Collaborative WHO xylitol field studies in Hungary. I. Three-year caries activity in institutionalized children

The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14-20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6-11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSC, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p less than 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).     

Turku sugar studies V: Final report on the effect of sucrose,fructose and xylitol diets on the caries incidence in man

The purpose was to study differences in the caries increment rate as influenced by various sugars. The trial involved almost complete substitution of sucrose (S) by fructose (F) or xylitol (X) during a period of 2 years. There were no significant initial differences as to caries status between the prospective sugar groups; 35 subjects in the S-group, 38 in the F-group, and 52 in the X-group. During the entire study 10 subjects discontinued or were excluded. The clinical and radiographical observer error was reported and discussed. After 2 years the mean increment of decayed, missed and tilled tooth surfaces was 7.2 in the S-group, 3.8 in the F-group, and 0.0 in the X-group. The weakness of the DMFS-index in not showing the development of new secondary caries and the increase in size of the lesions was overcome by expressing the caries activity in terms of indices showing the total quantitative and qualitative development. The results showed a massive reduction of the caries increment in relation to xylitol consumption. Fructose was found to be less cariogenic than sucrose. It was suggested that the non- and anticariogenic properties of xylitol principally depend on its lack of suitability for microbial metabolism and physico-chemical effects in plaque and saliva.     

The effect of supervised brushing on caries inhibition in school age children.

A supervised brushing program was incorporated into a three-year caries clinical trial whose primary objective was to compare the efficacy between two fluoride levels of a dentifrice (1,000 and 1,500 ppm F MFP). For each of the 2,415 children completing the three-year study, the total number of supervised brushing sessions completed was available. Results indicated that children who complied well with the supervised brushing program by participating in at least 70% of the sessions had a significantly lower caries increment in both fluoride levels (p less than .001) than children who did not comply as well. After adjusting for age, sex, and baseline DMFS of the children, as well as the fluoride level received, a multiple regression model showed that supervised brushing further reduced the three year caries increment (p less than .04). The more frequent use of the higher fluoride dentifrice affords the greatest prevention of decay. The conclusion from this study is that compliance with the supervised brushing program resulted in a reduced caries increment regardless of the level of fluoride in the dentifrice.     

Caries increment and gingival status during 2 years' use of chlorhexidine- and fluoride-containing dentifrices

Abstract – A total of 91 schoolchildren, 13 years of age, were distributed into three groups. Three test dentifrices were used containing 0.1% NaF, 0.1% NaF and 2% chlorhexidine, and 2% chlorhexidine, respectively. The caries increment and gingival conditions over a period of 2 years were recorded. The caries data of the groups were compared and related to two reference groups in order to estimate a possible influence upon the study results by a change in caries incidence general to the area and age groups in question. There was less caries in the group using the dentifrice containing fluoride and chlorhexidine than in the two other test groups. The differences in caries increment between the groups were not statistically significant. The gingival health seemed to improve in all groups, but there were no statistically significant differences between the groups. The caries data from the reference groups indicated that the general trend towards reduced caries incidence was different from that of the study group.     

Effect on caries of daily supervised toothbrushing with sodium monofluorophosphate and sodium fluoride dentifrices after 3 years.

In a 3-year clinical trial the effect of daily supervised toothbrushing with a dentifrice containing sodium fluoride/silicon dioxide and a dentifrice containing sodium monofluorophosphate/calcium phosphate and calcium carbonate was investigated. Initially about 400 children aged 9-11 years from one school in Malm? took part in the study. They were randomly divided into two groups. Each group brushed their teeth daily in school under the supervision of a dental hygienist. The children and their families were given the corresponding dentifrices for home use. The children were examined for caries at the start of the study and again after an interval of 1 year by the same dentist and according to the stated criteria. A comparison of the caries increments in the two dentifrice groups revealed a statistically significantly lower caries increment during the 2nd and 3rd experimental years in the sodium fluoride dentifrice group compared with the sodium monofluorophosphate dentifrice group.     

