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Xylitol and its effect on oral ecology: clinical studies in children and adolescents
Umeå University, Faculty of Medicine, Odontology.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Xylitol, classified as a natural sugar substitute, has for about 35 years been known as an agent that may act against caries. The mechanism of action; how it inhibits mutans streptococci (MS) and the clinical dose-response relationship are not however fully investigated. The general aim of the investigations was to evaluate the effect of xylitol on oral ecology in children and adolescents. A series of experimental and controlled clinical trials were performed in which samples of saliva and plaque was collected and analysed with respect to xylitol content, pH, microbial composition and lactic acid production. In paper I, significantly reduced proportions of xylitol-sensitive MS in saliva were demonstrated after 18 weeks of regular use of two dose regimens of xylitol-containing tablets (1.7g and 3.4g xylitol/day) but the acidogenicity in dental plaque was not affected. In paper II, the effect on interdental plaque-pH of two different single dose intakes (2.0g and 6.0g) of xylitol was evaluated. The higher xylitol dose counteracted the pH-drop significantly (p<0.05) when the chewing was followed by a sucrose rinse while the lower dose did not differ from the control. In paper III, the xylitol concentrations in saliva after use of different common xylitol-containing products (0.1g-1.3g) were investigated. Statistically significant elevations of salivary xylitol levels were demonstrated for all products during the first 8-16 min when compared with baseline (p<0.05) but the individual variation was considerable. In samples of supragingival dental plaque, a high dose rinse (6.0g) increased the xylitol concentrations for a longer period (>30 min) than a low dose rinse (2.0g). In paper IV, it was demonstrated that 6.0g of xylitol in chewing gums, every day in 4 weeks, gave significantly less visible plaque and a significantly reduced sucrose-induced lactic acid formation (p<0.05) in saliva. Furthermore, the proportion of MS decreased significantly (p<0.05) compared to baseline. In paper V, the salivary uptake of [14C]-xylitol was compared with a specific assay determining xylitol-sensitive MS and a fair positive correlation (p<0.05) between the two assays was found. In a controlled trial, the proportions of MS and the salivary xylitol uptake decreased significantly (p<0.05) in the xylitol gum test group after 4 weeks compared to baseline which was in contrast to the control gum group. No serious adverse effects were reported in any of the investigations.

The main conclusions from this thesis were: a) various xylitol-containing products increased the xylitol levels in saliva and plaque, b) 6.0g of xylitol could counteract the interdental pH-drop after sugar consumption and reduce lactic acid formation in saliva c) a daily dose of 6.0g xylitol reduced the amount of visible plaque and altered the salivary microbial composition, d) a transient shift of MS strains in saliva was demonstrated during periods of regular intake of xylitol products but no long-term impact was found after its termination. The relatively high amount of xylitol needed for a beneficial effect on the oral ecology calls for a further development of effective and safe routes for administration.

Place, publisher, year, edition, pages
Umeå: Odontologi , 2007. , 60 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 97
Keyword [en]
chewing gum, dental plaque, dose-response relationship, interdental plaque-pH, oral microorganisms, saliva, xylitol
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-986ISBN: 91-7264-223-8 (print)OAI: oai:DiVA.org:umu-986DiVA: diva2:145297
Public defence
2007-02-23, Sal B, 9tr, Tandläkarhögskolan, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2007-01-31 Created: 2007-01-31 Last updated: 2009-05-29Bibliographically approved
List of papers
1. Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances
Open this publication in new window or tab >>Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances
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2004 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 112, no 3, 244-248 p.Article in journal (Refereed) Published
Abstract [en]

