Donna Jalai, Aimee Park, Trinity Low
Project Smile Global
19 December, 2024
Within the scope of human health and development, oral health disparities are among one of the top concerns for a vast majority of the population. Specifically, cavities, or caries, are a common dental problem affecting people of all ages. With the high cost of dental care treatments, especially when paid out-of-pocket, many people are beginning to look for preventative measures to prevent caries from forming and thus preventing the need for drilling and filling of the affected tooth, a process that can be costly and negatively impact the lives of many communities facing oral health disparities. One preventative measure that has recently gained traction and buzz online is xylitol. Xylitol is a naturally occurring five-carbon sugar and sweetener used in many dental products for its promising positive effects on oral health, namely the prevention of dental caries (Salli et al. 39). Caries is one of the most prevalent diseases globally, affecting nearly 2.3 billion people who suffer from untreated forms of the condition (Giacaman et al., 2022). The chronic infection results from oral bacteria, primarily Streptococcus mutans (MS), which metabolize sugars to produce acid and demineralize the tooth structure over time (Rathee et al. 2023). Extensive research has delved into different preventative measures, with one of them being xylitol.
Xylitol is a sugar alcohol found in many plants, fruits, and vegetables. The naturally occurring sugar has a direct inhibitory effect on MS by reducing the formation of plaque and bacterial adherence and inhibits enamel demineralization by reducing the amount of acid produced through metabolism (Giacaman et al. 2022). The first xylitol studies in humans, known as the “Turku Sugar Studies,” were conducted in Finland in the 1970s. The study compared commonly used sugars with xylitol, finding that consuming sucrose was highly associated with a significant increase in caries development. Conversely, xylitol demonstrated an anti-cariogenic effect, as these participants had significantly fewer caries lesions and, in some cases, showed signs of arrest or reversal of existing caries lesions. (Scheinin et al. 1976). These findings provide further insight into sugar options that contribute to a healthier oral microbiome, promote xylitol as a sweetener, and suggest that consumers with dental concerns should avoid sucrose.
The sweetening properties of xylitol offer great opportunities for distribution to the general public, especially to children eager for sugary candies and sweets that typically contribute to caries. In fact, one study conducted at an elementary school involved distributing gummy bears containing xylitol to children to measure the average amount of plaque present on their teeth over a course of six weeks, testing specifically for MS and Lactobacillus spp. (Ly et al. 2008). The study found that, after six weeks, the levels of MS in all of the groups of children tested decreased significantly (Ly et al. 2008). The results from this study indicate that xylitol can be distributed into snacks typically seen as “bad” for children’s teeth and provide a healthier alternative that can actually improve the MS levels and plaque in their teeth without them knowing or having to compromise on their favorite sugary snacks. Another study found that sugar-free gums containing xylitol were more effective at reducing plaque in the oral cavity compared to standard sugar-free gums without xylitol (Nasseripour et al. 2022). These results suggested that xylitol-containing gums can be a more beneficial option for maintaining oral hygiene. As more snacks and gums containing xylitol become available, there is significant potential for a reduction in MS and plaque levels in the mouths of children and adults, thus leading to a decrease in dental caries and an increase in healthier smiles.
Addressing Oral Health Disparities
While the individual benefits of xylitol are clear in these studies, it also presents a unique opportunity to address oral health disparities at a systemic level. Oral health disparities stem from systemic barriers that disproportionately increase the prevalence of dental caries among low-income and underserved populations. If implemented effectively , the availability of xylitol-sweetened products offers an affordable and accessible preventative solution for these communities. Xylitol is also versatile as it can be incorporated into widely accepted and easily distributed products like chewing gum, mints, and candies (Ly et al., 2008). These products can, in turn, be explicitly targeted to high-risk groups such as children, pregnant women, and individuals living in areas where there is limited access to fluoridated water or professional dental care. They can also serve as a tool for preventative dental care, promoting a healthy oral microbiome and thus reducing the likelihood of costly dental procedures.
Research conducted by Ly et al. (2008) highlights the effectiveness of xylitol chewing gums as an effective means of reducing caries especially for children and pregnant women. This study has implications for potential school-based programs where xylitol can be distributed and consumed under supervised conditions (Ly et al., 2008). This preventative program not only gives children the necessary dental benefits, but allows for the education of children and their families about the importance of preventive oral care and the forming of long-term habits that can reduce caries incidence over time. Xylitol products can also be effectively distributed in prenatal care settings to improve oral health care for both mother and child and also spread awareness about the importance of oral health care during pregnancy. However, the study also mentions the need for more research to evaluate the effectiveness of other xylitol products in the form of mints or candies, which could be an alternative option for individuals who may not prefer or be able to chew gum (Ly et al., 2008).
Ultimately, the systemic implementation of xylitol-based products holds the potential to reduce the prevalence of dental caries and bridge the gap in oral health outcomes in underserved populations. Further research on alternative delivery methods, cultural acceptance, and cost-effective analyses are necessary to implement the most effective intervention plan. Still, with the current knowledge researchers and dentists have, the overall future for xylitol as a tool to combat dental caries is promising.
Works Cited
Giacaman, Rodrigo, et al. “Understanding dental caries as a non-communicable and behavioral disease: Management implications.” Frontiers in Oral Health, vol. 3, 2022, https://doi.org/10.3389/froh.2022.764479
Janakiram, Chandrashekar, et al. “Xylitol in preventing dental caries: A systematic review and meta-analyses.” Journal of Natural Science, Biology, and Medicine, vol. 8, no. 1, 2017, pp. 16-21. https://doi.org/10.4103/0976-9668.198344
Ly, Kiet A., et al. “Xylitol Gummy Bear Snacks: A School-Based Randomized Clinical Trial.” BMC Oral Health, vol. 8, no. 1, 2008, pp. 20–20, https://doi.org/10.1186/1472-6831-8-20.
“Xylitol - Uses, Side Effects, and More.” WebMD, www.webmd.com/vitamins/ai/ingredientmono-996/xylitol. Accessed 13 Dec. 2024
Nasseripour, Melanie, et al. “A Systematic Review and Meta-Analysis of the Role of Sugar- Free Chewing Gum on Plaque Quantity in the Oral Cavity.” Frontiers in Oral Health, vol. 3, 2022, pp. 845921–845921. https://doi.org/10.3389/froh.2022.845921.
Rathee, Manu, and Sapra, Amit. Dental Caries. StatPearls Publishing, 2023.
Scheinin, A, et al. “Turku sugar studies. V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man.” Acta odontologica Scandinavica, vol. 34, no. 4, 1976, pp. 179-216. https://doi.org/10.3109/00016357608997711