]. Xylitol helps to prevent dental caries [4][5][6][7][8][9], since diet is a major etiological factor in dental health, and limiting the consumption of fermentable carbohydrates and sugars is an effective strategy to control dental caries [10]. erefore, there is interest in replacing sucrose in chewing gum with nonfermentable sugars such as xylitol, which prevents the lactic acid production that can result in cavities [4][5][6][7][8]. ...
... Xylitol helps to prevent dental caries [4][5][6][7][8][9], since diet is a major etiological factor in dental health, and limiting the consumption of fermentable carbohydrates and sugars is an effective strategy to control dental caries [10]. erefore, there is interest in replacing sucrose in chewing gum with nonfermentable sugars such as xylitol, which prevents the lactic acid production that can result in cavities [4][5][6][7][8]. ...
Xylitol, a sugar substitute frequently used in sugar-free gum, is generally considered harmless to humans but it can be extremely toxic to dogs. Dog-owning customers are becoming increasingly aware of the risks associated with xylitol-containing chewing gums. However, there remains some uncertainty if these chewing gums are still dangerous to dogs after they have been partially consumed. In this work, a reliable low-cost analytical method has been developed to quantify the xylitol in sugar-free gum samples. Xylitol was extracted from gum samples using water as a solvent. Extractions were analyzed by GC-MS with direct aqueous injection (DAI). This method was successfully applied to over 120 samples including fresh gum and 5 min, 15 min, and 30 min chewed gum samples.
... These are the group of carbohydrate-based sweeteners has low calories and provide sweetness to various products because of sugar-free and having low calorific value. Polyols have some more important health benefits such as oral health, control of weight and dietary glycemic load reduction (Hayes, 2001;Wolever, 2002) etc. ...
Garden herbs have medicinal value and were used traditionally to promote well-being. It also means that herbs were in fact constituents of native diets. However, modern societies have neglected the benefits of herbs and rely on other food sources for nutrition. This study has examined a total of eight herbs; Amomum subulatum, Calendula officinalis, Cymbopogon flexuosus, Eryngium foetidum, Lantana indica,Ocimum bacilicum, Ocimum gratissimum and Salvia mirzayanii from a vast collection of 19 published works by using systematic review. The findings inform that herbs could be prepared in both, dry-form and extracts before being used in various applications. However, it was the essential oils of these herbs that divided them into categories such as safe for consumption and safe for industrial applications. The compounds of these essential oils were later evaluated for either medicinal, anti- microbial or for use in insecticide. The basis of most compounds was aromatic which means that all herbs are rich with phenols, oils and scent. These constituents enabled the herbs to have antioxidant properties. Through a scrutiny, only A. subulatum, C. officinalis, E. foetidum and O. bacilicum could be promoted for supplementary use because these herbs were extensively studied for oral intake. The findings of this work are crucial for the bio-extractive industry because not all herbs although used traditionally, could be processed into supplements to promote well- being.
... bactérias na saliva e na placa bacteriana, o que aumenta as suspeitas de que esse adoçante pode ser um grande aliado na prevenção da cárie dental16,17 . Desta forma, o xilitol tem se mostrado um dos substitutos do açúcar mais promissor para fins preventivos de cárie, uma vez que é tão doce quanto a sacarose e não pode ser metabolizado pela maioria das bactérias orais 4,12,18,19 .O objetivo deste trabalho foi realizar uma revisão de literatura para obter informações sobre o uso do xilitol na Odontologia e seu papel na prevenção da cárie dentária. ...
De acordo com a Organização Mundial da Saúde (OMS), a cárie é considerada a segunda maior doença do mundo, e afeta grande parte da população. A cárie é uma doença multifatorial, influenciada principalmente pelo estilo de vida do paciente, através da dieta, hábitos de higiene bucal, entre outros fatores. O passo mais importante para prevenção da cárie, é ter um bom hábito de higiene bucal (escovação, utilização de fio dental e enxaguatórios bucais com a presença de flúor) associado a uma dieta balanceada com níveis de açúcares baixos, no qual pode ser substituído por algum adoçante, como o xilitol. O xilitol pode ser encontrado na Odontologia em dentifrícios, enxaguatórios bucais, entre outros. Pesquisas apontam que, a introdução desse substituto do açúcar nos produtos odontológicos diminuem a incidência da cárie, por ele não ser metabolizado pelas bactérias. Outro produto que podemos encontrar o xilitol é em gomas de mascar, no qual pesquisas clínicas comprovam que o uso de tais gomas, algumas vezes ao dia, produz o aumento da salivação, que promove o efeito tampão, impedindo que os microorganismos se alojem na superfície dentária. O objetivo deste trabalho foi realizar uma revisão de literatura para obter informações sobre o uso do xilitol na Odontologia e seu papel na prevenção da cárie dentária. Para a realização deste trabalho foi efetuada uma pesquisa bibliográfica por meio das seguintes bases de dados: Scielo, Pubmed, Lilacs e Periódicos Capes. Diante da literatura revisada, pôde-se elucidar as diversas aplicabilidades clínicas do xilitol na Odontologia, como em dentifrícios, gomas de mascar, soluções para bochechos e vernizes. Concluiu-se que o efeito do xilitol na prevenc?a?o da ca?rie e? bastante controverso. Entretanto, seu uso parece ser um recurso promissor como coadjuvante dos procedimentos de higiene bucal, em pacientes de alto risco à cárie, carecendo de mais estudos.
... from using the combined fluoride xylitol toothpaste when compared to xylitol treated group and fluoride treated group. This increase may be attributed to xylitol as it may decrease lactic acid production, increase salivary flow potentially leading to an increased buffering of acids in plaque (Hayes 2001). These results concluded that there is no strong synergistic effect of fluoride with xylitol on salivary flow rate. ...
The aim of our study was to evaluate and compare the clinical and microbiological efficiency of Fluoride, Xylitol and combined Fluoride-Xylitol toothpastes on some salivary parameters in children by measuring salivary pH, salivary flow rate, salivary Streptococcus mutans (S. mutans) and Lactobacillus counts. Toothpastes were prepared by mortar and pestle technique. They were then evaluated for physicochemical properties like pH, cleanability, physical appearance, spreadability, abrasiveness, foaming power, homogeneity, content of moisture and volatile substances, and drug content. Twenty one normal apparently healthy children were selected from the Outpatient Dental Clinic of Pedodontic Department, Faculty of Dentistry, Suez Canal University. Children were randomly divided into three groups: children who brushed their teeth with fluoride toothpaste, children who brushed their teeth with xylitol toothpaste and children who brushed their teeth with combined fluoride xylitol toothpaste. Salivary samples were obtained from all groups and examined for salivary parameter changes (flow rate, pH) and microbiological assessment for (S. mutans and Lactobacilli) was done. All data were collected, tabled and statistically analyzed. Statistical significance was measured using p value. Xylitol was superior in increasing salivary flow rate and decreasing mean of S. mutans when compared to fluoride while Fluoride was superior in decreasing mean of Lactobacilli when compared to xylitol. Both had the same effect on increasing salivary pH.
... Xylitol is a sugar substitute that has 40% fewer calories than sucrose 70 . Sugar alcohols, such as xylitol, sorbitol, mannitol, and maltitol, have been shown to be noncariogenic 71,72 . The literature indicates that xylitol also reduces the level of mutans streptococci in plaque and reduces the level of lactic acid produced by bacteria 73 .Xylitol consumption in the range of 6-10 g/day, divided into at least three time periods, is effective in reducing bacteria levels and subsequent drop in acid production 74 . ...
The expression “dental caries” is utilized to represent the outcomes, signs, symptoms, and side effects of a localized chemical disintegration of the tooth surface (enamel and dentin) caused by dental plaque and mediated by saliva1. Caries is considered as disease with high incidence among childhood chronic conditions, where it is also well-thought-out to cause harm on both population and individual well- being2,3. When comparing it with other common diseases, dental caries is five times as frequent as asthma and seven times as common as hay fever4. The American Academy of Pediatrics demonstrates that dental and oral infections keep on infecting children and, specifically, very young children. In primary teeth, dental caries is a preventable and reversible disease if treated in early stages, but when left untreated it will lead to pain, bacteremia, alteration in growth and development, premature tooth loss, speech disorder, increase in treatment costs, loss of confidence, and negatively affect successor permanent teeth. The definitions used previously to describe this bacterial disease were related to cause and the improper utilization of nursing bottle. These terms are used interchangeably: “Early childhood tooth decay”, “early childhood caries (ECC)”, “bottle caries”, “nursing caries”, “baby bottle tooth decay”, or “night bottle mouth”5,6. The expression “ECC” was proposed more than 20 years ago during a workshop supported by the Centers for Disease Control and Prevention (CDC) trying to scope the consideration upon the various issues, such as financial, sociopsychological, and behavioral, which contributes to the formation of caries at such initial years, instead of attributing its manifestation solely on feeding bottles7. This article explores the various means of preventive strategies, including anticipatory guidance and future approaches to prevent ECC, interprofessional education and practice also explores the implications of ECC epidemiology for evolving health service delivery and financing approaches
... There is a drop in the count of mutans streptococci with the use of xylitol-sweetened chewing gums. This might be due to the fact that it starves the cariogenic bacteria (Hayes, 2001;Gales and Nguyen, 2000). There are also reports of reduction in plaque accumulation by the xylitol gum (Mäkinen et al., 1996a,b). ...
The chapter gives a picture of the current data on the available anticariogenic natural products and their mechanism of action. Different phytochemicals such as phenols, flavanoids, alkaloids, terpenoids, tannins, lectins, etc. and their anticariogenic efficacy have been discussed in detail. All the data emphasise the fact that the use of natural products is emerging as an effective strategy in the prevention and treatment of dental caries. Consequently, these natural products could be incorporated in toothpastes and other oral hygiene products to promote oral health.
... (12) It has also been associated with kno-Dental health status of adult population in Yemen (Thamar City) wledge, attitude and behaviors relating to preventive care. (13)(14)(15) Developing countries have experienced a deterioration in oral health due to a change in socio-economic condition, dietary habits and lack of education. (16,17) On the other hand, the trends of these two major dental diseases in developing countries call for integrated coordinated planning of preventive and treatment services for oral health as an urgent priority. ...
