| Mäkinen et al. [17]; Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study |
Obtaining information on the effect of using chewing gums with xylitol and sorbitol on caries rates. |
The study participants were divided into groups in order to test sorbitol and xylitol against a control group. The individuals who used the xylitol chewing gum had a high caries experience, low fluoride availability, and difficulties accessing dental care. Although data on the characteristics of the portion of the sample that did not receive xylitol or sorbitol chewing gum were not collected, it is believed they were people with better conditions. Nevertheless, the groups that received these interventions showed lower levels of dental caries. |
| Mäkinen et al. [18]; Xylitol chewing gums and caries rates: a 40-month cohort study |
Investigating longitudinally the effect of chewing gum use on dental caries levels in individuals initially 10 years old living in Belize. |
Chewing gums with mixtures of xylitol and sorbitol were less effective when compared to the use of xylitol alone. The systemic use of polyol-based chewing gums reduces caries rates in young individuals. The group that showed the best results was the one that used xylitol gum 5 times a day. In this sense, xylitol is a good option even when the consumption of sugary foods is high and access to preventive and restorative dental treatments is limited. |
| Mäkinen et al. [19]; A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme |
Providing descriptive statistics of Belize City regarding the changes in dental caries rates observed after a period (16 months) of extensive use of xylitol chewing gum (up to 14 grams daily per child). |
There was a reduction in the DMFT index, resulting in a significant change, mainly in component D (of decayed teeth), which reflected the stabilization of the carious process, making the carious lesions non-progressive. |
Seki et al. [20]; Effect of xylitol gum on the level of oral mutans streptococci
of preschoolers: block-randomised trial |
Evaluating the influence of chewing gum consumption with xylitol on Streptococcus mutans levels in Japanese preschoolers aged 3 to 4 years. |
Until 1997, xylitol was not permitted to be used as a sugar substitute in Japan. The popularization of this product is occurring gradually. In the context of the study, fluoride availability was limited.
The consumption of chewing gum over a 3-month period is effective in controlling Streptococcus mutans in dental plaque in 3- and 4-year-old children. Interestingly, in this study, 10% of the children in the xylitol group had diarrhea as a side effect, a proportion much higher than what is described in the literature. |
| Kandelman et al. [21]; A 24-month Clinical Study of the Incidence and Progression of Dental Caries in Relation to Consumption of Chewing Gum Containing Xylitol in School Preventive Programs |
Investigating whether the daily consumption of xylitol chewing gum can be easily integrated and if it provides an additional benefit in existing oral health prevention programs. |
Chewing xylitol gum has shown to provide a beneficial effect on the carious process on all types of dental surfaces, especially on buccal-lingual surfaces. In this way, the study demonstrated a significant reduction in the incidence of caries disease with the additional use of xylitol chewing gum in a school prevention program in Montreal, Canada. |
| Honkala et al. [22]; Chewing of xylitol gum--a well adopted practice among finnish adolescents |
Describing the changes in Finland regarding the use of xylitol chewing gum, as well as other types of gum, between the years 1977 and 1991, using comparable and nationally representative surveys. Additionally, to identify the subgroups that adopted xylitol gum more extensively. Furthermore, to study the possible side effects of xylitol. |
The daily use of xylitol chewing gum did not vary according to socioeconomic level or degree of urbanization. The growth in xylitol gum use proved to be an example of the positive effect of health education, which was provided by a comprehensive and preventive dental healthcare system aligned with commercial interests. It is concluded that, in the past, the habit of chewing gum was considered harmful due to the cariogenic effect of sucrose present in gum, in addition to being regarded as an improper habit in many regions. However, it is noted that the inclusion of xylitol in chewing gum redefined the act of ‘chewing gum’ as a healthy choice and as a preventive measure against carious lesions, given that many teenagers already chew gum routinely, thus combining the habit with health prevention. |
| Chi et al. [23]; Milk sweetened with xylitol: proof-of-principle caries prevention randomized clinical trial |
Evaluating the effectiveness of xylitol-sweetened milk as a preventive strategy for caries among school-aged children. |
The participants were at high risk for caries, making fluoride and the availability of dental care as complements to xylitol indispensable. Risk factors require adequate public policies for the implementation of these strategies. Xylitol-sweetened milk reduced Streptococcus mutans levels but did not decrease caries rates compared to sorbitol or sucrose-sweetened milk. Nevertheless, it is a promising strategy for comprehensive dental caries prevention in school-aged children. |
| Olak et al. [24]; Caries prevention with xylitol lozenges in children related to maternal anxiety. A demonstration project |
Comparing the effect of a dental caries prevention program with xylitol lozenges between children of mothers with anxiety and those without anxiety. |
More anxious mothers had more decayed teeth, higher smoking rates, lower education levels, worse hygiene habits, and visited the dentist less frequently. No significant differences were found in dental caries between the children of anxious and non-anxious mothers who used xylitol; however, the number of caries-free children in the intervention group was higher than in the control group (which did not use xylitol). All high-risk children benefited from the use of xylitol, regardless of maternal anxiety. |
