The effect of xylitol chewing gums and candies on caries occurrence in children: a systematic review with special reference to caries level at study baseline.

PURPOSE: A systematic review of published data was carried out to assess the caries-preventive effects of xylitol chewing gums and candies in children. METHODS: Electronic and hand searches were performed to find clinical studies on the effects of xylitol chewing gums and candies on dental caries in children (≤ 18 years). Prospective randomised or controlled clinical trials published before 2023 were included in the review. RESULTS: The initial search identified 365 titles to be evaluated. After applying inclusion and exclusion criteria, 15 articles with either fair or low quality were reviewed. Nine articles studied chewing gums, five candies, and one both of them. In the ten evaluated xylitol chewing gum studies xylitol consumption significantly reduced caries occurrence when compared with no treatment or a placebo polyol gum. The effect was clinically significant in studies with high or moderate caries level at study baseline. The results also suggested that the caries-reducing effect of xylitol gums may differ from sorbitol/polyol gums. In five of the six heterogenous xylitol candy studies, no caries-reducing effect was found independent of caries level. In addition to caries level, also the daily xylitol dose was a confounding factor. CONCLUSION: The present findings suggest that the caries-reducing effect of adding xylitol chewing gum to the daily diet has been well demonstrated in children and adolescents with high or moderate caries level at study baseline. Xylitol gum use could benefit subjects with active incipient caries lesions on smooth tooth surfaces.

Influence of 2'-fucosyllactose and galacto-oligosaccharides on the growth and adhesion of Streptococcus mutans.

Human milk oligosaccharides, such as 2'-fucosyllactose (2'-FL), and galacto-oligosaccharides (GOS), a prebiotic carbohydrate mixture, are being increasingly added to infant formulas, necessitating the understanding of their impact on the oral microbiota. Here, for the first time, the effects of 2'-FL and GOS on the planktonic growth and adhesion characteristics of the caries-associated oral pathogen Streptococcus mutans were assessed, and the results were compared against the effects of xylitol, lactose and glucose. There were differences in S. mutans growth between 2'-FL and GOS. None of the three S. mutans strains grew with 2'-FL, while they all grew with GOS as well as lactose and glucose. Xylitol inhibited S. mutans growth. The adhesion of S. mutans CI 2366 to saliva-coated hydroxyapatite was reduced by 2'-FL and GOS. Exopolysaccharide-mediated adhesion of S. mutans DSM 20523 to a glass surface was decreased with 2'-FL, GOS and lactose, and the adhesion of strain CI 2366 strain was reduced only by GOS. Unlike GOS, 2'-FL did not support the growth of any S. mutans strain. Neither 2'-FL nor GOS enhanced the adhesive properties of the S. mutans strains, but they inhibited some of the tested strains. Thus, the cariogenic tendency may vary between infant formulas containing different types of oligosaccharides.

Effect of Lactobacillus rhamnosus and Bifidobacterium lactis on gingival health, dental plaque, and periodontopathogens in adolescents: a randomised placebo-controlled clinical trial.

To determine the effect of a probiotic combination of Lactobacillus rhamnosus GG (LGG) and Bifidobacterium lactis BB-12 on the gingival health, dental plaque accumulation, and the oral carriage of four putative periodontal pathogens in healthy adolescents. 108 schoolboys, aged 13-15 years, participated in this study. They were divided into two groups: probiotics (n=54) and placebo (n=54). Both groups received two probiotic-laced or placebo lozenges twice a day during a four-week period. Plaque Index (PI) and Gingival Index (GI) were recorded at baseline and after four weeks. Salivary and plaque carriage of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum were also monitored likewise. 101 subjects completed the study. A statistically significant reduction in GI was seen in the probiotic group as compared to the placebo group (P=0.012). A reduction in PI was found for both groups, with no difference observed between the groups after intervention (P=0.819). Probiotic lozenges significantly reduced levels of A. actinomycetemcomitans and F. nucleatum in saliva and plaque (P<0.05) and levels of P. gingivalis in plaque (P<0.05), while no significant changes were found in the control group. A significant reduction (P<0.001) was also noted in the total salivary bacterial counts of the test group. The short-term daily consumption of LGG and BB-12 probiotic lozenges improved the gingival health in adolescents and decreased the microbial counts of A. actinomycetemcomitans, and P. gingivalis. Hence probiotic supplements may serve as a simple adjunct to standard oral care for promoting the oral health in adolescents.

