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Objectives: A systematic review of published data was conducted with the aim of assessing the effects of xylitol consumption on the amount of dental plaque., Materials and Methods: Electronic and hand searches were performed to find clinical studies concerning the effects of xylitol chewing gum or candies on dental plaque. Prospective randomized controlled clinical trials published between 1971 and 2020 conducted in healthy subjects were included in the review., Results: The initial search identified 424 xylitol articles. After applying inclusion and exclusion criteria, altogether 14 articles (16 studies) were reviewed. The review identified 12 of the total of 14 xylitol chewing gum studies as having fair or high quality. In 13 of the 14 chewing gum studies, xylitol gum decreased plaque accumulation. In six studies, xylitol gum chewing decreased plaque compared to sorbitol gum, and in three studies compared to gum base/no gum. In three fair-quality studies conducted with xylitol candies, plaque accumulation did not change., Conclusions: Habitual xylitol gum chewing appears to show plaque-reducing effects that differ from those of sorbitol gum. This suggests specific effects for xylitol on plaque accumulation. Xylitol candies appear not to decrease plaque. The heterogeneity of the studies warrants further research. Clinical relevance Habitual xylitol gum chewing is likely to decrease plaque., (© 2021. The Author(s).)

Background: Regular consumption of xylitol decreases the number of cariogenic streptococci in dental plaque. In vitro biofilm models to study the mechanism of xylitol action have been set-up, but the obtained results are contradictory. Biofilm growth is a dynamic process with time-specific characteristics that may remain undetected in conventional end-point biofilm tests. In this study we used an impedance spectroscopy instrument, xCELLigence Real Time Cell Analyzer (RTCA), that allows label-free, non-invasive real-time monitoring of biofilm formation, to explore effects of xylitol on biofilm formation by Streptococcus mutans. Based on the obtained information of biofilm dynamics, we assessed the number of viable bacteria, the polysaccharide content, and the expression levels of selected genes involved in glucan-mediated biofilm formation in different biofilm stages. Xylitol inhibition was compared with that of erythritol; another polyol suggested to have a positive impact on oral health., Results: Our results showed that real-time monitoring provided new information of polyol-induced changes in S. mutans biofilm formation dynamics. The inhibitory effect of polyols was more pronounced in the early stages of biofilm formation but affected also the measured total amount of formed biofilm. Effects seen in the real-time biofilm assay were only partially explained by changes in CFU values and polysaccharide amounts in the biofilms. Both xylitol and erythritol inhibited real-time biofilm formation by all the nine tested S. mutans strains. Sensitivity of the strains to inhibition varied: some were more sensitive to xylitol and some to erythritol. Xylitol also modified the expression levels of gbpB, gtfB, gtfC and gtfD genes that are important in polysaccharide-mediated adherence of S. mutans., Conclusion: The erythritol- and xylitol- induced inhibition of biofilm formation was only partly explained by decrease in the number of viable S. mutans cells or the amount of polysaccharides in the biofilm matrix, suggesting that in addition to reduced proliferation also the matrix composition and thereby the surface attachment quality of biofilm matrix may be altered by the polyols.

Few laboratory methods exist for evaluating the cariogenicity of food ingredients. In this study, a dental simulator was used to determine the effects of commercial sucrose and xylitol mint products on the adherence and planktonic growth of Streptococcus mutans. Solutions (3% w/v) of sucrose, xylitol, sucrose mints, xylitol mints, xylitol with 0.02% peppermint oil (PO), and 0.02% PO alone were used to test the levels of planktonic and adhered S. mutans. A dental simulator with continuous artificial saliva flow, constant temperature, and mixing was used as a test environment and hydroxyapatite (HA) discs were implemented into the model to simulate the tooth surface. Bacterial content was quantified by qPCR. Compared with the artificial saliva alone, sucrose and sucrose mints increased the numbers of HA-attached S. mutans, whereas xylitol decreased them. Similarly, planktonic S. mutans quantities rose with sucrose and declined with xylitol and xylitol mints. Versus sucrose mints, xylitol mints significantly reduced the counts of HA-bound and planktonic S. mutans. Similar results were observed with the main ingredients of both types of mints separately. PO-supplemented artificial saliva did not influence the numbers of S. mutans that attached to HA or planktonic S. mutans compared with artificial saliva control. In our dental simulator model, xylitol reduced the counts of adhering and planktonic S.mutans. The mints behaved similarly as their pure, main ingredients-sucrose or xylitol, respectively. PO, which has been suggested to have antimicrobial properties, did not influence S. mutans colonization.

