The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults

Fabio Cocco,Peter Lingström,Giovanna Carta,Guglielmo Campus,Maria Grazia Cagetti,Laura Strohmenger

doi:10.1007/s00784-017-2075-5

Fabio Cocco, Peter Lingström + Show 4 more

Open Access

https://doi.org/10.1007/s00784-017-2075-5

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Abstract

ObjectivesThe caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated.Materials and methodsIn this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann–Whitney U test.ResultsThe total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p < 0.01).ConclusionsSubjects using the low-dose xylitol chewing gum showed a significantly lower increment of initial and extensive caries lesions and overall a lower increment of caries experience.Clinical relevanceOne-year use of chewing gums provides an effective means for the prevention of caries disease.Trial registration numberNCT02310308

Highlights

Modern concepts regard caries as an interaction between host and environmental factors, where biological, social, and behavioural factors are expressed in a highly complex interactive manner with the dental biofilm as the key element [1]
Clinical relevance One-year use of chewing gums provides an effective means for the prevention of caries disease
This paper reports on findings obtained in a larger research project that examines the effect of several functional foods supplied through chewing gums on caries prevention in an adult population

Summary

Introduction

Modern concepts regard caries as an interaction between host and environmental factors, where biological, social, and behavioural factors are expressed in a highly complex interactive manner with the dental biofilm as the key element [1]. Dietary fermentable carbohydrates are the main triggering factor for development of cariogenic biofilm [2]. The presence of sugars promotes a higher plaque cariogenicity, keeping frequently pH value under the critical levels for the demineralization of enamel and dentine [3, 4]. Preventive strategies are needed and recommended to control caries risk factors, mainly based on dietary changes, i.e. sweetener intake reduction, and enhancing host resistance, i.e. twice-daily use offluoride toothpastes [6, 7]. The high-skewed caries prevalence distribution suggests the need of developing new and effective preventive approaches especially for high-risk groups [8, 9]. The use of sugar-free chewing gums may contribute to prevent dental caries [6, 10]. The increase of stimulated saliva flow rate promotes oral clearance and enhances the buffering capacity to

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