Adhesion and Early Colonization of S. Mutans on Lithium Disilicate Reinforced Glass-Ceramics, Monolithic Zirconia and Dual Cure Resin Cement.

OBJECTIVE: Monolithic zirconia and glass ceramics are increasingly used in implant crowns. Limited data is available on bacterial adhesion and early biofilm formation on these materials. METHODS: Four different materials were investigated: (1) Lithium disilicate glass-ceramics (LDS), (2) Fully stabilized zirconia (FSZ), (3) Partially stabilized zirconia (PSZ), and (4) Dual curing cement (DCC). The materials' surfaces were characterized with spinning disc confocal microscopy and by water contact angle and surface free energy (SFE) measurements. For the adhesion tests the materials were rolled in suspensions of Streptococcus mutans. Early biofilm formation was studied on the materials and allowing the biofilms to form for 24 h. S. mutans cell counts were determined by plate culturing. ANOVA and post-hoc Tukey's tests (p⟨0.05) were used for statistical evaluation. RESULTS: The LDS surfaces were clearly hydrophilic with the highest SFE value (p⟨0.001). For S. mutans adhesion, the ranking of the materials from lowest to highest was: LDS = FSZ ⟨ DCC ⟨ PSZ (p⟨0.05). No significant differences among the materials were noticed in biofilm formation. CONCLUSIONS: LDS has lower S.mutans adhesion than other materials examined in this study, but the difference was not reflected in early biofilm formation.

Salivary microbiota and caries occurrence in Mutans Streptococci-positive school children.

AIM: To compare the composition of the salivary microbiota in caries-affected vs. caries-free mutans streptococci (MS)- positive children with mixed dentition. MATERIALS AND METHODS: Twenty eight healthy, 11-12-year-old schoolchildren with high MS counts (>10⊃5 CFU/mL) were included in this study. The children were screened with the Dentocult SM Strip Mutans test (Orion Diagnostica, Espoo, Finland) and examined using the International Caries Detection and Assessment System (ICDAS). The microbial composition of the saliva was assessed using the Human Oral Microbe Identification Microarray (HOMIM). Microbial differences between caries-affected (n=18) and caries-free children (n=10) were compared by Mann-Whitney analysis. RESULTS: The microbiota of the caries-affected vs. caries-free children was rather similar. Abiotrophia defectiva and Actinomyces meyeri/A. odontolyticus were significantly higher in caries-affected than in caries-free children (p=0.006, 0.046, respectively). Shuttleworthia satelles was significantly higher in caries-free compared to caries-affected children (p=0.031). A. defectiva and A. meyeri/A. odontolyticus correlated positively with caries severity measured by ICDAS Caries Index (p = 0.494, 0.454, 0.400 respectively) while S. satelles was negatively correlated with caries severity (p= -0.489). CONCLUSIONS: Salivary A. defectiva and A. meyeri/A. odontolyticus and are associated with caries occurrence in MS-positive children with mixed dentition.

The effect of dietary intervention on paraffin-stimulated saliva and dental health of children participating in a randomized controlled trial.