The aim of this study was to investigate the impact of daily chewing, for 12 weeks, of 2 different probiotic gums compared with placebo on saliva flow rate, saliva IgA levels and saliva pH. The intervention study included 54 adult volunteers with hyposalivation in a double-blind, randomised and placebo-controlled design with three parallel groups. Volunteers were randomly assigned to 3 different groups: subjects in group A (n = 19) were given placebo chewing gum, group B (n = 17) received Bifidobacterium animalis ssp. lactis Bb12 (ATCC 27536) and group C (n = 18) received Lactobacillus rhamnosus LGG (ATCC 53103), Bifidobacterium longum 46 (DSM 14583) and Bifidobacterium longum 2C (DSM 14579) gums, during 3 months. Two volunteers from group B left the study for personal reasons leaving 19, 15 and 18 volunteers, respectively, for analyses. Clinical examinations, personal interviews, sialometries and saliva sampling were conducted at baseline and after 1, 2, 3 and 4 months. No statistically significant differences were found between probiotic and placebo groups for any of the parameters analysed. No side effects of probiotic or placebo chewing gums were observed. Chewing gum, with and without probiotics, had a positive impact on salivary flow rate and saliva pH and IgA levels.

Objectives: The aim of this study was to determine the effects of short-term xylitol gum chewing on the salivary microbiota of children., Materials and Methods: The study was a randomised, controlled, double-blind trial. Healthy children used xylitol chewing gum (xylitol group, n = 35) or sorbitol chewing gum (control group, n = 38) for 5 weeks. The daily dose of xylitol/sorbitol was approximately 6 g/day. At baseline and at the end of the test period, unstimulated and paraffin-stimulated saliva were collected. The microbial composition of the saliva was assessed using human oral microbe identification microarray (HOMIM). Mutans streptococci (MS) were plate cultured., Results: As judged by HOMIM results, no xylitol-induced changes in the salivary microbiota took place in the xylitol group. In the control group, Veillonella atypica showed a significant decrease (p = 0.0001). The xylitol gum chewing decreased viable counts of MS in both stimulated (p = 0.006) and unstimulated (p = 0.002) saliva, but similar effects were also seen in the control group., Conclusions: The use of xylitol gum decreased MS, in general, but did not change the salivary microbial composition., Clinical Relevance: Short-term consumption of xylitol had no impact on the composition of the salivary microbiota, but resulted in a decrease in the levels of MS.

We studied the effects of xylitol on biofilms containing xylitol-resistant (Xr) and xylitol-sensitive (Xs) Streptococcus mutans, Actinomyces naeslundii and S. sanguinis. The biofilms were grown for 8 and 24 h on hydroxyapatite discs. The viable microorganisms were determined by plate culturing techniques and fluorescence in situ hybridization (FISH) was performed using a S. mutans-specific probe. Extracellular cell-bound polysaccharides (EPS) were determined by spectrofluorometry from single-species S. mutans biofilms. In the presence of 5 % xylitol, the counts of the Xs S. mutans decreased tenfold in the young (8 h) biofilm (p < 0.05) but no effect was seen in the mature (24 h) biofilm. No decrease was observed for the Xr strains, and FISH confirmed these results. No differences were detected in the EPS production of the Xs S. mutans grown with or without xylitol, nor between Xr and Xs S. mutans strains. Thus, it seems that xylitol did not affect the EPS synthesis of the S. mutans strains. Since the Xr S. mutans strains, not inhibited by xylitol, showed no xylitol-induced decrease in the biofilms, we conclude that growth inhibition could be responsible for the decrease of the counts of the Xs S. mutans strains in the clinically relevant young biofilms.

