Effect of xylitol-containing chewing gums on interdental plaque-pH in habitual xylitol consumers

Objective. The aim was to investigate the effect of high and low amounts of xylitol on the interdental plaque-pH, directly and after sucrose challenge, in schoolchildren with habitual consumption. Material and methods. The study group consisted of 11 healthy children (10–15 years) with low caries risk and the experiment had a single-blind crossover (Latin square) design. After a 2-week run-in period with a daily 4.0 g xylitol intake, the children were subjected to single-dose exposures of chewing gums with (i) paraffin (CTR; no xylitol), (ii) low-dose xylitol (LX; 2.0 g xylitol), and (iii) high-dose xylitol (HX; 6.0 g xylitol) in a randomized order separated by a washout period of 1 week. Samples of chewing-stimulated whole saliva were collected prior to and after the experimental period for determination of bacterial counts. The outcome measures were in situ plaque-pH (micro-touch method) and area under the pH curve (AUC). Results. The AUC was significantly greater (p<0.05) in the HX group compared to the LX and control groups during the first 5 min after chewing. After a 10% sucrose rinse, the interdental plaque-pH dropped in all groups but the HX regimen displayed significantly less reduction 0–5 min after chewing (p<0.05). No significant alterations of the total viable counts or mutans streptococci levels in saliva were disclosed during the 4-week experimental period. Conclusions. The present results suggested that a high single dose of xylitol had a short and limited beneficial effect on interdental plaque-pH in habitual xylitol consumers, while a low single dose, resembling normal chewing gum use, did not differ from the control.     

麦芽糖醇口香糖对青少年牙菌斑的抑制效果

目的评价麦芽糖醇口香糖控制青少年牙菌斑集聚水平的临床效果。方法将30名13～15岁龋易感受试者随机分为A、B、C组,根据分组分别每天咀嚼麦芽糖醇口香糖、木糖醇口香糖、胶母基口香糖5次,每次10 min。采用改良Quigley-Hein菌斑指数记录法分别于基线、4周时检查受试者的菌斑指数情况。应用SPSS 17.0软件对数据进行统计分析。结果咀嚼口香糖4周后,3组受试者的菌斑指数都有明显下降,与基线相比的差异有统计学意义（P=0.000、0.000、0.006）;3组菌斑指数变化间的差异也有统计学意义（P=0.015）,组间两两比较结果表明,A组与B组菌斑指数变化间的差异无统计学意义（P=0.687）,而A组与C组、B组与C组菌斑指数变化间的差异有统计学意义（P=0.019、0.007）。结论麦芽糖醇口香糖对青少年牙菌斑的抑制效果与木糖醇口香糖相似。     

The effect of xylitol and chlorhexidine acetate/xylitol chewing gums on plaque accumulation and gingival inflammation

Chewing gums may be suitable vehicles for the delivery of xylitol (X) and chlorhexidine acetate (CHX), both of which can aid oral health. The aim of this study was to determine the clinical effectiveness of chewing gums containing X or a combination of X and CHX in a double-blind, randomised, cross over, 5-day clinical trial, with a 9-day washout period in a group of participants over 40 years old. After professional tooth cleaning, 8 subjects (mean age 51.3+/-10.4 years) used in a random order 2 pieces of ACHX (a liquorice flavoured CHX/X) gum, 2 pieces of BCHX (a chocolate mint flavoured CHX/X), 2 pieces of X (a liquorice flavoured X gum) and 1 piece of ACHX. Gums were chewed 2x daily for 15 min and volunteers refrained from all other oral hygiene procedures. Data were analysed using Friedman nonparametric analysis of variance. Plaque indices for chewing 2 pieces of ACHX gum (0.78+/-0.15) and BCHX gum (0.52+/-0.15) were significantly lower (p<0.0006) than for X gum (1.57+/-0.08). The gingival index was significantly greater (p<0.05) for X containing gum than for the other chewing regimes. The subjects' attitudes to the gums were also assessed by structured questionnaires which showed that all gums were easy to chew, did not adhere to dentures, teeth or restorations and that the subjects preferred to chew 2 pellets rather than 1.     

Effect on plaque growth of xylitol and sucrose-containing chewing gums

Two experiments tested the effects of xylitol or sucrose-containing chewing gums on plaque formation. In the first experiment the 18 subjects maintained their normal dietary habits, and in the second they received a sucrose-free diet during the 3-day experimental periods. Plaque formation was assessed gravimetrically and/or planimetrically. When the dietary habits were not altered, neither the sucrose nor the xylitol-containing chewing gums had significant effects on the plaque scores. When sucrose was almost eliminated from the diet, plaque formation was significantly higher in the sucrose than in the xylitol and the placebo groups. Although plaque formation was lower in the xylitol group than in the placebo group, the differences were not statistically significant.     