Aims: To evaluate the oral health status (dental caries, periodontal disease and treatment needs) in Yemenis adult individuals. Material and Methods: The sample included 471 individuals, age ranging between 20-59 years of both sexes using sharp dental caries explorers with WHO periodontal probes to detect periodontal health by the use of DMFT index of WHO (1997) and CPITN by WHO (1987). Results: The mean DMFT for the total sample was 7.33 + 0.3 which was increased with increasing age for the different age groups with a significant difference but no significant difference in the mean DMFT for total males and females has been found. The results also showed that the total number of teeth (880) with a mean of 1.81 tooth/person in need of treatment is the most prevalent needed one surface filling, and 581 teeth with a mean of 1.23 tooth/ person needed two or more surfaces filling. According to the highest CPITN there was significant difference between male and female in calculus at p < 0.05 and shallow pockets at p < 0.01. The results also revealed that the mean number of healthy sextants for the total sample was 4.13 while for bleeding and calculus were 1.02 and 0.21, respectively. It means that the treatment needs for periodontal disease is more toward oral hygiene procedure and prophylaxis. Conclusion: Dental health education program is an essential activity for promoting optimal oral health and preventing oral diseases.
... Most of the studied products resulted in a significant increase in pH after either 15 min or 30 min. These findings confirm earlier observations demonstrating a marked reduction in plaque acidogenicity associated with the regular consumption of xylitol gums and lozenges (Hayes, 2001;Van Loveren, 2004;Sengun et al., 2004;Splieth et al., 2009). Consumption of xylitol decreases the growth and metabolism of acidogenic and aciduric oral flora and stimulates salivary defense mechanisms, according to clinical and in vivo studies. ...
Objective
To assess the actual xylitol content in sugar-free chewing gums available in a market of Saudi Arabia and investigate its effect on acid production and pH change in vitro. Materials and methods: A total of 29 different brands of xylitol-containing sugar-free chewing gums were collected from five major grocery stores in Saudi Arabia. Xylitol was extracted and its concentration was determined using the D-Sorbitol/Xylitol Enzymatic Kit (Megazyme; Bray, Wicklow, Ireland). The pH of the extracts and the amount of acid production for each product was measured after 15-minute and 30-minute incubation with Streptococcus mutans. Descriptive analysis, concentrations, and one-way analysis of variance (ANOVA) with the least significant difference (LSD) as multiple comparisons were performed. Results: The xylitol content in grams was clearly stated on the labels of 16 products, while it was stated in percentages on the labels of ten products. The mean pH of most of the tested products was 5.857 ± 0.096. Significant differences in pH were recorded among 20 products (p ≤ 0.05). Highly significant differences in pH (p = 0.001) were observed in five of the products. Conclusion: The results of this study indicate, using an in vitro model, that xylitol can significantly affect salivary pH. The actual xylitol content in most brands of chewing gums currently available in the markets of Saudi Arabia is less than the concentration recommended for prevention of caries. Accurate information with proper labeling is required to enable dental professionals to take correct and informed decisions about recommending the use of these products.
... En 2001, après la revue de la littérature concernant une quarantaine d'études sur les sucres de substitution, Hayes concluait ainsi [111]. : ...
Cette thèse fait le point sur la maladie carieuse et les indicateurs utilisés pour l’évaluation du risque carieux individuel (RCI). Une synthèse est réalisée sur les recommandations actuelles et les stratégies de prévention de la carie ainsi qu’une revue la littérature concernant les dernières mises à jour sur l'utilisation de scellement des puits et sillons sur les molaires temporaires et permanentes chez les enfants et les adolescents.Dans un premier temps, une étude transversale ayant pour objectif l’exploration du risque carieux par une approche théorique a été mise en place afin de définir des indicateurs de risque plus pertinents que ceux utilisés jusqu’à présent. Les indices cliniques signant la présence de la maladie carieuse, associés aux facteurs socioculturels et aux quantifications bactériologiques en présence et en l’absence de carie, ont été analysés au moyen d’analyses des correspondances multiples, de régression linéaire multiple et de régression multiple par les moindres carrés partiels. Les résultats ont mis en valeur des priorités différentes de ces indicateurs entre les enfants et les adultes.Dans un deuxième temps, un essai clinique randomisé a été mené afin d’évaluer l’efficacité des agents de scellement sur l’incidence carieuse en denture temporaire. Après deux ans de suivi, les résultats n’ont pas montré une incidence carieuse significativement inférieure lorsque les molaires temporaires étaient scellées préventivement et ce, quel que soit le RCI. Cependant, plus de la moitié des sealants ont été perdus partiellement ou totalement. Les résultats de ces travaux indiquent que l’efficacité des sealants sur les molaires temporaires devrait être réévaluée dans un essai clinique à plus grande échelle en tenant compte des principaux facteurs de confusion.
... from using the combined fluoride xylitol toothpaste when compared to xylitol treated group and fluoride treated group. This increase may be attributed to xylitol as it may decrease lactic acid production, increase salivary flow potentially leading to an increased buffering of acids in plaque (Hayes 2001). These results concluded that there is no strong synergistic effect of fluoride with xylitol on salivary flow rate. ...
... The importance of healthy and balanced nutrition, which is an essential factor in oral health, should undoubtedly be included in the education of persons with disabilities and their caregivers. For example, this could include highlighting the negative role of sugar in the onset of dental disease and pointing out some ingredients in the diet that have a potentially anticarcinogenic effect, such as xylitol (13,21). ...
This paper aims to approximate and facilitate the routine of daily oral hygiene for persons with disabilities, as well as to emphasize the importance of educating persons with disabilities and their caregivers about oral health as an essential part of overall health. Desk research of electronic databases was conducted with the aim of writing this paper, using the following keywords: 'oral hygiene', 'dental plaque', 'oral health' and 'persons with disabilities'. Literature research has shown that persons with disabilities have poor oral hygiene, as well as that there is a lack of education among them and their caregivers about the importance of oral health and proper oral hygiene. Poor oral hygiene can affect a person's quality of life due to discomfort during eating, bad breath, poor self-esteem, pain, and disturbed sleep, which is a result of caries or other diseases of the oral cavity. Maintaining oral health is an essential part of overall health. (Juzbašić,M, Seifert D, Tomas M, Čandrlić M, Matijević M.
... Antibiotics such as penicillin, erythromycin, and tetracycline are effective in the prevention of oral disease, but they have not been utilized due to the overall increase in antibiotic resistance by bacteria [12]. Other studies have sought to inhibit oral periodontal bacteria using natural materials [11,13,14], inhibit GTase activity involving sucrose glucan formation [15], or use sucrose-alternative sweeteners that S. mutans is unable to metabolize [16]. Zinc ions, chlorhexidine (CHX) and cetylpyridinium chloride (CPC) and metal salts have been found to be effective in inhibiting the growth of halitosis-causing bacteria or in reducing the production of volatile sulfur compounds. ...
Background
Lactobacillus spp. have been researched worldwide and are used in probiotics, but due to difficulties with laboratory cultivation of and experimentation on oral microorganisms, there are few reports of Lactobacillus spp. being isolated from the oral cavity and tested against oral pathogens. This research sought to isolate and determine the safety and inhibitory capabilities of a Lactobacillus culture taken from the human body .
Results
One organism was isolated, named “ L. gasseri HHuMIN D”, and evaluated for safety. A 5% dilution of L. gasseri HHuMIN D culture supernatant exhibited 88.8% inhibition against halitosis-producing anaerobic microorganisms and the organism itself exhibited powerful inhibitory effects on the growth of 11 oral bacteria. Hydrogen peroxide production reached 802 μmol/L after 12 h and gradually diminished until 24 h, it efficiently aggregated with P. catoniae and S. sanguinis , and it completely suppressed S. mutans -manufactured artificial dental plaque. L. gasseri HHuMIN D’s KB cell adhesion capacity was 4.41 cells per cell, and the cell adhesion of F. nucleatum and S. mutans diminished strongly in protection and displacement assays.
Conclusion
These results suggest that L. gasseri HHuMIN D is a safe, bioactive, lactobacterial food ingredient, starter culture, and/or probiotic microorganism for human oral health.
... Although antibiotics such as penicillin, erythromycin, and tetracycline are effective in preventing dental caries, they have not been used in human studies due to increasing tolerance to antibiotics after long-term use [15]. In addition, various studies have attempted the inhibition of S. mutans using natural materials [16,17], the inhibition of GTase activity involved in glucan formation from sucrose [18], and the use of sucrose-alternative sweeteners that S. mutans cannot utilize [19]. These methods suppress the proliferation of oral pathogens but also inhibit other microorganisms that normally exist in the oral cavity or have a short duration of action, making it difficult to achieve lasting effects [20]. ...
It has been reported that certain probiotic bacteria have inhibitory effects against oral pathogens. Lactobacillus spp. have been studied and used as probiotics globally, but due to difficulties with laboratory cultivation and experimentation with oral microorganisms, there are few studies on Lactobacillus spp. isolated from the oral cavity being used against oral pathogens. The purpose of this study was to evaluate the biosafety and inhibitory effects of Lactobacillus fermentum OK as a potential oral biotherapeutic probiotic against oral pathogens. L. fermentum OK was evaluated based on microbial and genetic characteristics. A 5% dilution of L. fermentum OK culture supernatant showed that 60% inhibition against the growth of S. mutans and L. fermentum OK displayed significant inhibitory effects against the growth of Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus gordonii, and Streptococcus sanguinis. However, proliferation of L. fermentum OK, when co-cultured with harmful oral bacteria, was retarded. L. fermentum OK was shown to produce 1130 μmol/L hydrogen peroxide, aggregate efficiently with Streptococcus sobrinus, S. gordonii, S. mutans, S. sanguinis, and P. gingivalis, and reduce S. mutans that produced artificial dental plaque by 97.9%. The in vitro cell adhesion capacity of L. fermentum OK to an oral epithelial cell line was 3.1 cells per cell and the cell adhesion of F. nucleatum and S. mutans decreased strongly in protection and displacement assays. L. fermentum OK was evaluated for safety using ammonia production, biogenic amine production, hemolytic property, mucin degradation testing, antibiotic susceptibility, and whole genome sequencing (WGS). Based on this study, L. fermentum OK appears to be a safe and bioactive lactobacterial food ingredient, starter culture, and/or probiotic microorganism for human oral health.
... [18][19][20][21] El uso de sustitutos de azúcar sin efecto sobre los dientes constituye una alternativa que ha demostrado efectividad. 22 El mantenimiento de un bajo nivel de fluoruro de forma constante en la boca ha demostrado su efectividad en la prevención de la caries dental. 23,24 Los programas de fluoración del agua han logrado una reducción significativa de la caries. ...
Introducción
La Organización Mundial para la Salud (OMS) afirma que la caries dental, la enfermedad periodontal y el cáncer oral y faríngeo se consideran los mayores problemas globales que afectan la salud bucal en países industrializados y en las comunidades más pobres de los países en desarrollo. El incremento de enfermedades bucales indica la necesidad de un acercamiento integral a la promoción de la salud bucal.
Objetivo
Determinar el estado de salud bucodental y necesidades de tratamiento de estudiantes de la carrera de Cirujano Dentista de la FES Iztacala, UNAM.
