Clinical Effects of Sugar Substitutes on Cariogenic Bacteria: A Systematic Review and Meta-Analysis

BACKGROUND

The use of sugar substitutes in food products has recently increased. Limited information regarding the role of various sugar substitutes in caries prevention was found. This systematic review and meta-analysis was conducted to investigate the effects of sugar substitute consumption on reducing cariogenic bacteria in dental plaque and saliva.

METHODS

We systematically searched PubMed, EMBASE, and Web of Science (inception to July 2023) for prospective controlled trials published in English and investigated the effects of sugar substitute consumption on cariogenic bacteria in dental plaque and saliva. The primary outcome was the changes in cariogenic bacteria. Two independent reviewers screened the papers. Quality was assessed using the Cochrane risk-of-bias tools.

RESULTS

From 977 studies identified, 32 trials were included. Almost half (14/32, 44%) of the included studies had a high risk of bias. Almost all (31/32, 96.88%) were investigations of xylitol and other sugar alcohols (low-intensity sweeteners), such as sorbitol, erythritol, and maltitol. Only one trial investigated stevia, a high-intensity sweetener, whereas no studies on other high-intensity sweeteners, such as sucralose, saccharin, or aspartame, were found. Almost all studies (30/32, 93.75%) showed the consumption of low-intensity sweeteners led to a significant reduction of different types of cariogenic bacteria. The results of the meta-analysis showed that consumption of low-intensity sweeteners led to a significant reduction of cariogenic bacteria in both dental plaque and saliva compared to no treatment.

CONCLUSION

The consumption of low-intensity sweeteners helps reduce cariogenic bacteria in dental plaque and saliva. There is limited clinical evidence regarding the role of high-intensity sweeteners in reducing cariogenic bacteria.

Effect of chewing gum containing Xylitol and blackberry powder on oral bacteria: A randomized controlled crossover trial

OBJECTIVE

The aim was to determine the effect of chewing gum containing xylitol and freeze-dried blackberry powder on oral bacteria.

DESIGN

This was a randomized, controlled, cross-over study (RCT #: NCT05133557). Fifty participants chewed gum over an 8 h period, four times for 20 min at 2-hour intervals, containing 700 mg xylitol (CG) with or without 50 mg blackberry powder (BG), while wearing a stent containing a sterile enamel chip. After a 1 week washout, participants chewed gum from the other group following the same protocol. The primary outcome was the amount of nine oral bacteria in saliva as determined by quantitative PCR. The secondary outcome was bacteria formed on enamel chips.

RESULTS

Chewing BG for four twenty-minute intervals reduced mean total bacteria load and the relative abundance of six of the nine bacteria studied in saliva (p < 0.05). In comparison, only four bacteria were reduced in abundance in the CG group. After gum chewing and regardless of group, S. sanguinis and A. naeslundii were the predominant bacteria adherent to enamel, with S. mutans representing < 1 % of the total bacteria on enamel.

CONCLUSION

Bacterial loads in saliva were rapidly, differentially, and significantly reduced after one day of chewing BG.

Xylitol-Containing Chewing Gum Reduces Cariogenic and Periodontopathic Bacteria in Dental Plaque—Microbiome Investigation

Background

Dental caries and periodontal disease remain the most prevalent oral health problems in the world. Chewing xylitol gum may help reduce the risk of caries and periodontitis for dental health benefits. However, little evidence has shown healthy food estimation by sequencing 16S rDNA in oral microbial communities. This study investigated the clinical effect of xylitol chewing gum on dental plaque accumulation and microbiota composition using the PacBio full-length sequencing platform in 24 young adults (N = 24). The participants were randomly assigned to xylitol chewing gum and control (no chewing gum) groups. Participants in the chewing gum group chewed ten pieces of gum (a total of 6.2 g xylitol/day). Dental plaque from all teeth was collected for weighing, measuring the pH value, and analysis of microbial communities at the beginning (baseline, M0) and end of the 2-week (effect, M1) study period.

Results

The results suggested a 20% reduction in dental plaque accumulation (p &lt; 0.05) among participants chewing xylitol gum for 2 weeks, and the relative abundance of Firmicutes (a type of pathogenic bacteria associated with caries) decreased by 10.26% (p &lt; 0.05) and that of Bacteroidetes and Actinobacteria (two types of pathogenic bacteria associated with periodontitis) decreased by 6.32% (p &lt; 0.001) and 1.66% (p &lt; 0.05), respectively. Moreover, the relative abundance of Fusobacteria was increased by 9.24% (p &lt; 0.001), which has been proven to have a higher proportion in dental plaque of healthy adults. However, the dental plaque pH value stayed in a healthy range for the two groups.