Effect on caries of daily supervised toothbrushing with sodium monofluorophosphate and sodium fluoride dentifrices after 3 years

abstract – In a 3-year clinical trial the effect of daily supervised toothbrushing with a dentifrice containing sodium fluoride/ silicon dioxide and a dentifrice containing sodium monofluorophosphateo/calcium phosphate and calcium carbonate was investigated. Initially about 400 children aged 9–11 years from one school in Malmö took part in the study. They were randomly divided into two groups. Each group brushed their teeth daily in school under the supervision of a dental hygienist. The children and their families were given the corresponding dentifrices for home use. The children were examined for caries at the start of the study and again alter an interval of 1 year by the same dentist and according to the stated criteria. A comparison of the caries increments in the two dentifrice groups revealed a statistically. Significantly lower caries increment during the 2nd and 3rd experimental years in the sodium fluoride dentifrice group compared with the sodium monofluorophosphate dentifrice group.     

Biochemical, microbiologic, and clinical comparisons between two dentifrices that contain different mixtures of sugar alcohols

It has been customary to think that in a dentifrice only a few of its ingredients would be active and have clinically significant effects on dental caries, oral hygiene, and the levels of caries-inducive microorganisms or harmful plaque metabolic products. Therefore, most of the emphasis has been placed on the type of fluorine compounds, abrasives, or similar dentifrice ingredients. This study shows that such common dentifrice components as the humectants, which contribute to the texture, rheologic characteristics, and shelf life of the product, also may affect the type of dental plaque grown on the tooth surfaces between toothbrushings or during long-term neglect of toothbrushing or of oral hygiene. Commonly used humectants include sorbitol, a sugar alcohol of the hexitol type, which is used often in sugarless candies. This study showed that when sorbitol in a dentifrice was replaced by xylitol, a sugar alcohol of the pentitol type, the dental plaque of human subjects contained more ammonia and significantly less bacterial polysaccharides. It is accepted generally that ammonia neutralizes plaque acids and that bacterial polysaccharides are involved in promoting caries. Xylitol-containing dentifrice also reduced the saliva levels of S mutans. The results further indicated that if sorbitol and xylitol could be compared in a short-term dentifrice study that relied on subjective and coarse plaque determinations only, no differences between those dentifrices would be found necessarily. To demonstrate the differences between the experimental dentifrices used in this study, it was necessary to analyze specific plaque components and the salivary levels of S mutans.(ABSTRACT TRUNCATED AT 250 WORDS)     

The caries-preventive effect of xylitol/maltitol and erythritol/maltitol lozenges: results of a double-blinded, cluster-randomized clinical trial in an area of natural fluoridation

International Journal of Paediatric Dentistry 2012; 22: 180–190 Objective. Xylitol studies suggest caries reductions in the order of 50%. Based on animal/microbial studies, erythritol potentially has caries‐preventive properties. However, clinical studies are required to confirm this.The aim of the study was to investigate the additional caries‐preventive effect of xylitol/maltitol and erythritol/maltitol lozenges delivered at school, relative to controls receiving comprehensive prevention, in a low‐caries prevalence population. Methods. A 4‐year, cluster‐randomized, double‐blinded clinical trial. Five hundred and seventy‐nine 10‐year‐old consenting subjects from 21 schools were randomly assigned to one of five groups. Four groups used the lozenges on school days, in three teacher‐supervised sessions daily, over 1 or 2 years. The daily amount was 4.7 g/4.6 g for xylitol/maltitol and 4.5 g/4.2 g for erythritol/maltitol. The groups received free examinations and care in the public health centre. Four hundred and ninety‐six children were analysed. The main outcome measure was dentin caries increment based on a clinical examination at 4 years since the start. The groups were compared in relation to the increment using hierarchical logistic regression to adjust for potential clustering. Results. Use of xylitol/maltitol or erythritol/maltitol lozenges did not result in caries reduction. A strong relationship between baseline caries prevalence and the 4‐year increment was observed (OR = 7.38; 95% CI: 3.78–14.41). Conclusions. The results suggest that in relatively low‐caries conditions the school‐based use of xylitol/maltitol or erythritol/maltitol lozenges would not have additional caries‐preventive effect when compared with comprehensive prevention.     

