Long-term clinical and bacterial effects of xylitol on patients with fixed orthodontic appliances

Is xylitol effective in the prevention of dental caries? A systematic review

Background

Xylitol is a sugar alcohol increasingly used in dentistry as a preventative measure against dental caries. The objective of this systematic review was to assess xylitol's efficacy in caries prevention through the reduction of the most commonly associated bacteria: Streptococcus mutans.

Material and Methods

This systematic review followed PRISMA guidelines. A literature search was conducted in PubMed, Cochrane and Google Scholar databases. The search algorithm included the following key words: xylitol, dental caries, tooth demineralization, Streptococcus mutans, and prevention. The CASPe tool was used to assess risk of bias in the articles reviewed.

Results

After the search and selection processes, nine clinical trials (some of them placebo-controlled) in humans were included in the review. The objective proposed - to assess the efficacy of xylitol in caries prevention - was not fulfilled conclusively in all the works. Little heterogeneity was observed among the trials, as the study groups, evaluation periods, daily doses of xylitol etc. varied considerably between the works.

Conclusions

According to the present findings, the preventative effect of xylitol against dental caries cannot be confirmed. The results also highlight the need for further research with standardized protocols. Key words:Xylitol, dental caries, dental demineralization, Streptococcus mutans, prevention.

Evaluating the Therapeutic Properties of Natural Products in Orthodontic and Surgical Treatment of Dentofacial Deformities: A Systematic Review of Clinical Trials

The use of natural products as alternatives to traditional pharmacological treatments in orthodontics is gaining interest due to their anti-inflammatory, antibacterial, and antioxidant properties. This systematic review synthesizes evidence from clinical trials to evaluate the efficacy of natural products in reducing inflammation and bacterial presence in orthodontic and orthognathic treatment settings. The database search was conducted across PubMed, Scopus, and Embase up to January 2024. The review focused on randomized controlled trials only. The selected studies centered on the anti-inflammatory, antibacterial, and antioxidant effects of natural products, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction. Nine studies, totaling 358 participants, were included. Significant findings demonstrated a reduction in gingival inflammation by over 40% with the use of Aloe vera compared to chlorhexidine. Another study noted a decrease in bleeding on probing by 13.6 points in the treatment group over placebo. Additionally, honey showed a rapid modulation of plaque pH and significantly reduced bacterial counts of Streptococcus mutans. Furthermore, the use of resveratrol emulgel was linked to substantial improvements in gingival health, with a reduction in the gingival index and probing pocket depth. The results indicate that natural products can significantly enhance orthodontic treatment outcomes by reducing inflammation and bacterial levels. These products offer effective alternatives to traditional treatments and show potential for integration into routine orthodontic care protocols. Further research is encouraged to standardize application methods and dosages to maximize clinical benefits and patient satisfaction.

Oxidative Stress and Natural Products in Orthodontic Treatment: A Systematic Review

In recent years, orthodontics, a specialized branch of dentistry, has evolved considerably in terms of both techniques and materials used. Aimed at correcting dental malocclusions and craniofacial anomalies, it improves the functionality and aesthetics of the face and oral cavity. However, orthodontic treatment, in its developmental stages, may induce oxidative stress (O.S.) phenomena, with an increase in the production of reactive oxygen species (ROS), damaging the dental and periodontal tissues involved, affecting the short-, medium- and long-term results. Studies on the antioxidant effects of natural products (e.g., resveratrol, green tea, turmeric, etc.) in the medical field have aroused considerable interest in recent years. A systematic literature review was conducted on the PubMed, Scopus, and Web of Science databases using natural products (N.P.s), O.S., and orthodontic as keywords. The study aims to consider the determinants of the increase in ROS occurring during orthodontic treatment and the possibility of natural products being able to control and neutralize biochemical phenomena by restoring the physiological process in which the balance between the production of ROS and the ability of the body's antioxidant system to neutralize them is in favor of the latter.

Evaluation of the preventive effect of two concentrations of xylitol varnish versus fluoride varnish on enamel demineralization around orthodontic brackets: a randomized controlled trial

BACKGROUND

The highly prevalent white spot lesions around orthodontic brackets necessitate introducing preventive materials without relying on patient compliance.

OBJECTIVE

To evaluate the antidemineralizing effect of two concentrations of xylitol varnish.

TRIAL DESIGN

Triple-blind, four-arm, parallel-group, single-center, randomized controlled clinical trial.

METHODS

A total of 120 orthodontic patients were randomly assigned to four groups (n = 30), using a computer-generated randomized block list. The treatment groups were: 10% xylitol, 20% xylitol, 5% fluoride, and placebo. Tooth demineralization was measured with DIAGNOdent at T1 (before treatment), followed by varnish application. At T2 (third month), the varnish was re-applied, and at the third (T2) and sixth (T3) months, and after treatment (T4), the demineralization was measured. The white spot lesion frequency was assessed visually after treatment. The participants, the clinician, and data assessors were all blinded to group assignments.

RESULTS

A total of 115 patients underwent per-protocol analyses. At T2, the mean DIAGNOdent numbers in the fluoride and 10% xylitol groups were significantly lower than the placebo group (P = 0.00), with a mean difference of 0.63 (95% CI, 0.15-1.10) and 0.5 (95% CI, 0.04-0.95), respectively. At T3, the fluoride and 10% xylitol groups had significantly lower mineral loss than the placebo group (P=0.046) with a mean difference of 0.52 (95% CI, 0.14-0.89) in the fluoride and 0.45 (95% CI, 0.03-0.86) in the 10% xylitol groups, respectively. However, at T4, only the mean for the 10% xylitol group was significantly different (P=0.049) from the placebo group, with a mean difference of 1.18 (95% CI, 0.42-1.93). Visual assessment showed that after treatment, the prevalence of white spot lesions in the fluoride (P=0.03) and 10% xylitol (P=0.00) groups was less than the placebo group with the odds ratio of 0.67 (95% CI, 0.46-0.96) and 0.43 (95% CI, 0.28-0.64), respectively.

