The optimum time to initiate habitual Xylitol gum chewing for obtaining long-term caries prevention

(Hujoel, PP, Makinen, KK, Bennett CA et. al. J.Dent Res 78" 797-803 1999.)

Habitual Xylitol gum chewing may have a long term preventive effect for reducing the caries risk for several years after the habitual chewing has ended .

Habitual Xylitol gum chewing should be started least one year prior to tooth eruption.  Tooth eruption during the Xylitol intervention program had the largest long term effect on risk reduction. Long term caries preventive effect of Xylitol can be explained by Loesche's (1985) hypothesis that the characteristic of the infection established at eruption determines the life long caries risk.  Once a pit and fissure area is colonized by a specific bacteria, even very high salivary levels of ms far in excess of colonization threshold, will not displace the original bacteria (Svanberg and Loesch, 1977).   Xylitol use before tooth eruption insures the establishment of a benign infection with consequent long term benefits.  May be due to the development of a xylitol resistant strain of ms with less cariogenicity (Trahan et.al.1996).

The use of Xylitol in preventing Acute Otitis Media (AOM). “A Novel Use of Xylitol Sugar in Preventing Acute Otitis Media” (Uhari, et. Al) looked at 857 children in a randomized, controlled, and blinded study. Children received xylitol sugar in the form of syrup, chewing gum, or lozenges for a three-month period of time. A statistically significant decrease was noted in all groups with the chewing gum group posting a 40% decrease while the syrup and lozenge group showing 30% and 20% decreases respectively. The authors felt the beneficial effects of xylitol most likely had something to do with its local inhibitory action on the adhesive properties of pneumococci and H. influenza. Unfortunately, the concentrations of xylitol in the vehicles used in the study aren’t available in the United States.

Dosages of Xylitol in various studies:
   Turku study (1972)  mean of 50 gm/day had 85% caries reduction. (In various foods)*
   Turku study (1973)  6.7 gm/day had 82% caries reduction. (In gum).*
   Finish study (1983) 10 gm/day had 80% caries reduction. (In gum)
   Montreal study (1984) 3.5 gm/day had 35% caries reduction.(In gum)
   Beliez study (1988) 10 gm/day had 80% caries reduction. (In gum)
        1 stick of gum has 0.67 gms of Xylitol. Chewing 10 stick will provide 6.7 gms. This is the recommended dose.

*Scheinin, A and Makinen, KK, Turku sugar studies I-XXI, Acta Odontol Scan, 34(4), 1-350. 1976