2011 Guideline On Xylitol Use in Caries Prevention.

AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
Policy on the Use of Xylitol

Review Council
Council on Clinical Affairs
Latest Revision
2015
Purpose (MS) from mothers to children,19-21 and MS levels in chil-

The American Academy of Pediatric Dentistry (AAPD) dren.7,12,22-36 Such studies have been performed with xylitol
recognizes that there is considerable research on sugar substi- intake ranging from four to 15 grams per day divided into
tutes, particularly xylitol, and their potential oral health for three to seven consumption periods.5,6,16,18,23 Abdominal dis-
infants, children, adolescents, and persons with special health tress and osmotic diarrhea have been reported following the
care needs. This policy is intended to assist oral health care ingestion of xylitol.5,6,23
professionals making informed decisions about the use of Overall results of these trials are inconclusive, and there
xylitol-based products with the aim of preventing caries in appear to be study design issues and/or bias in many of the
children. studies (e.g., insufficient sample size, control group issues,
issues with randomization, blinding, and conflict of inter-
Methods est).6-35 Data is inconclusive for caries reduction for short-term
This policy was developed by the Council on Clinical Affairs use.9,12-14 Data also is inconclusive for long-term effectiveness
and adopted in 2006. This document is an update of the for reduction of MS 12,35 and caries reduction. 11,15-18 Most
previous version, revised in 2010. The update is based upon studies used a very large dose and at high frequency (generally
a review of current dental and medical literature related to four to five times a day)18,20,23,24,27,32,33,35 which may be un-
the use of xylitol in caries prevention. A literature search realistic in clinical practice.
®
was conducted using PubMed /MEDLINE with the terms:
xylitol AND caries prevention; field: all fields; limits: within Policy statement
the last 20 years, humans, English, birth through 18. Two The AAPD:
hundred eighty articles matched these criteria; 47 controlled • Supports the use of xylitol and other sugar alcohols as
clinical trial papers were reviewed for this revision. When non-cariogenic sugar substitutes.
data did not appear sufficient or were inconclusive, recom- • Recognizes that presently there is a lack of consistent
mendations were based upon expert and/or consensus evidence showing significant reductions in MS and dental
opinion by experienced researchers and clinicians. caries in children.
• Recognizes that the large dose and at high frequency of
Background xylitol used in clinical trials may be unrealistic in clin-
Xylitol is a five-carbon sugar alcohol derived primarily from ical practice.
forest and agricultural materials. It has been used since the • Supports further research to clarify the impact of xyli-
early 1960s in infusion therapy for post-operative, burn, and tol delivery vehicles, the frequency of exposure, and the
shock patients, in the diet of diabetic patients, and as a sweet- optimal dosage to reduce caries and improve the oral
ener in products aimed at improved oral health.1 Dental health of children.
benefits of xylitol first were suggested from Finnish studies
using animal models in 1970.2 The first xylitol studies in References
humans, known as the Turku Sugar Studies,3,4 demonstrated 1. Mäkinen KK. Biochemical principles of the use of xylitol
the relationship between dental plaque and xylitol, as well as in medicine and nutrition with special consideration
the safety of xylitol for human consumption. Xylitol as well as of dental aspects. Experientia Suppl 1978;30:1-160.
other sugar alcohols are not readily metabolized by oral bac- 2. Muhlemann HR, Regolati B, Marthaler TM. The effect
teria, and thus are considered non-cariogenic sugar substitutes.4 on rat fissure caries of xylitol and sorbitol. Helv Odontol
Xylitol is available in many forms (e.g., gums, mints, Acta 1970;14(1):48-50.
chewable tablets, lozenges, toothpastes, mouthwashes, cough
mixtures, oral wipes, nutraceutical products).5-7 The chewing
process enhances the caries inhibitory effect, which may be a ABBREVIATIONS
significant confounding factor for the efficacy of xylitol gum.8 AAPD: American Academy Pediatric Dentistry. MS: Mutans
Xylitol studies show varying results in the reduction of the streptococci.
incidence of caries,9-18 transmission of Mutans streptococci
ORAL HE ALTH POLICIES 55

REFERENCE MANUAL V 40 / NO 6 18 / 19
3. Scheinin A, Mäkinen KK, Tammisalo E, Rekola M. Turku 18. Mäkinen KK, Benett CA, Hujoel PP, et al. Xylitol chew-
sugar studies. XVIII. Incidence of dental caries in rela- ing gums and caries rates: A 40-month cohort study. J
tion to 1-year consumption of xylitol chewing gum. Dent Res 1995;74(12):1904-13.
Acta Odontol Scand 1975;33(5):269-78. 19. Alamoudi NM, Hanno AG, Sabbagh HJ, Masoud MI,
4. Scheinin A, Mäkinen KK, Ylitalo K. Turku sugar studies. Almushayt AS, El Derwi DA. Impact of maternal xylitol
V. Final report on the effect of sucrose, fructose and xyli- consumption on mutans streptococci, plaque and caries
tol diets on caries incidence in man. Acta Odontol Scand levels in children. J Clin Pediatr Dent 2012;37(2):163-6.
1976;34(4):179-216. 20. Söderling E, Isokangas P, Pienihäkkinen K, Tenovuo J,
5. Ly KA, Milgrom P, Rothen M. Xylitol, sweeteners, and Alanen P. Influence of maternal xylitol consumption on
dental caries. Pediatr Dent 2006;28(2):154-63; discus- mother-child transmission of mutans streptococci: 6 year
sion 192-8. follow-up. Caries Res 2001;35(3):173-7.
6. Lynch H, Milgrom P. Xylitol and dental caries: An over- 21. Nakai Y, Shinga-Ishihara C, Kaji M, Moriya K, Murakami-
view for clinicians. J Calif Dent Assoc 2003;31:205-9. Yamanaka K, Takimura M. Xylitol gum and maternal
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on cariogenic bacteria and caries in young children. J 89(1):56-60. doi: 10.1177/0022034509352958.
Dent Res 2012;91(7 Suppl):85S-90S. 22. Hanno AG, Alamoudi NM, Almushayt AS, Masoud MI,
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xylitol versus fluoride – A quantitative systematic review and salivary Streptococcus mutans levels among a group
of clinical trials. Int Dent J 2012;62(1):6-20. of mother-child pairs. J Clin Pediatr Dent 2011;36(1):
9. Seki M, Karakama F, Kawato T, Tanaka H, Saeki Y, 25-30.
Yamashita Y. Effect of xylitol gum on the level of oral 23. Campus G, Cagetti MG, Sale S, et al. Six months of
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trial. Int Dent J 2011;61(5):274-80. randomised, clinical trial. Clin Oral Investig 2013;17(3):
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children’s dental decay and need for restorative treatment. of xylitol chewing gum on mutans streptococci in saliva
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78(3):797-803. dental plaque from caries active pre-school children. Oral
12. Oscarson P, Lif Holgerson P, Sjöström I, Twetman S, Health Prev Dent 2003;1(3):195-9.
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56 ORAL HE ALTH POLICIES

AMERICAN ACADEMY OF PEDIATRIC DENTISTRY
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ORAL HE ALTH POLICIES 57

2011 Guideline On Xylitol Use in Caries Prevention.

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AMERICAN ACADEMY OF PEDIATRIC DENTISTRY

Policy on the Use of Xylitol

Purpose (MS) from mothers to children,19-21 and MS levels in chil-

ORAL HE ALTH POLICIES 55

56 ORAL HE ALTH POLICIES

ORAL HE ALTH POLICIES 57

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