Material y métodos
Estudio no experimental, comparativo y transversal sobre el total de la generación 2005-1. Se utilizó la Encuesta de Salud Bucodental (OMS).
Resultados
536 sujetos, con edades entre 17 y 44 años (media 19.15); 30% hombres y 70% mujeres. La mayoría presentó tejidos extraorales y mucosa sanos. La caries se presentó en 98.6% de sujetos. El CPO fue de 2.28, con valor mínimo de 0 y máximo de 6.25. Se encontraron diferencias significativas por sexo en el CPO, número de dientes sanos, obturados y perdidos, en favor de los hombres.
Conclusiones
Se observa disminución del CPO, sin embargo la mayoría presenta dientes con caries y un incremento en la prevalencia de fluorosis dental y maloclusiones en relación a las encuestas anteriores.
... There is a drop in the count of mutans streptococci with the use of xylitol-sweetened chewing gums. This might be due to the fact that it starves the cariogenic bacteria (Hayes, 2001;Gales and Nguyen, 2000). There are also reports of reduction in plaque accumulation by the xylitol gum (Mäkinen et al., 1996a,b). ...
The chapter gives a picture of the current data on the available anticariogenic natural products and their mechanism of action. Different phytochemicals such as phenols, flavanoids, alkaloids, terpenoids, tannins, lectins, etc. and their anticariogenic efficacy have been discussed in detail. All the data emphasise the fact that the use of natural products is emerging as an effective strategy in the prevention and treatment of dental caries. Consequently, these natural products could be incorporated in toothpastes and other oral hygiene products to promote oral health.
... Diğer iki şeker alkolünün aksine, oral streptokoklar tarafından fermente edilebilen sorbitol, sukroz, glikoz ve fruktoz gibi diğer şekerlere göre fermente edildiğinde, daha az oranda asit görüldüğü için nonkaryojenik şekerler sınıfına dâhil edilmektedir. [46][47][48] Yapılan çalışmalar, sorbitolün çürük engelleyici bir ajan olduğunu fakat bu etkisinin ksilitolden daha az olduğunu göstermektedir. 49,50 Gonçalves ve ark.nın yaptığı çalışmada, demineralizasyonu engellemede, florid, ksilitol ve sorbitolün birlikte kullanıldığı ağız çalkalama ajanlarının demineralizasyonu azalttığı gözlense de sadece floridli veya florid, ksilitol ve sorbitolün birlikte kullanıldığı ajanların etkinlikleri arasında anlamlı bir fark bulunmamıştır. ...
Despite advances in scientific knowledge, improved hygiene regimens and the increasing of new commercial preventative agents, dental caries continues to be a major public health problem in most countries. Over the last 30 years, there has been considerable increase in knowledge and understanding of the progress of caries through tooth structure. Demineralization and remineralization in the oral cavity is in equilibrium and deterioration of balance in favor of demineralization commences the development of caries. The caries process is resulting from many cycles of demineralization and remineralization. Demineralization begins at the crystal surface of the enamel and remineralization is the natural repair process for non-cavitated lesions. In the past two decades, caries research has been focused on the methodology for remineralization of carious lesions. At this point, minimum intervention dentistry tends to preserve dental hard tissues especially without the formation of caries lesions and remineralize existing demineralized/hypomineralized areas. Remineralization is naturally achived by salivary ions, and it can be enhanced by various methods and applications. There are several caries preventive agents and remineralization agents used in dental clinic, such as ionic technologies, various bioactive agents, sugar alcohols, calcium-phosphate based materials and herbal agents. In this review, it is aimed to present the current demineralization preventive agents and remineralization agents used in minimum intervention dentistry and the researches about these products. The continued development of new agents and methods for remineralization of white spots lesions and demineralized/hypomineralized lesions offers new therapeutic options and benefits to the dental profession.
... These are widely used in food products for people with diabetes (Manisha et al., 2012). The sorbitals are non-carcinogenic (Hayes, 2001) and prevents the formation of the teeth cavities (Anonymous, 2011). Very few common fruits and vegetables are reported with sorbitols (Lee, 2015). ...
There has been an increasing trend in recent times for taking more of green leafy vegetables (GLV) portion in the human diet. Among various GLVs available for human consumption, some are confined to a specific region and few are available in many parts of the world. Kale (Brassica oleracea L. var. acephala) is among the latter group which belongs to Brassicaceae family. This review summarizes the nutritional composition and anti-nutritional factors of kale available in different parts of the world. Consideration was also given for summarization of the studies reported on health benefits, pharmacological activities and different food products. It is noted from the literature that kale is a good source of fiber and minerals like potassium with higher calcium bioavailability than that of milk. Kale also contains prebiotic carbohydrates, unsaturated fatty acids and different vitamins while the anti-nutritional factors such as oxalates, tannins and phytate are present in higher concentrations. Research studies are reported different health beneficial activities of the kale like protective role in coronary artery disease, Anti-inflammatory activity, Antigenotoxic ability, gastro protective activity , inhibition of the carcinogenic compounds formation, positive to gut microbes, anti-Neela Satheesh
... Artificial sweetener is a food additive that duplicates the effect of sugar in taste, but has less food energy. The benefits of substituting artificial sweeteners include lower calorie intake, lower incidence of dental caries, better glycemic control and weight loss [1] . ...
... (12) It has also been associated with kno-Dental health status of adult population in Yemen (Thamar City) wledge, attitude and behaviors relating to preventive care. (13)(14)(15) Developing countries have experienced a deterioration in oral health due to a change in socio-economic condition, dietary habits and lack of education. (16,17) On the other hand, the trends of these two major dental diseases in developing countries call for integrated coordinated planning of preventive and treatment services for oral health as an urgent priority. ...
Aims: To evaluate the oral health status (dental caries, periodontal disease and treatment needs) in Yemenis adult individuals. Material and Methods: The sample included 471 individuals, age ranging
between 20–59 years of both sexes using sharp dental caries explorers with WHO periodontal probes to detect periodontal health by the use of DMFT index of WHO (1997) and CPITN by WHO (1987).
Results: The mean DMFT for the total sample was 7.33 + 0.3 which was increased with increasing age
for the different age groups with a significant difference but no significant difference in the mean
DMFT for total males and females has been found. The results also showed that the total number of
teeth (880) with a mean of 1.81 tooth/person in need of treatment is the most prevalent needed one
surface filling, and 581 teeth with a mean of 1.23 tooth/ person needed two or more surfaces filling.
According to the highest CPITN there was significant difference between male and female in calculus
at p < 0.05 and shallow pockets at p < 0.01. The results also revealed that the mean number of healthy
sextants for the total sample was 4.13 while for bleeding and calculus were 1.02 and 0.21, respectively.
It means that the treatment needs for periodontal disease is more toward oral hygiene procedure and prophylaxis. Conclusion: Dental health education program is an essential activity for promoting optimal oral health and preventing oral diseases
... Most bacteria cannot utilize sorbitol for energy, nevertheless it can be fermented slowly in the mouth by Streptococcus mutans, bacterium that contributes to tooth decay. In contrast, some other sugar alcohols such as xylitol and isomalt are considered nonacidogenic (Hayes, 2001;Nicolas et al., 2011). Also, it naturally occurs in several stone fruits and berries from the trees of the genus Sorbus (Nelson, 2005). ...
The research discussed the current developments in the chemistry, nutrition, and medical and health concerns of sugar alcohols, particularly sorbitol, xylitol, glycerol, arabitol, inositol, maltitol, and lactitol. Sugar alcohols (also called glycitols, polyols, polyhydric alcohols, polyalcohols, or alditols) are organic compounds, typically derived from sugars, containing one hydroxyl group attached to each carbon atom. Sugar alcohols are widely used as thickeners and sweeteners in the food industry. In commercial foods, sugar alcohols are commonly used in place of sucrose, usually in combination with high-intensity artificial sweeteners, in order to offset their low sweetness. Sorbitol is a sugar substitute, and is about 60% as sweet as sucrose (table sugar). Inositol is half as sweetness as sucrose, and is made naturally in humans from glucose. Glycerol is also widely used as a sweetener in the food industry and as a humectant in pharmaceutical formulations. Xylitol naturally occur in small amounts in plums, strawberries, pumpkin, and cauliflower; and can be produced industrially from lignocellulosic biomass from which xylan is extracted. Arabitol can be formed by reduction of either lyxose or arabinose. Lactitol is used as a laxative, and also as a replacement in bulk sweetener for low calorie foods with roughly 40% of the sugar sweetness. The high sweetness of maltitol allows its solitaire use without mixing with other sweeteners. Like other sugar alcohols, foodstuffs containing sorbitol may cause gastrointestinal distress. Sorbitol acts as laxative by drawing water into large intestine, stimulating bowel movements. Inositol is used in managing preterm babies who are at a risk of (or have) infant respiratory distress syndrome. Glycerol may pose very low toxicity when consumed. At high doses, xylitol and other polyols can cause gastrointestinal discomfort, including irritable bowel syndrome, flatulence, and diarrhea. Arabitol is associated with ribose-5-phosphate isomerase deficiency and Alzheimer's disease. Like other sugar alcohols, lactitol may cause diarrhea, cramping, and flatulence in some individuals who consume it.
... In Finland, the main xylitol products used are xylitol chewing gum products. Many people are aware that the consumption of 5 g xylitol per day promotes good oral health [30]. ...
Background: Background: The aim of this survey was to investigate family-related factors among healthy children treated under dental general anesthesia (DGA) compared to those treated in a normal dental setting. Methods: The survey comprised 87 children whose dental treatment was performed under DGA and 103 age-matched children who were treated in a normal setting. The children were healthy 3 to 11-year-olds, and their parents filled out the questionnaire on parental dental fear, DGA experiences in the family, and oral health behaviors. The data were collected in primary health care in the city of Oulu, Finland, during 2014-2016. Results: In the DGA group, the proportion of fearful parents was threefold higher and the proportion of siblings with DGA experience four-fold higher than in the comparison group; the differences between the groups were statistically significant. The dietary habits were statistically significantly poorer in the DGA group than among the comparison group when several indicators were considered. Linear regression analysis showed that treating a child in DGA was associated with harmful oral health behaviors like eating candy, drinking juice, and poor tooth brushing habits. Conclusions: Parental dental fear, DGA experiences of siblings, and harmful oral health behaviors were more common among children treated in a normal dental setting. Screening children and families for the risk indicators identified in this study may help prevent unnecessary DGAs among healthy control. Citation: Rajavaara P, Laitala M-L, Vähänikkilä H, Anttonen V (2018) Oral health behaviors associated with dental general anesthesia among healthy children. Adv Pediatr Res 5:3.
