The Mysterious Connection between Xylitol and Dental Caries: Part I of II

This article was written with the expert opinion of a consultant (DDS, MPH, Board Certified) on Preventive Dentistry. Edited by: ScientiFIT Editor, Paula Vasin

In a two-part series, we investigate the effectiveness of using Xylitol, a natural, low-caloric sugar, in preventing tooth decay (dental caries).

First, here are some not so sweet facts about dental caries. Dental caries are basically cavities and there is strong evidence to suggest that sugar is one of the major causes of cavities. However, the mechanism by which sugar results in cavities is complex.

We all have “normal flora” (bacteria) that reside in various organs of the body and in the case of dental caries, in the oral cavity. No one else has the exact same combination and concentration of bacteria because the bacterial flora in the mouth as well as the body is affected by the interaction of host, agent, and environment. And, just like most of us, bacteria like to eat sugar. So, when you go for that triple layer chocolate cake or pound your mocha chip double-whip Frappuccino with a caramel swirl, your bacteria will be incredibly happy and will dine like kings. Additionally, just like us, bacteria need to get rid of waste products. Acid is the byproduct or waste product of all that sugar consumption by the metabolism of certain types of bacteria in the mouth. This acid byproduct is what causes the tooth to demineralize or decay. One’s pre-disposition to getting cavities can be partially predicted by determining the concentration of these certain types of bacteria and the frequency of sugar consumed. Since sugar consumption can be controlled or at least manipulated, a number of sweeteners have been clinically tested for their efficacy in reducing tooth decay. One of these products is Xylitol.

Xylitol is a natural, low-caloric sweetener belonging to the family of sugar alcohols that include Sorbitol, Malitol, and Erithritol, to name a few. It is extracted from fibrous plant material, such as birch bark or corn husks, and is also manufactured in our own bodies. Xylitol costs more than other natural sweeteners. This could be one reason why commercial products do not contain Xylitol. However, economics is a minor factor that could be minimized by volume production.

So, why is it that products sweetened with Xylitol cannot be easily located in the typical commercial markets? The main reason it is difficult to find commercial products containing Xylitol as an alternate sweetener is that despite the many clinical studies conducted over the past two decades with Xylitol in various delivery vehicles, its effectiveness in preventing dental caries has shown inconsistent results. Because of the conflicting evidence, manufactures cannot bear labels of anti-caries (which you now know to be cavities) effectiveness that meet regulatory requirements.

In a subsequent article, we will provide a more in-depth evaluation and analysis of the scientific literature on the role of Xylitol in preventing dental caries.