Conclusion

In conclusion, chewing xylitol gum would benefit cariogenic and periodontal bacterial reduction in the oral cavity, which could help to prevent the diseases related to these bacteria.

Effects of xylitol and erythritol consumption on mutans streptococci and the oral microbiota: a systematic review

OBJECTIVE

A systematic review of published data was conducted with the aim of assessing effects of xylitol and erythritol consumption on levels of mutans streptococci (MS) and the oral microbiota.

MATERIALS AND METHODS

Electronic and hand searches were performed to find clinical microbiological studies concerning the consumption of xylitol and erythritol chewing gum or candies, and published between 2000 and 2019. Prospective randomized controlled clinical trials conducted in healthy subjects were included in the review.

RESULTS

The initial search identified 561 xylitol and 83 erythritol studies. After applying inclusion and exclusion criteria, 21 xylitol studies and one erythritol study were reviewed. The review identified nine xylitol studies with a fair or high quality, four conducted in children and five in adults, all demonstrating a decrease in MS levels in association with habitual consumption of xylitol. The three microbiota studies employing multispecies probe approaches revealed no effects for xylitol on the microbiota. The only erythritol study fulfilling the inclusion criteria showed no consistent effects on MS levels.

CONCLUSIONS

Xylitol consumption is likely to decrease MS counts but it may not change the overall microbiota. Xylitol shows thus properties of an oral prebiotic. More studies are needed to demonstrate the effects of erythritol on MS.

Efficiency of chewable toothbrush in reduction of dental plaque in students

Background

Besides classical and electrical toothbrushes market offers tooth brushes that can be chewed, like chewing gums. The aim of this study was to show the effectiveness of chewable toothbrush versus a conventional brush in the students’ population.

Methods

The prospective study included 346 students. For this research, we used a e-questionnaire for “smart” phones, that students completed outside the dental office. Respondents are divided into two groups: control group used conventional toothbrushes, respondents from the tested group used chewable toothbrush. For assessment of accumulation of the plaque we used TQHI index. For testing statistical hypotheses, the following were used: t-test for two independent samples and analysis of the variance of repeated measurements.

Results

Before brushing teeth, the average TQHI value for chewable brushes is 2.8 ± 0.3, while conventional is 2.7 ± 0.3, which is not a statistically significant difference (p = 0.448). After brushing teeth, the average TQHI value for chewable brushes is 2.0 ± 0.1, while conventional 2.0 ± 0.3, which is also not statistically significant (p = 0.729). Observing the index of the plaque values on the tooth surfaces in the upper jaw, in both groups, there was a statistically significant change in the amount of plaque in time (p < 0.001). There is a statistically significant interaction between groups and changes in the amount of plaque in the observed period (p = 0.013).

Conclusions

The fact that there is no significant difference in the effectiveness of the tested brushes indicates the benefits of using chewable toothbrushes in order to reduce plaque, primarily in the inability to use conventional brushes.

Effects of xylitol-containing chewing gum on the oral microbiota

In this interventional study, a randomized controlled trial was used to evaluate the short-term effects of xylitol-containing chewing gum on the salivary microbiota. In total, 70 healthy adult men recruited from the Japan Ground Self Defense Force participated in the study during a 2-day training at Yamaguchi camp, Yamaguchi Prefecture, Japan. The men were randomly divided into two groups: one group chewed two pieces of xylitol-containing chewing gum 7 times/day for 2 days (n = 34) and the other did not (n = 36). Baseline and follow-up stimulated saliva samples were collected and the salivary microbial composition was assessed using the 16S rRNA gene next-generation sequencing analysis. The total salivary bacterial count was quantified using a quantitative real-time PCR system. No statistically significant difference was found between the two groups regarding any parameter analyzed in the baseline samples; however, the follow-up samples of the test group showed significantly lower total salivary bacterial count than those of the control group. Conversely, no significant difference was observed in the overall composition of the salivary microbiota between the baseline and follow-up samples of the two groups. These results indicate that xylitol-containing chewing gum inhibits the increase in total salivary bacteria over a short time during which the salivary microbial composition is not affected.

Prenatal Maternal Factors, Intergenerational Transmission of Disease, and Child Oral Health Outcomes

This article reviews maternal prenatal risk factors for caries in children and intergenerational transmission of caries, emphasizing early interventions for pregnant women and mother-infant pairs. A growing body of evidence focuses on maternal interventions. Studies suggest that early prenatal clinical and educational interventions are effective at reducing mother-child mutans streptococci (MS) transmission and delaying colonization and caries in young children. Dental screenings and anticipatory guidance about maternal and infant oral health should be included in prenatal care and pediatric well visits. Dental care during pregnancy is safe and recommended and can reduce maternal MS levels. Infants should visit a dentist by age 1.

