Xilytol en Prevenciin de Caries

7/28/2019 Xilytol en Prevenciin de Caries

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AMERICAN ACADEMY OF PEDIATRIC DENTISTRY

ORAL HEALTH POLICI ES 45

PurposeTe American Academy o Pediatric Dentistry (AAPD) rec-ognizes the benets o caries preventive strategies involvingsugar substitutes, particularly xylitol, on the oral health oinants, children, adolescents, and persons with special healthcare needs. Tis policy is intended to assist oral health careproessionals make inormed decisions about the use o

xylitol-based products in caries prevention.

MethodsTis policy is an update o the previous policy, adopted in2006. Te update is based upon a review o current dentaland medical literature related to the use o xylitol in caries pre-vention. A MEDLINE literature search was conducted usingPubMed with the ollowing parameters: erms: xylitol

AND caries prevention; Field: all elds; Limits: within the

last 10 years, humans, English, birth through 18. wo hundredorty articles matched these criteria; 25 papers were reviewedat this revision. When data did not appear sucient or wereinconclusive, recommendations were based upon expert and/

or consensus opinion by experienced researchers and clinicians.

BackgroundXylitol is a ve-carbon sugar alcohol derived primarily romorest and agricultural materials. It has been used since theearly 1960s in inusion therapy or post-operative, burn, andshock patients; in the diet o diabetic patients; and, most re-cently, as a sweetener in products aimed at improved oral

health.

1

Dental benets o xylitol rst were recognized in Fin-land in 1970, using animal models.2 Te rst chewing gumdeveloped with the aim o reducing caries and improvingoral health was released in Finland in 1975 and in the UnitedStates shortly ater. Te rst xylitol studies in humans, knownas the urku Sugar Studies,3,4 demonstrated the relationshipbetween dental plaque and xylitol, as well as the saety o xy-litol or human consumption. Tese early studies showed thedecayed, missing, and lled (dmf) incidence in teeth in a sucrosechewing-gum group was 2.92 compared to 1.04 in the xylitolgum group. Te most comprehensive study with xylitol gum,conducted in 1995, compared the eect on caries incidence

or xylitol, sorbitol, and sucrose consumption.5 Te group thatreceived 100% xylitol gum 5 times/day had signicantly low-er levels o sucrose and ree sialic acid in whole saliva thanat baseline and signicantly lower plaque index scores.5 Te

xylitol group also exhibited the lowest levels o salivary lac-tobacilli at endpoint, and this group did not experience theage-related increase in Mutans streptococci (MS) as did theother groups.5

Xylitol studies show varying results in the reduction othe incidence o caries or MS levels.5-13 Studies suggest xylitolintake that consistently produces positive results ranged rom4-10 grams per day divided into 3 to 7 consumption periods.5-12

Higher amounts did not result in greater reduction in inci-dence o caries and may lead to diminishing anticariogenicresults.5-13 Similarly, consumption requency o less than 3times per day at optimal xylitol amount showed no eect. 14-16

Abdominal distress and osmotic diarrhea have been reportedollowing the ingestion o xylitol.17-18 Diarrhea has been re-ported in patients who have consumed 3-60 grams o xylitolper day.19-23

Xylitol reduces plaque ormation and bacterial adherence(ie, is antimicrobial), inhibits enamel demineralization (ie, re-duces acid production), and has a direct inhibitory eect onMS. Prolonged use o xylitol appears to select or a xylitol-resistant mutant o the MS cells.24 Tese mutants appear toshed more easily into saliva than the parent strains,25 resultingin a reduction o MS in plaque26 and possibly hampering theirtransmission/colonization rom mother to child. Long-lasting

eects have been demonstrated up to 5 years ater 2 years ousing xylitol chewing gum.27-28 Use o xylitol gum by mothers(2-3 times per day starting 3 months ater delivery and untilthe child was 2 years old) reduced the MS levels in childrenup to 6 years o age and was signicantly better than apply-ing fuoride varnish or chlorhexidine varnish at 6, 12, and 18months ater delivery. At 5 years o age, the xylitol group had70% reduction in caries (dm) as compared with the varnishand chlorhexidine groups. Fluoride varnish alone had littleeect on total salivary levels o MS.27 Some studies suggestthe chewing process may enhance the caries inhibitory eecto xylitol chewing gum.28-31