... en matière de consommation de xylitol Intérêt de la consommation du xylitolDès 2001, le National Institute of Health américain indiquait qu'« en raison des preuves jusque-là accumulées suggérant un effet protecteur important du xylitol en matière de prévention carieuse, il serait contraire à l'éthique de priver les patients des bénéfices potentiels du xylitol[63] ». Cet avis est partagé par le Community Dentistry and Oral Epidemiology qui indique que « les preuves sont suffisamment fortes pour supporter l'utilisation régulière de chewing-gums au xylitol comme mesure de santé publique en matière de prévention carieuse [64] ». ...
Since the 1970s, although many studies have shown that the consumption of xylitol reduces the incidence of dental caries, others have not shown such a benefit. As a result, a Cochrane review published in 2005 states that the efficacy of xylitol against caries is not proven. However, dozens of public health authorities, learned societies, armies, etc., recommend the consumption of xylitol to reduce the incidence of dental caries. The purpose of this article is to understand these discrepancies and to focus on the benefits of xylitol consumption in caries prevention on the basis of scientific knowledge.
... (12) It has also been associated with kno-Dental health status of adult population in Yemen (Thamar City) wledge, attitude and behaviors relating to preventive care. (13)(14)(15) Developing countries have experienced a deterioration in oral health due to a change in socio-economic condition, dietary habits and lack of education. (16,17) On the other hand, the trends of these two major dental diseases in developing countries call for integrated coordinated planning of preventive and treatment services for oral health as an urgent priority. ...
... (12) It has also been associated with kno-Dental health status of adult population in Yemen (Thamar City) wledge, attitude and behaviors relating to preventive care. (13)(14)(15) Developing countries have experienced a deterioration in oral health due to a change in socio-economic condition, dietary habits and lack of education. (16,17) On the other hand, the trends of these two major dental diseases in developing countries call for integrated coordinated planning of preventive and treatment services for oral health as an urgent priority. ...
Aims: To evaluate the oral health status (dental caries, periodontal disease and treatment needs) in Yemenis adult individuals. Material and Methods: The sample included 471 individuals, age ranging between 20–59 years of both sexes using sharp dental caries explorers with WHO periodontal probes to detect periodontal health by the use of DMFT index of WHO (1997) and CPITN by WHO (1987). Results: The mean DMFT for the total sample was 7.33 + 0.3 which was increased with increasing age for the different age groups with a significant difference but no significant difference in the mean DMFT for total males and females has been found. The results also showed that the total number of teeth (880) with a mean of 1.81 tooth/person in need of treatment is the most prevalent needed one surface filling, and 581 teeth with a mean of 1.23 tooth/ person needed two or more surfaces filling. According to the highest CPITN there was significant difference between male and female in calculus at p < 0.05 and shallow pockets at p < 0.01. The results also revealed that the mean number of healthy sextants for the total sample was 4.13 while for bleeding and calculus were 1.02 and 0.21, respectively. It means that the treatment needs for periodontal disease is more toward oral hygiene procedure and prophylaxis. Conclusion: Dental health education program is an essential activity for promoting optimal oral health and preventing oral diseases.
... (2,10) Sugar free xylitol gum is a chewing gum made with xylitol which is the popular sweetener substance that looks and tastes like sugar. (20) The benificial effects of xylitol on oral health it reduces the quantity of plague and the number of bacteria that cause tooth decay. (21)(22)(23)(24) Furthermore, sugar free gum has a beneficial means of saliva stimulation for people suffering from Xerostomia. ...
Aims: The aim of this study were to estimate the percentage of general and oral complications among patients receiving chemotherapeutic agents and correlate the oral complications with the age of the patients and with the drugs either used singly or in combination with the other chemotherapeutic agent and the effect of xylitol chewing gum on oral dental hygiene in patients having malignant diseases. Materials and Method: In this clinical trial, 70 patients with ages ranging between 7-65 years treated with different cancer chemotherapy for a duration from 3 months to 3 years. The patients were selected from those who treated in Hazim Al-Hafith center for treatment cancer in Mosul City. General and oral complications of chemotherapeutic agents were recorded and the agent recorded either used singly or in combination with the other chemotherapeutic agent. Twenty patients from those who had oral complications were examined and the plague and gingival indices were measured according to Silness and Loe (1963) at the base line. Then those patients were instructed to take xylitol chewing gum (4 grams/day); four times immediately after eating. The plague and gingival indices were measured again after 3 weeks of using the chewing gum. Results: The results of this study revealed that approximately half of the patients have general and oral complications while the others either had only general complications or had no complications (48.57%, 27.14%, 24.29% respectively). The incidence of oral complications correlated with the increasing in patients' age (P<0.01). The distribution of general and oral complications were correlated with the agent used either singly or in combination, where 100% of patients medicated with single therapy had general and oral complications while the patients medicated with multiple therapy 70.69% of them had general and oral complications and 29.13% had no significant complications. The patients who had taken xylitol chewing gum had a significant reduction in plague index while there is no significant reduction in gingival index (p<0.01). Conclusions: the study concluded that the general and oral complications arising in cancer patients can be attributed to the various modalities of cancer chemotherapy. Routine oral hygiene and elimination of preexisting dental disease and sources of mucosal irritation with a giving of salivary substitutes like xylitol reduce the incidence and severity of a number of oral complications of chemotherapy.
... Among polyols, erythritol ((2S,3R)butane-1,2,3,4-tetrol), xylitol (2S,4R)-pentane-1,2,3,4,5-pentol), and maltitol ((2S,3R,4R,5R)-4-[(2R, 3R, 4S, 5S, 6R)-3, 4, 5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxyhexane-1, 2, 3, 5, 6pentol) are the most recognised polyols used in bakery industry 68,69,70 . They provide good stability during baking with acceptable textural and sensory properties, low glycemic index and their sweetness are roughly comparable with this obtained from sugar (erythritol: 70%, xylitol: 100%, maltitol: 90% of the sucrose sweetness 71,72,73 . ...
... Increased health awareness has driven the demand for people to switch to noncaloric sweeteners which impart sweet taste and serve in reducing dental caries proven by field clinical trials. [8][9][10] Noncaloric sweeteners/ polyols are now dispensed in bakeries, confectionaries, chewing gums, mouthwashes, and dentifrices and are promoted for patients with diabetes mellitus or hyperglycemia and xerostomia owing to low glycemic response and decreased incidence of dental caries when compared with conventional sugar and starches. [11][12][13] Likewise, increase in disposable income in developing Asian countries increases the demand for noncaloric sweeteners, and commercial market is estimated to be valued at USD 13.26 billion in 2015, which is estimated to reach USD 16.53 billion by 2020. ...
Dental erosion is a nondestructive carious process, slowly dissolving tooth structure because of extrinsic, intrinsic, and idiopathic causes, resulting in painless loss of tooth structure without the involvement of microorganisms. Polyols/noncaloric sweeteners are promoted extensively owing to cariostatic action and low-glycemic response, but pose a risk of dental erosion because of acidic additives incorporated into sugar-free products which cause demineralization of enamel. Erythritol, sorbitol, mannitol, and xylitol are some of the polyols publicized in maintaining good oral health by the American Dental Association. A review of the existing literature was done by searching through databases such as PubMed, EBSCO, Hinari, and Sage on noncaloric sweeteners from February to end of May 2016 using keywords noncaloric sweetener, polyols, dental erosion, casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP), nanohydroxyapatite, and prevention of erosion. Novel preventive strategies by infusing CPP ACP, milk protein casein, and fluoride into sugar-free formulations may resolve the cause of dental erosion.
... [24,25] Multiple studies have been done to assess the anticariogenic efficacy of chewing gums such as xylitol, sorbitol, and mastic gums in the past. [26][27][28][29][30][31] Literature search reveals more studies on comparison between xylitol and sorbitol for anticariogenic efficacy. [32][33][34] However, only one study by Emamieh et al. has compared Xylitol with CPP-ACP gums for its ability to reduce S. mutans levels in saliva. ...
Aim:
The aim of the study is to compare the anticariogenic effectiveness of Casein phosphopeptide- Amorphous Calcium phosphate (CPP-ACP) and xylitol chewing gums based on salivary pH, buffer capacity, and Streptococcus mutans levels.
Materials and methods:
A group of twenty individuals in the age group of 18-25 years were randomly divided into two Groups A and B. Test arm A received xylitol gums and test arm B received CPP-ACP gums and they were instructed to use the gums thrice daily for 2 weeks. Unstimulated salivary samples were collected before they began the use of the gums for baseline values, 24 h after beginning the usage of chewing gums and at the end of 14 days. The samples were analyzed for pH, buffer capacity, and S. mutans levels.
Results:
A statistically significant reduction of salivary S. mutans levels, improvement in salivary pH, and buffer capacity were displayed in both groups 24 h and 14 days after the intervention when compared with baseline. Group B showed more statistically significant improvement in pH than group A after 24 h (P = 0.028) and at the end of 2 weeks (P = 0.041).
Conclusion:
CPP-ACP has better ability than xylitol in improving the pH of saliva. Both CPP-ACP and xylitol gums individually have remarkable ability in bringing down S. mutans levels while simultaneously improving the pH and buffer of saliva.
... Artificial sweetener is a food additive that duplicates the effect of sugar in taste, but has less food energy. The benefits of substituting artificial sweeteners include lower calorie intake, lower incidence of dental caries [1], better glycemic control [2], and weight loss [3]. Aspartame is one of the most commonly used artificial sweeteners nowadays. ...
Background and aim
Sugar is one of the commonest causes of weight gain and diabetes. Aspartame is
one of the most commonly used artificial sweeteners worldwide to replace sugar.
This study aimed to study the effects of aspartame in pregnant female albino rats on fetal and placental weights, length of umbilical cord, and possible histological changes in fetal pancreas.
Materials and methods
Thirty-six adult female albino rats and nine adult male albino rats weighing between
220 and 250 g were used. Each four female rats were housed with one male rat to
allow mating. Pregnant rats were divided into three groups (n=12 each): control
group (group І), low-dose-treated group (group ІІ), and high-dose-treated group
(group ІІІ). The low-dose-treated group received 14 mg/kg aspartame and the highdose-
treated group received 40 mg/kg aspartame daily from the first day of
pregnancy to the 20th day of pregnancy.
Results
This study showed a highly significant reduction of maternal weight gain, placental
weight, fetal weight, and umbilical cord length in both aspartame-treated groups.
Fetal pancreas showed histopathological changes in both aspartame-treated
groups as evidenced by light and electron microscopy. All the results in th
... It is a non-nutritive sweetener that has demonstrated effectiveness for preventing dental caries. 10 It has been introduced in different foods for children's including gum, candies, gelatin, sorbets, syrups and other products including multivitamins, lozenges, tooth paste, and oral rinses. Studies have demonstrated that daily ingestion of 5g of xylitol in different format reduces the level of dental caries. ...