Effect of maternal use of chewing gums containing xylitol on transmission of mutans streptococci in children: a meta-analysis of randomized controlled trials

BACKGROUND

Mutans streptococci (MS) are the major causative bacteria involved in human dental decay. Habitual consumption of xylitol has been proved to reduce MS levels in saliva and plaque.

AIM

To evaluate the effect of the maternal use of xylitol gum on MS reduction in infants.

DESIGN

A structured literature review and meta-analysis. A random effects model was used to assess the relative risks of the incidence of MS in the saliva or plaque of children who were 6, 9, 12, 18, and 24 months old.

RESULTS

We reviewed 11 RCTs derived from 5 research teams that included 601 mothers. Our results indicated that the incidence of MS in the saliva or plaque of the infants was significantly reduced in the xylitol group (risk ratio: 0.54; 95% confidence interval: 0.39-0.73, at 12-18 months) and (risk ratio: 0.56; 95% confidence interval: 0.40-0.79, at 36 months) compared with the control groups. The long-term effect of maternal xylitol gum exposure on their children's dental caries was controversial.

CONCLUSION

Habitual xylitol consumption by mothers with high MS levels was associated with a significant reduction in the mother-child transmission of salivary MS.

The Effectiveness of Xylitol in a School-Based Cluster-Randomized Clinical Trial

Objective: The purpose of this double-blind, cluster-randomized clinical trial was to examine the effects of xylitol gummy bear snacks on dental caries progression in primary and permanent teeth of inner-city school children. Methods: A total of 562 children aged 5-6 years were recruited from five elementary schools in East Cleveland, Ohio. Children were randomized by classroom to receive xylitol (7.8 g/day) or placebo (inulin fiber 20 g/day) gummy bears. Gummy bears were given three times per day for the 9-month kindergarten year within a supervised school environment. Children in both groups also received oral health education, toothbrush and fluoridated toothpaste, topical fluoride varnish treatment and dental sealants. The numbers of new decayed, missing, and filled surfaces for primary teeth (dmfs) and permanent teeth (DMFS) from baseline to the middle of 2nd grade (exit exam) were compared between the treatment (xylitol/placebo) groups using an optimally-weighted permutation test for cluster-randomized data. Results: The mean new d3-6mfs at the exit exam was 5.0 ± 7.6 and 4.0 ± 6.5 for the xylitol and placebo group, respectively. Similarly, the mean new D3-6MFS was 0.38 ± 0.88 and 0.48 ± 1.39 for the xylitol and placebo group, respectively. The adjusted mean difference between the two groups was not statistically significant: new d3-6mfs: mean 0.4, 95% CI -0.25, 0.8), and new D3-6MFS: mean 0.16, 95% CI -0.16, 0.43. Conclusion: Xylitol consumption did not have additional benefit beyond other preventive measures. Caries progression in the permanent teeth of both groups was minimal, suggesting that other simultaneous prevention modalities may have masked the possible beneficial effects of xylitol in this trial. © 2014 S. Karger AG, Basel

Topical xylitol administration by parents for the promotion of oral health in infants: a caries prevention experiment at a Finnish Public Health Centre

OBJECTIVES

This demonstration programme tested topical use of xylitol as a possible oral health promoting regimen in infants at a Finnish Public Health Centre in 2002-2011.

METHODS

Parents (usually mothers) began once- or twice-daily administration of a 45% solution of xylitol (2.96 m) onto all available deciduous teeth of their children at the age of approximately 6-8 months. The treatment (xylitol swabbing), which continued till the age of approximately 36 months (total duration 26-28 months), was carried out using cotton swabs or a children's toothbrush; the approximate daily xylitol usage was 13.5 mg per each deciduous tooth.

RESULTS

At the age of 7 years, caries data on the deciduous dentition of 80 children were compared with those obtained from similar, untreated children (n = 90). Xylitol swabbing resulted in a significant (P < 0.001) reduction in the incidence of enamel and dentine caries compared with the comparison subjects (relative risk 2.1 and 4.0, respectively; 95% confidence intervals 1.42-3.09 and 2.01-7.98, respectively). Similar findings were obtained when the children were 5 or 6 years old. The treatment reduced the need of tooth filling relative risk and 95% confidence intervals at 7 years: 11.86 and 6.36-22.10, respectively; P < 0.001). Compared with untreated subjects, the oral counts of mutans streptococci were reduced significantly (P < 0.001).

CONCLUSIONS

Considerable improvement in dental health was accomplished in infants participating in a topical at-home xylitol administration experiment, which was offered to families in the area by the Public Health Centre as a supplement to standard oral health care. Caregiver assessment of the programme was mostly rated as high or satisfactory.