XYLITOL

What is Xylitol?

Pure Xylitol is a white crystalline substance that looks and tastes like
sugar. On food labels, xylitol is classified broadly as a carbohydrate and
more narrowly as a polyol. Because xylitol is only slowly absorbed and
partially utilized, a reduced calorie claim is allowed: 2.4 calories per gram
or 40% less than other carbohydrates.

Xylitol has been used in foods since the 1960’s. It is a popular sweetener
for the diabetic diet in some countries. In the U.S., xylitol is approved as a
food additive in unlimited quantity for foods with special dietary purposes.

Over 25 years of testing in widely different conditions confirm that xylitol

is the best sweetener for teeth. Xylitol use reduces tooth decay rates both
in high-risk groups (high caries prevalence, poor nutrition, and poor oral
hygiene) and in low risk groups (low caries incidence using all current
prevention recommendations). Sugar free chewing gums and candies made
with xylitol as the principal sweetener have already received official
endorsements from six national dental associations.

WHY USE XYLITOL?

Effective:
Studies using xylitol as either a sugar substitute or a small dietary
addition have demonstrated a dramatic reduction in new tooth decay,
along with arrest and even some reversal of existing dental caries. Xylitol
provides additional protection that enhances all existing prevention
methods. This xylitol effect is long-lasting and possibly permanent. Low
decay rates persist even years after the trials have been completed.

Natural:
Our bodies produce up to 15 grams of xylitol from other food sources
using established energy pathways. Xylitol is not a strange or artificial
substance, but a normal part of everyday metabolism.

Xylitol is widely distributed throughout nature in small amounts. Some of

the best sources are fruits, berries, mushrooms and lettuce. One cup of
raspberries contains less than one gram of xylitol.
Chewing is a natural process and chewing gums provide some exercise
lacking in a refined diet. If chewing is uncomfortable, xylitol mints or
candies can also stimulate saliva, the natural tooth protector.

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Safe:
In the amounts needed to prevent tooth decay (less than 15 grams per
day), xylitol is safe for everyone.

HOW MUCH XYLITOL REQUIRED?

Studies show that 4 to 12 grams of xylitol per day are very effective. It’s
easy to keep track of your xylitol intake.

HOW OFTEN XYLITOL CAN USED?

If used only occasionally or even as often as once a day, xylitol may NOT
be effective, regardless of the amount. Use xylitol at least three, and
preferably 5 times every day.

Graph represents the amount of xylitol

a: one cup raspberries

b: one piece of chewing gum
c: one teaspoon, 4 grams
d: one tablespoon, 12 grams
e: daily decay prevention, 12 grams
f: daily metabolism, 15 grams
g: one ounce, 28.3 grams

Relative amounts - very little is needed for dental benefits

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SELECTION: Use sugar free items that list xylitol as the principal
sweetener. High-content, preferably 100% xylitol-sweetened products
that encourage chewing.

FREQUENCY IS THE KEY: Use at least 3 times per day. Five times a day
is better. CONSISTENCY IS IMPORTANT: Use daily.

How Does Xylitol Work?

Causes of tooth decay

Dental caries (tooth decay) is a multifactorial disease process. Enamel, the

mostly inorganic hard outer tooth layer, is dissolved (demineralized) by
acids produced from sugars by plaque bacteria. Bacteria can more rapidly
invade and eat away the inner dentin layer because it is softer and
contains more organic material. The tooth surface is in a dynamic state of
flux between demineralization (destruction) and remineralization (repair).
Acid conditions (lower pH) favor the loss of calcium and phosphate from
the tooth while neutral or alkaline (higher pH) conditions help to replace
minerals, as illustrated by the "Stephan Curve":

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Individuals susceptible to tooth decay tend to have less buffering capacity
against plaque acid. Their saliva pH tends to drop lower and recover more
slowly. Demineralization predominates at lower pH, beginning (somewhat
arbitrarily) at 5.7. Thicker plaque helps to hold acid against teeth and
leads to surface destruction that begins in localized sheltered areas.