Xylitol consumption decreases counts of mutans streptococci. However, the mechanism behind this decrease is not well understood. We studied not only type strains and clinical isolates of mutans streptococci, but also other polysaccharide-forming oral streptococci. Growth inhibition and adherence of cells to a smooth glass surface-reflecting synthesis of water-insoluble polysaccharides were studied in the presence of 2% (0.13 mol/l) and 4% (0.26 mol/l) xylitol. The effect of xylitol was compared to a novel polyol sweetener, erythritol. Except for Streptococcus mutans 10449 and S. sobrinus OMZ 176, the glass surface adhesion of most polysaccharide-forming streptococci was reduced by the presence of both 4% xylitol and erythritol. For the S. mutans and S. sobrinus type strains, the growth inhibition with 4% xylitol and erythritol was 36-77% and for the clinical S. mutans isolates 13-73%. Of the other oral streptococci, only S. sanguinis was inhibited with 4% xylitol (45-55%). For both polyols, the magnitude of the growth inhibition observed was not associated with the magnitude of the decrease in adherence (xylitol: r = -0.18; erythritol: r = 0.49). In conclusion, both xylitol and erythritol can decrease polysaccharide-mediated cell adherence contributing to plaque accumulation through a mechanism not dependent on growth inhibition.

No studies on the concentration dependency of the inhibition of Streptococcus mutans with xylitol are available. We studied xylitol-induced growth inhibition of two type strains, S. mutans NCTC 10449 and Ingbritt, and three clinical isolates of S. mutans. The strains were grown in Brain Hearth Infusion Medium in the presence of 0.001% (0.066 mM), 0.005% (0.33 mM), 0.01% (0.66 mM), 0.1% (6.6 mM), and 1% (66 mM) xylitol. Growth was followed by measuring the absorbance at a wavelength of 660 nm. The highest xylitol concentration tested in this study, 1%, showed mean inhibition percentages ranging from 61% to 76% when the growth inhibition of the five strains was compared to the control without xylitol at log-phase. For 0.1% xylitol, the inhibition percentages ranged from 22% to 59%. A concentration dependency was seen in the growth inhibition, with 0.01% xylitol being the lowest xylitol concentration inhibiting all five strains significantly (p < 0.001). The growth inhibition percentages determined for 0.01% xylitol, however, were low, and the inhibition was significantly weaker as compared to 0.1% and 1% xylitol. Our results suggest that low xylitol concentrations of 0.1% (6.6 mM) could inhibit mutans streptococci in vivo but even lower xylitol concentrations may be inhibitory.

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.

Aim: To investigate the use of polyol-containing chewing gums in a day-care centre (kindergarten) setting as a means to affect the growth of mutans streptococci and dental plaque., Design: Over a period of six months, 123 five-year-old children chewed xylitol (X group), sorbitol (G group), or did not chew gum (C group). Consumption of xylitol, and sorbitol was 4.5 to 5.0 g per day and subjects consumed in five supervised daily chewing episodes four at the day-care centres and one at home., Methods: Interproximal dental plaque was sampled at baseline and after six months for a laboratory study of mutans streptococci counts. The Quigley & Hein plaque index procedure was used. Interviews and questionnaires elucidated the acceptability of the programme., Results: Parents and kindergarten personnel regarded the programme as an important, additional procedure to promote better oral health. The children regarded the use of chewing gum as a pleasurable experience. Compared with groups G and C, there was a statistically significant reduction of mutans streptococci in the interproximal plaque in the X group. The Quigley & Hein plaque index scores tended to decrease in the X group, while no such trend was observed in the G group., Conclusions: Habitual use of relatively small daily quantities of polyol-containing chewing gum by young children may be regarded as an important additional caries-preventive procedure in a combined day-care centre and home setting. Especially xylitol-containing chewing gum may significantly reduce the growth of mutans streptococci and dental plaque which may be associated with dental caries.

