There are several prescriptive elements in managing dental caries:
- pH strategies
This article will focus on xylitol and its important role in dental caries prevention and treatment.
There are strong feelings both for and against the use of this 5 carbon sugar alcohol. There are a lot of studies out there on xylitol. In Dr. Kutsch’s opinion, the best approach is to couple xylitol and fluoride.
The conclusion of the study is that xylitol and fluoride have synergistic effects, xylitol potentiates even trace amounts of fluoride. A good strategy to combine them.
“This study indicates that fluoride and xylitol together have synergistic inhibitory effects on the acid production of Mutans streptococci and suggests that xylitol has the potential to enhance inhibitory effects of low concentrations of fluoride.”
Maehara H, Iwami Y, Mayanagi H, Takahashi N. Synergistic inhibition by combination of fluoride and xylitol on glycolysis by mutans streptococci and its biochemical mechanism. Caries Research November December 2005. 39(6):521-528
We all remember this study: Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J Am Dent Assoc. 2013 Jan;144(1):21-30. 691 Ad, 33 mo.
Where 5 xylitol mints were given to a group of high caries risk patients, and the results were nil.
“Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries.”
HOWEVER, when looking back at the results, they found that for patients with root surface caries, the results were quite profound:
“Participants in the xylitol arm developed 40% fewer root caries lesions (0.23 D2FS/year) than those in the placebo arm. Among these caries-active adults, xylitol appears to have a caries-preventive effect on root surfaces.”
Ritter AV, Bader JD, Leo MC, Preisser JS, Shugars DA, Vollmer WM, Amaechi BT, Holland JC. Tooth-surface-specific Effects of Xylitol: Randomized Trial Results. J Dent Res. 2013 Jun;92(6):512-7. 620/21-80/12/24/33MO
The lesson here, as practitioners we need to target our therapy recommendations to our patient’s needs.