Tooth decay occurs at the intersection of the necessary elements:

bacterial plaque acids dissolving a susceptible tooth over time. Xylitol
interferes with all of the destructive elements and helps to tilt the balance
in favor of dental protective factors.

Xylitol is non-acidogenic and non-cariogenic. Xylitol is essentially non-

fermentable and therefore cannot be converted to acids by oral bacteria.
Xylitol can be left on the teeth overnight and not cause any damage. With
proper use of xylitol can stop the formation of tooth decay (cariostatic).
Xylitol is not merely an inert bystander but can exert an active counter
force to decay (anticariogenic). This depends upon how the xylitol is used.
The delivery method, the amount, the timing, and the frequency are
important. Xylitol can enhance the remineralization or healing process.
This happens best in small decay spots just beginning in the enamel.
Larger holes won’t go away and will still require a filling or restoration,
but they can harden and become less sensitive.

Xylitol interferes with the intersection of the four elements necessary for
decay to progress:

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 TOOTH TIME

SUGAR
GERMS

TOOTH TIME

XYLITOL

GERMS SUGAR

DECAY PROGRESSES IN BLUE (SHADE) AREA.

Xylitol use after meals and snacks in products that encourage chewing or
sucking:

 stimulates saliva
 enhances protective factors in saliva
 stabilizes calcium and phosphate solutions
 encourages remineralization
 raises plaque Ph
 reduces time teeth are exposed to demineralizing acids inhibits
bacteria
 reduces plaque reduces contact time of sugars on teeth

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Replacing all dietary sugars with xylitol is not necessary. (or in a form
that can be kept in contact with the teeth for awhile), is all that is needed
to blunt the "acid attack" after eating. Consistently using small amounts of
xylitol tends to increase protective factors in saliva and help maintain pH
in the safe range above 5.7 (see graph—xylitol use can increase plaque
pH by almost 2 unites in this hypothetical snacker).

Oral pH becomes less acidic with continued xylitol use. There is more
saliva with greater buffering capacity so demineralizing conditions seldom
occur. Because saliva productions decreases during sleep, xylitol should
be used after late-night snacks or medications (syrups and chewable
tablets often contain sugar).

Introducing: Streptococcus mutans (Strep. mutans or S. mutans)

This group of bacteria is the principal instigator of dental caries. There is

so much genetic variation that the whole bunch is sometimes referred to
as "the mutans group of streptococi" or ms.

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 Nasty characteristics of ms:

 Aciduric—thrive at low pH that inhibits other bacteria

 Acidogenic—continue to generate acid even at low pH
 Form sticky polymers (extracellular polysaccharides) from sucrose
 Tenacious adherence to hard surfaces (like teeth)
 Store excess sugar inside their cells (intracellular polysaccharides)
 Ability to ferment sorbitol and mannitol—Uh oh, these are
sweeteners found in many "sugar free" products, including
toothpaste!

Other bacterial groups are also associated with tooth decay. For instance,
some varieties of lactobacilli are known as "secondary invaders", found
deep in active caries. Xylitol is virtually non-fermentable by oral bacteria.
With constant use, the low pH niche begins to disappear as the cariogenic
germs are crowded out by harmless bacteria.

Not All Dental Plaque Is the Same:

Dental plaque is populated by many varieties of bacteria. Only some of
these, like Streptococcus mutans, cause disease. Plaque fed high-test
"fertilizer" like sucrose (sugar) becomes extra harmful as bacteria ooze a
meshwork of sticky goo (extracellular polysaccharides).

Long term use of xylitol suppresses the nastiest gangs of bacteria, making
a long-lasting, possibly permanent, change in those bacterial communities.
The result is a kinder, gentler plaque that produces less acid and fewer
toxins and antigens (immune challengers). It contains more natural
cleaning enzymes and minerals for tooth repair.

During the past several years there has been a shift away from the
general plaque hypothesis toward the specific plaque hypothesis.