Originating CouncilCouncil on Clinical Affairs

Adopted2006

Review CouncilCouncil on Clinical Affairs

Revised2010

Policy on the Use of Xylitol in Caries Prevention


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46 ORAL HEALTH POLICIES

REFERENCE MANUAL V 34 / NO 6 12 / 13

Xylitol currently is available in many orms (eg, gums,mints, chewable tablets, lozenges, toothpastes, mouthwashes,cough mixtures, nutraceutical products).32-33 Xylitol chewinggum has been shown to be eective as a preventive agent.Te eectiveness o other xylitol products is being studied atthis time.

Policy statementTe AAPD:

1. supports the use o xylitol as part o a preventive strat-egy aimed speciically at long term caries pathogensuppression and caries (dm ) reduction in higher riskpopulations.

2. recommends that, as urther research and evidence-basedknowledge is available, protocols be established to urtherclariy the impact o delivery vehicles, the requency oexposure, and the optimal dosage to reduce caries andimprove the oral health o children.

3. encourages xylitol-containing products be labeled clear-

ly with regard to their xylitol content to enable dentistsand consumers to ensure therapeutic levels o exposure.31

References1. Mkinen KK. Biochemical principles o the use o xylitol

in medicine and nutrition with special consideration odental aspects. Experientia Suppl 1978;30:1-160.

2. Muhlemann HR, Regolati B, Marthaler M. Te eecton rat ssure caries o xylitol and sorbitol. Helv Odontol

Acta 1970;14(1):48-50.3. Scheinin A, Mkinen KK, ammisalo E, Rekola M.

urku sugar studies. XVIII. Incidence o dental caries inrelation to 1-year consumption o xylitol chewing gum.

Acta Odontol Scand 1975;33(5):269-78.4. Scheinin A, Mkinen KK, Ylitalo K. urku sugar stud-

ies. V. Final report on the eect o sucrose, ructose andxylitol diets on caries incidence in man. Acta OdontolScand 1976;34(4):179-216.

5. Mkinen KK, Benett CA, Hujoel PP, et al. Xylitol chew-ing gums and caries rates: A 40-month cohort study. JDent Res 1995;74(12):1904-13.

6. Mkinen KK, Hujoel PP, Bennett CA, et al. A descriptivereport o the eects o a 16-month xylitol chewing-gumprogramme subsequent to a 40-month sucrose gum pro-gramme. Caries Res 1998;32(2):107-12.

7. Milgrom P, Ly KA, Roberts M, Rothen M, Mueller G,Yamaguchi DK. Mutans Streptococci dose response toXylitol chewing gum. J Dent Res 2006;85(2):177-81.

8. Hujoel PP, Mkinen KK, Bennett CA, et al. he opti-mum time to initiate habitual xylitol gum-chewing orobtaining long-term caries prevention. J Dent Res 1999;78(3):797-803.

9. Mkinen KK. Te rocky road o xylitol to its clinical ap-plication. J Dent Res 2000;79(6):1352-5.

10. Mkinen KK, Chiego DJ Jr, Allen P, et al. Physical, chemi-cal, and histologic changes in dentin caries lesions oprimary teeth induced by regular use o polyol chewinggums. Acta Odontol Scand 1998;56(3):148-56.

11. Mkinen KK, Mkinen PL, Pape HR, et al. Conclusionand review o the Michigan Xylitol Programme (1986-1995) or the prevention o dental caries. Int Dent J

1996;46(1):22-34.12. Deshpande A, Jadad AR. Te impact o polyol-containing

chewing gums on dental caries: A systematic review ooriginal randomized controlled trials and observationalstudies. J Am Dent Assoc 2008;139(12):1602-14.

13. Stecksn-Blicks C, Holgerson PL, wetman S. Eect oxylitol and xylitol-fuoride lozenges on approximal cariesdevelopment in high caries-risk children. Int J PaediatrDent 2008;18(3):170-7.

