School-based use of xylitol/maltitol or erythritol/maltitol lozenges in low caries area had no additional caries preventive effect

Photograph of carious teeth

The aim of the study was to investigate whether, in a school-based setting in a low caries prevalence population xylitol/maltitol  or erythritol/maltitol conferred any additional caries preventive effect.

  • Xylitol is a non-fermentable sugar alcohol
  • Erythritol is a noncaloric tetritol (tetrahydroxy alcohols) with about  70% of the sweetness of  sucrose.
  • Maltitol is generally considered an inert polyol

In this  4-year, cluster-randomized, clinical trial 579, 10-year-old children from 21 schools in Finland were randomly assigned to one of five groups.  Each of the four intervention groups ( A,B,C,D) received  lozenges on school days, in three teacher-supervised sessions daily, over 1 or 2 years a fifth control group received no lozenges group

  • Group A  –  4.7 g/4.6 g  xylitol⁄maltitol  for 1 year
  • Group B  –  4.7 g/4.6 g  xylitol⁄maltitol  for 2 years
  • Group C  –  4.5 g/4.2 g erythritol⁄maltitol for 1 year
  • Group D  –  4.5 g/4.2 g erythritol⁄maltitol for 2 years
  • Group E  –  Control

The children received free examinations and care in the public health centre. 496 were examined the main outcome measure being dentine caries increment at 4 years

They found

  • No caries reduction with lozenge use
  • A strong relationship between baseline caries prevalence and the 4-year increment (OR = 7.38; 95% CI: 3.78–14.41).

The authors concluded

The results suggest that in relatively low-caries conditions the school-based use of xylitol/maltitol or erythritol/maltitol lozenges would not have additional caries-preventive effect whencompared with comprehensive prevention.

Lenkkeri AM, Pienihäkkinen K, Hurme S, Alanen P. The caries-preventive effect of xylitol/maltitol and erythritol/maltitol lozenges: results of a double-blinded, cluster-randomized clinical trial in an area of natural fluoridation. Int J Paediatr Dent. 2011 Sep 23. doi:10.1111/j.1365-263X.2011.01182.x. [Epub ahead of print] PubMed PMID: 21951305.



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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