Xylitol makes for a great sweetener, as it looks and tastes like sugar – a white, crystalline powder with a cooling twist. However, it is not only used for its excellent flavour but can be linked to many health-inducing benefits as well. As such, xylitol has long lasting roots as a part of Finnish health education as well as industrialized xylitol production in Finland. Fazer Xylitol is the first industrially produced xylitol from oat hulls and a great example of modern Nordic innovation at work.

XYLITOL AND DENTAL HEALTH
Xylitol prevents caries occurrence

The caries-preventing effect of xylitol was first demonstrated in the Turku sugar studies in the early 70’s. In the 2-year study all sucrose in the diet was replaced with xylitol which practically stopped the caries occurrence. After that several clinical trials have demonstrated that adding xylitol to a normal diet in the form of chewing gums or pastilles reduces the risk of caries (1-3). It appears to be important for the caries-preventive effect of xylitol that xylitol consumption is habitual and that daily xylitol doses are high enough, 5 g or more. However, also lower daily xylitol doses may be effective: in an Italian study in high-caries-risk adults xylitol-sorbitol (2.5g xylitol/day) gum was better than isomalt-sorbitol gum in reducing caries occurrence (4).



The key to xylitol’s dental benefits can be found in its 5-carbon structure

Dental plaque bacteria do not produce acids from xylitol, nor does it “learn” to use xylitol. In other words, when you use xylitol as a sweetener, the harmful bacteria in your mouth reduces and starves, creating less tooth decay. As xylitol is a sweet substance, it stimulates salivary flow and the neutral pH favours mineralization. Xylitol has also been suggested to boost the caries-preventive effects of fluoride (5).


Effects on plaque and mutans streptococci
  •  Daily use of xylitol especially in chewing gums reduces dental biofilm (plaque) accumulation (6). Habitual, long-term xylitol consumers have low levels of dental plaque (7). Also, the acid production potential, a virulence factor of plaque, is reduced (4).
  • Xylitol consumption reduces the counts of caries-associated mutans streptococci in plaque but appears not to affect the microbiota in general (8). In this way xylitol acts as an oral prebiotic reducing plaque dysbiosis.
  • The colonization of the infant’s teeth with mutans streptococci significantly increases the future caries risk of the child. Xylitol consumption of mothers has reduced the mother-child transmission of mutans streptococci and caries occurrence (9-11)

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Finnish Current Care Guidelines 2020: Caries control
  • To control caries occurrence daily use of xylitol chewing gum or pastilles (5 g/day or more) after meals is recommended
  • Caretakers of young children are recommended to use xylitol products (at least 5-6 g xylitol/day) on daily basis especially if they have a history of dental caries
  • Daily use of xylitol chewing gum or pastilles after meals is recommended before the eruption of permanent teeth or during their eruption
  • To promote oral health of children in daycare controlled delivery of xylitol products is recommended
To whom xylitol is beneficial?

All xylitol consumers should benefit from the effects of xylitol on oral health. The reduction in the amount and virulence of dental plaque is important from a cariological point of view but also for the plaque-related periodontal disease. Habitual xylitol consumption is recommended for example for caries-active patients, caretakers of young children and subjects with reduced oral hygiene. People suffering from symptoms of dry mouth should benefit from xylitol. Older people living in a community chewed xylitol chewing habitually for 6 months. The plaque index, gingival index and self-perceived oral health improved in the xylitol gum group (12).

Xylitol vehicles

Dental benefits of xylitol have been studied mostly with chewing gums, but also pastilles may have similar benefits (13). Effects of oral rinses and toothpastes on oral health should be improved by high concentrations of xylitol.

BENEFITS OF XYLITOL FOR RESPIRATORY HEALTH, SINUSITIS AND ACUTE OTITIS MEDIA

Benefits for xylitol have been suggested in relieving congestion and sinusitis, however, more studies are needed on these topics (14). There is convincing evidence that xylitol may reduce the risk of acute otitis media (15).

BENEFITS OF XYLITOL FOR SKIN

Exposure of the skin with xylitol appears to reduce skin moisture loss. The mechanism appears to relate to increased tight junction and barrier formation in the skin (14). Xylitol also shows antimicrobial activity against skin pathogens like Pseudomonas aeruginosa and Staphylococcus aureus especially when combined with antimicrobial agents like lactoferrin (14, 16).

OTHER HEALTH BENEFITS OF XYLITOL

Several other health benefits have been reported for xylitol. Xylitol is proposed to have potential anti-hyperglycemic properties and a benefit on the metabolic health in general (14, 17). Studies also suggest that xylitol may influence satiety hormones and help in weight management (14, 17). The proposed immune modulatory effects of xylitol may reflect its prebiotic properties (18).

ADVERSE EFFECTS OF XYLITOL

Digestive disorders are sometimes associated with polyol consumption. Xylitol belongs to the FODMAP substances which may no suit persons with digestive disorders. Complaints about digestive discomfort in xylitol studies are, however, rare (8, 19). Also, no complaints on problems with temporomandibular joint dysfunction have been reported. For dental benefits relatively small daily xylitol doses are needed, 5 g/day, and xylitol is dissolved from the chewing gum within 5 minutes of chewing (20).

References

  1. Desphande A, Jadad A. JADA 2008, 139, 1602-1613
  2. Mäkinen KK. Med Princ Pract 2011, 20, 303-320
  3. Janakiram C, Kumar C, Joseph J. J Nat Sci Biol Med 2017, 16-21
  4. Cocco F, Carta G, Cagetti M, Strohmenger L, Lingström P, Campus G. Clin Oral Investig 2017, 21, 2733-2740
  5. Fontana M. Caries Res 2016, 50(suppl 1): 22-37
  6. Maguire A, Rugg-Gunn A. Br Dent J 2003, 194, 429-436
  7. Söderling E, Isokangas P, Tenovuo J, Mustakallio S, Mäkinen KK. Caries Res 1991, 25, 153-157
  8. Söderling E, Pienihäkkinen K. Acta Odontol Scand 2020 78, 599-608
  9. Söderling E, Isokangas P, Pienihäkkinen K, Tenovuo J. J Dent Res 2000, 79, 882-887
  10. Laitala ML, Alanen P, Isokangas P, Söderling E, Pienihäkkinen K. Community Dent Oral Epidemiol 2013, 41, 534-540
  11. Li Y, Tanner A. Pediatr Dent 2015, 37, 226-244
  12. Al-Haboubi M, Zoitopoulos L, Beighton D, Gallagher J. Community Dent Oral Epidemiol 2012, 40, 415-424
  13. Alanen P, Isokangas P, Gutmann K. Community Dent Oral Epidemiol 2000, 28, 218-224
  14. Salli K, Lehtinen M, Tiihonen K, Ouwehand A. Nutrients 2019, 11, 1813
  15. Azarpazhooh A, Laerence H, Shah P. Cochrane Database Syst Rev 2016, 8, CD007095
  16. Ammons M, Ward L, James G. Int Wound J 2011, 8, 268-273
  17. Wölnerhanssen B, Meyer-Gerspach A, Beglinger C, Islam Md. Crit Rev Food Sci Nutr 2020, 60, 1986-1998
  18. Ruiz-Ojeda F, Plaza-Diaz J, Saez-Lara M, Gil A. Adv Nutr 2019, 10(suppl 1), S31-S48
  19. Mäkinen KK. Int Dent J 2016; 2016:5967907
  20. Lif Holgerson P, Stecksen-Blicks C, Sjöström I, Twetman S. Caries Res 2006, 40, 393-397