The effect of xylitol on dental caries and oral flora

Clinical, Cosmetic and Investigational Dentistry Dovepress open access to scientific and medical research Review Clinical, Cosmetic and Investigational Dentistry downloaded from https://www.dovepress.com/ by 5.135.15.0 on 12-Jul-2018 For personal use only. Open Access Full Text Article The effect of xylitol on dental caries and oral flora This article was published in the following Dove Press journal: Clinical, Cosmetic and Investigational Dentistry 10 November 2014 Number of times this article has been viewed Prathibha Anand Nayak 1 Ullal Anand Nayak 2 Vishal Khandelwal 3 Department of Periodontics, NIMS Dental College and Hospital, Jaipur, Rajasthan, India; 2Department of Pedodontics and Preventive Dentistry, NIMS Dental College and Hospital, Jaipur, Rajasthan, India; 3Department of Pedodontics and Preventive Dentistry, Index Dental College and Hospital, Indore, Madhya Pradesh, India 1 Introduction Correspondence: Prathibha Anand Nayak Department of Periodontics, NIMS Dental College and Hospital, Shobha Nagar, Jaipur-Delhi Highway, Jaipur, Rajasthan 303121, India Tel +91 88 9031 8168 Email Xylitol, a naturally occurring five-carbon sugar polyol, is a white crystalline carbohydrate known since a century ago. It has been widely studied during the last 40 years for its effect on dental caries. It is found naturally in fruit, vegetables, and berries and is artificially manufactured from xylan-rich plant materials such as birch and beechwood.1 Since a study conducted in Turku, Finland, evaluating the effectiveness of xylitol on dental plaque reduction in 1970, xylitol has been widely researched and globally accepted as a natural sweetener approved by the US Food and Drug Administration (FDA) and the American Academy of Pediatric Dentistry.2 It has been observed that when all associated factors of dental caries, such as age, sex, race, number of teeth, and oral hygiene, were controlled, taste was found to be the only variable that was related to overall caries experience.3 In the recent past, sugar consumption has increased, especially in children and adolescents, to 120 pounds per person each year or 20 teaspoons of table sugar per day.4 This excessive consumption of sugar has led to negative health concerns like diabetes mellitus and dental caries and has increased awareness among the public and medical and dental professionals regarding the benefits of replacing sugar with nonsugar sweeteners. Hence, artificial sweeteners or noncaloric sweeteners are effective in reducing weight and such health disorders. However, an artificial sweetener is 300–400 times sweeter than table sugar, and a small amount of it can provide the same level of sweetness. Sweeteners can be divided into nutritive and non-nutritive sweeteners. The nutritive sweeteners contain carbohydrates and provide energy. The non-nutritive sweeteners 89 submit your manuscript | www.dovepress.com Clinical, Cosmetic and Investigational Dentistry 2014:6 89–94 Dovepress © 2014 Nayak et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/CCIDE.S55761 Powered by TCPDF (www.tcpdf.org) Abstract: Dental caries, the most chronic disease affecting mankind, has been in the limelight with regard to its prevention and treatment. Professional clinical management of caries has been very successful in cases of different severities of disease manifestations. However, tertiary management of this disease has been gaining attention, with numerous methods and agents emerging on a daily basis. Higher intake of nutritive sweeteners can result in higher energy intake and lower diet quality and thereby predispose an individual to conditions like obesity, cardiovascular disorders, and type 2 diabetes mellitus. Non-nutritive sweeteners have gained popularity as they are sweeter and are required in substantially lesser quantities. Xylitol, a fivecarbon sugar polyol, has been found to be promising in reducing dental caries disease and also reversing the process of early caries. This paper throws light on the role and effects of various forms of xylitol on dental caries and oral hygiene status of an individual. Keywords: xylitol, caries preventive effect, oral flora Dovepress Clinical, Cosmetic and Investigational Dentistry downloaded from https://www.dovepress.com/ by 5.135.15.0 on 12-Jul-2018 For personal use only. Nayak et al offer little or no energy when they are consumed. The US Department of Agriculture pattern for 2,000 kcal recommends no more than 32 g (8 tsp added sugars per day) or 6% of 2,000 kcal. The FDA regulates health claims on food labels, and the claim that sweeteners do not promote dental caries has been successfully approved for sugar alcohols, isomaltulose, erythritol, D-tagatose, and sucralose.5 Currently, more than 35 countries have approved the use of xylitol in foods, pharmaceuticals, and oral health products, principally in chewing gums, toothpastes, syrups, and confectioneries. Habitual xylitol consumption may be defined as daily consumption of 5–7 g of xylitol at least three times a day.6 The recommended dose for dental caries prevention is 6–10 g/d. For those with temporomandibular joint dysfunction and who have difficulty in chewing, xylitol candy should be used instead of chewing gum. At high dosages, xylitol can cause diarrhea in children at 45 g/d and 100 g/d in adults. The amount tolerated varies with individual susceptibility and body weight. Most adults can tolerate 40 g/d. Mechanism of action Xylitol reduces the levels of mutans streptococci (MS) in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death.7 It reduces the adhesion of these microorganisms to the teeth surface and also reduces their acid production potential.8,9 Xylitol, like any other sweetener, promotes mineralization by increasing the salivary flow when used as chewing gum or large xylitol pastille. The uniqueness of xylitol is that it is practically nonfermentable by oral bacteria. Also, there is a decrease in levels of MS, as well as the amount of plaque, when there is habitual consumption of xylitol.10 Streptococcus mutans transports the sugar into the cell in an energy-consuming cycle that is responsible for growth inhibition. Xylitol is then converted to xylitol-5-phosphate via phosphoenolpyruvate: fructose phosphotransferase system by S. mutans resulting in development of intracellular vacuoles and cell (...truncated)