GENERAL PLAQUE HYPOTHESIS SPECIFIC PLAQUE HYPOTHESIS

Plaque is Plaque is Plaque Different plaques have different
ecologies
Plaque is bad. Some plaques are worse than others.
Everybody has plaque—no diagnosis Diagnosis is essential to identify risk.
needed
Get rid of it. Modify it.
Bacteria are bad—kill them. Some bacteria are useful. Just
eliminate the pests.
Mechanical Treatment: Medical Treatment:
--Drill & Fill --Address the underlying problem
--Recheck in six months --Test to Make sure the pests are gone

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Xylitol should make both groups happy. Regular xylitol use leads to less
plaque and less plaque acid. Additionally, it results in the specific
inhibition of Streptococcus mutans, thereby modifying the remaining
plaque and preventing the overgrowth of harmful bacteria.

Xylitol and Gum Disease:

Gingivitis is an inflammation of the soft gum tissues that can lead to more
serious periodontal disease involving the breakdown of supporting
connective tissues with progressive, intermittent destruction of the jaw
bone that surrounds tooth roots.

Plaque accumulations are believed to be the primary cause of gum

disease. Tartar (dental calculus) is a hard but porous mineralized plaque
that acts as a matrix for additional soft plaque build-up.

The most direct way to control gum disease is by mechanical plaque and
tartar removal. Good oral hygiene needs to be supported by a diet
adequate in essential nutrients such as protein, vitamins and minerals.

Regular xylitol use leads to lower plaque accumulations. The use of anti-
plaque substances does not necessarily guarantee less tartar. For
example, chlorhexidine effectively reduces plaque but it can also increase
calculus accumulation. Xylitol forms weak interactions with calcium in
solution, helping to prevent precipitation. This stabilizing effect of xylitol
makes salivary calcium available for remineralization of enamel while
slowing the rate of tartar formation.

Thick plaque blocks out oxygen and saliva, favoring harmful anaerobic
bacteria. Less plaque is, by itself a useful xylitol effect. Xylitol can also
modify the plaque to make it periodontally less harmful. Xylitol plaque is
less adhesive, less irritating and less inflammatory than sucrose plaque.
Xylitol does not support the growth of any of the bacteria associated with
periodontal disease and may be inhibitory.

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Xylitol and Fluoride:

Small amounts of fluoride can help reduce tooth decay. In low

concentrations fluoride decreases solubility of tooth enamel and promotes
remineralization. Topically applied high concentrations also have a direct
toxic effect on acid-loving cariogenic bacteria. Fluoride seems to be best
delivered directly to the teeth frequently and in small amounts, such as in
toothpaste, but water fluoridation produces the best results in socially and
economically depresses communities where education, nutrition, hygiene,
and health-care delivery are lagging.

Small amounts of naturally occurring fluorides are widely distributed in a

variety of foods. The richest sources are seafood (especially bones of
sardines and salmon) and tea leaves. For those who wish to avoid
additional fluoride, xylitol is a legitimated alternative.

6. GRAPH

• Xylitol has performed as well as or better than fluoride in side-by-

side trials. The very best results have been obtained in studies
where xylitol and fluoride are both used.

• Fluoride-treated teeth are able to withstand a greater number of

acid challenges; xylitol helps to reduce the extent and severity of
bacterial acid production after eating. Xylitol can enhance the
benefits of all prevention methods. Xylitol is complementary with
brushing, flossing, sealants, fluoride, and the antimicrobial rinse
chlorhexidine. Lower concentrations of fluoride and chlorhexidine
can be effective when teamed with xylitol.

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Who Can Use Xylitol

Pregnant Women / New Mothers

Regular use of xylitol is a safe, convenient, and effective way to protect
you when tooth trouble is most unwelcome.

Mothers tend to pass their mouth bacteria on to their babies, not

genetically, but physically—for example, when tasting their baby’s food.

If your mouth bacteria are under control chances are good that your
baby’s teeth will get a healthy start.