OBJECTIVES: The aim was to study the impact of dietary intervention on the properties of paraffin-stimulated saliva, and on dental caries. STUDY DESIGN: At 7 months of age 1062 infants (540 intervention; 522 controls) started in the prospective, randomized Special Turku Intervention Project (STRIP) aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis of adult age (www.clinicaltrials.gov NCT 00223600). At 3 years of age, every fifth child was invited to an oral sub-study, and 148 (78 boys) children attended. At 6, 9, 12 and 16 years of age 135, 127, 114 and 88 children were restudied, respectively. Dietary intakes of carbohydrates, protein, saturated fat, calcium, phosphate, and fibre were regularly recorded using 4-day food records. Height and weight were regularly monitored. Paraffin-stimulated saliva samples were collected at 6, 9, 12 and 16 years of age, and analyzed for flow rate, buffer capacity, calcium, phosphate and proteins. Dental health was recorded and expressed as d3mft/D3MFT, and as time of caries onset. RESULTS: Dietary intakes of calcium, phosphate and fibre, and salivary flow rate increased with time in both groups (p<0.001, GLM for repeated measures). Fibre intake and salivary flow rate were higher in the intervention than in the control group (p=0.042 and p=0.0394, respectively, GLM for repeated measures). There were no correlations between dietary intakes and salivary concentrations of calcium or phosphate. Children who did not have caries experience (d3mft/D3MFT=0) during the entire follow-up had higher salivary calcium than those who had caries already at 3 years of age. The association between salivary calcium and caries onset was significant up to 12 years of age. Toothbrushing frequency was statistically significantly associated with caries-onset at ages 6 (gamma statistic 0.457, p=0.046) and 12 years (gamma statistic 0.473, p=0.019). CONCLUSIONS: The current long-term dietary intervention increased children's paraffin-stimulated salivary flow rate. The concentration of salivary calcium was directly correlated to dental health. Higher salivary flow rate in the intervention group is believed to be due to higher fibre intake in the intervention group.

Administration of Bifidobacterium animalis subsp. lactis BB-12 in early childhood: a post-trial effect on caries occurrence at four years of age.

Probiotic bifidobacteria are widely used in the prevention of childhood diseases. These bacteria are also associated with caries occurrence. The present secondary analysis in a low-caries population evaluated the effect of early administration of Bifidobacterium animalis subsp. lactis BB-12 (BB-12) on caries occurrence and identified markers of dental decay in early childhood. In the original randomized, double-blind, placebo-controlled study (NCT00638677, http://www.clinicaltrials.gov), infants (n = 106) received BB-12, xylitol or sorbitol tablets from the age of 1-2 months to 2 years with a slow-release pacifier or a spoon (daily dose of BB-12 10(10) colony-forming units, polyol 200-600 mg). The present data were collected using clinical examinations and questionnaires at the age of 4 years. The occurrence of dental caries was assessed using the International Caries Detection and Assessment System. Oral hygiene status and mutans streptococci (MS) levels were also determined. No differences were detected between the study groups in the occurrence of enamel caries (p = 0.268) or obvious dentinal caries (p = 0.201). The occurrence of caries was associated with daily consumption of sweet drinks (p = 0.028), visible plaque observed (p = 0.002) and MS detected in the dental plaque (p = 0.002). Administration of BB-12 in infancy does not seem to increase or decrease the occurrence of caries by 4 years of age in a low-caries population.

Xylitol carryover effects on salivary mutans streptococci after 13 months of chewing xylitol gum.

To assess mutans streptococci (MS) during xylitol gum chewing (mean 3.8 g/day, 2.9 times/day) for 13 months and then for 15 months after the intervention, Japanese mothers with high salivary MS were randomized into two groups: xylitol gum (n = 56) and no gum (n = 51). The proportion of low MS levels was highest at 3 months of consumption (48.8%), but was significantly lower compared to baseline at the end of the intervention (p < 0.001). MS levels did not change during the postintervention period. The data suggest that in the xylitol group 23.3% showed persistent carryover effects by xylitol gum chewing in the postintervention period.

Clinical evidence for polyol efficacy.

Xylitol is a safe dental caries preventive when incorporated into chewing gum or confections used habitually. The goal of this paper is to identify and assess the work on xylitol and other polyols and dental caries since 2008. Xylitol is effective when used by the mother prenatally or after delivery to prevent mutans transmission and subsequent dental caries in the offspring. One new completed trial confirmed that children of mothers who used xylitol lozenges after delivery had less dental caries than a comparison group. A similar study confirmed that the use of xylitol gum by the mother either prevented or postponed MS transmission to the offspring. Xylitol use among schoolchildren delivered via a gummy bear confection reduced S. mutans levels, but a once per day use of xylitol-containing toothpaste did not. Randomized trials, with caries outcomes, assessing xylitol-containing lozenges in adults and xylitol-containing gummy bears in children will release results in the coming year. Other studies are ongoing but are not systematic and will fail to answer important questions about how xylitol, or other polyols, can address the global dental caries problem.

