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

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


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

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    • "The best-case scenario was calculated by adding the number of lost-to-follow-up participants in the test group to the successes of that group and adding the number of lost-to-follow-up participants in the control group to the failures of that group. The method to assess attrition bias risk as sensitivity analysis by calculation of best/worse case scenarios was developed in collaboration with the School of Statistics & Actuarial Science, University of the Witwatersrand and applied in a number of published systematic reviews[12,28,29]. "
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    Full-text · Article · Jan 2016 · PLoS ONE
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    • "Against this background, it can be assumed that xylitol would yield a higher anticaries effect than sorbitol and an at least similar effect than topical fluoride. Topical fluoride may be considered as the gold standard for preventing and treating tooth caries, owing to the accumulated evidence in support for its active anticaries effect [18] [19] [20] [21] [22] [23] [24] [25]. "
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