This study aimed to investigate two dose regimens of xylitol-containing tablets on the ecology of dental plaque and saliva during treatment with fixed orthodontic appliances. The study group comprised 56 healthy patients (mean age 15.8 yr) randomly assigned into the following groups: A, (n = 23) two xylitol tablets two times a day (1.7 g xylitol d(-1)) for 18 wk; B, (n = 23) two tablets four times per day (3.4 g xylitol d(-1)) for 18 wk; and C, (n = 10) no tablets. The levels of mutans streptococci (ms) were enumerated in plaque and saliva and the proportion of xylitol-sensitive (X(S)) strains in saliva was determined by autoradiography with [(14)C]-xylitol at baseline and at 6, 12, and 18 wk. The lactic acid formation rate was assessed enzymatically in sucrose-challenged plaque suspensions. A drop in salivary ms levels was found in Group A after 6 wk but not after 12 or 18 wk. The proportion of X(S) ms was decreased after 6 wk in groups A and B and remained so during the experimental period. The lactic acid formation rates decreased slightly ( approximately 10%) in the two xylitol groups compared with baseline. In conclusion, our results showed that although an alteration of ms strains was demonstrated following a regular daily low-dose intake of xylitol, the long-term total ms counts in plaque and saliva as well as plaque acidogenicity remained unchanged.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-5691 (URN)10.1111/j.1600-0722.2004.00130.x (DOI)15154922 (PubMedID)
Available from: 2007-01-31 Created: 2007-01-31 Last updated: 2017-12-14Bibliographically approved
2. Effect of xylitol-containing chewing gums on interdental plaque-pH in habitual xylitol consumers.
Open this publication in new window or tab >>Effect of xylitol-containing chewing gums on interdental plaque-pH in habitual xylitol consumers.
2005 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 63, no 4, 233-238 p.Article in journal (Refereed) Published
Abstract [en]

Abstract. The aim was to investigate the effect of high and low amounts of xylitol on the interdental plaque-pH, directly and after sucrose challenge in schoolchildren with a habitual consumption. The study group consisted of 11 healthy children (10-15 years) with low caries risk and the experiment had a single-blind crossover (Latin square) design. After a 2-week run-in period with a daily 4.0 g xylitol intake, the children were subjected to single-dose exposures of chewing gums with i) paraffin (CTR; no xylitol), ii) low dose xylitol (LX; 2.0g xylitol), and iii) high dose xylitol (HX; 6.0g xylitol) in a randomised order separated by a wash-out period of one week. Samples of chewing-stimulated whole saliva were collected prior to and after the experimental period for determination of bacterial counts. The outcome measures were in situ plaque-pH (micro-touch method) and area under the curve (AUC) above pH 6.0. The AUC was significantly greater (p<0.05) in the HX group compared to the LX and control groups during the first 5 minutes after chewing. After a 10% sucrose rinse, the interdental plaque-pH dropped in all groups but the HX regimen displayed significantly less reduction 0-5 min after chewing (p<0.05). No significant alterations of the total viable counts or mutans streptococci levels in saliva were disclosed during the 4-week experimental period. The present results suggested that a high single dose of xylitol had a short and limited beneficial effect on interdental plaque-pH in habitual xylitol consumers while a low single dose, resembling a normal chewing gum use, did not differ from the control.

Identifiers
urn:nbn:se:umu:diva-13279 (URN)10.1080/00016350510019883 (DOI)16040446 (PubMedID)
Available from: 2008-02-07 Created: 2008-02-07 Last updated: 2017-12-14Bibliographically approved
3. Xylitol concentration in saliva and dental plaque after use of various xylitol-containing products
Open this publication in new window or tab >>Xylitol concentration in saliva and dental plaque after use of various xylitol-containing products
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2006 (English)In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 40, no 5, 393-397 p.Article in journal (Refereed) Published
Abstract [en]