A cohort study on the association of early mutans streptococci colonisation and dental decay.

In children, a strong relationship between the timing of colonisation of mutans streptococci (MS) and future caries risk has been shown to exist. The aim of the study was to examine the association of early MS colonisation with dental decay and the need for restorative treatment. The subjects had been participants in an earlier Finnish mother-child study and assumed to be high-caries-risk subjects due to their mothers' high MS levels. The information on MS colonisation at 2 years of age was available for 164 children. Of them, comprehensive data on dental health, visits and treatments until 10 years of age were found in the registers for 147 subjects. The children who had not been colonised by MS at 2 years of age (n = 118) maintained their teeth caries-free longer than the MS-colonised (n = 29) children. The median value for the caries-free time for MS-colonised children was 4.6 years, in comparison with 8.0 years for non-MS-colonised children (p < 0.001, hazard ratio 2.70; 95% CI 1.72-4.25, Cox regression). Until 10 years of age, the MS-colonised children had made on average 4.6 visits for restorative treatment, while the non-MS-colonised had made 2.8 visits (p = 0.005, Student's t test). The results suggest that the avoided early MS colonisation may lead to favourable long-term effects on caries experience and need for restorative treatment.

Caries prevention with xylitol lozenges in children related to maternal anxiety. A demonstration project.

AIM: This was to compare the effect of a prevention program between children of anxious and non-anxious mothers. METHODS: Mothers (n=120) with high and low dental anxiety scores (DAS>15 and DAS <8, respectively), and with high levels of mutans streptococci (>10(5)cfu/mL) were recruited at a maternity clinic of Tartu, Estonia. Two groups: 30 highly anxious, and 30 non-anxious mothers used xylitol (6 g/day) for 33 months and a non-treatment group of 60 mothers, both highly and low anxious (30 in each sub-group), acted as controls. All mothers were interviewed for oral health habits and education, and their dental health was examined. Due to discontinued participation 75% of the children (n=90) were examined at 2 and at 3 years of age. RESULTS: Anxious mothers brushed less frequently (p=0.014), had a longer time since their last dental visit (p<0.0001), and a lower level of education (p<0.0001) than their non-anxious counterparts. However, maternal anxiety had no effect on children's dental health, contrary to the caries prevention program which was effective both at 2 and at 3 years of age (p<0.01; OR 6.6, 1.8-25.0 and OR 3.9, CI 1.5-10.0, respectively). CONCLUSION: Children benefited from the caries prevention program, irrespective of maternal anxiety.

Bifidobacterium animalis subsp. lactis BB-12 administration in early childhood: a randomized clinical trial of effects on oral colonization by mutans streptococci and the probiotic.

A randomized clinical trial studied the effects of early administration of Bifidobacterium animalis subsp. lactis BB-12 (BB-12) on oral colonization of (1) mutans streptococci (MS), and (2) BB-12. In this double-blind, placebo-controlled study, infants (n = 106) received probiotic bacteria (BB-12 group), xylitol (X group), or sorbitol (S group). Test tablets were administered twice a day (from the age of 1-2 months) with a novel slow-release pacifier or a spoon (daily dose of BB-12 10(10) CFU, polyol 200-600 mg). Samples were collected from mucosa/teeth at the age of 8 months and 2 years for BB- 12 determination (qPCR) and plate culturing of MS (MSB, TYCSB), lactobacilli (Rogosa) and yeasts (Sabouraud). The MS levels of the mothers were determined (Dentocult SM Strip Mutans). The baseline characteristics of the three groups were similar. Mean duration of tablet delivery was 14.9 ± 6.7 months. In all groups, >90% of the mothers showed high MS counts (log CFU ≥5). MS colonization percentages of the children at the age of 2 years were rather low (BB-12 group: 6%; X group: 31%; S group: 10%; p < 0.05). The levels of lactobacilli and yeasts did not differ between the groups. BB-12 cell counts barely exceeding the detection limit were found in three of the oral samples of the 8-month-old children; however, the 2-year samples did not contain BB-12. The early administration of BB-12 did not result in permanent oral colonization of this probiotic or significantly affect MS colonization in the children.