14. Isokangas P. Xylitol chewing gum in caries prevention. Alongitudinal study on Finnish school children. Proc FinnDent Soc 1987;83(suppl 1):1-117.

15. Rekola M. Correlation between caries incidence andrequency o chewing gum sweetened with sucrose orxylitol. Proc Finn Dent Soc 1989;85(1):21-4.

16. Taweboon S, Taweboon B, Soo-Ampon S. Te eecto xylitol chewing gum on mutans streptococci in salivaand dental plaque. Southeast Asian J rop Med PublicHealth 2004;35(4):1024-7.

17. Scheie AA, Fijerskov O. Xylitol in caries prevention: Whatis evidence or clinical eicacy? Oral Dis 1998;4(4):268-78.

18. Mkinen KK. Dietary prevention o dental caries byxylitol Clinical eectiveness and saety. J Appl Nutr1992;44:16-28.

19. Akerblom HK, Koivukangas , Puuka R, Mononen M.Te tolerance o increasing amounts o dietary xylitol inchildren. Int J Vitam Nutr Res Suppl 1982;22:53-66.

20. Giertsen E, Emberland H, Scheie AA. Eects o mouthrinses with xylitol and luoride on dental plaque andsaliva. Caries Res 1999;33(1):23-31.

21. Salminen EK, Salminen SJ, Porkka L, Kwasowski P,Marks V, Koivistoinen PE. Xylitol vs glucose: Eect onthe rate o gastric emptying and motilin, insulin, and gas-tric inhibitory polypeptide release. Am J Clin Nutr 1989;49(6):1228-32.

22. Uhari M, Kontiokari , Koskela M, Niemela M. Xylitol

chewing gum in prevention o acute otitis media: Doubleblind randomized trial. Brit Med J 1996;313(7066):1180-4.

23. Waler SM, Rolla G. [Xylitol, mechanisms o action anduses]. Nor annelaegeoren id 1990;100(4):140-3.

24. rahan L, Mouton C. Selection or Streptococcus mutanswith an altered xylitol transport capacity in chronic xyli-tol consumers. J Dent Res 1987;66(5):982-8.


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AMERICAN ACADEMY OF PEDIATRIC DENTISTRY

ORAL HEALTH POLICIE S 47

25. rahan L, Sderling E, Dran MF, Chevrier MC, Iso-kangas P. Eect o xylitol consumption on the plaque-saliva distribution o mutans streptococci and the occur-rence and long-term survival o xylitol-resistant strains. JDent Res 1992;71(11):1785-91. Erratum in: J Dent Res1993;72(1):87-8.

26. Sderling E, rahan L, ammiala-Salonen , Hkkinen

L. Eects o xylitol, xylitol-sorbitol, and placebo chewinggums on the plaque o habitual xylitol consumers. Eur JOral Sci 1997;105(2):170-7.

27. Sderling E, Isokangas P, Pienihkkinen K, enovuo J,Alanen P. Infuence o maternal xylitol consumption onmother-child transmission o mutans streptococci: 6 yearollow-up. Caries Res 2001;35(3):173-7.

28. Mkinen KK, Alanen P, Isokangas P, et al. hirty-ninemonth xylitol chewing gum programme in initially 8-year-old school children: A easibility study ocusing onmutans streptococci and lactobacilli. Int Dent J 2008;58(1):41-50.

29. Machiulskiene V, Nyvad B, Baelum V. Caries preventiveeect o sugar-substituted chewing gum. CommunityDent Oral Epidemiol 2001;29(4):278-88.

30. Scheie AA, Fejerskov O, Danielsen B. he eects oxylitol-containing chewing gums on dental plaque andacidogenic potential. J Dent Res 1998;77(7):1547-52.

31. Van Loveren C. Sugar alcohols: What is the evidence or

caries-preventive and caries-therapeutic eects? CariesRes 2004;38(3):286-93.

32. Ly KA, Milgrom P, Rothen M. Xylitol, sweeteners, anddental caries. Pediatr Dent 2006;28(2):154-63. Discussion92-8.

33. Lynch H, Milgrom P. Xylitol and dental caries: An over-view or clinicians. J Cali Dent Assoc 2003;31:205-9.

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Xilytol en Prevenciin de Caries