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The many sides of xylitol

The frequency of application is as important as the amount of xylitol used, says Sandra Berger.
Sandra Berger, RDH, BS

Sandra Berger, RDH, BS

Fri. 4 June 2010

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What is xylitol? How does it work? How long has it been around? How does it benefit me? Where do I find it? How much do I need? Are there any disadvantages? These are some of the questions I am asked by my patients, friends and even cashiers when I mention xylitol.

I’ve educated many a convenience store worker in my quest for a particular gum or mint I know to contain xylitol. This one ingredient has enhanced my life as well as the lives of many others.

Xylitol was once only found in health food stores, however, it has become much more mainstream and is now readily available at retail outlets. This availability makes it much easier for patients to incorporate it into their daily schedule, and as a result, reap the multi-sided benefits.

What is Xylitol?

Xylitol, a naturally occurring sugar substitute, is clinically proven to be a natural enemy of bacteria. Xylitol is often referred to as wood or birch sugar because it was typically manufactured from birch trees. However, today xylitol is mainly extracted from corncobs. This is more practical considering the vast amount of xylitol that is being produced and consumed. Other natural sources of xylitol include plums, strawberries and raspberries.

Pure xylitol looks like sugar because it has a white crystaline appearance and it even tastes like sugar. However, it has 40 percent less calories than sugar. Only one-third of the absorbed xylitol gets metabolized in the body.

How does it work?

Over 400 strains of bacteria inhabit the human mouth. Sugar is one of the major energy sources for these bacteria and helps them proliferate.

When these sugars are consumed, acid is produced, creating a highly acidic enviroment in the oral cavity that demineralizes enamel and makes it vulnerable to attack by bacteria, leading to tooth decay.

Because xylitol is a five-carbon polyol, it is not metabolized by mouth bacteria, and as a result, no acids are produced in the mouth that can cause tooth decay.

The sweetness also stimulates saliva flow, which neutralizes any acids that have been formed and rinses away excess sugar residue. Xylitol helps keep an alkaline enviroment in the oral cavity that is inhospitable for mouth bacteria.

Thus, xylitol is both non-cariogenic in that it does not contribute to caries formation, and it is cariostatic because it prevents or reduces the incidence of new caries.

Xylitol actually reduces the amount of plaque and the number of Mutans streptococci (MS) in plaque.

How long has it been around?

German chemist Emil Fisher and French chemist M.G. Bertrand first discovered xylitol in the late 1800s. The first attempt at producing xylitol was a mixture with a syrup-like consistency.

Xylitol was not manufactured in a crystalline form until World War II, when war-associated sugar shortages created the need to find alternative sweeteners.

Early on, xylitol was primarily used in diabetic diets and infusion therapy for burn and shock patients as well as for postoperative patients in Europe and Asia. It was when further study into xylitol’s biological properties, including dental, that large-scale production was needed.

Industrialized xylitol manufacturing began in Finland in the early 1970s in the form of gum and mints. It quickly became a daily part of Finnish life. Over the next 35 years, global awareness of the significant advantages xylitol offers continues, as does the variety of items that contain the substance.

How much do I need?

It was previously thought that the benefits of xylitol were dose related, not frequency related. However, researchers from the University of Washington did a series of studies in order to potentially substantiate these responses on Mutans streptococci’s prevalence and possible reductions with xylitol.

In one study, the efficacious dosage of xylitol was researched and the researchers concluded that MS levels were reduced with increasing doses of xylitol. The effect leveled off between 6.88 grams and 10.32 grams per day.1

In the second study, the participants consumed 10.32 grams per day (the higher leveling off amount from the previous study) of xylitol divided into two, three or four administrations per day.

After five weeks of use, there was no significant difference in MS levels in either plaque or unstimulated saliva in groups consuming xylitol two times per day.

However, significant differences were seen in the groups consuming 10.32 grams xylitol over three and four administrations per day. These results confirmed previous suggestions regarding xylitol dosage and frequency of consumption.

A dose range of 6 to 10 grams divided into at least three consumption periods per day is necessary for xylitol to be effective with chewing gum as the delivery system.2

Thus, the frequency is as important as the amount of xylitol used.

Where do I find it?

Many products in local grocery stores contain xylitol. The easiest to find are gum and candy, but check the ingredients. Just because one flavor or type contains xylitol does not mean that all types of gum from that manufacturer will contain it.

Health food stores will carry a larger selection of products, such as mouthwash, toothpaste, mints, individual packets to use in coffee/tea, bulk packaging to use in cooking, nasal sprays and neti pots.

Search the Internet for brands and then ask your local pharmacy, grocery or health food store to stock the product. Many items may also be ordered directly from the manufacturer.

Are there any disadvantages?

Xylitol was approved by the U.S. Food and Drug Administration (FDA) in 1963, and it has no known toxic levels or serious known side effects for humans; up to 40 grams per day have been noted with little more than a mild laxative effect.

Nonetheless, it should be mentioned that it may be dangerous if consumed by pets, such as dogs and cats.

Conclusion

Prof. Jason Tanzer summed things up best:
“Xylitol is inhibitory to the metabolism, growth and plaque formation by Mutans streptococci ... xylitol is conducive to remineralization of initial carious lesions ... I have full confidence that these data distinguish xylitol from any other sugar substitute.”3

Xylitol is a low-glycemic sweetener and is metabolized independently of insulin. Xylitol does not cause the sharp increase in blood sugar levels or the associated serum insulin response, which is usually seen following consumption of other carbohydrates.

Because of this and the dental and medical benefits it provides, xylitol can be recommended as a sugar-free sweetener suitable for diabetics as well as for the general population seeking a healthier lifestyle.

About the author

Sandra Berger graduated from Ohio State with her RDH and a BS in education. She is the New Jersey clinical specialist for Oral DNA Labs, a salivary diagnostic company. Berger is currently vice president and C.E. chair of NJDHA. She is a recipient of the Sunstar RDH Award of Distinction 2007, member of AmyRDH Listers and Career Fusion Alumni 2009 and 2010.

References

1. Milgrom P, Ly K, Roberts M, Rothen M and Mueller G. Mutans streptococci dose response to xylitol chewing gum. J Dent Res 2006;85:177–81.
2. Ly K, Milgrom P, Roberts M, Yamaguchi D, Rothen M and Mueller G. Linear response of Mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial. BMC Oral Health 2006, 6:6.
3. Prof. Jason Tanzer, Head of Connecticut School of Dental Medicine, “What experts say,” www.xylitolinfo.com, 21 April, 2009.

 

One thought on “The many sides of xylitol

  1. Paul says:

    Thank you very much for the article content! What a tremendous help with my basic inquiry of questions considering I actually noticed Trident ingredients. Please continue to contribute good content!!

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