Salivary mutans streptococci and dental caries in three-year-old children after maternal exposure to chewing gums containing combinations of xylitol,sorbitol, chlorhexidine,and fluoride

The aim of this study was to evaluate the effect of maternal use of chewing gums containing combinations of xylitol, sorbitol, chlorhexidine, and fluoride on salivary mutans streptococci (MS) counts and caries prevalence in the mothers' 3-year-old children. After screening 416 women with newborn babies, 173 mothers with high counts of salivary MS were randomly assigned into 3 experimental chewing gum groups containing (A) xylitol (n=61), (B) chlorhexidine/xylitol/sorbitol (n=55), and (C) sodium fluoride/xylitol/sorbitol (n=57). Mothers with low or medium MS counts formed a reference group (D) without any intervention (n=232). The participants in the experimental groups were instructed to chew one piece of the gum for 5 min 3 times a day. The chewing regimen started when the child was 6 months old and was terminated 1 year later. The outcome measures were salivary MS counts and caries prevalence at the age of 3 years. Bacterial enumeration was carried out with a chair-side technique and caries (defs) was scored by clinical examination. Medium and high counts of salivary MS were found in 13%, 16%, and 22% in groups A, B, and C, respectively. The mean defs was 0.1 in group A, 0.2 in group B, and 0.4 in group C. The differences concerning salivary MS and caries were not statistically significant. The MS counts and caries prevalence in children of mothers with low MS counts (group D) were similar to those found in groups A and B. In conclusion, lower but non-significant levels of salivary MS and dental decay were observed in 3-year-old children to mothers who used high-content xylitol gums compared with those who used lower amounts of xylitol. The efficiency of this type of targeted intervention in a low-caries community may be questioned.     

Oral mutans streptococci levels following use of a xylitol mouth rinse: a double‐blind,randomized, controlled clinical trial

Xylitol‐sweetened chewing gum has cariostatic properties, but is not suitable for all patients. This study evaluated the effect of xylitol rinse on mutans streptococci (MS) levels in the mouth. One hundred and five subjects with high salivary MS levels were randomly assigned to one of three groups. Subjects in the positive control group (N = 35) chewed two xylitol gum pellets for at least 5 minutes three times daily (xylitol dose: 4.3g/day). The experimental group (N = 36) rinsed with 20 mL of an aqueous solution of xylitol twice daily for 60 seconds (dose: 4.4g/day). The negative control group (N = 34) used neither product. No attempt was made to change the subjects’ diet. Mean MS levels at baseline were 5.6 (0.1) in positive control, 5.4 (0.1) in experimental, and 5.5 (0.1) in negative control groups. After 3 months, MS levels were 4.4 (0.2), 4.4 (0.2), and 4.9 (0.2), respectively. Differences between groups were not significant by ANOVA (p = .2); however, MS levels tended to be lower in the experimental and positive control groups. Xylitol rinse and chewing gum caused a similar but statistically insignificant reduction in MS levels in the mouth.     

咀嚼无糖口香糖对成年人菌斑指数的影响

目的 评价麦芽糖醇口香糖对菌斑集聚水平的影响。方法 60名年龄于25~50岁之间,符合纳入标准的志愿者,按照性别、Qu igley-Hein(Turesky改良)菌斑指数(MPI)随机分为3组,每组20人,3组分别为麦芽糖醇口香糖组(MCG)、木糖醇口香糖组(XCG)、单纯胶基口香糖组(GB);指导志愿者咀嚼口香糖,每天5次,每次2粒(约1.4 g/粒),持续12周。通过记录MPI来评价菌斑集聚水平的变化,采用多因素重复测量方差分析的方法对处理因素,时间因素,以及处理与时间交互因素进行分析(P<0.05)。结果 与基线值相比,MCG组、XGG组、GB组受试者MPI分别下降了48.1%、52.4%、21.6%,MCG组与XCG组之间无显著性差异(P>0.05),MCG组、XCG组与GB组之间均有显著性差异(P<0.01)。结论 传统木糖醇口香糖与麦芽糖口香糖对菌斑抑制有着相似的功效。     

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes

AIM: A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated. METHODS: Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months. RESULTS: In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum. CONCLUSION: The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.     