Xylitol is a pentahydroxy sugar-alcohol which exists in a very low quantity in fruits and vegetables (plums, strawberries, cauliflower, and pumpkin). On commercial scale, xylitol can be produced by chemical and biotechnological processes. Chemical production is costly and extensive in purification steps. The precursor xylose is produced from agricultural biomass by chemical and enzymatic hydrolysis and can be converted to xylitol primarily by yeast strain. Hydrolysis under acidic condition is the more commonly used practice influenced by various process parameters. Biotechnological xylitol production is an integral process of microbial species belonging to Candida genus which is influenced by various process parameters such as pH, temperature; time, nitrogen source, and yeast extract level. It is a functional sweetener as it has prebiotic effects which can reduce blood glucose, triglyceride, and cholesterol level. Dental caries is an infectious microbiologic disease of the tooth that results in localized dissolution and destruction of calcified tissues. Xylitol has been shown to reduce dental caries when mixed with food, chewing gums and milk. Dental caries are prevalent in acidic pH where Streptoccocus mutans (MS) ferment resulting in demineralization of tooth, where as Streptococcus mutans cannot ferment xylitol thus it reduces MS by altering their metabolic pathway and enhance remineralization and helps arrest dentinal caries. Reduction in caries rate is greater, when xylitol is used as the sugar substitutes. This review discusses the taste acceptability of xylitol in milk as a step towards measuring the effectiveness for the reduction of dental caries. Keywords: Xylitol, Carbohydrates, Caries, Remineralisation, Demineralization, Streptoccocus mutans
... These polyols including xylitol have been proven to be extremely poorly cariogenic in clinical caries studies by replacing fermentable sugars and reducing the total cariogenic load of the diet. Hayes [4] reviewed 14 clinical studies from 1966 to 2001 and found a consistent decrease in dental caries ranging from 30% to 60% among patients using sugar substitutes as compared to subjects in a control group. However, to be cost-effective, recommendations of agents for use in health improvement should be based on the minimum concentration and frequency required for clinical benefit to be attained. ...
Introduction:
Dental caries is a multi-factorial, infectious disease, the prevention of which is based on multifaceted approaches. Chewing sugar-free gum has potential beneficial effects on dental health.
Objectives:
The aim of this study is to assess and compare the effectiveness of xylitol and polyol chewing gums on salivary Streptococcus mutans in 12-15 years old schoolchildren residing in hostels in Belgaum city. The acceptability of the two chewing gums was also assessed.
Materials and methods:
Sixty children of 12-15 year age groups from three hostels, who fulfilled all the inclusion criteria, were included in this triple blind randomized controlled field trial. They were then randomly allocated into one of the three groups using lottery method. Xylitol chewing gum, polyol chewing gum and control group (no chewing gum). Patients were instructed to chew one pellet two times a day after meals for 5 min each for 30 days. Salivary samples were collected at baseline, 30 days after chewing gum use and 30 days after discontinuation, for microbiological analysis. The data were subjected to statistical analysis using SPSS software version 18.
Results:
Chewing 100% xylitol chewing gum 2 times a day for 5 min for 30 days can successfully reduce salivary S. mutans counts. The xylitol gum has shown a maximum benefit against salivary S. mutans when compared to polyol gum and control group.
Conclusion:
Xylitol-containing chewing gums can be used as an adjunct to regular home care preventive procedures to prevent dental caries.
... Polyols such as sorbitol (E420), mannitol (E421), isomalt (E953), maltitol (E965), lactitol (E966), xylitol (E967), erythritol and hydrogenated starch hydrolysates (HSHs) belong to bulk sweeteners, and consumption does not promote tooth decay [3]. This research aims to synthesise polyhydric alcohol from agricultural residue using local strain of Saccharomyces cerevisiae. ...
... It is produced as an important precursor for the production of ascorbic acid. Sorbitol has been shown to display an in vivoanti-cariogenic effect as it is not fermented by Streptococcus (S.) mutants, which are the most potent cariogenic bacterium [7]. Sorbitol functions in textile applications basically as a dispensing agent, humectant bodying agent and sequestering agent. ...
Background and Objective: Sorbitol is a non-toxic and slightly hygroscopic compound with different applications. Zymomonas mobiles produces sorbitol from sucrose or mixtures of glucose and fructose (formation is coupled with the dehydrogenation of glucose to glucono-d- lactone). Recombinant Zymomonas mobilis may produce sorbitol and gluconic acid from glucose and fructose using different divalent metal ions with reduced the ethanol yield and significantly increased yield of sorbitol. Current study envisaged to alter the media components, physical process parameters and supplementation of amino acids for enhanced sorbitol production. Materials and Methods: Several process variables were evaluated on sorbitol production including carbon sources (glucose, fructose, maltose, sucrose), carbon concentrations (5, 10, 20 and 25 g l⁻¹), nitrogen sources (peptone, tryptone, yeast extract, beef extract and organic nitrogen mix), temperatures (25, 29, 33, 37, 41°C), pH (6, 6.5, 7, 7.5, 8), agitation rate (50, 100, 150, 200 rpm) and amino acids (cysteine, cystine, tryptophan) in batch cultivation of Lactobacillus plantarum NCIM 2912. Shake flask cultivation performed under optimum conditions like temperature 37°C, pH 7.0 and agitation rate of 150 rpm, resulted in enhanced sorbitol production. Comparative study of sorbitol production in solid state fermentation and submerged fermentation was also evaluated. Results and Conclusion: Batch cultivation under submerged conditions further performed in 7.5-l lab scale bioreactor (working volume 3.0-l) under optimized conditions resulted in maximum cell biomass of 8.95±0.03 g l⁻¹ and a sorbitol content of 9.78±0.04 g l⁻¹ after 42.0 h of fermentation. Scale up study on bioreactor resulted in maximum sorbitol yield (Yp/x) and productivity of 1.11 g g⁻¹ and 0.50 g l⁻¹ h⁻¹ under submerged fermentation, respectively. Conflict of interest: The authors declare no conflict of interest.
... Xylitol also stimulates increases salivary flow which reduce the risk of caries and promote remineralization. [21,22] Sensistat technology Based on arginine technology, in which arginine bicarbonate, amino acid, and calcium carbonate particle are incorporated in toothpaste. This arginine compound holds calcium carbonate particles on the tooth surface as a result of which calcium carbonate dissolves slowly and release calcium which results in tooth remineralization. ...
Dental caries is a common disease affecting teeth present in the oral cavity. Dental caries is a disease process resulting in the dissolution of dental hard tissue like enamel and dentin. There has been a change in concept from GV Black's “extension for prevention” to a minimal intervention approach in the recent time. Accurate and reliable detection of early enamel caries is very crucial. The new diagnostic methods and remineralization approach would enable the dentist to detect and diagnose early and direct appropriate preventive measures to promote conservation of the tooth substance. These preventive strategies are much more efficient. The aim of Minimal dentistry is to manage early carious lesion by remineralization. The objective of writing this review on early carious lesion is to understand the early caries disease process and its clinical stages, identification of early caries before there is evidence of surface cavitation through various new technologies and allowing remineralization of such lesion.
... This means that they are labeled as such and counted as free/added sugars when used in food manufacturing. Interestingly, sugar alcohols (e.g., xylitol and sorbitol), which have been also shown to be non-cariogenic (Hayes 2001) and are associated to positive dental health claims in Europe (EFSA 2011) and in the US (FDA 2017) are not declared as added sugars but under total carbohydrates. ...
Dietary guidelines indicate that complex carbohydrates should provide around half of the calories in a balanced diet, while sugars (i.e., simple carbohydrates) should be limited to no more than 5–10% of total energy intake. To achieve this public health goal a collective effort from different entities including governments, food & beverage industries and consumers is required. Some food companies have committed to continually reduce sugars in their products. Different solutions can be used to replace sugars in food products but it is important to ensure that these solutions are more healthful than the sugars they replace. The objectives of this paper are, (1) to identify carbohydrates and carbohydrates sources to promote and those to limit for dietary intake and food product development, based on current knowledge about the impact of carbohydrates on the development of dental caries, obesity and cardio-metabolic disorders (2) to evaluate the impact of food processing on the quality of carbohydrates and (3) to highlight the challenges of developing healthier products due to the limitations and gaps in food regulations, science & technology and consumer education.
... Among all the polyols, xylitol is by far the most widely investigated. Xylitol has been tested as caries-preventive agent in several randomized controlled trials, arguing a reduction in biofilm accumulation, in acid production (Beiswanger et al., 1998) and in the inhibition of the metabolic activity of S. mutans (Hayes, 2001). A study comparing the metabolic effect of fluorides and xylitol in vivo, nevertheless, showed that while fluoride appears to repress acid production, xylitol is not able to inhibit acidogenesis from the dental biofilm, acting as a non-fermentable sugar alcohol (Takahashi & Washio, 2011). ...
The traditional concept of caries as a multifactorial transmittable and infectious disease has been challenged. Novel conceptual ideas have come to add to the complexity of this highly prevalent disease worldwide. Current etiological understanding of the disease has emphasized the pivotal role of sugar in caries. In fact, current definition points towards an ecological disease caused by the commensal microbiota that under ecological imbalances, mainly due to high and or frequent sugar consumption, creates a state of dysbiosis in the oral biofilm. This modern conceptual idea, however, tends to underrate a key issue. Since humans are omnivore and consume a mix diet composed by a multitude of substances, the role of the diet in caries must not be restricted only to the presence of simple sugars. This review explores the contribution of other food components, ubiquitous to the diet, mostly as potentially protective factors. Anticaries nutrients might determine an environmental change, affecting the ecology of the oral microbiome and partially mitigating the effect of sugar. Understanding the function of the food usually consumed by the people will contribute new knowledge on the mechanisms associated with the onset of caries, on new caries risk variables and on potential novel strategies for the prevention and treatment of the disease.
... It is produced as an important precursor for the production of ascorbic acid. Sorbitol has been shown to display an in vivoanti-cariogenic effect as it is not fermented by Streptococcus (S.) mutants, which are the most potent cariogenic bacter-ium [7]. Sorbitol functions in textile applications basically as a dispensing agent, humectant bodying agent and sequestering agent. ...
