If you’re a label reader you’ve probably noticed the ingredient Xylitol in many toothpastes, ‘breath mints’, and chewing gums. Xylitol, and products with xylitol in them, have been sold in natural health food stores for years. And, as a reader of Nutrition & Healing, you very likely already know that xylitol is a powerful tool for preventing tooth decay.
That’s why it’s so sad that the medical and dental ‘mainstream’, as well as public health ‘authorities’ are ignoring… or are simply ignorant of… all of the solid research on xylitol and its tremendous and inexpensive potential to reduce, and in many cases entirely eliminate, tooth decay. In fact, the New York Times recently published (6 March 2012) an article titled ‘Preschoolers in Surgery for Mouthful of Cavities’. The opening paragraph described a 2½-year-old boy with cavities in 11 of 20 baby teeth. He was having root canal surgery and two extractions at the Center for Pediatric Surgery at Seattle Children’s Hospital.
The article went on to say that the Centers for Disease Control and Prevention (CDCP) in the US “noted an increase in the number of preschoolers with cavities in the study five years ago,” and that “dentists nationwide say they are seeing more preschoolers at all income levels [Just a note: I didn’t realise that preschoolers are earning money now!] with six to 10 cavities or more.” It would appear that the CDCP is quite unaware of xylitol’s scientifically-proven ability to prevent and even eliminate tooth decay.
The rest of the New York Times article notes the alarming and growing use of general anaesthesia in treating dental cavities in preschoolers. One centre in Columbus, Ohio reportedly used general anaesthesia for dental surgery in roughly 2,205 children in 2011 alone. The average age of the patients was four, most of the children had decay in six to eight teeth, and the most severe cases had 12 to 16 decayed teeth.
Although risks were noted in the article… including nausea, vomiting, and “in very rare cases” brain damage or death… I don’t think nearly enough emphasis was put on them. The fact is, risk of death from tooth decay treatment, rare as it may be, is totally unacceptable when there is a proven natural preventative for the problem. The article did carry one dentist’s lament that fluoride toothpaste isn’t being used. But fluoride is not the most effective tooth decay preventer, and there was not a word about xylitol, which solid research has shown to prevent tooth decay more effectively than fluoride!
Natural sugar proven to drive away tooth decay
First of all: What is xylitol? It’s a natural sugar (for the technically inclined, a ‘sugar alcohol’, a ‘polyol’). Human metabolism produces very small amounts of xylitol, which is also found in fruit, berries, vegetables, birch wood, corn residues, straw, seed hulls and nutshells, but we can’t eat enough of these foods to get the amount of xylitol needed to help prevent tooth decay.
Even though as a Nutrition & Healing reader you (and apparently not the medical/ dental mainstream and public ‘health’ authorities) probably know something about preventing tooth decay with xylitol, you may not know the details about just how effective it can be. Or that xylitol can actually help reverse tooth decay in its early stages. In fact, with regular use, xylitol can actually eliminate tooth decay for an entire lifetime!
Cavities and decay virtually stopped in their tracks
Scientific research evaluating the systematic use of xylitol chewing gum and other products in the prevention of dental decay dates back more than 30 years. The initial studies were conducted under the auspices of the University of Turku in Finland. Since then, numerous studies from Finland, Hungary, and other countries have been virtually unanimous in their conclusion that xylitol… and to a lesser extent, other sugar alcohols… reduces the incidence of dental cavities both in children and adults. Let’s review a few of these studies.
One Finnish study evaluated xylitol in 10- to 11-year-old school children, who had been participating in a rigorous dental hygiene programme that included regular brushing and flossing, dietary instruction, systematic check-ups, and use of fluorides. Because this programme was so intense, the local dental and school authorities believed that the addition of xylitol to this regimen would have little or no benefit. They couldn’t have been more wrong! The children who chewed xylitol gum daily significantly decreased tooth decay, by nearly 50%. Permanent teeth that erupted during the time the children were chewing the xylitol gum were especially well protected.1
In a double-blind study conducted in Belize, 1,277 school children stopped everything several times each day to chew gum. Some of the children chewed ordinary gum sweetened with sucrose, while others chewed gum sweetened with either xylitol or sorbitol. After up to 40 months of daily gum chewing (including weekends and holidays), the xylitol group experienced 73% fewer cavities, compared with a reduction of 26% in the sorbitol group, and an increase of 120% in the sucrose group.2 (For the technically inclined, that’s extremely significant with a p<0.0001).