The study consisted of two sets of experiments, one in saliva and one in dental plaque. The xylitol concentration in saliva was determined enzymatically in 12 children (mean age 11.5 years) after a standardised use of various xylitol products: (A) chewing gums (1.3 g xylitol), (B) sucking tablets (0.8 g xylitol), (C) candy tablets (1.1 g xylitol), (D) toothpaste (0.1 g xylitol), (E) rinse (1.0 g xylitol), and (F) a non-xylitol paraffin. Unstimulated saliva was sampled 1, 3, 8, 16 and 30 min after use. The concentration in dental plaque was determined after mouthrinses with contrasting amounts of xylitol (LX = 2.0 g, HX = 6.0 g, and control) and supragingival plaque was collected and pooled after 5, 15 and 30 min. The mean xylitol concentration in saliva at baseline was approximately 0.1 mg/ml. All xylitol-containing products resulted in significantly increased levels (p < 0.05) immediately after intake and remained elevated for 8-16 min in the different groups. The highest mean value in saliva was obtained immediately after use of chewing gums (33.7 +/- 16.4 mg/ml) and the lowest was demonstrated after using toothpaste (8.2 +/- 4.9 mg/ml). No significant differences were demonstrated between chewing gums (A), sucking tablets (B), candy (C) and rinses (E). In dental plaque, the mean values were 8.6 +/- 5.4 and 5.1 +/- 4.0 mg/ml 5 min after HX and LX rinses. Concerning the higher concentration, the values remained significantly elevated (p < 0.05) during the entire 30-min follow-up. In conclusion, commonly advocated xylitol-containing products gave elevated concentrations of xylitol in unstimulated whole saliva and dental plaque for at least 8 min after intake. Copyright 2006 S. Karger AG, Basel.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-5693 (URN)10.1159/000094284 (DOI)16946607 (PubMedID)
Available from: 2007-01-31 Created: 2007-01-31 Last updated: 2017-12-14Bibliographically approved
4. Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum.
Open this publication in new window or tab >>Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum.
2007 (English)In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 17, no 2, 79-85 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to investigate the effect of a fixed daily dose of xylitol on mutans streptococci in saliva and the amount of visible dental plaque. A second aim was to explore if the possible effects differed between children with and without caries experience. METHODS: The study was designed as a double-blind randomized controlled trial with two parallel arms. All pupils (n=149) in grades 1-6 in a comprehensive school in northern Sweden were invited, and 128 children (mean age=12.7 years) consented to participate. The children were stratified as having caries experience (DMFS/dmfs>or=1) or not before the random allocation to a test or control group. The control group (A) was given two pellets containing sorbitol and maltitol three times daily for 4 weeks, and the test group (B) received corresponding pellets with xylitol as single sweetener (total dose=6.18 g day). Clinical scoring and saliva samples were collected at baseline and immediately after the test period. The outcome measures were visible plaque index, salivary mutans streptococci counts and salivary lactic acid production. RESULTS: The amount of visible plaque was significantly reduced in both groups after 4 weeks (P<0.05). Likewise, the sucrose-induced lactic acid formation in saliva diminished in both groups (P<0.05). The proportion of mutans streptococci decreased significantly in the test group compared to baseline, but not in the control group (P<0.05). The alterations in the test group seemed most prominent among children without previous caries experience. CONCLUSIONS: The results suggest that chewing gum with xylitol or sorbitol/maltitol can reduce the amount of dental plaque and acid production in saliva in schoolchildren, but only the xylitol-containing gum may also interfere with the microbial composition.

National Category
Dentistry Dentistry
Identifiers
urn:nbn:se:umu:diva-14271 (URN)10.1111/j.1365-263X.2006.00808.x (DOI)17263856 (PubMedID)
Available from: 2007-05-27 Created: 2007-05-27 Last updated: 2017-12-14Bibliographically approved
5. Decreased salivary uptake of [14C]-xylitol after a four-week xylitol chewing gum regimen.
Open this publication in new window or tab >>Decreased salivary uptake of [14C]-xylitol after a four-week xylitol chewing gum regimen.
2007 (English)In: Oral health and preventive dentistry, ISSN 1602-1622, Vol. 5, no 4, 313-319 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aims were to evaluate a simple method to disclose a microbial shift in saliva and to investigate the short- and long-term effects of daily use of xylitol-containing chewing gums on mutans streptococci (MS) and [14C]-xylitol uptake in saliva. MATERIALS AND METHODS: In a pilot set-up, saliva samples were collected from 15 healthy adults and the uptake of xylitol was compared with a specific assay determining xylitol-sensitive MS. The main study consisted of 109 schoolchildren (mean age 9.9 years) who volunteered after informed consent. The children were randomly allocated to a test or control group. The control group was given two pellets containing sorbitol and maltitol 3 times daily for 4 weeks and the test group received identical pellets with xylitol as single sweetener (total dose 6.2 g/day). Saliva samples were collected at baseline, after 4 weeks and 6 months after the intervention. The outcome measures were MS and total viable counts, proportion of MS and salivary uptake of [14C]-xylitol. RESULTS: The pilot study disclosed a fair positive correlation (p < 0.05) between the assays. The proportions of MS and salivary xylitol uptake decreased significantly in the xylitol group by 60% and 30% respectively after 4 weeks compared to baseline which was in contrast to the sorbitol/maltitol group (p < 0.05). Six months after the intervention, the outcome measures did not differ significantly from baseline in any of the groups. CONCLUSION: A relatively high daily dose of xylitol could alter salivary microbial composition during the intervention period but no long-term impact was observed.

Identifiers
urn:nbn:se:umu:diva-22650 (URN)18173093 (PubMedID)
Available from: 2009-05-14 Created: 2009-05-14 Last updated: 2009-09-22

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  • modern-language-association-8th-edition
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