Xylitol source: weldental.com By Pirre Blom, Farideh Bonakdar, and - - PowerPoint PPT Presentation

Xylitol

By Pirre Blom, Farideh Bonakdar, and Phuong Nga Ho

source: weldental.com source: weldental.com

What is Xylitol?1

• Tooth-friendly, non-fermentable sugar alcohol
• Natural sweetener in chewing gum
• Colorless, crystalline structure
• Sweetness comparable to table sugar; less calories
• In fruit and vegetables, made by body
• Industrial production from wood

source: superfoodevolution.com source: medchemexpress.com

History of Xylitol1

• Greek ‘Xylo’ for wood
• Originally from birch, often called ‘birch sugar’
• First isolated in Germany and France in the 1890’s
• Early studies conducted in Finland in the 1960’s
• Benefits researched by numerous studies

source: nutritionadvance.com

Oral Health Benefits of Xylitol2,3

• Promotes remineralization
• Reduces numbers of bacteria
• Lowers plaque levels
• Decreases caries occurrence
• Reduces xerostomia
• Lessens incidence of erosion
• Enables neutral pH
• Improves malodor

source: weldental.com source: gettyimages.com

How to use Xylitol effectively ?4

• At least 3 times a day
• After a meal/snack
• For at least 5-10 min
• In daily doses of 5-6 g
• Regularly, longterm
• In high xylitol concentrations

source: confectionarynews.com

Results from the Xylitol for Adult Caries Trial (X-ACT)6

Type of study: RCT Objective: In this randomized placebo-controlled trial, the authors evaluated the effectiveness

• f xylitol lozenges in preventing caries in adults at elevated risk of developing caries.

Methods: 691 participants, aged 21-80 consumed five 1 g xylitol or placebo lozenges daily for 33 months. Participants underwent clinical examinations at baseline and at 12, 24 and 33 months. Result/Conclusion: Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant.

By Bader JD, Vollmer WM,and Shugars DA, et al.

Six months of high-dose xylitol in high-risk caries subjects—a 2-year randomised, clinical trial 7

Type of study: Randomised Clinical Trial , Double-blind Research Question: In high-risk school children, is use of a high dose of a xylitol gum for 6 months, comparing to non-xylitol gum, more effective in reduction of development new caries

• n permanent first molar, and reduction of SM & LB, after 2 years?

Inclusion criteria: the presence of two or three carious lesions The presence of all the first permanent molars. Salivary SM concentration of >105 CFU/mL Exclusion Criteria: Children with systemic disease Systemic antibiotic use during the past 6 months

Method/Material: 157 children with high caries risk

Xylitol group: 11.6 g, five times a day immediately after main meals and snacks, for 5 min Non-xylitol group: Non-xylitol gum

• Caries status
• Salivary SM and Lb concentration ….. At beginning & After 2 years

Result/Conclusion

• Caries status

Xylitol group: showed a significantly lower increase in the number of new carious lesions.

• Salivary SM and Lb concentration

No significant finding

Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial 8

Type of study: Randomised Clinical Trial(RCT) Double-blind Research Question: Dose using xylitol gum 3 and 4 times/day, comparing to 2 times/day, or using non-xylitol gum significantly reduce SM level in Plaque and saliva? Exclusion Criteria: Taking antibiotics during the last four weeks Subjects with history of GI problems Subjects intolerant to phenylalanine. Method & Material: Participants (n = 132) Active groups: 10.32 g xylitol/day

• 2 times/day
• 3 times/day
• 4 times/day

Placebo control: Sorbitol

SM in …. Plaque & Saliva Baseline & After five weeks

Result & Conclusion linear response relationship between the reduction of SM and the increase in frequency of xylitol gum use. 2x/day: Smaller reduction of SM

It was not statistically different from the control G

3x/day & 4x/day:

Significantly difference in reduction SM relative to the control group

Xylitol pediatric topical oral syrup to prevent dental caries: a double blind, randomized clinical trial of efficacy

Type of Study: Double blinded RTC Objective: To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries of very young children ➢ Exclusion: (1) were in the lower 10 percentile of U.S. standard weight and height, (2) had a history of esophageal or digestive disease, (3) had congenital craniofacial malformation, or (4) had a history of adenoidectomy, tympanostomy tubes, or tympanic membrane perforations.

By Peter Milgrom, DDS, Kiet A. Ly, MD, MPH, Ohnmar K. Tut, BDS, Lloyd Mancl, PhDa, Marilyn C. Roberts, PhD, Kennar Briand, MB,BS, and Mary Jane Gancio, MD

9

Method: 108 healthy age 9-15 months were screened and 100 were enrolled. Parents apply 8g of xylitol syrup per day in 2 active treatment conditions for 12 months ➢ 2 doses of xylitol (4g xylitol per dose) ➢ 3 doses of xylitol (2.67g xylitol per dose) Result: 94 had at least 1 follow up caries assessment and were included in the final analysis. ➢ Nearly 52% of children in control condition had tooth decay ➢ 40.6% of children among Xyl-3X and 24.2% of group Xyl-2X had tooth decay ➢ There was no significant difference between the two xylitol conditions (P=0.22) Conclusion: Oral xylitol syrup administered topically two or three times each day at a total dose of 8 g was effective in preventing Early Childhood Caries.

