Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum

OBJECTIVE: The aim of this study was to investigate the effect of a fixed daily dose of xylitol on mutans streptococci in saliva and the amount of visible dental plaque. A second aim was to explore if the possible effects differed between children with and without caries experience. METHODS: The study was designed as a double-blind randomized controlled trial with two parallel arms. All pupils (n=149) in grades 1-6 in a comprehensive school in northern Sweden were invited, and 128 children (mean age=12.7 years) consented to participate. The children were stratified as having caries experience (DMFS/dmfs>or=1) or not before the random allocation to a test or control group. The control group (A) was given two pellets containing sorbitol and maltitol three times daily for 4 weeks, and the test group (B) received corresponding pellets with xylitol as single sweetener (total dose=6.18 g day). Clinical scoring and saliva samples were collected at baseline and immediately after the test period. The outcome measures were visible plaque index, salivary mutans streptococci counts and salivary lactic acid production. RESULTS: The amount of visible plaque was significantly reduced in both groups after 4 weeks (P<0.05). Likewise, the sucrose-induced lactic acid formation in saliva diminished in both groups (P<0.05). The proportion of mutans streptococci decreased significantly in the test group compared to baseline, but not in the control group (P<0.05). The alterations in the test group seemed most prominent among children without previous caries experience. CONCLUSIONS: The results suggest that chewing gum with xylitol or sorbitol/maltitol can reduce the amount of dental plaque and acid production in saliva in schoolchildren, but only the xylitol-containing gum may also interfere with the microbial composition.     

Effects of xylitol, xylitolsorbitol, and placebo chewing gums on the plaque of habitual xylitol consumers

Xylitol reduces plaque but the reduction mechanism is largely unknown. The main aim of the present study was to determine whether the xylitol-induced reduction in the amount of plaque and the number of mutans streptococci could be demonstrated in subjects with (presumably) high levels of xylitol-resistant (X^R; not inhibited by xylitol) mutans streptococci acquired following previous xylitol consumptions. 37 healthy dental students participated in the double-blind study. All subjects had been uncontrolled, habitual consumers of xylitol-containing products for at least 1 yr before the study, A 1-month washout period was followed by a 2-week test period during which either xylitol, xylitol-sorbitol or unsweetened chewing gum base was chewed 3–5 × a day. Plaque and saliva samples were collected at baseline and at the 2-week point for determination of the amount of plaque, microbiological variables, and hydrolytic enzymes. Mixtures of xylitol and sorbitol seemed to perform equally well with respect to reduction in the amount of plaque but not the number of mutans streptococci. Thus, polyols were the active ingredients of chewing gums able to modulate the amount of plaque and its microbial composition. Xylitol reduced plaque with a mechanism which appeared not to be associated with the study-induced changes in the proportion (%) of mutans streptococci in plaque, the number of salivary mutans streptococci, the proportion of X^R strains in plaque or saliva, or the hydrolytic enzyme activities of plaque.     

Thirty-nine-month xylitol chewing-gum programme in initially 8-year-old school children: a feasibility study focusing on mutans streptococci and lactobacilli

AIM: To investigate the use of xylitol-containing chewing-gums in public elementary schools as a means to affect the growth of salivary and plaque mutans streptococci and salivary lactobacilli. DESIGN: Over a period of 24 months, 750 8- to 9-year-old children chewed xylitol (X group; n = 255) or xylitol-sorbitol (XS group; n = 264) gum on school days (454 days over 2 years), or chewed no gum at all (C group; n = 231). Consumption of xylitol in the X and the XS groups was 6.6 and 5.4g per day, respectively. Use of gum took place at school in four daily episodes of which three were supervised by teachers. Following the 24-month chewing-gum period, the subjects were re-examined after 15 months (total follow-up period: 39 months) at which time an extraneous comparison group (ExC; n = 117) was also examined. The numbers of subjects examined after 39 months were: X, 239; XS, 248; C3 217. METHODS: Salivary and plaque levels of mutans streptococci and the salivary levels of aerobically cultured aciduric bacteria (mostly representing lactobacilli) were determined using the Orion Diagnostica Dentocult SM and LB test kits, respectively. RESULTS: There were statistically significant differences after 24 and 39 months between the two xylitol chewing-gum groups and the C group with regard to salivary and plaque mutans streptococci and salivary lactobacilli: the use of xylitol-containing chewing-gums significantly reduced these bacterial scores. The reductions were statistically more significant in the X group than in the XS group. The bacterial scores of groups C and ExC were similar. CONCLUSIONS: Long-term use of xylitol-containing chewing-gum can reduce the growth of mutans streptococci in saliva and dental plaque, and lactobacilli-type bacteria in saliva, even if xylitol is used only on school days. The results also suggest that xylitol gum use can have a long-term, delayed growth-retarding effect on these micro-organisms, since reduced bacterial growth was still observed 15 months following the termination of xylitol use. The results indicate a close biochemical relationship between xylitol and mutans streptococci, and suggest that a similar relationship may exist regarding aerobically cultured aciduric bacteria present in saliva.     