Further studies in other countries have yielded similar findings. For example, researchers in Estonia evaluated the use of xylitol gums and sweets in 10-year-old school children. Overall, three years of xylitol gum chewing, compared to a no-gum control group, resulted in a 53.5% reduction in tooth decay, while sucking on xylitol sweets led to a 33% to 59% reduction.3
Most xylitol research has been done on gums or sweets, but one study from Costa Rica compared xylitol-sweetened toothpaste with ‘control’ toothpaste. Both products contained fluoride. After 3 years of twice-daily brushing, the xylitol group had statistically significant fewer cavities (10.5%-12.3%), depending on the tooth surface examined.4
Avoid the dentist’s drill by chewing gum?
Yes, xylitol definitely prevents tooth decay! But now let’s cover some research-proven facts about xylitol’s abilities when it comes to reversing tooth decay. There’s a common belief that once a cavity gets going, the only solution is a dentist’s drill. Not true! Research has shown that xylitol can arrest the progress of tooth decay and eventually restore the affected tooth’s enamel coating, actually healing the cavity!5
This was clearly demonstrated in another study in Belize school children. The xylitol group had the highest per cent of arrested tooth decay at 27%, compared with the sorbitol group at 7%, and the no-gum control group at 9%.6 This particular research paper carried a particularly interesting title, starting with ‘Stabilisation of rampant caries…’, which of course means the dental cavities were getting out of control before xylitol stopped and even reversed them.
Steven Steinberg D.D.S. (at that time at the Harvard Dental School) wrote: “The anti-cariogenic effects of xylitol are well-documented. In some studies, not only were there decreases in the rate of new caries, but caries reversal also was noted – there was evidence of remineralisation.”7 In other words, Dr. Steinberg confirms that xylitol has the ability to not only halt tooth decay, but also to reverse it by restoring lost enamel.
So powerful you may be able to ‘cavity-proof’ your teeth for life
The truth is Xylitol is so effective that if you use it for long enough – perhaps two or three years – then even if you stop using it, you might never have another cavity for the rest of your life! This is especially true of small children. How can this be?
Tooth decay is actually an infectious disease, caused by a streptococcal bacterium named Streptococcus mutans. ‘Strep mutans’ is passed from mother (and father) to child, from brother to sister – and from boyfriend to girlfriend, husband to wife, mostly by kissing. The bacteria are almost entirely dependent on carbohydrates, especially sucrose and common starches, for energy production and growth.
In the presence of sucrose, Strep mutans bacteria thrive, churning out lots of tooth-dissolving acid and encouraging the reproduction of even more Strep mutans. But when Strep mutans is presented with xylitol, it treats it as lunch (or maybe breakfast or dinner) and takes it up as it does ordinary sugar. But Strep mutans can’t metabolise xylitol well at all, in a manner of speaking ‘gagging’ on it. As a result the bacteria can’t grow properly, producing only very small amounts of tooth-enamel destroying acid.
With xylitol, the population of Strep mutans goes down, down, down, until it’s replaced by other bacteria – there are literally dozens of others in our mouths which aren’t bothered in the same way by xylitol, and none of these cause tooth decay! (More on this bacteria-promoting side effect later.) Which means, of course, that to prevent re-infection and protect your teeth for the rest of your life, you… and your whole family for that matter… should be chewing xylitol gum or using xylitol toothpaste or products.
You could cut your risk of cavities by more than half
Long-term xylitol protection against tooth decay was demonstrated most clearly in yet another school-based study in Belize. The children were six years old on average when the study started.8 For two years, they chewed gum sweetened with either xylitol or sorbitol, while a control group had no gum. Then, five years later, their teeth were examined by dentists who did not know which treatment they had received. The xylitol group had a mean of only 1½ new cavities each in those five years, compared with 2½ each for the sorbitol group, and four for the no-gum group. Overall, use of xylitol was associated with a statistically significant 59% reduction in risk of dental cavities.