Infants:
As soon as the first teeth erupt you can moisten a gauze pad or cotton
swab with a xylitol rinse and gently rub the teeth and gums. Xylitol is
being tested as a preventive agent with pacifiers to delay colonization of
teeth by Streptococcus mutans. Delayed colonization correlates to a low
or nil caries rate for primary teeth.

Day Care Centers:

This could be an ideal situation for a xylitol program. The children enjoy
xylitol, and they are gaining protection before the permanent teeth erupt.
The xylitol effect appears to be long-standing, so the benefits may extend
well after graduation from the Head Start Program.

Young children enjoy an occasional treat, but let’s take care of their teeth
even when they’re away from home.

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Children:
The very best time to use xylitol is when new teeth are erupting. The
emerging enamel quickly "matures" by soaking up minerals from its
surroundings. The permanent teeth come in between ages 5 and 12, with
the third molars ("wisdom teeth") stubbornly lagging behind for a few
more years.

Orthodontic Patients:

People with poor tooth alignment (mal-occlusion) are already at risk for
dental caries and gum disease. Maintaining good oral hygiene becomes
even more difficult and time consuming when orthodontic appliances are
introduced.

A survey of sixty children wearing braces demonstrated significantly

reduced plaque and Streptococcus mutans scores with xylitol chewing
gum. The gum was entirely compatible with the fixed orthodontic
hardware, with no breakage or stick problems reported.

Suggestion: Begin using xylitol before the braces are placed. Check with
your orthodontist about using xylitol gum during treatment. Xylitol tablets
and rinse are a good substitute for gum. Regular use of xylitol during
extended treatment will help prevent formation of unattractive decalcified
areas around bands and brackets.

Adults / Elderly:
As more effort is being made to retain the natural teeth throughout life,
coupled with an expanding geriatric population, a new risk guard for tooth
decay is emerging. Deterioration of existing fillings provides a foothold for
bacteria and leads to secondary decay.

Some folks use hard candy, like lemon drops and cough drops, to help
soothe a dry mouth and throat. The sugar in these products stimulates the
bacteria and acids that eat away at vulnerable areas of the teeth. As gums
recede with age, the tooth roots are exposed. This part of the tooth is not
protected by enamel and can become sensitive or decay. Root decay is
usually slowly progressive, except when saliva decreases. Most
awareness of this increasing trend of root caries, along with the
availability and use of soothing xylitol products can help ease this
problem.

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Persons with Dry Mouth (Xerostomia):
Decreased saliva production is becoming recognized as in important health
concern. Dry mouth is uncomfortable and can make chewing difficult. Lack
of saliva leads to a loss of lubrication and protection, resulting in
discomfort, mouth sores, infection, and tooth decay, including root caries.
Xerostomia can be caused by medications, cancer treatment, or disease.

Medications:

Dry mouth is a frequent side effect of commonly used drugs, especially

antihypertensives (for high blood pressure) and antidepressants,
tranquilizers, analgesics (painkillers), diuretics, and antihistamines can
also decrease saliva.

Cancer treatments:
Radiation therapy to the head and neck can cause permanent damage to
the salivary glands. Chemotherapy can cause a change in the quality of the
saliva.

Diseases:
Nutritional deficiencies, anxiety, and endocrine disorders (including
diabetes) can aggravate dry mouth.

Coping with Xerostomia usually includes a change in diet favoring softer

foods since hard, dry food sticks to teeth and makes swallowing difficult.
Xylitol chewing gum and candy help to stimulate saliva and protect teeth.
Water with some xylitol mixed in can be used as a rinse or sipped
frequently. Commercial artificial saliva now contains xylitol combines with
a lubricant for soothing comfort.

Because xylitol is a versatile sweetener it can also fulfill many functions

of a sugar substitute.

Crystalline xylitol can be sprinkled on cereal or fruit, mixed in salad

dressings, or used in cooking and baking.