Effect on caries of different fluoride prophylactic programs in preschool children. A two year clinical study

376 three-year old children were divided into four experimental groups and exposed to different combinations of preventive programs for a period of two years. All the groups were given the same basic prophylactic information. Additionally Group I received fluoride tablets (FLUDENT) for daily sucking twice a day plus a placebo dentifrice free of fluoride. Group II was given a fluoride dentifrice containing 0.025% F, (ACTA). Group III was given a placebo dentifrice plus fluoride varnish (Duraphat) twice a year. Group IV a fluoride dentifrice containing 0.025% F (ACTA) plus fluoride varnish (Duraphat) twice a year. No statistically significant difference in caries increment during the two experimental years was found between the groups. A tendency to lower caries increment was found in Group IV, i.e. in the children using the low fluoride dentifrice and treated twice a year with fluoride varnish.     

Collaborative WHO xylitol field studies in Hungary. VII. Two-year caries incidence in 976 institutionalized children

The aim was to assess caries increment as influenced by partial substitution of sucrose by xylitol (X group) over a 2-year period in comparison with systemic fluoride (F group) and restorative treatment only (C group). The study differed from the 3-year field study of the same series primarily in that existing base-line differences were eliminated because the protocol required that all the new subjects entering the institutions in the 1st year were to be included for a 2-year trial. During this period the number of dropouts was 243 (19.9% of all subjects), the final material consisting of 976 children (6-12 years old). The 2-year DMFS increment was 3.8 in the X group, 4.8 in the F group, and 6.0 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSX, 4.5; RSF, 5.5; and RSC, 7.5. The xylitol regimen resulted in a lower increment of caries than measured in the F and C groups (p less than 0.001; convariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants.     

Caries-preventive effect of fluoride dentifrices with and without anticalculus agents: a 3-year controlled clinical trial

A 3-year, double-blind, randomized caries trial was conducted to evaluate the relative anticaries efficacy of four sodium fluoride dentifrices containing 250 ppm fluoride, 1,000 ppm fluoride in combination with 1% disodium 1-hydroxyethylidene-1.1-bisphosphonate (HEBP), and 1,000 ppm fluoride in combination with 1% disodium azacycloheptylidene-2.2-bisphosphonate (AHBP). As a positive control, a monofluorophosphate dentifrice (1,000 ppm fluoride) was used. At outset 1,161 Icelandic children, 11 and 12 years of age, were randomly assigned to one of the five treatment groups and 1,035 subjects completed the trial. After 3 years of unsupervised brushing, the dentifrice containing 250 ppm fluoride was significantly less effective in controlling the caries increment. The combination of sodium fluoride and AHBP was significantly more effective than the positive control.     

Caries-preventive effect of a dentifrice containing 2% sodium monofluorophosphate in a natural fluoride area in Denmark

abstract A 3-year, unsupervised, toothbrushing study with a double-blind, controlled design was conducted to evaluate the caries-preventive effectiveness of a 2 % sodium monofluorophosphate dentifrice among 1,407 7- to 12-year-old children residing in an optimal, natural fluoride (= 1.2–1.4 parts/10⁶) area of Denmark. With the initial caries lesion as a differential, two levels of clinical caries diagnosis were applied in the quantitative evaluation of the effects. A comparison of the monofluorophosphate dentifrice with a null control dentifrice indicated that its use at home, coupled with regular motivation by home visitors, conferred about a 30 % reduction in dental caries increment over a 3-year period, beyond those anticariogenic benefits assumed to have been provided by the waterborne fluoride.     

Caries-preventive effect of a dentifrice containing 2% sodium monofluorophosphate in a natural fluoride area in Denmark

abstract A 3-year, unsupervised, toothbrushing study with a double-blind, controlled design was conducted to evaluate the caries-preventive effectiveness of a 2 % sodium monofluorophosphate dentifrice among 1,407 7- to 12-year-old children residing in an optimal, natural fluoride (= 1.2–1.4 parts/10⁶) area of Denmark. With the initial caries lesion as a differential, two levels of clinical caries diagnosis were applied in the quantitative evaluation of the effects. A comparison of the monofluorophosphate dentifrice with a null control dentifrice indicated that its use at home, coupled with regular motivation by home visitors, conferred about a 30 % reduction in dental caries increment over a 3-year period, beyond those anticariogenic benefits assumed to have been provided by the waterborne fluoride.     