The long-term protection depended strongly on when the children’s permanent teeth erupted. Those teeth that erupted during the second year of xylitol gum chewing were almost completely protected from dental cavities (93% risk reduction). Even teeth that erupted after the children stopped chewing xylitol gum had substantial (88%) protection.
This was a very important study, because it showed that, if children get in the habit of chewing xylitol gum… or probably using other xylitol products, as well… at least one year before their permanent teeth erupt they will likely be protected from tooth decay for the rest of their lives.
Dousing dry mouth and tooth decay starts here
Although much research on xylitol has been done with children, adults can benefit as well. Adults at greatest risk of dental cavities are those who have poor oral hygiene due to illness, advanced age, or just bad habits.
Also at risk are some adults who suffer from a condition known as ‘dry-mouth’ syndrome, or xerostomia, because their ability to salivate is impaired. People who do not salivate enough are at increased risk for dental cavities because saliva normally helps neutralise bacterial acids and helps rinse bacteria and carbohydrates away from the teeth and out of the mouth.
‘Dry mouth’ can be a side effect of many medications, and it can also occur as a result of certain diseases, such as Sjögren’s syndrome, and radiation therapy to the head or neck. Chewing xylitol gum or sucking on xylitol sweets is an effective and pleasant way to stimulate salivation and has been shown to significantly reduce the incidence of tooth decay in adults who use it regularly.11,12
While nearly any sweets or gum would stimulate saliva just as well, sweets or gum containing xylitol have the further advantage of discouraging the growth of Strep mutans. This was demonstrated quite clearly in a study published in 2000 in the Journal of the American Dental Association13 in which 151 people, who were first treated with an oral antimicrobial mouth rinse containing chlorhexidine for two weeks, had their oral bacterial levels measured immediately after chlorhexidine disinfection, and again three months later. The participants were randomly assigned to chew either xylitol gum, sorbitol gum, or no gum beginning immediately after disinfection. By three months, bacteria had grown back to their pre-disinfection levels in both the sorbitol and no gum groups, but only to about one-third of their pre-disinfection levels in the xylitol group, a statistically significant difference.
This study was titled ‘Maintaining mutans streptococci suppression with xylitol chewing gum’ and appeared in the American Dental Association’s own journal 12 years ago! What could be clearer? Suppressing Strep mutans with xylitol, proven, in the American Dental Association Journal. Why isn’t this information being put to use by public health ‘authorities’ and the medical/ dental ‘mainstream’. What could be easier and less expensive health care than chewing xylitol gum? But I digress…
Xylitol sends plaque packing
Some paragraphs ago, you read that Strep mutans bacteria can’t metabolise xylitol well at all, so their population goes way down, and tooth decay goes down with them. But there’s also a second and independent ‘mechanism of action’ for xylitol: this natural sugar-alcohol prevents bacteria from sticking to tooth enamel as well.
When Strep mutans causes sucrose or other sugars to ferment, it produces not only lactic acid, which literally ‘rots teeth’, but it also makes a sticky polysaccharide (for the non-technically inclined, a ‘multiple sugar chain’) that glues bacteria together into plaque on the tooth surface. This concentrates acid on the dental enamel surface, making cavity formation progress faster. Strep mutans does not – and cannot – ferment xylitol, so the sticky polysaccharide isn’t produced, plaque doesn’t form to glue Strep mutans to dental enamel surfaces, and dental cavities are not promoted.14
And that isn’t all! Remember earlier I said xylitol promotes the growth of certain bacteria? A third way that xylitol helps reduce or eliminate tooth decay is by promoting the colonisation of other non-Strep mutans bacteria, which don’t cause tooth decay! If the environment becomes less hospitable for one type of bacteria, it may die off or survive with a dramatically smaller population, but other bacteria will move in to take their place. We all know that on planet Earth, there are very few totally germ-free areas – maybe in the exceptionally high temperatures of erupting volcanoes or the exceptionally low temperatures beneath miles of Antarctic ice – but definitely not inside human mouths! So when the Strep mutans ‘gags and chokes’ on xylitol and its population declines, it’s quickly replaced by literally dozens, maybe hundreds of other bacteria, none of which are even close to Strep mutans in its ability to rot your teeth!