Xylitol pediatric topical oral syrup to prevent dental caries: a double blind, randomized clinical trial of efficacy

By Peter Milgrom, DDS, Kiet A. Ly, MD, MPH, Ohnmar K. Tut, BDS, Lloyd Mancl, PhDa, Marilyn C. Roberts, PhD, Kennar Briand, MB,BS, and Mary Jane Gancio, MD

9

Indications

➔ Moderate, high or extreme caries-risk patients ➔ Xerostomia patients ➔ Children less than 4 year old

Contraindications

3

Different Types of Xylitol Products

source: greenhome.com

References

1. Ur-Rehman S, Mushtaq Z, Zahoor T, et al. Xylitol: A Review on Bioproduction, Application, Health Benefits, and Related Safety

• Issues. Crit. Rev. Food Sci. Nutr. [Online]. 2013 Oct 25 [cited 2019 Feb 2];55(11): 1514-1528. In: Taylor & Francis [Internet].

Oxfordshire (UK): Available from: https://www.tandfonline.com/doi/abs/10.1080/10408398.2012.702288?journalCode=bfsn20 2. Ritter AV, Bader JD, Leo MC, et al. Tooth-surface-specific Effects of Xylitol: Randomized Trial Results. J Dent Res. [Online]. 2013 Jun [cited 2019 Feb 28]; 92(6): 512–517. In: PubMed Central [Internet]. Bethesda (MD): National Library of Medicine (US): Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654758/ 3. Nayak PA, Nayak UA, and Khandelwal V. The effect of xylitol on dental caries and oral flora. Clin Cosmet Investig Dent. [Online]. 2014 Nov [cited 2019 Mar 4]; 6: 89–94. In PubMed Central [Internet]. Bethesda (MD): National Library of Medicine (US): Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232036/ 4. Darby ML, Walsh M. Dental hygiene: theory and practice. 4th ed. St. Louis: Elsevier Health Services; 2015. Chapter 18; pgs. 308-309, chapter 33; pgs. 592-593.

5. Xlear Inc. How Xylitol Works Spry Dental Defense from Xlear. YouTube [online]. 2017 Feb 23. [cited 2019 Mar 9]. Available from: https://www.youtube.com/watch?v=wnhbMKaGW6Y.

6. Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J Am Dent Assoc. [Online]. 2013 Jan [cited 2019 Feb 28];144(1):21-30. In: PubMed Central [Internet]. Bethesda (MD): National Library of Medicine (US): Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926805/ 7. Campus G, Cagetti M, Sale S, and et al. Six months of high-dose xylitol in high-risk caries subjects-a 2-year randomised, clinical

• trial. Clin Oral Investig. [Online].2013 April [cited 2019 Jan 15]; 17(3): 785-91.In: Dentistry & Oral Sciences Source [Internet]
• EBSCOhost. Available from:

https://ezproxyfh.fhda.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ddh&AN=86304438&site=eh

• st-live

8. Ly KA, Milgrom P, Roberts MC, and et al. Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial . BMC Oral Health [Online]. 2006 [Cited 2019 Feb 15]; 6: p6. In: Dentistry & Oral Sciences Source [Internet] EBSCOhost. Available from: https://ezproxyfh.fhda.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ddh&AN=29438409&site=eh

• st-live

9. Milgrom P, Ly KA, Tut OK, Mancl L, Roberts MC, Briand K, et al. Xylitol pediatric topical oral syrup to prevent dental caries. Arch Pediatr Adolesc Med [Online]. 2009 Jul 6 [Cited 2019 March 10];163(7):601–7. In: PubMed Central [Internet]. Bethesda (MD): National Library of Medicine (US). Available from: https://ezproxyfh.fhda.edu:2063/pmc/articles/PMC2722805/pdf/nihms131183.pdf 10. Pediatric Dentistry. Guideline on xylitol use in caries prevention. Am Acad of Ped Dent. 2013 [cited 2019 Jan 14];35(6):171-174. In: Dentistry & Oral Sciences Source [Internet] EBSCOhost. Available from: https://ezproxyfh.fhda.edu:2063/pmc/articles/PMC2722805/ 11. Haghgoo R, Afshari E, Ghanaat T, et all. Comparing the efficacy of xylitol-containing and conventional chewing gums in reducing salivary counts of Streptococcus mutans: An in vivo study. In J of Inter Soc of Prev & Comm Dent. [Online]. 2015 [Cited 2019 Feb 15]; 5(8), 112-117. In: Dentistry & Oral Sciences Source [Internet] EBSCOhost. Available from: http://www.jispcd.org/text.asp?2015/5/8/112/172947 12. Cocco F, Carta G, Cagetti MG, et al. The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults. Clin Oral Investig. [Online]. 2017 Mar 16 [cited 2019 Jan 14];21(9): 2733–2740. In: PubMed Central [Internet]. Bethesda (MD): National Library of Medicine (US): Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693987/

Questions?