Effect of xylitol-containing chewing gums on interdental plaque-pH in habitual xylitol consumers

OBJECTIVE: The aim was to investigate the effect of high and low amounts of xylitol on the interdental plaque-pH, directly and after sucrose challenge, in schoolchildren with habitual consumption. MATERIAL AND METHODS: The study group consisted of 11 healthy children (10-15 years) with low caries risk and the experiment had a single-blind crossover (Latin square) design. After a 2-week run-in period with a daily 4.0 g xylitol intake, the children were subjected to single-dose exposures of chewing gums with (i) paraffin (CTR; no xylitol), (ii) low-dose xylitol (LX; 2.0 g xylitol), and (iii) high-dose xylitol (HX; 6.0 g xylitol) in a randomized order separated by a washout period of 1 week. Samples of chewing-stimulated whole saliva were collected prior to and after the experimental period for determination of bacterial counts. The outcome measures were in situ plaque-pH (micro-touch method) and area under the pH curve (AUC). RESULTS: The AUC was significantly greater (p < 0.05) in the HX group compared to the LX and control groups during the first 5 min after chewing. After a 10% sucrose rinse, the interdental plaque-pH dropped in all groups but the HX regimen displayed significantly less reduction 0-5 min after chewing (p < 0.05). No significant alterations of the total viable counts or mutans streptococci levels in saliva were disclosed during the 4-week experimental period. CONCLUSIONS: The present results suggested that a high single dose of xylitol had a short and limited beneficial effect on interdental plaque-pH in habitual xylitol consumers, while a low single dose, resembling normal chewing gum use, did not differ from the control.     

Effect of xylitol on mutans streptococci and lactic acid formation in saliva and plaque from adolescents and young adults with fixed orthodontic appliances

This study aimed to investigate two dose regimens of xylitol-containing tablets on the ecology of dental plaque and saliva during treatment with fixed orthodontic appliances. The study group comprised 56 healthy patients (mean age 15.8 yr) randomly assigned into the following groups: A, (n = 23) two xylitol tablets two times a day (1.7 g xylitol d(-1)) for 18 wk; B, (n = 23) two tablets four times per day (3.4 g xylitol d(-1)) for 18 wk; and C, (n = 10) no tablets. The levels of mutans streptococci (ms) were enumerated in plaque and saliva and the proportion of xylitol-sensitive (X(S)) strains in saliva was determined by autoradiography with [(14)C]-xylitol at baseline and at 6, 12, and 18 wk. The lactic acid formation rate was assessed enzymatically in sucrose-challenged plaque suspensions. A drop in salivary ms levels was found in Group A after 6 wk but not after 12 or 18 wk. The proportion of X(S) ms was decreased after 6 wk in groups A and B and remained so during the experimental period. The lactic acid formation rates decreased slightly ( approximately 10%) in the two xylitol groups compared with baseline. In conclusion, our results showed that although an alteration of ms strains was demonstrated following a regular daily low-dose intake of xylitol, the long-term total ms counts in plaque and saliva as well as plaque acidogenicity remained unchanged.     

咀嚼木糖醇口香糖对牙面菌斑原位pH值的影响

目的通过对牙面菌斑原位pH值的动态检测，观察咀嚼木糖醇口香糖对牙菌斑pH值的影响。方法采用受试者自身对照的试验方法，选择9名健康成人志愿者为受试对象，用pH微电极在口内测定菌斑的原位pH值。在测定受试者牙面48小时成熟菌斑的基线pH值之后用10％的蔗糖溶液漱口，测定漱口后即刻、3、8、13、20、30、40分钟后菌斑的pH值，然后分别咀嚼蔗糖口香糖和木糖醇口香糖，测量相同时间点、相同位点牙菌斑的pH值。结果用10％的蔗糖溶液漱口后牙菌斑pH值迅速下降至5．5以下，咀嚼蔗糖口香糖后牙菌斑pH值也有下降。但下降幅度较小，在即刻、3、8分钟三个时点二者之间有显著性差异（P〈0．05）。咀嚼木糖醇口香糖后牙菌斑的pH值没有下降，在即刻、3、8、13、20分钟五个时点的pH值明显高于咀嚼蔗糖口香糖后的pH值（P〈0．05）。结论咀嚼木糖醇香糖不会导致口腔中牙菌斑pH值的下降，有助于釉质再矿化。     

Comparative effects of xylitol- and sucrose-sweetened chew tablets and chewing gums on plaque quantity