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.     

Long-term effect of xylitol gum use on mutans streptococci in adults

Many studies have shown the effects of chewing xylitol gum on mutans streptococci (MS) over short- and long-term periods in children; however, few studies have addressed long-term periods in adults. The objective of this investigation was to examine for 6 months the effects of chewing xylitol gum on MS in saliva and plaque in 127 adults (mean age 28.0 years). The participants were assigned to three groups according to gum type, in part taking preference for flavor into account and in part at random: xylitol (XYL), maltitol (MAL) and control (CR); 33, 34 and 27 subjects in each group, respectively, completed the trial. Daily gum use of the XYL and MAL groups was 7.9 and 7.1 g, respectively. MS levels, which declined significantly in saliva (p < 0.05) and plaque (p < 0.001) in the XYL group after 6 months, exhibited a significant increase in plaque in the MAL group (p < 0.001). Differences in relative changes of MS levels in plaque during the experimental period were significant between the XYL group and the CR (p < 0.05) and MAL groups (p < 0.001). Differences in relative change of amount of plaque during the experimental period were not statistically significant between the groups. The present study demonstrated that chewing xylitol gum for 6 months continued to inhibit the growth of mutans streptococci in adults.     

麦芽糖醇口香糖对口腔三种致龋菌的抑制作用

目的:探讨麦芽糖醇口香糖对口腔中3 种致龋菌的抑制效果.方法: 将30 名13～15 岁龋易感儿童随机分为3 组,即麦芽糖醇口香糖组(A组)、木糖醇口香糖组(B组)、空白胶母口香糖组(C组).咀嚼口香糖前后共收集2 次牙菌斑,运用平板法进行牙菌斑中细菌培养计数观察咀嚼口香糖前后3 种致龋菌(变链、乳杆、黏放)数量的变化.结果: 与咀嚼前相比,咀嚼口香糖4 周后A、B、C 3 组变链、乳杆、黏放致龋菌数量均呈下降趋势(P<0.001);与C组相比,咀嚼口香糖4 周后A、B 2 组更能显著降低变链数量(P<0.05);3 组间乳杆菌数量和黏放数量的下降无统计学差异(P>0.05).结论:麦芽糖醇口香糖抑制牙菌斑内变链菌数量较为明显,对乳杆菌、黏放菌的抑制作用则不明显.     

The effect of polyol-combinant saliva stimulants on S. mutans levels in plaque and saliva of patients with mental retardation

The effect of chewable saliva-stimulants on Streptococcus mutans levels in dental plaque and paraffin-stimulated whole saliva among participants who were mentally disabled was investigated. Over 64-days, 98 participants chewed one of four saliva-stimulating tablets five times/day. The tablets contained one of the following: xylitol (X) or sorbitol (S), or 1:1 mixtures of xylitol and erythritol (XE) or sorbitol and erythritol (SE). Consumption of xylitol and sorbitol in Groups X and S was 5.4 grams/day/ subject, and of each polyol in Groups XE and SE, consumption was 2.7 g/day/subject. Interproximal dental plaque and stimulated whole saliva were sampled at baseline, at Day 36, and Day 64. There was a statistically significant reduction of S. mutans in plaque and saliva counts in Groups X and XE. The percentage of S. mutans in total streptococci increased significantly in dental plaque in Group S but decreased in the other groups. The results suggest that xylitol-containing saliva stimulants may be more effective than sorbitol-containing products in controlling some caries-associated parameters in people who are mentally disabled. Also a relationship may exist between the pentitol-type xylitol and S. mutans , and erythritol may exert a specific biochemical effect on this organism, although further studies are needed.     

Effect of xylitol-containing chewing gum on sorbitol metabolism in dental plaque

The aim of the present study was to examine whether a long-term use of chewing gum with xylitol as the only sweetener would affect sorbitol metabolism in dental plaque. Ten test subjects used xylitol-sweetened chewing gum for 12 weeks. Plaque was collected at three occasions; 1) Control plaque; 2) Test plaque I: plaque collected after 12 weeks of chewing xylitol-containing chewing gum; 3) Test plaque II: sucrose-stimulated plaque collected 2 d after Test plaque I was collected. Plaque suspensions were incubated with [¹⁴C]sorbitol, and uptake of sorbitol and production of sorbitol metabolites were determined by HPLC. Plaque formation and sorbitol uptake were significantly reduced.     