For persons who desire to replace large amounts of sugar in their diet, it
makes sense to take a conservative approach. Where high levels of
sweetness are needed xylitol may not be economical. The only side
effects from ingesting too much xylitol are transient gastrointestinal
discomfort and diarrhea, especially when xylitol is taken in liquids on an
empty stomach. Therefore, first choice for soft drinks, lemonade, and
powdered drink mixes will likely remain the intense sweeteners.

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If you have never used xylitol before, allow your system a little time to
adjust to higher quantities. It is easiest to begin with the dental
recommendation of 4 to 12 grams. Adaptation to increasing amounts of
xylitol is very rapid. Soon almost everyone can comfortably tolerate
substantial amounts of xylitol in divided servings. By limiting individual
servings of xylitol to 20-30 grams (about an ounce) a daily total of nearly
100 grams is accepted without any or much trouble.

Xylitol tastes like sugar with a nearly equivalent sweetness and no

aftertaste. Xylitol is sometimes added to a product just to improve
sweetness and flavor. Solid xylitol dissolved quickly in the mouth and
produces a noticeable cooling sensation as it melts. This cooling along
with water-binding gives a little sharpness or spicy flavor that provokes
salivation. With regular use xylitol reverses the damaging trends
established by frequent sucrose consumption. Xylitol leads to a decrease
in harmful bacteria, yeast, plaque, and plaque acids, insoluble
Extracellular polysaccharides, lipoteichoic acids (which increase plaque
stickiness), and enzymes that process sucrose.

Xylitol is not affected by stomach acid and exists unchanged. Larger

amounts of xylitol added to a mixed meal slow gastric emptying and help
maintain a feeling of fullness.

Xylitol is slowly absorbed from the small intestine by passive diffusion.

Small doses are more completely absorbed than large amounts, a portion
of which continues along to the large intestine. The absorbed xylitol
travels to the liver via the portal vein.

The liver is the principal site of xylitol metabolism along normal,

established pathways. More than 80% of xylitol metabolism occurs in the
liver where xylitol is oxidized for energy, converted to glucose (or
glycogen, the storage form of glucose), or glycolytic intermediates. Most
xylitol is processed through the pentose shunt, a pathway which connects
6- and 5-carbon sugars. The liver has a very large capacity for xylitol
and can process more than 400 grams (almost a pound) per day.

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What it does………. Where it goes.... What it means…..
Xylitol dissolves rapidly with a MOUTH Preference for a sweet flavour
pleasant sweet taste & a increases acceptance &
cooling effect compliance.
Non-fermentable by cariogenic TEETH Decreased plaque-cariostatic
bacteria/ no acid production
Increased salivation inhibits SALIVARY Soothes dry mouth- promotes
mineral precipitation GLANDS remineralization.
Not broken down by acid. Slows STOMACH Increases eatery
gastric emptying.
Passive transport via portal SMALL A portion continues unchanged
vein to liver. Slowly and INTESTINE and on to the large intestine.
incompletely absorbed.
Principal site of xylitol LIVER Increases glycogen. Slow
metabolism. Stepwise release of energy anticatabolic
conversion to metabolites and antioxidant effects.
including glucose.
Releases insulin very slowly in PANCREAS Minimal insulin of blood sugar
response to a trickle of glucose fluctuations.
derived from the Xylitol
Xylitol in bloodstream can be BLOOD Xylitol can also be administered
metabolized by RBC parentally.
Unabsorbed xylitol behaves like LARGE Laxative effect in unadapted
dietary fiber. Friendly bacteria INTESTINE individuals. A healthier colon.
ferment xylitol to volatile short- Additional energy source
chain fatty acids. independent of insulin.

WHAT IS POLYOLS?

Polyols are hydrogenated "reduction products" of sugars. Because they

contain an extra OH functional group (hydroxyl or ‘alcohol’ group), they
are sometimes called polyhydroxy alcohols or sugar alcohols. This is a
chemistry designation and has nothing to do with getting inebriated . . .
(Ethanol, drinking alcohol, is absorbed rapidly but metabolized slowly,
breaking down to acetaldehyde, a toxic metabolite). Polyols lack the
carbonyl reducing group, are less chemically reactive and less harmful to
teeth than their sugar counterparts.

