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USE OF XYLITOL

DHASNY Position Statement:

Resolved, that the Dental Hygienists’ Association of the State of New York advocate the use of xylitol for its preventive benefits against oral disease

-       Adopted by the DHASNY House of Delegates, October 31, 2010


Background:

Nature of xylitol: Xylitol is a naturally occurring sugar extracted from birch bark, corncobs, and fruit. A sugar substitute for people with diabetes, it is also made in the human body in small amounts.  Xylitol can be obtained from health food stores in granulated form for use as a sugar substitute, as a first ingredient in some candies, and in many toothpastes. There also is a pacifier with slow release xylitol gel.

 

In 1963 xylitol was approved by the U.S. Food and Drug Administration for special dietary purposes. It also has been approved by the World Health Organization’s Joint Expert Committee on Food Additives and the European Union’s Scientific Committee for Food.  It has been the subject of numerous studies, such as the frequently referenced 1995 Tanzer research indicating that a reduction in caries has been shown through the substitution of xylitol for sucrose and fructose, or the addition of xylitol to the diet (Tanzer, JM (1995). Xylitol chewing gum and dental caries. International dental journal 45 (1 Suppl 1):65-76) and the Milgrom study, released in 2009, regarding effective dosage ranges (Milgrom P, Ly KA, Roberts MC, Rothen M, Mueller G, Yamaguchi DK (2006). "Mutans streptococci dose response to xylitol chewing gum". Journal of Dental Research 85 (2): 177-181)

 

Xylitol inhibits the growth of the bacteria that cause cavities as these bacteria (Streptococcus mutans) cannot utilize xylitol to grow. In using xylitol over time, the quality of the bacteria in the mouth changes and fewer decay-causing bacteria survive on tooth surfaces, less plaque forms, and the level of acids attacking the tooth surface is lowered.

 

Three to five exposures of xylitol each day will reduce plaque biofilm accumulations and tooth decay by making bacteria slippery, so they can’t stick to teeth or each other and simply slide right down the digestive tract.

 

Studies show that Streptococcus mutans is passed from parents to their newborn children, thus beginning the growth of these decay-producing bacteria in the child. Regular use of xylitol by mothers has been demonstrated to significantly reduce this bacterial transmission, resulting in fewer cavities for the child.

 

According to the Academy of Pediatric Dentistry, chewing gum with xylitol as a first ingredient for two years will cause a nearly life-long shift to non-cavity causing bacteria in the mouth. When mothers of newborns chewed 100% xylitol-sweetened gum daily for two years, they prevented the spread of cavity causing bacteria to their babies for long-term oral health benefits.

 

Organization Endorsements: In 2008, the Dental Hygienists’ Associations in California, Arizona and Hawaii endorsed the use of xylitol for its preventive and therapeutic benefits.

 

The American Academy of Pediatric Dentistry (AAPD) adopted the following policy statement in 2006, revised 2010 recognizing the benefits of caries preventive strategies involving sugar substitutes, particularly xylitol, on the oral health of infants, children, adolescents, and persons with special health care needs. The policy (copy attached), references the development of xylitol and studies:

 

1.  Supports the use of xylitol as part of a preventive strategy aimed specifically at long term caries pathogen suppression and caries (dmf) reduction in higher risk populations.

2.  Recommends that, as further research and evidence-based knowledge is available, protocols be established to further clarify the impact of delivery vehicles, the frequency of exposure, and the optimal dosage to reduce caries and improve the oral health of children.

3.  Encourages xylitol-containing products be labeled clearly with regard to their xylitol content to enable dentists and consumers to ensure therapeutic levels of exposure.

In Europe, the measure was endorsed by the Finnish Dental Association in 1988, the Swedish Dental Association in 1989, and the British Dental Association in 1990.