Background and Objective: Sorbitol is a non-toxic and slightly hygroscopic compound with different applications. Zymomonas mobiles produces sorbitol from sucrose or mixtures of glucose and fructose (formation is coupled with the dehydrogenation of glucose to glucono-δ-lactone). Recombinant Zymomonas mobilis may produce sorbitol and gluconic acid from glucose and fructose using different divalent metal ions with reduced the ethanol yield and significantly increased yield of sorbitol. Current study envisaged to alter the media components, physical process parameters and supplementation of amino acids for enhanced sorbitol production. Material and Methods: Several process variables were evaluated on sorbitol production including carbon sources (glucose, fructose, maltose, sucrose), carbon concentrations (5, 10, 20 and 25 g l-1), nitrogen sources (peptone, tryptone, yeast extract, beef extract and organic nitrogen mix), temperatures (25, 29, 33, 37, 41°C), pH (6, 6.5, 7 , 7.5 ,8), agitation rate (50, 100, 150, 200 rpm) and amino acids (cysteine, cystine, tryptophan)in batch cultivation of Lactobacillus plantarum NCIM 2912. Shake flask cultivation performed under optimum conditions like temperature 37°C, pH 7.0 and agitation rate of 150 rpm, resulted in enhanced sorbitol production. Comparative study of sorbitol production in solid state fermentation and submerged fermentation was also evaluated. Results and Conclusion: Batch cultivation under submerged conditions further performed in 7.5-l lab scale bioreactor (working volume 3.0-l) under optimized conditions resulted in maximum cell biomass of 8.95±0.03 g g-1 and a sorbitol content of 9.78±0.04 g l-1 after 42.0 h of fermentation. Scale up study on bioreactor resulted in maximum sorbitol yield (Y p/x) and productivity of 1.11 g g-1 and 0.50 g l-1 h under submerged fermentation, respectively.
A method for determining the iron, arsenic, cadmium, mercury, and lead content in Sunset Yellow by ICP-MS was developed, verified, and implemented for routine ICP-MS analysis. Inductively coupled plasma mass spectrometry (ICP-MS) is a good instrument for determining the basic composition of numerous substances. Iron, arsenic, cadmium, mercury, and lead metal as defined in USP (233) linearity, method precision, accuracy, robustness, and ruggedness factors were taken into account and analysed for method validation in this work. The recovery rates of iron, arsenic, cadmium, mercury, and lead metals ranged between 92.0% and 101.4%. The detection limits of all elements investigated demonstrated the procedure's suitability for routine analyses. To summarize, the provided analytical processes can be used to measure the mass fractions of iron, arsenic, cadmium, mercury, and lead components in Sunset Yellow samples.
A thickening and gelling agent made from cellulose is called cellulose hydroxyethylate. In the formulation of capsules, cellulose hydroxyethylate is commonly utilised with hydrophobic medications. Lead is highly dangerous; its usage can pollute the environment, endanger human health, and alter entire ecosystems. A method was developed and put into use for routine analysis to determine the lead content in cellulose hydroxyethylate using ICP-MS. Lead metal, as classified as a hazardous metal by USP (233), was used in this investigation. The lead metal recuperation rates were found to be between 70 to 150 percent. After a summary, it can be said that the analytical methods for determining the mass fractions of lead elements in cellulose hydroxyethylate that have been described.
El consumo de goma de mascar es un hábito ampliamente practicado en la sociedad moderna. Estudios han demostrado que la goma de mascar con edulcorantes como el xilitol, sorbitol y manitol, traen consigo efectos beneficiosos en la cavidad bucal: controla la colonización de Streptococcus mutans, actúa en el control del flujo y pH salival, detiene la formación de la biopelícula dental y, a su vez, es capaz de controlar la inflamación de los tejidos gingivales. A pesar de esto, la revisión de la literatura sugiere que en Venezuela no se ha estudiado la información que poseen los odontólogos sobre el consumo de goma de mascar. Por lo tanto, el presente estudio, descriptivo y transversal, tuvo como objetivo describir la información de los odontólogos de la ciudad de Mérida, Venezuela, sobre los efectos de la goma de mascar en la salud bucal. Se seleccionaron 130 odontólogos que laboran en los sectores público, privado y universitario, a quienes se les administró un cuestionario de 24 ítems. Se determinó que, para los odontólogos participantes, el chicle se compone de azúcares perjudiciales para la salud bucal. Por ello, el consumo de este producto no se suele prescribir, ni recomendar. Esto sugiere el manejo de poca información actualizada sobre la gama de beneficios para la salud bucal que aporta el consumo de chicle con edulcorantes. Se recomienda incluir en la formación de los odontólogos evidencia científica sobre los efectos de la goma de mascar.
Introduction: Lactobacillus brevis NB10 isolated from human saliva, showed in vitro effect on inhibiting the growth and the biofilm formation of Streptococcus mutans - a major pathogen that initiates dental plaque and caries. Formulation of chewing gum containing L. brevis NB10 is the next step in using this probiotic for the prevention of dental diseases related to S. mutans. Methods: Cryoprotectants such as sorbitol, mannitol, xylitol, lactose, maltodextrin, skim milk and potassium ascorbate were selected to formulate the freeze-dried powder containing L. brevis NB10. Next, the freeze-dried powder of L. brevis NB10 was used to make chewing gum by direct compression method using HIG-04 gum base (Heath in Gum ®). Other ingredients such as xylitol, strawberry flavor powder, glycerin, aerosil, talc, and magnesium stearate were selected to formulate chewing gum with suitable chewing feel, taste, and flavor. Results: The freeze-dried powder showing the highest bacterial survival rate (75.5 ± 7.6%) consists of 6% maltodextrin, 6% skim milk, and 0.25% potassium ascorbate. The optimal formula of chewing gum tablet consists of 10% L. brevis NB10 freeze-dried powder, 10% xylitol, 2% strawberry powder, 1.5% glycerol, 1.5% magnesium stearate, 1.5% talc and 2.5% aerosil. The bacterial survival rate after tablet compression is 34.34 ± 0.55 %. The product is stable for at least 3 months at 5 ºC ± 3 ºC. Conclusion: This study was successful in formulating chewing gum containing at least 107 CFU/tablet of L. brevis NB10.
Functional foods are the foods claimed that have additional health benefits beyond their basic nutritional values, and functional food components are bioactive, potentially beneficial compounds that are found either naturally in foods or added to them as functional ingredients. Some important functional food components are carotenoids, isothiocyanates, soluble and insoluble dietary fiber, phenolic acids, fatty acids, plant stanols and sterols, flavonoids, polyols, soy protein, prebiotics and probiotics, phytoestrogens, vitamins, and minerals. Most of the functional food components occur mainly in plant foods (whole grains, fruits, and vegetables), however, few functional foods components, such as omega-3, -6, and -9 polyunsaturated fatty acids are also found in animal products (e.g. milk, fermented milk products, and cold-water fish). Evidence suggested that there is a relationship between functional food components and health benefits. Functional food components can be used for the treatment and prevention of different diseases. Biologically active functional food components can reduce the risk of certain non-communicable diseases, such as cancer, type II diabetes, cardiovascular diseases, osteoporosis, inflammation, and lowering of blood cholesterol. Thus, people should consume a wide variety of foods to assure the ingestion of functional food components in their body, such as fatty acids, fiber, carotenoids, flavonoids, prebiotics and probiotics, vitamins, and mineral.
A monometallic Ni and a bimetallic Ni-Fe catalyst were used in the aqueous phase hydrogenation of xylose in batch conditions (T = 50 - 150 °C, PH2 = 10 - 30 bar, xylose mass fraction in water = 3.7 - 11.0 wt.%) to evidence the benefits of promoting Ni by Fe. The activity of the catalysts increased with temperature, but a temperature of 80 °C allowed minimizing nickel leaching at full conversion. The presence of reduced Fe at the surface of the bimetallic nanoparticles increased both the first-order apparent rate constant and the adsorption constant of xylose. The catalytic activity of Ni/SiO2 strongly declined and no deactivation was found for the Ni-Fe catalyst. A restructuring of the bimetallic nanoparticles took place, as the size of the metal particles and the Fe proportion in the surface layers increased, suggesting a flattening and coalescing of the particles over the silica surface.
Background
Specific probiotic bacteria may have inhibitory effects against oral pathogens. Lactobacillus spp. have been researched worldwide and are used in probiotics, but due to difficulties with laboratory cultivation of and experimentation on oral microorganisms, there are few reports of Lactobacillus spp. being isolated from the oral cavity and tested against oral pathogens. This research aimed to determine the safety and inhibitory impacts of L. gasseri HHuMIN D as a potential oral probiotic with biotherapeutic capabilities against oral pathogens.
Results
The microbial and genetic characteristics of L. gasseri HHuMIN D were evaluated in this research. A 5% dilution of L. gasseri HHuMIN D culture supernatant exhibited 88.8% inhibition against halitosis-producing anaerobic microorganisms and L. gasseri HHuMIN D exhibited powerful inhibitory effects on the growth of every harmful oral bacterium tested. Unfortunately, other oral bacteria affected the growth of L. gasseri HHuMIN D, suggesting a poor proliferative response to most co-cultures. Hydrogen peroxide production by L. gasseri HHuMIN D reached 802 µmol/L after 12 hours and gradually diminished until 24 hours. It efficiently aggregated with P. catoniae and S. sanguinis, and completely supressed S. mutans-manufactured artificial dental plaque. L. gasseri HHuMIN D’s KB cell adhesion capacity was 4.41 cells per cell, and the cell adhesion of F. nucleatum and S. mutans diminished strongly in protection and displacement assays. L. gasseri HHuMIN D was evaluated for safety using ammonia and biogenic amine development, hemolytic property and mucin degradation testing, antibiotic susceptibility, and whole genome sequencing (WGS).
Conclusion
Our results suggest that L. gasseri HHuMIN D may be a safe, bioactive, lactobacterial food ingredient, starter culture, and/or probiotic microorganism for human oral health.
The recent explorations in the field of carbohydrate chemistry have unveiled a wide array of plant based bioactive oligosaccharides and polysaccharides which are potential candidates against cancer, diabetes, influenza, tumor, inflammation, thrombosis, infection etc. Due to strong binding abilities, hydrophilic nature and conformational flexibility, these polymers exhibit biological activities, either by illustrating the effect themselves or by inducing effects via complex reaction cascades. Some of the important plant derived carbohydrate based drugs include Lentinan, Krestin, Dextrose, Mannitol, Fucoidan, Schizophyllan, etc. Polysaccharides are also used as food fibre, excipients, bioadhesives, etc. in pharmaceuticals. Further, polysaccharides facilitate meticulous drug delivery of non-carbohydrate molecules. Intriguingly, the growing range of saccharide based drugs and their diverse industrial applications necessitate knowledge of their primary structure, a critical prerequisite to better understanding of the mechanism of polysaccharide activity as well as efficient commercial utilization of these natural polymers. The chapter discusses recent advancements in oligosaccharides and polysaccharides based drugs and future perspectives.
