Friday, February 20, 2009

The Power of Xylitol

Smack, smack, POP! As I write this essay I am enjoying my Trident® Watermelon Twist™ gum and its benefits to my oral health. Trident® gum is one of many products on the market containing xylitol. In clinical studies, xylitol has been proven to safely and naturally reduce decay by increasing saliva production, “starving” Streptococcus mutans, and maintaining the pH balance of the oral cavity. Xylitol is also believed to have a yeast-inhibitory effect, thereby reducing the risk of oral candidiasis.

Xylitol is a white substance with a crystalline structure that looks and tastes like sugar. It is a natural substance produced in amounts up to 15 grams by our own bodies during normal metabolism and is found in foods such as berries, lettuce, and mushrooms (Xylitol, 2009). Cup for cup xylitol’s sweetness equals that of sugar. The FDA approved xylitol for use in special dietary foods in 1963 and is safe when consumed in amounts of less than 15 grams per day, with the recommended amount being 7-14 grams per day (Burt, 2006; Xylitol, 2009). Xylitol is safe for use in diabetic patients because the sugar alcohols do not promote pancreatic hormone excretion (Gutkowski, 2004).

Before you can understand the action of xylitol, you must first understand the process involved in cavity formation. An article published in the Journal of the American Dental Association states, “Dental caries is a bacterial disease in which diet is a major etiologic factor” (Burt, 2006). Bacteria consider carbohydrates to be a food. Anytime food or drink enters the oral cavity, especially food high in carbohydrates, the bacteria “eat” the sugar. When the sugar is metabolized by the bacteria, acid is produced as a by-product. Streptococcus mutans, the main bacteria involved in decay, proliferates in this acidic environment. The bacteria sit on the teeth, allowing the acid to sit on the teeth. The acid breaks the calcium-phosphate matrix resulting in weakened enamel and allowing the bacteria into the tooth causing decay.

Fluoride is one of the common agents used to prevent decay. It works by slipping in between the broken calcium-phosphate bonds and creating a stronger matrix – this is especially true of acidulated phosphate fluoride which works by breaking the bonds and rebuilding them stronger. “This is all done in the name of fighting decay. This disregards the bacterial nature of the disease and ignores it as an infection” (Gutkowski, 2004). For years people have tried to quit using sugar in an effort to prevent decay; however, this is ineffective because people do not want to change their diet permanently. Scientists took a hint from people trying to quit smoking and decided to recommend a sugar substitute (Burt, 2006). With the use of xylitol, a dramatic decrease in dental caries has been noted along with arrest and some reversal of existing caries. The effect is long-lasting and possibly permanent (Xylitol, 2009).

Xylitol works in several ways. Gum chewing (any kind of gum) stimulates salivary flow thereby increasing the buffering capacity of saliva and neutralizes the acids produced by eating (Burt, 2006). When xylitol is added to the gum and thus to the saliva, the pH is further restored because bacteria do not metabolize xylitol. (Sellman, 2003). In fact, bacteria do not recognize xylitol as sugar; therefore, the bacteria cannot proliferate because they essentially starve to death (Sidder, 2007).

Another way xylitol works is by reducing accumulation of bacterial plaque (Burt, 2006). Plaque is mostly made up of microorganisms. When these organisms fail to thrive, their numbers are reduced, thereby reducing the accumulation of plaque on the teeth. With the death of S. mutans other microorganisms may thrive, but they have less veracity.

Xylitol has been shown to have benefits for a child when used by a mother. Infants do not have an established oral flora when they are born. Over time, this is developed and the oral flora of the mother has a great impact on the composition of the flora of the child due to factors such as kissing, sharing food, sharing cups, and things of that nature. In the Journal of the American Dental Association, Burt writes that there was a study done in Finland to study the results of xylitol use in a mother on the child. The study used 195 mother-infant pairs and all of the women used in the study had a significant level of Streptococcus mutans in their saliva. The study showed that the children of mothers who chewed xylitol gum had a significant reduction in the colonization of S. mutans when compared with the mothers who used only fluoride or a chlorhexidine rinse (2006).

In addition to its ability to prevent caries, xylitol has also been shown to prevent oral candidiasis by decreasing the ability of the fungus to adhere to the oral mucosa (Gutkowski, 2004). A study was done on adults over 60 years of age who were frail, but otherwise healthy. In the study, Group A was given no xylitol gum, Group B was given xylitol gum, and Group C was given xylitol gum with an antimicrobial agent. “At the end of the study, the researchers reported that the group who received xylitol gum had substantially lowered their risk of developing thrush, a fungal or yeast infection that can cause mouth soreness” (Sellman, 2003).
Xylitol has very few adverse effects. The only one mentioned in the articles is that it can act as a laxative and cause gastrointestinal upset; however, this can be prevented by slowly increasing the amount consumed in small increments (Gutkowski, 2004).

Xylitol has been shown time and time again to have numerous oral health benefits. For the patient interested in adding it to their diet, it can be recommended that they chew gum sweetened with xylitol. This method of incorporating xylitol into your diet is cost effective and easy and gives the added benefit of increased saliva production. Xylitol is also available in powdered form in some health food stores for use in recipes. Connie Sidder recommends in her article to not use anymore than one cup of xylitol in a recipe in order to prevent the laxative effects of it (2007).

References

Burt, B.A. (2006). The use of sorbitol- and xylitol-sweetened chewing gum in caries control [Electronic Version]. Journal of the American Dental Association, 137, 190-196.

Gutkowski, S. (2004). The Magic of Xylitol [Electronic Version]. RDH, March 2004.

Sellman, S. Nexus New Times, January-February 2003. Retrived on February 19, 2009 from http://www.xylitolcanada.come/media.htm

Sidder, C. (2007). The Practical Use of Xylitol [Electronic Version]. RDH, January 2007.

Xylitol. Retrieved February 19, 2009 from http://www.xylitol.org/main.asp
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