XYLITOL

Xylitol is a naturally occurring, diabetic-safe, low-calorie sugar that is not metabolized by MS. Since it is not broken down by cariogenic microorganisms, xylitol starves the MS in a manner similar to removing sucrose from the diet completely. Including xylitol into the diet will also inhibit MS attachment to the teeth making it a good product for decreasing the bacterial load of primary care givers and interrupting the vertical transmission of MS to the child. Since there is no metabolism and no drop in the salivary pH, the environment favors nonacidogenic bacteria. Makinen et al. found that the systematic use of xylitol chewing gum significantly reduced the relative risk of caries compared to gums containing sorbitol/xylitol and sucrose. Using the same population, he and his coworkers found that the use of a xylitol gum was more frequently associated with the arrest of dentinal caries than the other combinations of chewing gum.
In summary, the use of xylitol-containing products, such as chewing gum, mints, candy, and cookies has resulted in decreasing the incidence of dental caries, arresting carious lesions and decreasing the transmission of MS from mothers and caregivers to children. The only side effect of too much xylitol ingestion is that it may have a mild laxative effect. The benefit of using xylitol-containing products is complemented by increasing the salivary flow, which draws the buffering capacity of saliva into action
as well as the electrolytes that contribute to remineralization. Therefore, the benefit of using xylitol is not confined to children, it is extended to many adults who experience dry mouth. The amount of xylitol needed for benefits against caries is slowly being refined. In 2006, Makinen narrowed the daily dose
to between 6-10 grams per day. To determine the exact amount of xylitol in a product, the manufacturer should be consulted or alternatively, patients can be advised to choose products with xylitol listed on the label as the first ingredient.
Conclusion
The evidence base for recommending products manufactured with xylitol is strongly supported by controlled clinical trials.
Application
More products containing xylitol are becoming available. For moderate, high, and extreme caries risk patients (ask about your risk level from your dentist), two pieces of xylitol gum or two pieces of xylitol hard candy/mints should be used for five minutes following meals or snacks four times daily. The target dose of xylitol is 6 to 10 grams spread throughout the day. Excessive or prolonged gum chewing is not advised. Most xylitol-sweetened products contain flavor that only lasts a short time to discourage excessive chewing. Adults with dry mouths or senior citizens, who may not like to chew gum because of occlusion problems, have the option of using xylitol in mints, candies, mouthwash, toothpaste, or mouth sprays.