Effect of xylitol and xylitol-fluoride lozenges on approximal caries development in high-caries-risk children

Aim.  To evaluate the effect of xylitol- and xylitol/fluoride-containing lozenges on approximal caries development in young adolescents with high caries risk.
Study design.  A 2-year double-blind trial with two parallel arms and a nonrandomized reference group.
Material and methods.  One hundred and sixty healthy 10- to 12-year-old children with high caries risk were selected. After informed consent, they were randomly assigned into a xylitol and a xylitol/fluoride group. They were instructed to take two tablets three times a day (total xylitol and fluoride dose 2.5 g and 1.5 mg, respectively). The compliance was checked continuously and scored as good, fair, or poor. A reference no-tablet group was also selected ( n  = 70) for group comparison. The outcome measure was approximal caries incidence.
Results.  The dropout rate was 28%, and 41% exhibited a good compliance with the study protocol. No statistically significant differences in caries incidence could be found between the study groups ( P  > 0.05). Among a subgroup of children who demonstrated good compliance, the mean ΔDMFSa value was significantly lower in the xylitol/fluoride group compared to the xylitol group, 1.0 ± 2.3 vs. 3.3 ± 4.6 ( P <  0.05), while no difference could be displayed between any of the study groups and the reference group ( P  > 0.05).
Conclusion.  The results from this 2-year trial did not support a self-administered regimen of xylitol- or xylitol/fluoride-containing lozenges for the prevention of approximal caries in young adolescents with high caries risk.     

Caries-preventive effect of dentifrices containing various types and concentrations of fluorides and sugar alcohols

The caries-inhibiting effect of unsupervised daily use of four different toothpastes was compared in a 3-year clinical and microbiological study: (1) 0.8% sodium monofluorophosphate (MFP) with 3% xylitol and 6% sorbitol; (2) 0.03% sodium fluoride with 3% xylitol and 6% sorbitol; (3) 0.8% MFP with 9% sorbitol, and (4) 0.03% sodium fluoride with 9% sorbitol. In all 284 children, 12-13 years old at baseline, took part in the study. After 3 years, no statistically significant differences were found between the different toothpaste groups concerning either development of initial or gross caries lesions or number of mutans streptococci and lactobacilli in saliva. However, children with no detectable approximal caries at baseline, who used the MFP toothpaste with the xylitol-sorbitol mixture, showed a lower (p less than 0.05) caries increment as compared with children who used the MFP toothpaste with sorbitol alone.     

Low-fluoride dentifrice and caries lesion control in children with different caries experience: a randomized clinical trial

Since there is no consensus on the anticaries effectiveness of low-fluoride (F) dentifrice, this randomized clinical trial evaluated its effect in children at different caries activity status. One hundred and twenty 2- to 4-year-old children, half with and half without active caries lesions, were randomly divided into 2 groups which used 500- or 1,100-microg F/g (NaF) dentifrices during 1 year. Caries progression or regression were evaluated as the number of lesions becoming active/cavities or inactive, respectively. The anticaries effect of the low-F dentifrice was similar to the conventional F dentifrice when used by caries-inactive children. However, in children with active caries lesions the low-F dentifrice was less effective than the 1,100-microg F/g dentifrice in controlling the progression of lesions. The data suggest that the child caries activity may be taken into account to recommend a low-F dentifrice.     

A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs

The effect of chewing gum containing xylitol on the incidence and progression of dental caries was tested in a sample of 274 children, aged eight and nine years, of low socio-economic status and high caries rate. They were divided into two experimental groups (15% and 65% xylitol chewing gum distributed three times a day at school) and one control group (without chewing gum). The three groups were exposed to the same basic preventive program. Children who chewed gum had a significantly lower net progression of decay (progressions-reversals) over a 24-month period than did the controls. Results for the two groups chewing gum were similar. Chewing xylitol gum had a beneficial effect on the caries process for all types of tooth surfaces, and especially for bucco-lingual surfaces. The two experimental groups had a DMF(S) increment of 2.24 surfaces, compared with 6.06 surfaces for the control group. For this indicator, there was no difference between the two experimental groups. Results for the plaque index were in agreement with those of the DMF(S) increment and the net progression of decay.     