Abstract – The effects of chewing gums and chew tablets sweetened with sucrose or xylitoi on the quantity and adhesivity of dental plaque were studied with 14 volunteer dental students (mean age 23.2). The subjects participated in a four-phase study in wliicfa one of four different test products was used! during each period. Tke 3-d periods were interspaced with 4-d normalization phases. The following four experimental products were tested : chewinggums (CG) and chew tablets (GT), sweetened withsucrose (&) orxylitol (×). The amount of plaque was determined through an automatic planimetric procedure on teeth treated with Dentotest°. The total plaque areas before brushing were significantly larger in the CTs group compared with the CTx group. After brushing, the plaque areas remained larger in the CTs group. In the determination of the thick plaque areas, the use of CTx was associated with significantly smaller plaque scores than the use of GTs. In the adhesivity studies CGx consistently yielded the lowest plaque scores, but the differences between x and s were not significant. The comparison between CT and CG suggested that CTx produced significantly smaller plaque scores than CGx before brushing, but not after. This finding was considered to result from the differences involved in the texture and chemical composition between tablets and chewing gums. The present study showed that the use of CGx and CTx was associated with clinically more advantageous plaque effects than the use of corresponding products sweetened with sucrose.     

The effect of chewing sugar-free gum on plaque regrowth at smooth and occlusal surfaces

BACKGROUND AND AIM: Chewing gum has the potential to provide oral health benefits including plaque control. The aim of this study was to determine the effects of chewing sugar free gum on plaque regrowth at buccal, lingual and occlusal surfaces of teeth. METHOD AND MATERIALS: 11 healthy and dentally-fit dental hygiene students participated in this randomised, single-blind crossover 4-day plaque regrowth study. From a zero plaque score on day 1, subjects suspended oral hygiene measures and either chewed gum or did not chew gum over 4 days. Gum chewing was one piece chewed for 30 min 4 x per day. On day 4, subjects were scored for plaque after disclosing from buccal, lingual and unrestored occlusal surfaces. RESULTS: There was no significant difference in smooth surface plaque scores between the treatments but significantly less plaque accumulated (44%) at occlusal surfaces during gum chewing compared to no gum chewing. CONCLUSION: Chewing gum can reduce plaque accumulation at sites of predilection for caries but has little or no effect at sites of predilection for gingivitis.     

2种胶姆糖对菌斑pH值的影响

目的：观察咀嚼2种胶姆糖后口腔菌斑pH值的变化情况.方法：选择8例健康受试者（年龄23～27岁,男4例,女4例）参加3次试验,每次实验开始前停止刷牙24h,在使用10%的蔗糖溶液漱口前以及漱口后5、10、15、20min,用Beetrode pH微电极测量口腔菌斑的pH值,作为基线值.1周后先测量静息pH值,再用蔗糖溶液漱口,1min后给予无糖胶姆糖咀嚼,在5、10、15、20min时间点,分别测量非咀嚼侧的菌斑pH值.1周后重复上述实验,胶姆糖改为含茶多酚胶姆糖.应用SPSS10.0统计软件包对数据进行单因素方差分析和SNK分析.结果：与基线值比较,咀嚼2种胶姆糖都能有效防止由于含漱蔗糖水导致的菌斑pH值下降,并使pH值维持在静息pH值以上.2种胶姆糖之间无显著性差异（P＞0.05）.结论：咀嚼2种胶姆糖均能防止菌斑pH值下降,减少患龋危险.     

咀嚼木糖醇口香糖后牙菌斑pH值的变化趋势

目的:接触法测定咀嚼木糖醇口香糖后牙菌斑原位pH值的变化趋势。方法:在9名志愿者停止口腔卫生措施48h后,采用pH微电极测定其菌斑原位pH值作为基线,再含漱0.1kg/L蔗糖溶液后测定即刻、3、8、13、20、30、40min时的菌斑pH值,然后分别咀嚼蔗糖口香糖和木糖醇口香糖,测定以上相同时间点、相同位点的菌斑pH值。结果:受试者含漱0.1kg/L蔗糖溶液和咀嚼蔗糖口香糖后,3~13min时降到最低值,此后菌斑pH值缓慢回升,至30~40min时与基线水平无显著性差异。而咀嚼木糖醇口香糖后,菌斑pH值呈上升趋势,3min时达最高,13min后pH值逐渐接近基线水平(与基线水平无显著性差异)。木糖醇口香糖组与蔗糖口香糖组、0.1kg/L蔗糖溶液组相比,pH值下降幅度在不同时间点均有显著性差异。结论:咀嚼木糖醇口香糖可以升高牙菌斑pH值,有促进釉质再矿化的功效。     