A systematic review of published data was conducted with the aim of assessing effects of xylitol and erythritol consumption on levels of mutans streptococci (MS) and the oral microbiota. Electronic and hand searches were performed to find clinical microbiological studies concerning the consumption of xylitol and erythritol chewing gum or candies, and published between 2000 and 2019. Prospective randomized controlled clinical trials conducted in healthy subjects were included in the review. The initial search identified 561 xylitol and 83 erythritol studies. After applying inclusion and exclusion criteria, 21 xylitol studies and one erythritol study were reviewed. The review identified nine xylitol studies with a fair or high quality, four conducted in children and five in adults, all demonstrating a decrease in MS levels in association with habitual consumption of xylitol. The three microbiota studies employing multispecies probe approaches revealed no effects for xylitol on the microbiota. The only erythritol study fulfilling the inclusion criteria showed no consistent effects on MS levels. Xylitol consumption is likely to decrease MS counts but it may not change the overall microbiota. Xylitol shows thus properties of an oral prebiotic. More studies are needed to demonstrate the effects of erythritol on MS. [ABSTRACT FROM AUTHOR]

Objectives In a Finnish study carried out in 1990s, high-caries-risk mothers used xylitol gum on daily basis when their child was 3-24-month old, whereas the high-risk control mothers received biannual fluoride or chlorhexidine treatments. The maternal prevention reduced colonization of mutans streptococci and early childhood caries in children. The present retrospective study aimed to extend the post-trial follow-up to 10-year-old children ( n = 148). Additionally, the dental health of these high-caries-risk children was compared with a reference group comprising the rest of the children in the same age cohort ( n = 359). Methods The annual data on dental health and treatments were gathered from public dental care registers. Results The median caries-free age (dmft = 0 and DMFT = 0) was 8.2 in the xylitol, 5.8 in the control, and 8.1 in the reference group (xylitol versus control, P = 0.005, HR = 1.75; 95% CI 1.18-2.60, reference versus xylitol, P = 0.410, HR = 1.13; 95% CI 0.84-1.51 Cox regression). Thus, the children in the xylitol group had caries-free teeth longer than the control group. Compared to the reference group, the xylitol group did not show notable difference. Up to 4 years of age, figures for cumulative restorative treatment visits were 0.2 in the xylitol, 0.7 in the control, and 0.4 in the reference group (xylitol versus control P = 0.006, Student's t-test). Conclusions The reduced mother-child transmission of mutans streptococci seems to have long-term effects on children's dental health. The maternal use of xylitol reduces caries occurrence and need for restorative treatment in assumed high-caries-risk children to the average level of the whole age cohort. [ABSTRACT FROM AUTHOR]

The expulsion mechanism, of xylitol 5-phosphate in Streptococcus mutans ATCC 25175 was studied using resting cells incubated in the presence of 14C-xylitol. The expulsion appeared to be a two-step process: xylitol 5-phosphate was first hydrolyzed to xylitol and. inorganic phosphate, and the xylitol was subsequently expelled from the cells. The dephosphorylation step appeared to be energy-requiring and it was most likely associated with a phosphatase which was active on xylitol 5-phosphate. Two to three successive cultivations of the cells in the presence of 6% xylitol increased this enzyme activity 4.3-fold. These results are in accordance with the presence of an energy-dependent xylitol 5-phosphate cycle in S. mutans, which is regulated by exogenous xylitol. [ABSTRACT FROM AUTHOR]

The effect of successive cultivations in the presence of 6% xylitol on the uptake and expulsion of14C-xylitol was studied using the cells of Streptococcus mutans 25175. Three sequential cultivations did not alter the growth inhibition percentage (approximately 50%) observed in the presence of 6% xylitol. The 14C-xylitol uptake experiments performed with growing and resting cells showed that both the uptake and the expulsion of xylitol were enhanced by xylitol-culturing. Both xylitol-cultured and resting control cells contained only one major labeled compound which was identified as 14C-xylitol 5-phosphate. The label subsequently was expelled from the cells as 14C-xylitol. These results indicate that S. mutans possesses an intracellular xylitol cycle and this cycle is regulated by adding xylitol to the growth medium. [ABSTRACT FROM AUTHOR]

pH changes and the production of lactic acid, acetic acid and ammonia were studied in suspensions of salivary sediment supplemented with mixtures of xylitol and other carbohydrate sweeteners. The only mixtures which increased the pH values o the suspensions were those containing xylitol alone or mixtures of xylitol and sorbitol. Mixtures of xylitol and Lycasin 80/55 caused a relatively small pH reduction. Xylitol was not able to inhibit the acid production from the easily fermented glucose, fructose and Lycasin 05/60. The levels of lactic acid, determined in the incubation mixtures, directly reflected these pH changes. The levels of acetic acid and ammonia were, however, relatively similar in all incubation mixtures. The results suggest that the inhibitory effects of xylitol on acid production of oral flora should be retained, provided that xylitol is used either alone or in mixtures with slowly fermentable carbohydrates, such as sorbitol and Lycasin 80/55. [ABSTRACT FROM AUTHOR]