Polyols tend to be slowly and incompletely absorbed in the gut so caloric

utilization and glycemic index are lower than their corresponding sugars.
Ingesting large amounts can produces a laxative effect. With adaptation,
this laxation threshold can be increased.

HSH (Hydrogenated Starch Hydrolysates) are the polyol versions of

syrups, usually made from corn syrup. Depending on the concentration of
components, HSH can also be listed as "maltitol syrup", "sorbitol syrup",
or even "hydrogenated glucose syrup". HSH is becoming more popular in
sugar free products and is much sager for teeth than sugar syrups.

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MALTITOL is becoming more popular in sugar free confections because it
is closer to sucrose in sweetness and possibly a little less cariogenic than
sorbitol. Maltitol is digested to glucose and sorbitol. Some reports state
that up to 100 grams per day can be used in divided feedings. Other
suggests that malitol can provoke a most annoying and persistent diarrhea
at dosages below levels where xylitol is well tolerated, because malitol is
more aggressively fermented into osmotically-active products in the
colon.

ISOMALT (Palatinit) is produced from a sucrose molecule whose bond is

tweaked by an enzyme (isomerized), and then hydrogenated. It’s much
less harmful to teeth than sucrose.

SORBITOL is found naturally in fruits and berries and produced by adding

hydrogen to glucose. Although only half as sweet as sucrose, sorbitol is
widely used as a sweetener in sugar free and diabetic foods. Sorbitol
combines well with xylitol for products with better flavor, sweetness, and
dental benefits. Xylitol tooth protection seems to predominate even at low
concentrations when mixed with sorbitol. By itself sorbitol is fairly safe
for teeth because it is only slowly fermented by mouth bacteria, but ms
can grow on it, making subsequent sugar attacks more harmful.

Sorbitol attracts and releases moisture under different humidity conditions

(hygroscopic). It is therefore often used in toothpaste as a humectants
(retains water) to ensure a nice creamy consistency.

Does it make any sense to brush your teeth with sorbitol? Bacteria do
tend to adapt to sorbitol over time, but acid production is low (about 40%
of glucose) and diluted if saliva is adequate. No need to throw away the
sorbitol toothpaste—just follow it up with a xylitol rinse, gum, or candy.

MANNITOL is very similar to sorbitol in sweetness and dental effects.

Crystalline mannitol is not hygroscopic and is often used in combination
with sorbitol to improve shelf-stability or for "dusting". Mannitol has a
very low laxation threshold of about 20 grams per day, which has
contributed to skepticism about increased use of polyols.

LACTITOL is produced by adding hydrogen to milk sugar. Lactitol has a

bland flavor with only a faint sweetness, but it combines nicely with xylitol
to make very stable good-tasting products. Lactitol is not hygroscopic so
it will not absorb moisture.

Lactitol is practically inert in the mouth and does not cause cavities. It is
not metabolized or absorbed until it reaches the large intestine and yields
only 2 calories per gram. Lactitol does not induce an increase in blood
sugar or insulin levels.

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XYLITOL is pentitol or five carbon sugar alcohol. The secret of xylitol’s
important tooth-friendly advantage is explained by this "hexitol-pentitol
theory". Most other carbohydrates discussed here are based on the six
carbon "hexose" unit, whereas xylitol features a FIVE CARBON “pentose”
backbone which is bacteria are unable to utilize. Even if plaque could
ferment xylitol, the end products would be less acidic (one mole of acetic
acid compared to 4 moles of lactic acid from sucrose).

Xylitol is a rather unreactive molecule. All of its chemical bonds are

satisfied and resistant to change. The odd number of carbon makes it
more difficult for microorganisms to pry it open and extract energy from
it. Its molecular shape tends to attract water (hydrophilic) and form weak
complexes with calcium in solution. These complexes are not strong
enough to dissolve solid calcium such as tooth enamel.