Xylose can be selectively converted to xylitol in water, with an optimized yield of 98%, in the presence of a simple silica supported monometallic cobalt ‐ Co/SiO 2 ‐ catalyst. This catalyst displays initial outstanding catalytic properties in a proper solvent, the best results being obtained in pure water. Recyclability studies show a moderate deactivation of the catalyst, while selectivity to xylitol remains almost unchanged after 4 cycles, confirming that this catalyst formulation is very promising for the xylitol production process.
Proficiency with instrumental analysis via GC–MS is an important skill for chemistry students. The application of analytical techniques and fundamental theoretical principles to real-world problems can be valuable learning exercises for undergraduates which can also improve their analytical thinking skills. Xylitol is generally considered safe for human consumption and is frequently used in sugar-free gum; however, it is extremely toxic to dogs. In this laboratory experiment, upper-level undergraduate chemistry students extract xylitol from both fresh and chewed gum sticks followed by direct aqueous injection GC–MS analysis. Students learn the proper steps and techniques required for sample extraction and preparation and GC–MS analysis, and they determine concentrations of xylitol present in gum samples. Identification and quantification of the chemical components in gum extract occurs via GC–MS analysis; however, other GC detectors could be used. Students also compare external and internal standard calibration methods for xylitol quantification. Upon quantification of xylitol in chewed and unchewed gum samples, students are able to calculate the level of hazard for dogs upon ingestion.
Dental caries is one of the most common childhood diseases, affecting up to 80% of all individuals at some stage of their lives. It is a debilitating and painful condition which impacts on mastication, speech, aesthetics and psychosocial behaviour. The prevalence of caries in South African children is around 40% and almost half of this burden goes untreated. The end results are pain, swelling and abscess formation, all of which have negative effects on aspects of the lives of the patients. Although dental caries is preventable, the prevalence continues to remain relatively high. This paper discusses the spread of caries and some of the methods by which it can be reduced and/or prevented.
The protective role of saliva is demonstrated by the rampant caries seen in human subjects with marked salivary hypofunction, and in desalivated animals. In normal cases, however, the relationship between saliva flow and coronal or root caries experience is doubtful, and to examine the concept that stimulation of saliva might have protective effects against caries, one must look beyond a simple correlation between caries and flow rate.
Protective properties of saliva which increase on stimulation include salivary clearance, buffering power, and degree of saturation with respect to tooth mineral. These benefits are maximized when saliva is stimulated after the consumption of fermentable carbohydrates, by reducing the fall in plaque pH leading to demineralization and by increasing the potential for remineralization.
Plaque acid production is neutralized, and experimental lesions in enamel are remineralized, when gum is chewed to stimulate saliva after a carbohydrate intake. The pH-raising effects are more easily explained by the buffering action of the stimulated saliva than by clearance of carbohydrates. The remineralization action depends upon the presence of fluoride. These findings suggest that the protective actions of saliva can be mobilized by appropriate salivary stimulation, and that in addition to established procedures such as tooth cleaning and fluoride regimens, eating patterns which lead to saliva stimulation to increase the potential for saliva protection might be included in recommendations for caries prevention. Confirmation of this concept in clinical tests is required.
The effect of 2-year chewing-gum use on the caries rates of primary teeth was studied in a combined school and home program in a sample of 510 initially 6-year-old subjects with high caries experience, low availability of fluoride, and difficult access to dental care. The gum, formed into either sticks or pellets, comprised either xylitol, sorbitol, or mixtures thereof. The gum was chewed for 5 min under supervision five times a day during the school year, and for variable times during nonschool days. Seven groups were studied. One group received no gum; two xylitol gum groups received either pellet or stick gum as did, two sorbitol gum groups, and two groups received either of two types of xylitol/sorbitol pellet gum. The response variable was the development of a frank carious lesion detectable by physical loss of enamel and probable extension to the dentin for those surfaces of primary teeth that were not cavitated at baseline. Caries rates associated with the use of each of the gum types were compared to the caries rates in the no-gum group. The usage of all polyol gums resulted in a significant decrease of the caries onset rate (p < 0.05). The caries onset risk for a primary surface in the xylitol pellet and the sorbitol pellet groups was 35 and 44% of that in the no-gum group (relative risk, 0.35; 95% confidence interval, 0.21-0.59; relative risk, 0.44; 95% confidence interval, 0.30-0.63, respectively). The caries onset risk in the xylitol stick gum group was 53% of that in the no-gum group (relative risk, 0.53; 95% confidence interval, 0.39-0.72), which was marginally (p = 0.1520) lower than in the sorbitol stick gum group (relative risk, 0.70; 95% confidence interval, 0.52-0.94). The usage of both xylitol/sorbitol mixtures in pellet form was associated with a caries onset rate comparable with the usage of the xylitol stick gum. The largest caries risk reduction was observed in the group receiving xylitol pellet gum.
Intra-oral remineralisation of experimental caries-like lesions in human enamel, as determined by polarised light microscopy and quantitative microradiography, was promoted to a similar extent (% fall in delta Z, 18.6 and 19.0) by chewing a sorbitol or sorbitol/xylitol (3:1)-sweetened gum for 20 min after each of three meals and two sugary snacks daily. The results suggest that reported differences in the properties of the two sweeteners do not affect their ability to enhance remineralisation due to salivary stimulation.
The number of non-sugar sweeteners that are approved for use in foods and drinks is increasing and manufacturers are using these as alternatives to cariogenic sugar. These non-sugar sweeteners are generally classed as non-cariogenic. The most frequently used non-sugar sweetener is sorbitol, and concern has been expressed that the oral flora may adapt to sorbitol so that it looses its 'safe for teeth' property. The purpose of this review is to describe the mechanisms whereby oral microorganisms, and mutans streptococci in particular, might metabolize sorbitol and to summarize published research into changes in plaque acid production and changes in plaque flora after exposure to sorbitol. Finally, the possibility that some groups of people may be especially 'at-risk' from adaptation of oral microorganisms to sorbitol is considered. It is concluded that frequent or long-term use of sorbitol is unlikely to present any increased risk of dental caries in normal people, but that frequent use of sorbitol may present a small cariogenic risk in people with low salivary flow.
The relationship between the caries status and the microbiological status [mutans streptococci (MS)] in the proximal areas of lower right and upper left molars was investigated in subjects of the Ylivieska xylitol study in Finland (1982-1985) in a cross-sectional follow-up in 1988. Those children who had used xylitol chewing gum regularly since 1982 showed significantly lower caries indices in 1988, including the proximal caries scores. The presence of MS (expressed in log10 colony-forming units) in the proximal areas studied was significantly lower in habitual xylitol consumers. Carious interproximal areas of all subjects had significantly higher total levels of MS than clinically and radiographically sound interproximal areas. The present study supports the idea of a close association between MS and dental caries, and shows that the total level of MS in the human dentition can be influenced by xylitol. It is likely that the long-term (between 1982 and 1988) habitual xylitol consumption had decreased the prevalence of MS in the interproximal areas of the present subjects and, subsequently, decreased the proximal and overall caries indices.
Recent evidence of the actions of chewing gum on plaque pH needs to be assessed against the background of other evidence, including clinical data. 'Sugar-free' gums are non-cariogenic and potentially beneficial in reversing early caries, while the potential cariogenicity of sucrose-sweetened gums can be modified by additives or selected patterns of use.
Plaque and whole saliva samples were collected from initially 11- to 12-year-old children randomly chosen from two groups which participated in a 2- to 3-year field trial designed to test the efficacy of xylitol chewing gums in caries prevention. No initial differences were observed between the groups with regard to the plaque levels of Streptococcus mutans, but at the end of the 2-year xylitol gum regimen, the levels were smaller (p less than 0.05) in children using xylitol gum than in control children. In a similar follow-up study on children who were considered to be at high risk with regard to dental caries and who continued the study over a 3rd year, the xylitol-consuming subjects showed at the end of the study significantly smaller (p less than 0.004) salivary S. mutans counts than the control children. These effects were achieved after using up to 3 xylitol gums/day (daily xylitol dose per child was 7-10 g). Salivary flow rate and several salivary chemical parameters did not change.
The objective of the study was to determine quantitatively the effect on the potential for in situ remineralization of artificial caries-like lesions in human enamel when sugar-free gum containing mainly sorbitol as sweetener was chewed after meals and snacks. Artificial white-spot lesions were created in extracted human premolars and divided into three parts. One part was used as reference and the other two worn consecutively for two 21-day periods by 10 volunteers in a cast silver band cemented on lower molar teeth and covered with gauze to promote plaque formation. During the experimental periods, the subjects used fluoridated toothpaste twice daily, and consumed three meals (breakfast, lunch, and dinner) and two snacks (selected from chocolate bar, raisins, chocolate wafer, and iced cupcake). Sorbitol gum was chewed for 20 min immediately after each meal or snack during one of the experimental periods. The three parts of the enamel lesions were then sectioned (congruent to 80 microns) and examined together by means of quantitative microradiography and by polarized light microscopy. All estimates of mineral content indicated that significant remineralization occurred and was approximately doubled with gum-chewing. It is suggested that sorbitol gum stimulates salivation, which is responsible for the significantly enhanced remineralization, thus contributing to a therapeutic, caries-preventive effect. Because the gum was chewed immediately after meals and snacks, inhibition of demineralization may also have occurred.
Abstract Plaque accumulation and characteristics were determined gravimetrically, planimetrically, visually, and microbiologically in 24 human subjects who consumed a carbohydrate-free diet for 4 days. In addition, the effects of xylitol-, sorbitol- and sucrose-containing can dies upon plaque formed during consumption of the diet were ascertained. Experimental design was such that all 24 subjects traversed each 4-day test period; a 9-day interval between test periods was observed. All plaque measurement methods demonstrated that the subjects in all groups, including a control group which received no candies, accumulated significant amounts of dental plaque. No significant differences in plaque amount could be detected among the xylitol, sorbitol and control groups. However, subjects receiving sucrose-containing candies clearly exhibited larger amounts of plaque.
The bacteriological investigations corroborated the clinical observations. The number of microbial colonies from plaque samples taken from the sucrose test group was clearly higher than in the other three groups. In addition, the number of bacteria in plaque samples from the sorbitol group was higher than in the xylitol group. A statistically significant increase in the proportion of anaerobic sorbitol-and xylitol-fermenting bacteria was detected in the sorbitol and xylitol test groups during the 4-day test periods.
