Effect of Xylitol on Salivary Streptococcus Mutans: A Systematic Review and Meta-analysis
AbstractObjectives: This study aimed to systematically review the available randomized clinical trials (RCTs) on the effect of xylitol on the number of Streptococcus mutans (S. mutans) colonies.
Methods: An electronic search was carried out in Medline and Scopus databases for the RCTs published during 2002-2014. The inclusion criteria were evaluation of xylitol gums, having at least one control group and counting S. mutans colonies. The articles were divided into three groups based on the subjects’ age group namely 0-6, 6-18 and over 18 years. To assess the quality of RCTs, the retrieved articles were independently reviewed by two reviewers in terms of randomization and in order to prevent the effect of blinding on the results. Review Manager (RevMan) software, heterogeneity test and I2 coefficient as the quantitative scale of heterogeneity were used for statistical analysis.
Results: Primary search of the literature using keywords related to sugar alcohols. After applying the inclusion criteria, 46 articles were found in PubMed and 356 in Scopus. Heterogeneity was not found in the two age groups of 6-18 and over 18 years and the I2 coefficient in these two groups was 0%. This rate for the 0-6 year-olds was 51% (P=0.15); which indicates moderate heterogeneity. The P value was 0.25, 0.34 and 0.04 for the 6-18, 0-6 and over 18 year-olds, respectively. This value was only significant for the over 18 year-old group. Data for all groups were analyzed irrespective of age, which revealed significant differences (P=0.01).
Conclusions: The available literatures show xylitol as an alternative sweetener, could help to prevent dental caries by reducing the count of S. mutans in the saliva.
2. Marthaler TM. Changes in dental caries 1953-2003. Caries Res. 2004 May-Jun; 38(3):173-181.
3. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005 Sep; 83(9):661-669.
4. Antonio AG ML, Vianna RBC, Quintanilha LELP. Preventive strategies in oral health promotion. Cien Saude Colet. 2005 10:279-286.
5. Burt BA. The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Am Dent Assoc. 2006 Feb137(2):190-196.
6. Isogangas P, Makinen KK, Tiekso J, Alanen P. Long-term effect of xylitol chewing gum in the prevention of dental caries: A follow-up 5 years after termination of a prevention program. Caries Res. 1993; 27(6):495-498.
7. Makinen KK, Bennett CA, Hujoel PP, Isokangas PJ, Isotupa KP, Pape HR, Jr, et al. Xylitol chewing gums and caries rates: A 40-month cohort study. J Dent Res. 1995 Dec;74(12):1904-1913.
8. Scheinin A, Pienihakkinen K, Tiekso J, Banoczy J, Szoke J, Esztari I, et al. Collaborative who xylitol field studies in hungary. Vii. Two-year caries incidence in 976 institutionalized children. Acta odontol Scand. Dec;1985 43(6):381-387.
9. Lingstrom P, Holm AK, Mejare I, Twetman S, Soder B, Norlund A, et al. Dietary factors in the prevention of dental caries: A systematic review. Acta odontol Scand. 2003 Dec;61(6):331-340.
10. Mickenautsch S, Leal SC, Yengopal V, Bezerra AC, Cruvinel V. Sugar-free chewing gum and dental caries: A systematic review. J Appl Oral. 2007 Apr;Sci 15(2):83-88.
11. Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev. 2015 Mar 26;3:CD010743. doi: 10.1002/14651858.CD010743.pub2. Review.
12. Lin HK, Fang CE, Huang MS, Cheng HC, Huang TW, Chang HT, et al. 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. 2016 26(1):35-44.
13. Trahan L. Xylitol: A review of its action on mutans streptococci and dental plaque--its clinical significance. IntDent J. 1995 Feb;45(1 Suppl 1):77-92.
14. Fontana M, Gonzalez-Cabezas C. Are we ready for definitive clinical guidelines on xylitol/polyol use? Adv Dent Res. 2012 Sep;24(2):123-128.
15. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. [accessed]. http://handbook.cochrane.org/2011.
16. Review manager (revman) [computer program]. Version 5.3. Copenhagen: The nordic cochrane centre, the cochrane collaboration, 2014.; [accessed].
17. Holgerson PL, Sjostrom I, Stecksen-Blicks C, Twetman S. Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum. Int J Paediatr Dent. 2007 Mar;17(2):79-85.
18. Campus G, Cagetti MG, Sacco G, Solinas G, Mastroberardino S, Lingstrom P. Six months of daily high-dose xylitol in high-risk schoolchildren: A randomized clinical trial on plaque ph and salivary mutans streptococci. Caries Res. 2009 Dec;43(6):455-461.
19. Campus G, Cagetti MG, Cocco F, Sale S, Sacco G, Strohmenger L, et al. Effect of a sugar-free chewing gum containing magnolia bark extract on different variables related to caries and gingivitis: A randomized controlled intervention trial. Caries Res. 2011 Aug;45(4):393-399.
20. Milgrom P, Ly KA, Roberts MC, Rothen M, Mueller G, Yamaguchi DK. Mutans streptococci dose response to xylitol chewing gum. J Dent Res. 2006 Feb;85(2):177-181.
21. Anttonen V, Halunen I, Pakkila J, Larmas M, Tjaderhane L. A practice-based study on the effect of a short sucrose/xylitol exposure on survival of primary teeth caries free. Int J Paediatr Dent. 2012 Sep;22(5):356-362.
22. Makinen KK, Isotupa KP, Makinen PL, Soderling E, Song KB, Nam SH, et al. Six-month polyol chewing-gum programme in kindergarten-age children: A feasibility study focusing on mutans streptococci and dental plaque. IntDent J. 2005 Apr;55(2):81-88.
23. Mickenautsch S, Yengopal V. Effect of xylitol versus sorbitol: A quantitative systematic review of clinical trials. Int Dent J. 2012 Aug;62(4):175-188
24. Deshpande A, Jadad AR. The impact of polyol-containing chewing gums on dental caries: A systematic review of original randomized controlled trials and observational studies. JAm Dent Assoc. 2008 Dec;139(12):1602-1614.
25. Rethman MP, Beltran-Aguilar ED, Billings RJ, Hujoel PP, Katz BP, Milgrom P, et al. Nonfluoride caries-preventive agents: Executive summary of evidence-based clinical recommendations. J Am Dent Assoc. 2011 Sep;142(9):1065-1071.
26. Antonio AG, Pierro VS, Maia LC. Caries preventive effects of xylitol-based candies and lozenges: A systematic review. J Public Health Dent. 2011 Spring;71(2):117-124
27. Bader JD, Shugars DA, Bonito AJ. Systematic reviews of selected dental caries diagnostic and management methods. J Dent Educ. 2001 Oct;65(10):960-968.
28. Sintes JL, Elias-Boneta A, Stewart B, Volpe AR, Lovett J. Anticaries efficacy of a sodium monofluorophosphate dentifrice containing xylitol in a dicalcium phosphate dihydrate base. A 30-month caries clinical study in costa rica. Am J Dent. 2002 Aug;15(4):215-219.
29. Alamoudi NM, Hanno AG, Sabbagh HJ, Masoud MI, Almushayt AS, El Derwi DA. Impact of maternal xylitol consumption on mutans streptococci, plaque and caries levels in children. J Clin pediatrDent. 2012 Winter;37(2):163-166.
30. Isokangas P, Soderling E, Pienihakkinen K, Alanen P. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. J Dent Res. 2000 Nov;79(11):1885-1889.
31. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 2000 Mar;79(3):882-887.
32. Thorild I, Lindau B, Twetman S. Caries in 4-year-old children after maternal chewing of gums containing combinations of xylitol, sorbitol, chlorhexidine and fluoride. Eur Arch Paediatr Dent. 2006 Dec;7(4):241-245.