Solubility of xylitol is a little lower than sucrose at cold temperatures, but

above 30°C (86°F) it is higher. Xylitol absorbs more moisture than sucrose
but less than sorbitol. Xylitol syrups are substantially less viscous
(thinner) than sucrose syrups.

Xylitol is very heat and acid stable. When heated to 94°C (201°F) it just
melts, and boils at 216°C (421°F). Xylitol does not undergo the Maillard
Reaction, which is non-enzymatic browning that occurs when reducing
sugars are heated with amino acids.

In most application xylitol has the same sweetness as sucrose. The

perception of sweetening power depends on concentration, pH,
temperature, combination with other sweeteners (synergy), and the form
of the product. More xylitol is required to sweeten hot, bitter or sour
liquids, like coffee or lemonade. When solid xylitol dissolves in the mouth
there is a pleasant cooling effect resulting from a high negative heat of
solution (endothermic reaction). This is particularly advantageous with
certain spicy, herbal, and mint flavors.

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Xylitol is sweet enough to be used directly as a sugar replacer without the
need for an added intense sweetener. Xylitol can synergistically improve
flavor when used in combination with other polyols.

Crystalline xylitol melts quickly and produces an immediate cooling

sensation when it dissolves in the mouth. There is a clean sweet taste
with no aftertaste.

Sweetness and cooling effect also depend on particle size and solubility at
mouth temperature. Finer products dissolve more quickly and seem cooler
and sweeter.

Xylitol History:

Xylitol was synthesized through the hydrogenation of wood sugar (xylose)

by German chemist Emil Fischer in 1891. It did not receive much attention
until after World War II, when chronic sugar shortages prompted a search
for other sweeteners using locally available materials. For instance, in
Finland, xylose (and xylitol) could be readily obtained from birch trees and
wood scraps produced by furniture manufacturing.

By the late 1950's xylitol had been identified as a normal intermediate in

human metabolism, with a turnover capacity of about 15 grams (about half
an ounce) per day in the flucuronic acid pathway. Another cycle termed
the hexose monophosphate shunt or pentose shunt was found to process
much larger amounts of xylitol for a total metabolic capacity of nearly 600
grams per day - more than one pound, administered via infusion. That's a
lot of xylitol!

The potential of xylitol as a major energy source was now readily

apparent, especially in light of its largely insulin-independent metabolism.
By the 1960's xylitol was being used (mostly in Germany, Switzerland, the
Soviet Union, and Japan) as a preferred sweetener in diabetic diets and as
an energy source for infusion therapy in patients with impaired glucose
tolerance (diabetic, burn, severe trauma) and insulin resistance. Xylitol
was approved for special dietary purposes in 1963 by the United State
Food and Drug Administration (FDA).

In early 1969 xylitol was introduced to Australia for use as an intravenous

nutrient. Ten reports of adverse reactions prompted withdrawal of xylitol
form clinical use in Australia by 1970.
Abnormalities were also reported from Chicago. These reports negatively
influenced attitudes toward xylitol worldwide, with particular persistence
in the United States.

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Review of the cases revealed possible contamination of the Australian
preparation. Otherwise the toxicity could be attributed to overwhelming
the metabolic capacity and hyperosmolarity (administering too much, too
quickly.)

Further research helped to define safe levels and rates of xylitol

administration to prevent side effects from unutilized accumulations.
Xylitol continues to be used intravenously within these guidelines.

Meanwhile the safety of orally ingested xylitol had already been well
established. Five trials demonstrated that xylitol was well-tolerated at
levels of at least 90 grams per day (more than 3 ounces of 22 teaspoons)
with no adverse effects, except for a transient laxative effect in a few
unadapted individuals.

By the early 1970's evidence was mounting that xylitol was a particularly
safe sweetener for teeth.