Effect of infancy-onset dietary intervention on salivary cholesterol of children: a randomized controlled trial.

This study investigated salivary cholesterol of children from 6 to 16 years of age in response to dietary intervention. One thousand sixty-two infants started in the prospective, randomized project. At 3 years of age, every fifth child was invited into the study (n=178). Of these, 148 enrolled, and 86 completed the oral sub-study at 16 years of age. The intervention aimed at restricting the child's saturated fat and cholesterol intake. Control children received no special recommendations. Every third year, paraffin-stimulated saliva samples (10.0 mL) were collected for cholesterol assays. Nutrient intakes and serum total cholesterol concentrations were regularly followed up by means of 4-day food records and blood samples. Intake of saturated fatty acids (SAFA) was lower in the intervention than in the control group (p<0.001). Salivary cholesterol concentration increased from 1.9 (±1.1) µmol/L at 6 years of age to 16.0 (±9.0) µmol/L at 16 years of age. The increase was smaller in the intervention than in the control group (p<0.001). The ratios of salivary to serum cholesterol concentrations tended to be higher in boys than in girls (p=0.07). Thus, dietary intervention was reflected in children's salivary cholesterol values more sensitively than in serum cholesterol values. (clinicaltrials.gov NCT00223600).

Salivary cortisol and IgA levels in patients with myofascial pain treated with occlusal appliances in the short term.

In many studies, the endocrinological response of individuals to different kinds of stresses has been tested. There seems to be widespread agreement that stress, depression, disability and dysfunctional illness behaviors are critical aspects of patients suffering from symptoms like pain, arising out of temporomandibular disorders (TMD). We aimed to explore treatment-induced changes in salivary cortisol, IgA and flow rate values in TMD patients suffering from myofascial pain. Temporomandibular disorders patients (n = 39) were randomized into two groups and treated with two different occlusal appliances. Perceived stress regarding family, work, economy, relationships, general health and stress in general was evaluated at baseline according to a verbal scale. Paraffin-stimulated saliva samples were collected before treatment and during follow-up at 6 and 10 weeks. Flow rate was measured immediately after the saliva collection while salivary cortisol and IgA were determined from samples stored at -70 degrees C. No clear association between reported stress and cortisol or IgA values could be observed at baseline. At 10 weeks follow-up, 92% of the patients felt 'better, much better, symptom-free' and no difference was found between the two appliance groups. Cortisol, IgA and flow rate values showed no systematic between appliance groups' differences. All salivary parameters showed interindividual differences but stayed intra-individually on a similar level throughout the study and no statistically significant changes could be observed when comparing before and after treatment levels. To conclude, there were no treatment-induced changes in saliva parameters despite successful appliance therapy in myofascial pain patients.

Acid production from sugars and sugar alcohols by probiotic lactobacilli and bifidobacteria in vitro.

Some probiotic bacterial strains have been suggested to improve oral health. However, lactobacilli and bifidobacteria are associated with the progression of dental caries. The pH fall caused by 14 probiotic and dairy bacterial strains from glucose, lactose, sucrose, sorbitol and xylitol was followed. All strains used glucose, nine lactose and seven sucrose. Six of the lactobacilli caused a small decrease in pH with sorbitol and two with xylitol. None of the bifidobacteria fermented sugar alcohols. As all the strains could be considered acidogenic, more long-term clinical trials are needed before recommendations for oral health purposes can be made.

Dissolution of xylitol from a food supplement administered with a novel slow-release pacifier: preliminary results.

