The Effectiveness of Xylitol in a School-Based Cluster-Randomized Clinical Trial

Abstract

Objective: The purpose of this double-blind, cluster-randomized clinical trial was to examine the effects of xylitol gummy bear snacks on dental caries progression in primary and permanent teeth of inner-city school children. Methods: A total of 562 children aged 5-6 years were recruited from five elementary schools in East Cleveland, Ohio. Children were randomized by classroom to receive xylitol (7.8 g/day) or placebo (inulin fiber 20 g/day) gummy bears. Gummy bears were given three times per day for the 9-month kindergarten year within a supervised school environment. Children in both groups also received oral health education, toothbrush and fluoridated toothpaste, topical fluoride varnish treatment and dental sealants. The numbers of new decayed, missing, and filled surfaces for primary teeth (dmfs) and permanent teeth (DMFS) from baseline to the middle of 2nd grade (exit exam) were compared between the treatment (xylitol/placebo) groups using an optimally-weighted permutation test for cluster-randomized data. Results: The mean new d_3-6mfs at the exit exam was 5.0 ± 7.6 and 4.0 ± 6.5 for the xylitol and placebo group, respectively. Similarly, the mean new D_3-6MFS was 0.38 ± 0.88 and 0.48 ± 1.39 for the xylitol and placebo group, respectively. The adjusted mean difference between the two groups was not statistically significant: new d_3-6mfs: mean 0.4, 95% CI -0.25, 0.8), and new D_3-6MFS: mean 0.16, 95% CI -0.16, 0.43. Conclusion: Xylitol consumption did not have additional benefit beyond other preventive measures. Caries progression in the permanent teeth of both groups was minimal, suggesting that other simultaneous prevention modalities may have masked the possible beneficial effects of xylitol in this trial. © 2014 S. Karger AG, Basel

Efecto del flúor y xilitol en la actividad antimicrobiana de dentífricos infantiles

“…Todos os dentifrícios apresentaram efeito antimicrobiano contra S. mutans(p < 0,001). Existiu diferença significante entre os dentifrícios fluoretados, de modo que o dentifrício Aquafresh apresentou a maior atividade antimicrobiana (22,48±1,59), seguido do dentifrício Tandy (20 …”

“…Da mesma forma, Mickenautsch, Yengopal 9 realizaram uma revisão sistemática e sugeriram que a utilização de xilitol associado com fluoreto pode ser benéfica na prevenção da cárie dentária. Por sua vez, Lee et al 20 demonstraram em um ensaio clínico randomizado que a utilização de gomas de mascar contendo xilitol não apresentou benefício adicional a outras medidas preventivas, como por exemplo o uso de fluoretos, em comparação ao placebo. Estudos demonstrando o efeito de dentifrícios contendo xilitol associado ao flúor em comparação a dentifrícios que contém apenas o flúor, ainda são considerados com baixa evidência científica, o que justifica o desenvolvimento de estudos clínicos randomizados com maior qualidade 21,22 .…”

Effectiveness of Xylitol in Caries Prevention

“…Alternatively, xylitol can be introduced into the oral environment of kindergarten and school children in the form of a gummy-bear snack [28][29][30]. Ly et al [29] evaluated the efficiency of the administration 3 times a day of such snacks containing doses of xylitol, in total reaching up to 15.9 g and 11.7 g, and 44.7 g maltitol, on the levels of S. mutans, S. sobrinus and Lactobacilli spp.…”

“…bacteria. Instead, Lee et al [30], administering xylitol (7.8 g/day) to 5-6-year-old children 3 times a day within 9 months, or alternatively a placebo (inulin, 20 g/day) in the form of gummy bears, found a lower caries incidence in children that were receiving xylitol.…”

Long-Term Effect of Erythritol on Dental Caries Development during Childhood: A Posttreatment Survival Analysis

“…A systematic review assessing the caries-preventive effect of consuming xylitol-based candies and lozenges concluded that a reduction in caries increment could be observed in 2 out of 3 intervention groups [Gonçalves Antonio et al, 2011]. However, some recent intervention trials did not confirm a significant effect on caries development associated with xylitol lozenge/candy consumption in children [Lenkkeri et al, 2012;Lee et al, 2015] or adults [Fontana and Gonzalez-Cabezas, 2013]. In recent years, erythritol, a polyol of the tetritol type, has been shown to have a similar effect on caries risk factors as previously reported for xylitol [Kawanabe et al, 1992;Mäkinen et al, 2005].…”