The effect of 8 polyols and 14 aldoses or ketoses on the spontaneous aggregation of Ca-proteinates was followed spectrophotometrically in supernatants and filtrates of human mixed saliva. Each carbohydrate was added to the saliva samples at 37°C and the precipitated material was analyzed for protein, total carbohydrate and Ca. Based on their effect on aggregation, the carbohydrates could be divided into three groups: 1) those that showed no effect on aggregation: D-xylose, D-ribose and i-erythritol, 2) those that inhibited aggregation strongly: xylitol, D-sorbitol and D-mannitol, and 3) those that inhibited aggregation moderately: glucose, fructose and sucrose. The inhibitory effect of the above polyols on the aggregation of Ca-proteinates varied greatly among the saliva donor, and correlated positively with the turbidity of the saliva and its protein content more than with the Ca-concentration or the pH of the saliva sample. It is suggested that inhibition of aggregation shown the most clearly for xylitol, sorbitol and manitol manifests itself as a retardation of the final, irreversible aggregation of those glycoproteins that already exist in a precipitated form and which are responsible for the turbidity of saliva. [ABSTRACT FROM AUTHOR]

Five Streptococcus mutans pairs (serotype c S. mutans 10449 and four clinical isolates of S. mutans: 123.1, LG1, OMFA, T10B) were used to find out if the xylitol-resistant (X[sup R]) natural mutants of the corresponding xylitol-sensitive (X[sup S]) S. mutans parental strains differ in their growth patterns in saliva. The isogenic X[sup R] natural mutants of the parental S. mutans strains were selected after sequential cultivations in the presence of xylitol and glucose. The X[sup R]/X[sup S] strains pairs were grown in individual and pooled glucose-supplemented filter-sterilized salivas (one to five sequential cultivations). The two salivas used represented subjects with good or poor support of the growth of S. mutans in vivo. Protease and peptidase activities were determined from the saliva growth media and cell suspensions. Salivary protein profiles were analyzed using SDS-PAGE and native IEF before and after the cultivations. The growth properties of the X[sup R]/X[sup S] S. mutans pairs were similar in both individual and pooled salivas. Sequential cultivation of all strains did not show any differences in growth patterns. X[sup S] strains were inhibited by the presence of xylitol (2% w/v) in pooled saliva, as shown for other glucose-supplemented media. Protease and peptidase activities of the X[sup R]/X[sup S] S. mutans pairs were low and of similar magnitude. Also, the general hydrolytic properties of most X[sup R]/X[sup S] S. mutans pairs appeared similar as judged by the small growth-induced changes in salivary protein profiles. In conclusion, saliva, the source of nutrients for salivary microorganisms in vivo, favored neither the X[sup R] nor the X[sup S] strains of S. mutans. [ABSTRACT FROM AUTHOR]

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 (XR; not inhibited by xylitol) mutans streptococci acquired following pretous 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, xylitols orbitol 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 XR strains in plaque or saliva, or the hydrolytic enzyme activities of plaque. [ABSTRACT FROM AUTHOR]

The chemical composition of stimulated human palatine secretions (HPS) was studied after rinsing with aqueous solutions of sucrose or xylitol, or with water only. Stimulation with water was associated with increased concentration levels of protein. The levels of sialic acids (per mg protein) and the specific arylamidase activities were simultaneously increased, within the physiologic range. In contrast to a previous report, these results indicate that HPS does contain arylaminopeptidases the activity of which is strongly increased by Cl-. The Cl- -dependent activity was revealed when using &Nscript;-L-arginyl-2-naphthylamide as substrate. The filter paper method used is recommended for collecting HPS for chemical analyses. In spite of the use of a relatively effective and versatile stimulation procedure, only one third of the subjects produced detectable HPS. Very poor secretion of HPS should perhaps be considered in subjects wearing total dentures. [ABSTRACT FROM AUTHOR]