| Milgrom et al. [25]; Xylitol pediatric topical oral syrup to prevent dental caries: a double blind, randomized clinical trial of efficacy |
Evaluating the effectiveness of a pediatric topical oral xylitol syrup in reducing the incidence of dental caries in young children and to observe the effect of xylitol on reducing acute otitis media in a subsequent study. |
Xylitol is effective for the prevention of caries in deciduous teeth. However, caution should be exercised when using xylitol in children, as it may exacerbate the innate preference for sweet taste, which is already more common in individuals from low socioeconomic backgrounds. Nevertheless, xylitol is very important for the prevention of dental caries, and strategies are needed to enable its application at the population level, especially in social groups with high caries rates, where these interventions are likely to be cost-effective. |
| Alanen et al. [26]; Xylitol candies in caries prevention: results of a field study in Estonian children |
Testing xylitol candies as preventive agents for caries in schoolchildren with erupting permanent teeth. |
The occurrence of dental caries is related to socioeconomic factors. In this sense, the use of xylitol in schools for a period of 2 to 3 years was able to equalize the annual increase in dental caries between the groups that initially had higher and lower caries rates. The doses of xylitol used were lower than those in other studies and demonstrated excellent effectiveness. The best timing and duration of xylitol use should also be further investigated. Xylitol chewing gums and candies are effective in preventing dental caries. School distribution systems can be a practical way to control and use xylitol products, and a 3-month break for the summer holidays did not eliminate the preventive effects. It is an alternative especially for populations with limited access to dental services but with well-functioning schools. However, cost-effectiveness calculations depend on longer follow-up periods than those conducted in studies so far. |
| Meurman et al. [27]; Oral health programme for preschool children: a prospective, controlled study |
Evaluating the preventive effect of a risk-based oral health program (OHP) versus a traditional OHP focused on the occurrence of dental caries in Finnish preschool children. The program established for children with Streptococcus mutans colonization consisted of repeated motivation, oral health education, and at-home use of xylitol lozenges. |
In the studied population, Streptococcus mutans colonization in dental biofilm and the occupation of the caregiver or guardians were strongly associated with dental caries in children up to 5 years old. The risk-based oral health program, which even included the use of xylitol lozenges, appeared to have a better preventive effect in white-collar families than in blue-collar families. Thus, it was concluded that additional support and different methods for promoting oral health are necessary for families with blue-collar workers. |
| Ritter et al. [28]; Risk indicators for the presence and extent of root caries among caries-active adults enrolled in the Xylitol for Adult Caries Trial (X-ACT) |
Identifying associations between baseline data and two different dependent variables: the presence of any root caries and the extent of root caries. |
Further studies on the subject are needed to develop and validate risk models with large samples in longitudinal follow-ups of high-caries-risk participants, in order to obtain more effective results regarding the efficacy of daily xylitol lozenge use in reducing the increment of coronal and root caries in caries-active adults and children. In this regard, several determinants must be taken into consideration. |
| Al-Sudani et al. [29]; Association of current employment status with oral health-related behaviors: findings from the Finnish Health 2000 Survey |
Comparing the oral health-related behaviors (OHRBs) of unemployed individuals with those of employed individuals. Additionally, to assess whether OHRBs differed according to the duration of unemployment, considering demographic and socioeconomic factors. |
Current unemployment indicated irregular dental attendance among individuals, infrequent use of xylitol, daily smoking, risky alcohol use, and less beneficial OHRBs. Thus, it was concluded that unemployed individuals may constitute a risk group for oral health problems and associated health behaviors. Therefore, further research and oral health promotion programs should be conducted with a focus on this population group. |
| Tolvanen et al. [30]; Children’s oral health-related behaviors: individual stability and stage transitions |
Between 2001 and 2005, a community-level oral health promotion program was targeted at all 11- to 12-year-old children residing in Pori, a city in Finland. Thus, the study aimed to describe individual stability and transition stages concerning behaviors among the children of Pori exposed to this program. |
Behaviors are quite stable in childhood, especially positive ones, and it is evident that individuals who learned healthy behaviors at a young age are likely to maintain them during adolescence. Furthermore, any lapses into inappropriate behaviors during adolescence tend to be temporary in children who previously learned healthy behaviors. Regarding the use of xylitol products, the percentages for this behavior were not as strong, as the recommendation to use it three times daily is quite demanding and relatively recent. Additionally, improving xylitol use requires parents or children to purchase the product, which makes maintaining this habit more challenging. |
Socioeconomic factors associated with xylitol use as a behavior related to oral health: a literature review