Xylitol is a low-calorie sweetener found naturally in a number of fruits and vegetables. It has been used as a sugar substitute for more than 30 years. It has been suggested that xylitol may reduce the levels of mutans Streptococci (MS) in plaque.

The aim of this review was to assess the effect of maternal use of xylitol gum on MS reduction in infants to evaluate the role of xylitol gum in caries prevention strategies.

Methods

The PubMed, Embase, Scopus, and Cochrane Central Register of Controlled trials databases were searched without language restrictions. Randomised or quasi-randomised controlled trials that evaluated the outcome of the maternal use of xylitol gum on MS colonization in infants were considered. Two reviewers extracted data independently and study quality assessed using the Cochrane risk of bias tool. The primary outcome was the presence of MS in the saliva or plaque of infants; the secondary outcome was dental decay.

Results

• 11 articles reporting the results of 5 trials were included.
• The included studies recruited mothers with high salivary levels of MS.
• The daily dose of mothers’ xylitol consumption ranged from 1.95 to 5.28 g
• Studies used various objective definitions of MS colonization
• The incidence of MS in their saliva or plaque was significantly reduced in the xylitol group, and the Risk Ratios were:-
  • 0.44 (95% CI: 0.08–2.40) at 6–9 months
  • 0.54 (95% CI: 0.39–0.73) at 12–18 months
  • 0.60 (95% CI: 0.34–1.08) at 24 months,
  • 0.56 (95% CI: 0.40–0.79) at 36 months
  • 0.61 (95% CI: 0.48–0.76) at 60 months.
• 3 studies evaluated decay as an outcome but the data could not be pooled. Findings were inconsistent with some studies demonstrating caries reductions and others showing no differences.

Conclusions

The authors concluded:

Habitual xylitol consumption by mothers with high MS levels was associated with a significant reduction in the mother-to-child transmission of salivary MS. These findings, however, were based on evidence that may have suffered from biases, warranting further research involving large RCTs.

Comments

This review has conducted a wide search for evidence and identified 11 reports of 5 trials. Three research groups have published one or more papers; in the main representing different follow up time points from the original studies. The authors have meta-analysed the data at these five time points. However, only one of these time points (12-18 months) included more than 2 studies.

While the studies designs themselves were reasonably homogeneous, there was a marked variation in the amount of xylitol consumed per day 1.95 to 5.28g and some of the variation in the findings may be due to this variation in ‘dosage.’

It also needs to be borne in mind that the hypothesis is that by delaying the transmission of MS there will be an impact on caries. So while the review suggests that xylitol use reduced MS transmission, the evidence related to caries reduction is mixed.

Two Cochrane reviews are underway related to xylitol use (Richards et al 2012 & Sharif et al 2013).

Links

Lin HK, Fang CE, Huang MS, Cheng HC, Huang TW, Chang HT, Tam KW. Effect of maternal use of chewing gums containing xylitol on transmission of mutans streptococci in children: a meta-analysis of randomized controlled trials. Int J Paediatr Dent. 2015 Feb 13. doi: 10.1111/ipd.12155. [Epub ahead of print] PubMed PMID: 25684114.

Richards D, Duane B, Sherriff A. Maternal consumption of xylitol for preventing dental decay in children (Protocol). Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD010202. DOI: 10.1002/14651858.CD010202.

Sharif MO, Ahmed F, Worthington HV. Xylitol-containing products for preventing dental caries in children and adolescents (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD010743. DOI: 10.1002/14651858.CD010743.