Xylitol as an anti-cavity agent

I’ll just start with the elephant in the room, at least for those of us following xylitol research (lol!). Cochrane, one of my favorite sources for reviews of healthcare evidence, had stated in March 2015 that there was insufficient evidence to show that xylitol has an anti-cavity effect. They gave a weak endorsement of fluoride toothpastes that contain xylitol.

So what exactly does this mean? Should we throw out the entire idea of using it? I say no, and here’s my logic.

First, I’ll go into the purported benefits of xylitol use for decreasing cavity risk. Xylitol is a sugar substitute found naturally in trace amounts in many fruits and vegetables. It is chemically similar enough to taste sweet to us, but chemically dissimilar enough to be unable to be eaten by strep mutans, a cavity causing bacteria. (Usually strep mutans eats carbohydrates and sugars, producing cavity-causing acid as a byproduct) It has been suggested that xylitol decreases levels of strep mutans and make it more difficult for the bacteria to stick to the teeth.

Back to the Cochrane article–just because Cochrane says that the evidence is weak does not mean that xylitol does not lower cavity risk. It means there are not enough good studies out there to prove it. There has been a lot of research (here’s one recent one) done about xylitol and I believe it’s compelling enough to endorse it’s use. Like stated in my fluoride article, Cochrane has very high standards, sometimes to the point of knocking down practices that have seen clinical success. While this is not a high level of evidence in the strict sense, it should not be dismissed outright, especially if risks from an intervention are low and benefits are potentially high.

This is how I see xylitol, low risk and potential for high benefit. It can be difficult to change the composition of bacteria in the mouth once established as a baby. Xylitol is one way to do that. It takes dedication. In order to be effective, you must use between 5 and 10 grams per day. Using over 10 grams isn’t recommended as it has no added benefit and can lead to stomach upset. I like the gum modality best since it has the added benefit of stimulating saliva (which decreases cavity risk as well). You also should chew the gum as often as possible during the day, usually suggested at 5 times a day.

You have to use special xylitol products. If the gum doesn’t have enough xylitol in it, it won’t be effective. I recommend using Epic xylitol gum since each Chiclet-sized piece contains 1 gram of xylitol. It is super easy to track how much you have gotten. Another good brand is Spry, which contains .7 grams per piece.

So despite the Cochrane article, I chew xylitol gum and still recommend it!

*If stomach upset occurs or jaw pain starts, you should not continue to use xylitol gum.

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