The purpose of this paper is to report clinical observations on the stabilisation of dentine caries in two chewing gum studies carried out in young subjects. One study focused on the permanent dentition of 1,277 initially 10-year old subjects, while the other study was carried out on 510 initially 6-year old subjects and focused on the primary dentition. In both trials, several chewing gum formulas containing dietary polyols (xylitol and sorbitol, or their combinations) were used for up to 40 months (10-year olds) or up to 24 months (6-year olds). The daily consumption level of both polyols was up to 10.7 g per subject, used normally in 5-minute chewing episodes 3 to 5 times per day. Supervised chewing in schools lasted 5 min per episode, and for variable times during non-school days. Rehardening of dentine caries lesions was observed clinically by experienced, blinded examiners using sharp dental explorers and fibre optic light. After 40 months (permanent dentition) or after 18 months (primary dentition), rehardening (caries arrest) generally occurred more frequently in subjects who used polyol gums than in subjects who did not receive gum as part of the programmes, or who received sucrose gum. Arrest or non-progression of dentine caries was most frequently observed in subjects who used 100 per cent xylitol gums or mixtures of xylitol and sorbitol, but the differences between gums were not consistently significant. However, the usage of 100 per cent xylitol pellet-shaped gum was more frequently associated with arrest of dentine caries than other treatments. These results and previous studies suggest that high-xylitol chewing gum usage can retard or arrest even rampant dentine caries in conditions where effective restoration and prevention programmes have not been instituted, and can also provide additional protection against further caries development during full implementation of restorative procedures by holding the lesion in a non-progressive condition.
To evaluate the efficacy of a sodium fluoride (NaF)/silica/xylitol dentifrice compared with that of a positive control NaF/silica dentifrice on caries increments in school children over a 3-year period in an area without an optimal level of fluoride in the drinking water (mean level <0.1 ppm).
A 3-year, double-blind clinical caries study was conducted in 2,630 children initially aged 8-10 years at 17 schools in the San Jose, Costa Rica metropolitan area. Clinical dental examinations were performed at participating schools utilizing portable dental equipment. Caries evaluations employed conventional tactile/visual methodology consisting of artificial light, dental mirrors and single-edge #23 explorers. Children accepted into the study were stratified by age and sex into two balanced groups within each school, and randomly assigned to use either a positive control dentifrice containing 0.243% NaF/silica or a test dentifrice containing 0.234% NaF/silica/10% xylitol. Children were instructed to brush with the assigned dentifrice twice daily. Caries evaluations were conducted at baseline, 2 years, and 3 years.
After 3 years, subjects using the 0.234% NaF/silica/10% xylitol dentifrice had statistically significantly reduced decayed/filled surfaces (DFS; -12.3% reduction; P < or = 0.001) and decayed/filled buccal and lingual surfaces (DFS-BL; -10.5% reduction; P < or = 0/01).
The major results of the Michigan Xylitol Programme (1986-1995) are summarised. The Programme consisted of several clinical trials and laboratory investigations designed to study the usage of xylitol-containing saliva stimulants in the prevention of dental caries. The trials patients included young (initially 6 year olds) and adult or geriatric subjects who were given saliva stimulants (mostly chewing gum) for periods of two weeks to 56 months. A special rationale behind these studies was the need to further test the validity of the 'pentitol-hexitol theory' in the prevention of caries. This theory has maintained that pentitols (sugar alcohols with five hydroxyl groups, such as xylitol) may be cariologically more effective than hexitols (sugar alcohols with six hydroxyl groups, such as sorbitol). The accumulated clinical, sialochemical and microbiologic evidence suggests that xylitol, a natural carbohydrate sweetener of the pentitol type, is more effective in preventing dental caries than sorbitol, and cariologically safer than sorbitol, a natural carbohydrate of the hexitol type. Sorbitol was found to be significantly less cariogenic than sucrose. The Programme's results shed additional light on the cariologic and oral biologic effects of natural, dietary polyols, and suggest that the usage of xylitol chewing gum (and in some cases xylitol dragées) can be considered a valuable additional tool in caries prevention and in stabilisation of caries in all age groups.
The prevalent use of chewing gum has prompted interest in its dental effects. Important defining aspects are the ability to use sugar substitutes in gum manufacture and the prolonged stimulation of a protective flow of saliva. The main sugar substitutes used are sorbitol and xylitol. Because it is not fermented by oral bacteria, xylitol is considered to be non-cariogenic, and while sorbitol in solution can be fermented slowly by mutants streptococci, chewing sorbitol-sweetened gum does not cause a fall in plaque pH. Effects of chewing sugar-free gum on the ability of plaque to form acid from sucrose are equivocal, although the tendency is for the plaque acidogenicity to be reduced with the use of xylitol gum for 2-3 weeks, due to its inhibitory effects on mutants streptococci. Gum-chewing also stimulates a protective salivary flow when used after an acidogenic stimulus, and may enhance salivary function, especially in subjects with low flow rates. Sorbitol and xylitol gums have similar beneficial effects in promoting enamel remineralisation in short-term in-situ experiments. Clinical trials indicate that xylitol gum has a useful anticaries role, superior to the effects of sorbitol gum. In conclusion, both sorbitol and xylitol chewing gums are non-cariogenic in contrast to sugared gum, and exhibit beneficial anticaries properties through salivary stimulation. In addition, xylitol's antibacterial properties seem likely to lead to caries reductions superior to the more modest reductions with sorbitol gum.
To determine the effect of chewing sugar-free gum on caries incidence, the authors conducted a randomized clinical study. A total of 1,402 children in Puerto Rico, in grades 5 through 7 at baseline, completed the study. They were randomized by classroom into a control group or chewing gum group; those in the gum group were instructed to chew sugar-free gum for 20 minutes after each of three meals a day. Clinical and radiographic evaluations were performed at baseline and after two and three years. The results show that all subjects and high-risk subjects, respectively, in the gum group developed 7.9 percent and 11.0 percent fewer decayed, missing or filled surfaces than subjects in the control group. Based on these findings, the authors concluded that chewing sorbitol-based sugar-free gum after eating significantly reduces the incidence of dental caries.
To summarize published data on the comparative efficacy of sorbitol and xylitol for prevention of dental caries.
Published double-blind comparative trials, using sorbitol and xylitol products, identified by MEDLINE (January 1966-December 1998) and International Pharmaceutical Abstracts (January 1970-December 1998) searches.
Clinical trials generally used sorbitol and xylitol gums, which patients chewed three to five times daily for 20-40 months. Xylitol was superior to sorbitol in two longer, secondary dentition trials (30-63% reductions), but not in two primary dentition trials.
The data suggest that xylitol-containing gums may provide superior efficacy in reducing caries rates in high-risk populations.
Xylitol is effective as a non-cariogenic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) with impaired adhesion properties, i.e., they shed easily to saliva from plaque. One hundred sixty-nine mother-child pairs participated in a two-year study exploring whether the mothers' xylitol consumption could be used to prevent mother-child transmission of mutans streptococci. All mothers showed high salivary levels of mutans streptococci during pregnancy. The mothers in the xylitol group (n = 106) were requested to chew xylitol-sweetened gum (65% w/w) at least 2 or 3 times a day, starting three months after delivery. In the two control groups, the mothers received either chlorhexidine (n = 30) or fluoride (n = 33) varnish treatments at 6, 12, and 18 months after delivery. The children did not chew gum or receive varnish treatments. MS were assessed from the mothers' saliva at half-year intervals and from the children's plaque at the one- and two-year examinations. The MS were cultured on Mitis salivarius agars containing bacitracin. The salivary MS levels of the mothers remained high and not significantly different among the three study groups throughout the study. At two years of age, 9.7% of the children in the xylitol, 28.6% in the chlorhexidine, and 48.5% in the fluoride varnish group showed a detectable level of MS. In conclusion, therefore, habitual xylitol consumption by mothers was associated with a statistically significant reduction of the probability of mother-child transmission of MS assessed at two years of age. The effect was superior to that obtained with either chlorhexidine or fluoride varnish treatments performed as single applications at six-month intervals.
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.
The objective of this investigation was to evaluate the effect on dental caries experience of using carbamide polyol chewing gum as a supplement to standard oral hygiene procedures for schoolchildren in a developing country (Madagascar). In 1994, grades 1 and 4 children of demonstration schools were allocated to experimental and control groups; all children participated in a school-based oral health education programme, including daily toothbrushing supervised by the classroom teacher. At grade 1, the test group (n = 125) also used chewing gum (V6: 55.5 per cent sorbitol, 4.3 per cent xylitol, 2 per cent carbamide) three times a day. At grade 4, one test group (n = 177) had chewing gum three times a day and an additional test group (n = 74) had chewing gum five times a day. The control groups included 117 children at grade 1 and 209 at grade 4. Dental caries was registered in 1994 and 1997 according to the Recording System for the Danish Child Dental Services. In grade 1 children, the preventive effect of the total DMFS was not statistically significant except for occlusal caries (-0.65 DMFS, P < 0.01). In the grade 4 test groups, non-significant reductions of dental caries experience were found when compared with controls. The present community trial indicates that the use of polyol chewing gum may be considered a supplement to the control of occlusal dental caries in young primary schoolchildren, particularly in developing countries with limited resources for dental care.
One strategy for treating dental caries is to suppress oral mutans streptococci, or MS, with chlorhexidine, or CHX, mouthrinse. Oral MS levels, however, tend to quickly return to baseline values without further intervention. In this clinical study, the authors evaluated the effect of xylitol chewing gum on MS regrowth.
The authors selected 151 subjects with elevated oral MS levels (> or = 105 colony-forming units per milliliter, or CFU/mL, of paraffin-stimulated saliva). Subjects rinsed with 0.12 percent CHX gluconate mouthrinse twice daily for 14 days. The authors then randomly assigned the subjects to one of three groups. Those in the test group (n = 51) chewed a commercial xylitol gum three times daily for a minimum of five minutes each time for three months. The placebo group subjects (n = 50) used a commercial sorbitol gum, and the control group subjects (n = 50) did not chew gum. The authors estimated MS load on the dentition using paraffin-stimulated saliva samples. The authors serially diluted the samples, plated them on selective media and incubated them anaerobically; they then enumerated the colonies under a stereomicroscope.
MS levels were not significantly different between the three groups at baseline (mean log CFU/mL +/- standard deviation: 5.4 +/- 0.7, 5.4 +/- 0.8, 5.2 +/- 0.7, respectively) nor after CHX therapy (2.7 +/- 0.8, 3.1 +/- 1.1, 3.0 +/- 1.1, respectively). After three months of gum chewing, the test group subjects had significantly lower salivary MS levels (3.6 +/- 1.2) than did the placebo (4.7 +/- 1.2) or control (4.4 +/- 1.3) group subjects.
Xylitol chewing gum appears to have the ability to prolong the effect of CHX therapy on oral MS.
Maintaining long-term caries-pathogen suppression is feasible with currently available commercial products and can be expected to result in significant caries inhibition.