ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Daily Use of Xylitol Gum by Children Over a Period of Time Can Have Long Term Caries Reducing Effects Even After the Gum is No Longer Used
Clinical Question In high caries risk children, does daily use of xylitol gum over time reduce their caries risk even after the use of gum is discontinued?
Clinical Bottom Line In high caries risk children, the daily use of xylitol gum for several months can have caries reducing effects years after the gum is no longer used.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22791282Campus/2012176 High caries risk schoolchildren.Randomized clinical trial
Key resultsThe children used either high dose xylitol (11.6 g daily) or non-xylitol gum for 6 months. They were re-evaluated 2 years after they stopped using the gum. In the xylitol group, the difference in proportion of children with decayed first permanent molars at baseline and follow-up was 1.43 % for frank lesion and 2.86 % for early lesions; while in the non-xylitol group was 10.26 % (p<0.01) and 16.66 % (p<0.01), respectively. The use of high dose xylitol via chewing gum for 6 months gave a long-term caries protective effect up to 2 years after the usage of xylitol stopped.
#2) 10096456Hujoel/1998288 children in BelizeCohort
Key resultsThe children participated in a 2 year habitual gum-chewing program. They were re-evaluated 5 years after they stopped using the gum. The children in the xylitol group (p-value< 0.0034) and the xylitol/sorbitol group (p-value< 0.02) had a significant reduction in caries increment compared to the no-gum group. The long-term decrease in caries increment however only benefited the teeth that erupted during the second year of gum chewing and the year after the gum chewing had stopped (long-term caries risk reduction—teeth erupting the second year of gum-chewing: xylitol 93%, xylitol/sorbitol 67%; Teeth erupting the year after gum-chewing stopped: xylitol 88%, xylitol/sorbitol 64%). The use of gum with 100% xylitol for 2 years gave a long-term benefit for the teeth that erupted during the second year of gum use and the year after the gum use ended, hence the long-term caries risk reduction associated with xylitol strongly depended on when teeth erupted (p < 0.02).
Evidence Search Xylitol gum chewing preventive long-term caries risk
Comments on
The Evidence
The Campus 2012 study was a randomized control trial. 176 children participated and were randomly assigned to 2 experimental groups. 148/176 completed the study (84% completion rate). A power analysis was done prior to the study which showed 132 participants were needed (66 in each group) to make a statistical finding. The Hujole 1998 study was not a randomized trial. 510 children started, 310 completed the 2 year portion (61% of 510) and 288 (93% of 310) were re-evaluated at 5 years.
Applicability These results are applicable most specifically to children in the mixed dentition stage. The long-term caries-preventive effects of xylitol gum can be maximized, if chewing is started at least one year before permanent teeth erupt.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry)
Keywords Xylitol gum long-term caries prevention
ID# 2327
Date of submission: 08/06/2012spacer
E-mail winward@livemail.uthscsa.edu
Author Brent Winward
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor/Co-author e-mail amaechi@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Brent Winward (San Antonio, TX) on 09/17/2012
The biological basis for this treatment outcome is rooted in Loesche's hypothesis that the characteristics of the plaque flora established at the time of tooth eruption determines the life-long caries risk of the tooth (PMID 3858226). Long-term use of xylitol results in the emergence of a xylitol-resistant mutans that is less virulent and cariogenic than its parent strains (PMID 9003237). The less cariogenic mutants colonize the plaque in the areas most prone to caries on teeth that erupted after 1 year of xylitol use. Once established, they prevent colonization by their more cariogenic parent strains thus reducing the caries risk of the newly erupted teeth long-term. Xylitol-resistant strep mutans have a reduced ability to produce polysaccharide which aids in the adhesion on tooth surfaces. The reduced ability to adhere to the tooth reduces plaque formation and acid production capability. Thus the overall benefit of xylitol is a non-cariogenic commensal plaque flora compatible with dental health.
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