In the dental results the fructose group did a little better than sucrose,
while the xylitol substitution group had an astounding caries reduction of
at least 85%! Remarkably, the xylitol chewing gum group also had nearly
an 85% reduction, so just a small dietary addition worked as well as the
full substitution, implying a real-world practical application of major
importance.

By the end of the trial both xylitol groups had a declining caries rate,
suggesting that small caries had remineralized. At the time of the report it
was considered pretty audacious to flatly state that teeth can heal!

WHO then compared xylitol with fluoride in Hungary. The fluoride group
used fluoride toothpaste and systemic fluoride in water and milk. The
xylitol group had 45% fewer cavities than the controls (no fluoride) and
35% fewer cavities than the fluoride group.

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By the mid-1980 a surprising result came in from Montreal where small
amounts of xylitol in chewing gum having xylitol/sorbitol mixtures
produced large decreases in caries incidence.

From 1982 the Finnish government sponsored an effort to see if existing

"maximum" caries prevention programs could be improved. The control
group in a small rural town, Ylivieska, received fluoride toothpaste, topical
fluoride and fluoride tablets, along with hygiene instruction and
monitoring. The caries rate was already low. In addition to this existing
program, the test groups used xylitol gum one, two, or three times each
day. After two years, "one gum" was the same as the controls, "two gums"
resulted in a 30% caries reduction, and "three gums" yielded an
impressive 60% reduction. A parallel program for "high risk" children with
higher caries rates produced similar results in three years with decreased
caries of "one gum" 0%, "two gums" 50%, and "three gums" 80%! Ylivieska
clearly showed that the frequency of xylitol use is a crucial factor in its
effectiveness.

The amazing results from Ylivieska demonstrated that "state of the art"
caries prevention programs for both low risk and high-risk populations
are now obsolete without the addition of
Xylitol.

Follow-up examinations in Ylivieska revealed another exciting xylitol

advantage. Even five years after the discontinuation of the program, the
xylitol groups did not backslide, but maintained extremely low caries
rates. The powerful protective effect of xylitol was most evident with
teeth which had erupted during regular xylitol use, which seem almost
impervious to decay.

Long-term and perhaps permanent xylitol protective effect can be

explained by optimal mineralization and/or the shift in bacterial
populations with the disappearance of harmful germs.

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Effect of a triclosan-containing toothpaste supplemented with 10%
Xylitol on mutans streptococci in saliva and dental plaque. A 6-
month clinical study.
• Jannesson L,
• Renvert S,
• Kjellsdotter P,
• Gaffar A,
• Nabi N,
• Birkhed D.
Department of Health Sciences, University of Kristianstad, Sweden.
Lillemor.Jannesson@staff.hkr.se
The aim of the present investigation was to evaluate the effect of the
combination of triclosan and Xylitol in toothpaste on mutans streptococci
(MS) in saliva and dental plaque. 155 individuals with >10(5) MS/ml
saliva were included in a 6-month double-blind clinical study. They were
divided into three groups (n = 51-52) balanced according to their MS
counts at baseline. Each group used one of the following types of
dentifrice: (1) Colgate Total with the addition of 10% Xylitol (Total-
Xylitol), (2) Colgate Total and (3) Colgate Total without triclosan and
without Xylitol. Whole saliva and pooled plaque samples were obtained
after 2, 4 and 6 months. When comparing the MS counts within the
groups for saliva and plaque samples, Total-Xylitol showed significant
reduction at all three sampling occasions (p < 0.001). Mean reduction at
the 6-month sample for saliva was 0.81/ml and for plaque 0.89 per
sample (log values). ANOVA revealed significant differences between
Total-Xylitol and the two other products at 6 months for MS in saliva and
dental plaque. The conclusion from this 6- month study is that the
addition of 10% Xylitol to a triclosan-containing dentifrice reduces the
number of MS in saliva and dental plaque. Copyright 2002 S. Karger AG,
Basel
PMID: 11961328 [PubMed -

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