Plaque growth while chewing sorbitol and xylitol simultaneously with sucrose flavored gum

In a recent study, sorbitol flavored chewing gum was found neither to increase nor decrease the normal rate of plaque formation, whereas high plaque scores were obtained with sucrose gum during 4 days of no mechanical tooth cleaning. The aim of the present study was to see if chewing sorbitol or xylitol flavored gum together with sucrose gum would affect the growth rate of plaque and whether chewing of xylitol flavored gum could reduce the amount of already formed plaque. Twenty-seven dental students refrained from mechanical oral hygiene measures from Monday to Friday morning for 3 weeks. The students were randomly divided into three groups. A three time crossed-over double-blind approach was used. During each test period one group chewed a combination of one piece sorbitol and one piece sucrose flavored gum five times per day, the second group correspondingly chewed xylitol and sucrose flavored gum, while the third group served as a no hygiene control group. After each test period the students in the control group chewed one piece of xylitol gum every 15 minutes for 2.5 hours. The participants started out each week with clean teeth and were at the end of each test period scored for visible plaque on the facial, mesial and lingual surfaces of their teeth. There was somewhat more plaque after 4 days of chewing sucrose-sorbitol and sucrose-xylitol gum combinations than after no oral hygiene alone. There was no difference between the two test treatments. The 2.5-hour chewing of xylitol flavored gum after the no oral hygiene period did not result in a reduction of the 4-day-old plaque.     

Mutans streptococci dose response to xylitol chewing gum

Xylitol is promoted in caries-preventive strategies, yet its effective dose range is unclear. This study determined the dose-response of mutans streptococci in plaque and unstimulated saliva to xylitol gum. Participants (n = 132) were randomized: controls (G1) (sorbitol/maltitol), or combinations giving xylitol 3.44 g/day (G2), 6.88 g/day (G3), or 10.32 g/day (G4). Groups chewed 3 pellets/4 times/d. Samples were taken at baseline, 5 wks, and 6 mos, and were cultured on modified Mitis Salivarius agar for mutans streptococci and on blood agar for total culturable flora. At 5 wks, mutans streptococci levels in plaque were 10x lower than baseline in G3 and G4 (P = 0.007/0.003). There were no differences in saliva. At 6 mos, mutans streptococci in plaque for G3 and G4 remained 10x lower than baseline (P = 0.007/0.04). Saliva for G3 and G4 was lower than baseline by 8 to 9x (P = 0.011/0.038). Xylitol at 6.44 g/day and 10.32 g/day reduces mutans streptococci in plaque at 5 wks, and in plaque and unstimulated saliva at 6 mos. A plateau effect is suggested between 6.44 g and 10.32 g xylitol/day.     

Effect of xylitol chewing gum on salivary Streptococcus mutans in preschool children

Dental caries remains a significant problem for poor children in the United States. One strategy for treating dental caries is to suppress streptococcus mutans, the chief pathogen responsible for the disease. The purpose of this study was to evaluate the effect of xylitol gum in salivary S. mutans levels in preschool children. Sixty-one children were randomly assigned into the xylitol group and the control group. The xylitol group chewed gum sweetened only with xylitol (XyliFresh100%, Hershey Food Corporation, U.S.A.) three times a day for three weeks. S. mutans counts were tested using the Dentocult-SM Strip Mutans-test (Orion Diagnostica, Finland) at baseline and after three weeks. The shift from higher S. mutans scores to lower was greater in the xylitol group than in the control group (p;lt0.05). This study supports the suggestion that chewing xylitol gum may reduce salivary S. mutans levels. Xylitol chewing gum may provide a feasible caries prevention method for preschool children.     

Effect of three-year consumption of erythritol,xylitol and sorbitol candies on various plaque and salivary caries-related variables

Objective

The objective of the present paper is to report results from oral biologic studies carried out in connection with a caries study.

Methods

Samples of whole-mouth saliva and dental plaque were collected from initially 7- to 8-year-old subjects who participated in a 3-year school-based programme investigating the effect of the consumption of polyol-containing candies on caries rates. The subjects were randomized in three cohorts, consumed erythritol, xylitol, or sorbitol candies. The daily polyol consumption from the candies was approximately 7.5 g.

Results

A significant reduction in dental plaque weight from baseline (p < 0.05) occurred in the erythritol group during almost all intervention years while no changes were found in xylitol and sorbitol groups. Usage of polyol candies had no significant or consistent effect on the levels of plaque protein, glucose, glycerol, or calcium, determined yearly in connection with caries examinations. After three years, the plaque of erythritol-receiving subjects contained significantly (p < 0.05) lower levels of acetic acid and propionic acid than that of subjects receiving xylitol or sorbitol. Lactic acid levels partly followed the same pattern. The consumption of erythritol was generally associated with significantly (p < 0.05) lower counts of salivary and plaque mutans streptococci compared with the other groups. There was no change in salivary Lactobacillus levels.