Caries prevention in Chinese children with sodium fluoride dentifrice delivered through a kindergarten-based oral health program in China

Caries in China appears to be a significant problem, especially among preschool children. The effect of caries prevention in the primary teeth of preschool children through the use of fluoridated dentifrices and prevention programs has not been widely addressed. The purpose of this study was to examine the caries preventive effects of an 1100 ppm sodium fluoride dentifrice used in the context of a kindergarten-based oral health program compared to a matched placebo dentifrice in the absence of a kindergarten-based oral health program. This was a randomized, placebo-controlled, examiner-blind, two-year caries study. A population of 1,334 preschool school children, three years of age, was recruited from 24 school kindergartens in Huairoi and Miyun counties, located approximately 60 kilometers northeast of Beijing, China. Classrooms were stratified based on mean baseline dmfs scores derived from the visual-tactile baseline examination, and randomly assigned to one of the two dentifrice treatment groups: 0.243% sodium fluoride (1100 ppm fluoride ion) or placebo (0 ppm fluoride ion). Children attending the schools participating in the program brushed twice a day (morning and afternoon) at school under the supervision of classroom teachers during the school week. The children randomized to schools receiving the placebo dentifrice were supplied with toothbrushes and dentifrice for ad libitum use at home and did not participate in the school program or supervised classroom brushing. For the primary examiner, the two-year caries increment data demonstrated evidence of anticaries efficacy for the sodium fluoride dentifrice/school program group as compared to the placebo/no school program group. In the evaluable subset, the 1100 ppm fluoride treatment group had a 20.7% reduction in dmfs compared to the placebo treatment group, that was statistically significant (p = 0.004). The secondary examiner observed a similar overall treatment effect, as the 1100 ppm fluoride treatment group had an 22.1% reduction in dmfs compared to the placebo treatment group that was statistically significant (p = 0.014). In contrast to the primary examiner, there was a county-by-treatment interaction for the secondary examiner's results necessitating that the counties be examined independently. In Miyun county, the sodium fluoride/school program group had a 39.9% reduction in caries compared to the placebo/no program group that was statistically significant (p = 0.001). In Huairou county, the sodium fluoride/school program group had a 6.8% reduction in caries compared to the placebo/no program group that was not statistically significant (p > 0.05). These results demonstrate that fluoride in conjunction with increased dental awareness can deliver important reductions in caries in preschool children.     

Clinical results after 12 months from a study of the incidence and progression of dental caries in relation to consumption of chewing-gum containing xylitol in school preventive programs

This study was designed to evaluate the effect of chewing-gum containing xylitol on the incidence and the progression of dental caries. A sample of 433 children, aged 8 and 9 years, of low socio-economic status and high caries rate, was divided into two experimental groups (15% or 65% xylitol chewing-gum distributed three times a day at school) and one control group (without chewing-gum). The three groups were exposed to the same basic preventive program. Children who chewed gum had a significantly smaller DMF(S) increment over a 12-month period than did the control group. The former had increments of 1.58 surfaces, compared with 3.28 for the latter. No statistically significant difference, however, was demonstrated between the two experimental groups. The net progression of decay (progressions-reversals) showed a significant difference between the two experimental groups and the control group. In addition, 65% xylitol chewing-gum produced better results than did that containing 15% xylitol, suggesting a dose-response relationship. Chewing xylitol gum had a beneficial effect on the caries process for all types of tooth surfaces, but chewing gum with a higher xylitol content had an additional positive effect on buccolingual surfaces. A questionnaire asking the participants about stomach pain indicated that there was no difference between the experimental and control groups. The feasibility of such a preventive measure has been demonstrated by the excellent level of participation of both children and teachers. This activity could easily be integrated into existing preventive public health programs.     

Screening of caries in children through salivary lactobacilli and yeasts

The caries predictive value of salivary counts of lactobacilli and yeasts was evaluated in 298 children (from 6 to 11 yr of age) concurrently to a 3-yr xylitol field study in Hungary. On a group level the salivary yeasts and the combined information of lactobacilli and yeasts predicted the 3-yr caries increment acceptably. On an individual basis salivary yeasts had more power than salivary lactobacilli. At best the sensitivity and specificity of yeasts were 74% and 75%, and the combined information of lactobacilli and yeasts, 69% and 83%, respectively. Although the results were not that good in all subgroups of the study, they indicate the value of salivary yeasts in caries prediction either as a sole test or together with salivary lactobacilli.