Effects of frequent mouthrinses with palatinose and xylitol on dental plaque

The aim was to evaluate the effects of frequent mouthrinses with palatinose, xylitol and a mixture of palatinose and xylitol on plaque pH, plaque formation and cariogenic microorganisms. 15 subjects refrained from toothbrushing during 3 test periods and rinsed 15 × daily for 4 d with 10 nil of: (1) 50% palatinose, (2) 37.5% palatinose+ 12.5% xylitol, or (3) 50% xylitol. A contrast period with no mouthrinses was also carried out. The 4 periods were carried out in a randomized order with a cross–over design. After the 4–day periods, 3 parameters were measured: (1) plaque pH during the first 30 min after a mouthrinse with palatinose, a mixture of palatinose and xylitol or xylitol alone, directly followed by a 2nd rinse with 10% sucrose; (2) number of mutans streptococci and lactobacilli in plaque and saliva; (3) plaque index. The most pronounced pH drop for the sugar substitutes was found when rinsing with 50% palatinose after the palatinose period, and the least pH drop with 50% xylitol after the xylitol period. The sucrose rinse gave similar pH fall after all 4 periods. The microbial data showed no differences between the 4 periods, but the mutans streptococcus counts in saliva decreased after the xylitol period in contrast to the 3 other periods. Regarding the plaque index, xylitol gave lower scores compared to the other 3 periods.     

The effects of sugar-free chewing gums on dental plaque regrowth: a comparative study

Sugar-free chewing gum has been claimed to be a useful means of reducing dental plaque accumulation. The incorporation of additives, such as enzymes, abrasives and divalent metal ions, into gum formulations might improve their antiplaque activity, particularly at the buccal and lingual surfaces of the teeth. OBJECTIVES: The aim of this study was to investigate the plaque inhibitory effects of three sugar-free chewing gums each containing lactoperoxidase (LP), micro granules of silicon dioxide (SD), and zinc gluconate (ZG). METHODS: The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 12 healthy volunteers in a 4-day plaque regrowth model. An additive-free (AF) gum served as positive/negative control for occlusal and smooth surfaces, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced chewing their allocated product. Gum chewing was one piece chewed for 30min 4 times a day. On day 5, subjects were scored for disclosed plaque. RESULTS: There were no significant differences in antiplaque activity of the gums tested, neither for the smooth nor for the occlusal surfaces (P=0.447 and P=0.418, respectively). Similar results were obtained for the anterior and posterior sites of smooth surfaces (P>0.05), and for the lower and upper sites of occlusal surfaces (P=0.451 and P=0.53, respectively). CONCLUSIONS: These findings suggest that the chewing gums containing LP, SD and ZG would provide no plaque inhibitory effects on smooth surfaces. The gums containing these additives, therefore, should not be recommended as adjuncts to mechanical oral hygiene.     

Effect of xylitol gum on the level of oral mutans streptococci of preschoolers: block-randomised trial

Objectives: To assess the influence of xylitol chewing gum consumption on mutans streptococci level of 3–4 years old Japanese preschoolers. Methods: 248 participants were examined regarding caries‐related factors at baseline and were followed up at 6, 9, and 12 months after the baseline: assessors were blinded, subjects were open labelled and blocked parallel randomised; 142 were selected to use xylitol gum for 3 months (from months 6 to 9) and 106 were controls. Results: 161 participants were analysed (xylitol n = 76, control n = 85). Nineteen caries‐related variables, including xylitol gum consumption, were analysed for any association with the main outcome, plaque mutans streptococci scores development within the intervention period, by logistic regression. Six showed statistically significant associations by univariate analysis (P < 0.05). However, only xylitol gum consumption remained a significant negative association (P < 0.05) by multiple analyses. Interestingly, over 10% xylitol group children experienced diarrhoea, which was larger than previous investigations. Conclusion: Xylitol gum is effective in avoiding increased plaque mutans streptococci in young children.     

Does the presence of xylitol in a sorbitol-containing chewing gum affect the adaptation to sorbitol by dental plaque?

It is known that xylitol inhibits sorbitol metabolism in some bacteria in vitro. The effect of xylitol/sorbitol-containing chewing gum on sorbitol adaptation of dental plaque was therefore examined. Ten subjects used this chewing gum for 12 wk, and plaque was collected before (control plaque) and after (test plaque) the exposure to sorbitol/xylitol. The metabolism of sorbitol by the plaque was examined with ^l4C-labeled sorbitol, and the radioactive metabolites were detected by high-performance liquid chromatography (HPLC). A considerable individual variation in acid formation was found. The mean values of total acids in the test plaque increased, as compared with the control plaque. An adaptation of dental plaque to sorbitol thus occurred in spite of the presence of xylitol in the chewing gum. The concentration of acetic acid predominated over other acids in both the control and test plaques. The proportions of acids expressed in percentage of total acids differed only slightly. Thus, long-term use of xylitol/sorbitol-containing chewing gum did not eliminate the adaptation of dental plaque to sorbitol.