Conclusion

Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.     

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.     

The effect of chewing xylitol gum on the plaque and saliva levels of Streptococcus mutans

Eating foods containing sucrose between meals can be highly cariogenic. The use of sucrose substitutes that provide the hedonistic appeal of sucrose, yet are not fermented by the plaque flora to the low pHs that are associated with caries, is a reasonable approach to caries control. Xylitol, a sweet-tasting pentitol, has been reported to cause about an 80% reduction in caries increment when chewed in a gum. The present investigation was designed to determine whether the chewing of xylitol gums affected the salivary and plaque levels of S mutans and lactobacilli. The chewing of xylitol gums for four weeks caused a significant reduction in saliva levels and plaque proportions of S mutans compared with pretreatment values. The levels were also significantly reduced to values obtained by chewing either sorbitol or fructose sweetened gum. The chewing of various gums had no significant effect on the proportions of lactobacilli in the plaque. These findings suggested that the small amounts of xylitol used (about 5 gm) resulted in a suppression of S mutans.     

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.     

XYLITOL

High-concentration xylitol chewing gum has been used therapeutically in public health programs in Europe for quite some time. The use of xylitol as a sweetener is slowly increasing in the United States. There is much evidence that xylitol can be a useful adjunct in preventing dental caries because of its effect on mutans streptococci ( MS ) in the oral environment. This review examines some of the literature that identifies the various benefits and capabilities of xylitol as a preventive therapeutic agent. Xylitol chewing gum is a convenient and pleasant preventive tool that almost all patients can use and enjoy.     

Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age

Studies have shown that prevention of mutans streptococci (MS) colonization in early childhood can lead to prevention of dental decay. In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels, regular maternal use of xylitol chewing gum resulted in a statistically significant reduction in MS colonization in their children's teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment. The children did not chew gum or receive varnish treatments. For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS. Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each child's age at the first caries attack in the primary dentition. In children at the age of 5 years, the dentinal caries (dmf) in the xylitol group was reduced by about 70% as compared with that in the fluoride or chlorhexidine group. We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child.     

咀嚼麦芽糖醇口香糖对牙菌斑原位pH值的影响

目的探讨咀嚼麦芽糖醇口香糖后牙菌斑原位pH值的变化趋势。方法将30名13～15岁龋易感儿童随机分为3组，即麦芽糖醇口香糖组（A组）、木糖醇口香糖组（B组）、胶母口香糖组（C组）。通过微电极原位接触法对牙菌斑pH值进行检测，观察咀嚼口香糖4W前后菌斑pH值的变化趋势。结果三组受试者分别在咀嚼口香糖后，菌斑pH值于各个时间点均呈上升趋势，约20min达到最高值，随后仍保持高于基线值水平。咀嚼口香糖4周后，三组各时间点牙菌斑pH值均上升，与咀嚼前比较具有显著性差异（P〈0．05）；三组间在各个时间点pH值上升幅度（△pH）比较具有显著性差异（P〈0．05）。结论麦芽糖醇口香糖对牙菌斑pH值的作用同木糖醇口香糖一样较为明显。     

Chocolate mouth rinse: Effect on plaque accumulation and mutans streptococci counts when used by children

Background: Glucosyltransferases (GTF) play an important role in the adherence of bacteria to acquired pellicle. Cocoa bean husk extract (CBHE) has been shown to possess anti-glucosyltransferase and antibacterial activity. Aim: This study aimed to evaluate the effect of CBHE on plaque accumulation and mutans streptococcus count when used as a mouth rinse by children. Materials and Methods: Scaling of the teeth of the selected children was done and the children were instructed to refrain from their routine oral hygiene practices till the morning of the fourth day; they were instead given a placebo mouth rinse for use during this period. On the fourth day, saliva was collected from each subject for microbiological analysis and plaque was disclosed and scored using the modified Quigley and Hein plaque index; later, the teeth were cleaned. After 1 week, scaling of the subjects was done and they were given CBHE mouth rinse to rinse their mouth, following the above protocol. The data was statistically analyzed using Wilcoxon's signed rank test. Results: There was a 20.9% decrease in mutans streptococci counts and a 49.6% decrease in plaque scores in the CBHE group as compared to the placebo group, which was highly significant (P value Conclusion: CBHE is highly effective in reducing mutans streptococci counts and plaque deposition when used as a mouth rinse by children.