Friday, June 21, 2024

    Xylitol — More than Just a Sweetener?

                Do you like visiting your dentist? Hearing all sorts of drilling sounds? The average person is not overly thrilled to see the dentist, however visiting the dentist is vital in maintaining good oral health! Dental caries, also known as cavities, is one of the most common oral diseases, but is one of the most preventable! Dental caries creates a burden on individuals causing significant effects financially, aesthetically, thereby reducing the quality of life by causing pain and discomfort. There are many factors involved in the development of dental caries: the complex interactions of bacteria in the mouth, diet, time, and genetics. Oral health education is essential in order to understand the importance of our personal efforts in maintaining oral hygiene. Prioritizing preventative measures such as, toothbrushing (with a fluoridated toothpaste) and flossing, play a key role in maintaining good oral health and reducing the risk of developing cavities. Furthermore, visiting the dentist regularly for cleanings and checkups, drinking fluoridated water, and consuming a low sugar diet with limited snacking all contribute to lowering the incidence of dental caries. There are oral healthcare aids that claim to enhance prevention efforts, such as xylitol. For years xylitol has been increasing in popularity for its benefits to the oral cavity, however researchers are still uncertain on how effective it is. 

    What is xylitol? 

                Xylitol is a naturally occurring substance that is extracted from tree bark and is commonly used as a low calorie sugar substitute. Refined sugar that is part of our everyday diet is considered a major cause to dental caries. However, not only is xylitol commonly used as an over-the-counter sugar substitute, it is said to exhibit properties that prevent dental caries. Today, xylitol is manufactured in products targeted to improve oral health, dispensed in an array of forms such as mouthwashes, chewing gum, candies, lozenges, syrup, and many more! 

    How does it work?

                Normally bacteria in the mouth feed on sugar consumed from our diet, which is converted into acids that dissolve the structure of the tooth leading to dental caries. The mechanism of action of xylitol works to deplete the amount of Streptococcus mutans (S. mutans), a bacterial species commonly found to cause cavities in saliva and plaque, disrupting its process of energy production. Essentially, xylitol disturbs the growth of S. mutans by starving it. As a result, other harmful bacteria have a difficult time sticking to tooth surfaces and therefore, the acid normally a by-product from sugars we consume is reduced. Xylitol is said to prevent tooth decay by directly inhibiting the harmful effects of S. mutans due to its ability to kill bacteria. Additionally, xylitol in the form of a lozenge or chewing gum, increases the saliva flow which helps maintain intact tooth structure. Once xylitol presents in the oral cavity, the amount of S. mutans and plaque is reduced. Aside from benefits to the oral cavity, xylitol has been shown to reduce the growth of certain bacteria that contribute to pneumonia.

                For the most part, xylitol is safe to use and is well tolerated, however some individuals can experience digestive side-effects if consuming too much. It can cause bloating, gas, and diarrhea. If intake is gradually increased over time, an individual’s tolerance can improve. Conversely, xylitol as a sugar substitute is a good alternative because it does not increase blood sugar or insulin levels.  

                Sorbitol, another sugar substitute, when compared to xylitol, also claims to exhibit benefits to the oral cavity, primarily in lowering the risk of developing dental caries, while also promoting saliva flow, and inhibiting S. mutans. Research suggests that xylitol has superior efficacy. One study compared xylitol with a fluoride varnish and all controls separately. Results suggested that xylitol was supported in all scenarios providing evidence in the reduction of dental caries. Interestingly, erythritol, a zero calorie sweetener, benefiting oral health has been found to be more effective than both xylitol and sorbitol in caries prevention. In various long-term studies, erythritol performs significantly better than sorbitol and slightly better than xylitol in preventing caries. Xylitol and erythritol have very similar properties, but xylitol is more accessible and easier to extract from a wider variety of plants than erythritol.

    What does the research say? 

                The volume of studies on xylitol is quite significant as it has been undergoing research since the 1970s as a dental caries preventative agent, and its efficacy. Many studies demonstrate the dental caries preventative effects of xylitol, however these are low quality studies and would require an improved research design to allow for conclusions to be made. A group of authors published a high quality paper focusing on the effects of xylitol on dental caries in children. This paper concluded there is insufficient evidence on xylitol in reducing dental caries. It is worth noting that the dosage of xylitol made a difference—higher xylitol dosage showed greater effects in limiting the progression of dental caries. On the other hand, the low quality of evidence means the efficacy of xylitol is inconclusive. 

    Source: Deniz Mirza, Dental Student at Melbourne Dental School

    Photo by Mathilde Langevin on Unsplash


    Cock, P. D., Mäkinen, K., Honkala, E., Saag, M., Kennepohl, E., & Eapen, A. (2016). Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints. International Journal of Dentistry, 2016, 1-15. doi:10.1155/2016/9868421

    Gales, M. A., & Nguyen, T. (2000). Sorbitol Compared with Xylitol in Prevention of Dental Caries. Annals of Pharmacotherapy, 34(1), 98-100. doi:10.1345/aph.19020

    Janakiram, C., Deepan Kumar, C. V., & Joseph, J. (2017). Xylitol in preventing dental caries: A systematic review and meta-analyses. Journal of natural science, biology, and medicine8(1), 16–21.

    Marghalani, A.A., Guinto, E., Phan, M., Dhar, V., Tinanoff, N. (2017). Effectiveness of Xylitol in Reducing Dental Caries in Children. Paediatric Dentistry, 39(2), 103-110.

    Nayak, P. A., Nayak, U. A., & Khandelwal, V. (2014). The effect of xylitol on dental caries and oral flora. Clinical, cosmetic and investigational dentistry6, 89–94.

    Disclaimer: The statements made in the above article are published on authority of the author and have not been peer reviewed. They do not necessarily reflect the views of Dental Digest and publishing them is not to be regarded as an endorsement of them by Dental Digest.

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