AIM: The aim of the study was to monitor the pattern of release and salivary xylitol concentrations during sucking of a slow-release pacifier used to deliver a novel food supplement. METHODS: The food supplement tablet contained 300 mg xylitol and 0.5 x 10(10) colony-forming units of Bifidobacterium lactis Bb-12 (Bb-12). The reference tablet contained 300 mg xylitol and was used by 10 adults (mean age 32 years) in the study. Whole saliva samples were collected with 2.5 min intervals during pacifier sucking. The salivary xylitol concentrations were determined using an enzyme assay kit. RESULTS: All subjects showed salivary xylitol concentrations exceeding 1% at least at one collection point. The xylitol and xylitol-Bb-12 tablets showed similar dissolving with no clear concentration peaks (comparison of saliva collection times; p = 0.139). CONCLUSION: Xylitol released from the food supplement, delivered with the novel pacifier, may result in salivary xylitol concentrations high enough to inhibit mutans streptococci in vivo.

The effect of liquorice extract-containing starch gel on the amount and microbial composition of plaque.

The aim of this study was to find out whether liquorice-containing starch gel could affect plaque accumulation and its microbial composition. Sixteen healthy volunteers (mean age: 30.4+/-6.9 years) used 6 g of either control [8% acid-hydrolyzed corn starch, 25% maltitol syrup, water (w/w)] or liquorice gel (control + 2.5% liquorice extract), three times a day for 2 weeks. The gels were used in a random order with a 2-week washout period in between. At the end of each fortnight, plaque was allowed to accumulate for 2 days and all available plaque from the right side of the mouth was collected, weighed, and transferred to transport medium. The plaque on the left side was dyed and photographed in a standardized manner. Mutans streptococci, total streptococci, and facultative bacteria were assessed from the plaque using plate culturing. Plaque index (0-5) of incisors and canines on the left side was evaluated from the photographs. The clinical study was preceded by an in vivo acid production test. The acid production from gels containing 2.5-10% liquorice extract was monitored with a microelectrode. The in vivo acid production potential of the maltitol-containing starch gel was about 50% compared to the sucrose control. Liquorice inhibited acid production from the gel. In the clinical study, the weight of plaque after consumption of the liquorice gel did not differ from that of the control gel. No differences were found in the microbial counts nor in the plaque index between the two gels. In addition, the liquorice gel had no effect on the stability of the predominant bacterial populations of the plaque samples of 16 individuals as detected by PCR-denaturing gradient gel electrophoresis. In conclusion, an addition of liquorice extract to starch-containing gel with a low acid production potential had no effect on the plaque formed during a 2-week gel consumption period.

Similarity of the effects of erythritol and xylitol on some risk factors of dental caries.

Several sugar alcohols (polyols) have been promoted as potential sugar substitutes in caries limitation. However, differences in the effects of simple alditol-type sugar alcohol homologues on dental plaque have not been compared in clinical tests. The effects of 6-month use of erythritol (a sugar alcohol of the tetritol type), xylitol (a pentitol) and D-glucitol (sorbitol, a hexitol) were investigated in a cohort of 136 teenage subjects assigned to the respective polyol groups or to an untreated control group (n = 30-36 per group). The daily use of the polyols was 7.0 g in the form of chewable tablets, supplemented by twice-a-day use of a dentifrice containing those polyols. The use of erythritol and xylitol was associated with a statistically significant reduction (p < 0.001 in most cases) in the plaque and saliva levels of mutans streptococci. The amount of dental plaque was also significantly reduced in subjects receiving erythritol and xylitol. Such effects were not observed in other experimental groups. Chemical analyses showed D-glucitol to be a normal finding in dental plaque while xylitol was less consistently detected. Erythritol was detected in measurable amounts only in the plaque of subjects receiving this polyol. Erythritol and xylitol may exert similar effects on some risk factors of dental caries, although the biochemical mechanism of the effects may differ. These in vivo studies were supported by cultivation experiments in which xylitol, and especially erythritol, inhibited the growth of several strains of mutans streptococci.