Remember, one of the research studies reviewed earlier found that when mothers start chewing xylitol gum shortly after giving birth, their children don’t get cavities? The reason for this can now be traced to the development and transmission of these ‘friendly’ strains of bacteria, instead of transmitting Strep mutans, and with it, tooth decay. Once the ‘friendly bacteria’ are well-established in the mother’s mouth, she passes them on to her baby. And once established in the baby’s mouth, they help to keep the Strep mutans from growing in the mouth again, providing their children with potentially permanent protection against tooth decay. While it’s true that romantic interludes later in life might re-expose the now-grown child to Strep mutans again, continued use of xylitol chewing gum and/or toothpaste will continue to promote protection against dental cavities.
Are you getting the most out of your xylitol?
In addition to chewing gum and toothpaste, there are xylitol sweets, breath sprays, breath mints, mouthwashes, and supplements. The ‘delivery systems’ that produce the best anti-cavity effects are those that permit xylitol to come in direct contact with the teeth for the longest time. At the top of this list are xylitol chewing gums, especially ‘pellet-type’ gums that have a pure xylitol-sweetening coating. Chewy, sticky, hard, or tablet sweets made with a large proportion of xylitol are also quite effective. Toothpaste is good too, but few of us brush our teeth for the same length of time that we chew gum.
Studies show that using about 4 to 12g of xylitol per day is very effective for reducing cavities. If a piece of gum contains 1g of xylitol, then chewing four pieces per day should do the job. So read product labels carefully, and, when in doubt – because it’s so safe – it’s best to use a bit more rather than a bit less.
How often we use xylitol products may be more important than how much we use at any particular time. Clinical experience suggests that three times a day provides minimum effectiveness, while five times a day is ideal.
For the best lifetime effect, your mother (and father, too!) should have been chewing xylitol gum when she was pregnant with you! If that didn’t happen, to minimise tooth decay in the future, start using xylitol products as soon as you read this! Children should start chewing xylitol gum as soon as they can be trusted not to swallow it or choke on it, but at a minimum one year before their permanent teeth begin erupting. (To make sure, start no later than four to four and a half years of age.) Studies show that teeth treated this way will be strong and have long-lasting protection7. In fact, children who use xylitol have just as much protection as that provided by dental sealants.15
Adults can achieve the best results by first going to the dentist for a regular oral prophylaxis procedure that includes full mouth disinfection.16,17 After that, chewing xylitol gum regularly, as described above, can help keep Strep mutans bacteria suppressed. Using xylitol immediately after every meal or snack will help even more, and chewing xylitol gum between meals is also recommended. Only about three to five minutes of chewing is required. Beyond that, the xylitol content is generally depleted.
Xylitol works best when it is the only sugar present. Thus, it is still best to avoid foods that contain sucrose or a mixture of xylitol and sucrose or other dental-cavity-promoting carbohydrates, like starches, because these serve to dilute its effect. The old advice of limiting sweet between-meal snacks, still applies, as does brushing after every meal and flossing daily. Xylitol is a very effective product, but it’s not a guaranteed ‘get-out-of-dental-cavities-free card’.
In the amounts found in (and recommended for) dental health, xylitol is extremely safe. However, if xylitol is consumed in very large amounts (more than 20g per meal or more than 60g per day), it can cause diarrhoea in some sensitive people, but even these people eventually adapt to these high levels. The amounts recommended for dental protection (up to 12g per day) should never cause anyone any problems.
There’s just no question. If you want to reduce… or even eliminate… dental cavities in the future – and perhaps reverse some just developing now – use xylitol chewing gum, toothpaste, sweets and mints!Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Volume 6, Issue 5 – May 2012
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.