CONCLUSION

The 10% xylitol varnish short-term effects on caries control were significantly greater than 20% xylitol varnish and placebo but similar to fluoride varnish. However, the 10% xylitol long-term effect was almost better than fluoride varnish.

TRIAL REGISTRATION

The protocol was registered at IRCT.ir under the code IRCT20180913041032N1.

Effects of xylitol impregnated toothbrushes on periodontal status and microbial flora in orthodontic patients

OBJECTIVES

To investigate whether the use of xylitol-impregnated toothbrushes affects periodontal condition and microbial flora in orthodontic patients with poor oral hygiene.

MATERIALS AND METHODS

Forty-four patients with baseline mean Turesky plaque index scores ≥1.5 were randomly divided into two groups. Half received xylitol-containing toothbrushes and the other half, xylitol-free toothbrushes. The periodontal measurements and saliva samples were taken at baseline (T0), 1 month later (T1), and 3 months after brushing (T2) to evaluate periodontal health and microflora changes. Periodontal status was assessed with plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores. Data were statistically analyzed with Mann-Whitney U and Friedman tests.

RESULTS

All periodontal parameters significantly decreased from T0 to T1 and from T0 to T2 in both groups. The PI and GI scores reduced significantly in the control group, while BOP scores reduced in both groups between T1 and T2. Intergroup comparisons showed significant differences for BOP, PI, and GI at T0, T1, and T2 times, respectively. For microbial parameters, there were no statistically significant differences within groups from T0 to T1. Total bacterial counts significantly decreased in the xylitol group between T1 and T2. Decreases in Streptococcus mutans and total bacteria were significant in both groups from T0 to T2. No significant differences were found between the groups in microbial flora at any time.

CONCLUSIONS

A 3-month use of xylitol-containing toothbrushes showed almost the same changes and provided no positive effects on periodontal and microbial parameters compared to the control group.

Effects of short-term xylitol chewing gum on pro-inflammatory cytokines and Streptococcus mutans: A randomised, placebo-controlled trial

INTRODUCTION

Dental caries is an infectious disease with predominantly of cariogenic bacteria such as Streptococcus mutans (S mutans). Xylitol is considered as one of the effective agents that can limit this dental infection. In this randomised, placebo-controlled trial, we aimed to evaluate the potential reflection of short-term xylitol consumption on pro-inflammatory cytokines (TNF-α, IL-6 and IL-8) and S mutans counts by ELISA and qPCR (Quantitative real-time PCR), respectively.

METHODS

In this study, 154 participants were assigned to two groups, control and xylitol. Dental examination, saliva and swab samples were done at baseline and at 3-week for clinical and microbiological assessment.

RESULTS

In xylitol group at the end of 3-week, gingival and plaque index scores were significantly decreased with respect to baseline values (P < .001 and P < .05, respectively). The salivary concentration of TNF-α, IL-6 and IL-8 were statistically declined at 3-week, more so than those at baseline in xylitol group (P < .001). S mutans expression was reduced about fivefold at 3-week use of xylitol and it was a statistically significant difference compared to baseline (P < .001).

CONCLUSION

Intriguingly, even short-term consumption of xylitol might play a favourable role in maintaining the oral health status, possibly as a result of decreasing the release of pro-inflammatory cytokines and the counts of S mutans. Nonetheless, this investigation warrants further endorsement.

[Preventive and therapeutic advantages of sugar-free chewing gums in orthodontics. A study conducted on practitioners and patients]

OBJECTIVE

The objective of this study is to assess the level of knowledge in a cohort of oral health professionals and patients about preventive and therapeutic actions of sugar-free chewing gums.

MATERIALS AND METHODS

A forward-looking monocentric study of perception regarding the level of information about the effects of sugar-free chewing gums consumption was conducted on 135 young patients, from 11 to 17 years old, carriers of fixed orthodontic appliances and treated in the Department of Orthodontics in the Oral Medicine and Surgery Center of the University Hospitals of Strasbourg. Besides, 34 practitioners in the Department of Orthodontics and Pediatric Dentistry were also included. Data were collected between May 2016 and July 2016. A specific questionnaire, using the adapted terminology and dealing with the same items was developed for each studied population.

RESULTS

The majority of the individuals of both studied populations believe that the consumption of sugar-free chewing gum leads to a greater risk of orthodontic device unsticking or fracture and that it is not associated to a decrease of the orthodontic pain.

DISCUSSION

Our results confirm the fact that the knowledge, mainly acquired in an empirical way, is against the data of the current literature. The evaluation of the level of knowledge demonstrated that there is a real lack of information about the preventive interests of the consumption of sugar-free chewing gums during orthodontic treatment.

CONCLUSIONS

This study highlights the need for information campaigns and oral prevention in general population, as well as in healthcare professionals, concerning the preventive and analgesic interests of sugar-free chewing gums during orthodontic treatments.

Addition of ammonium-based methacrylates to an experimental dental adhesive for bonding metal brackets: Carious lesion development and bond strength after cariogenic challenge

INTRODUCTION

In this study, we evaluated the caries inhibition and shear bond strength achieved with the addition of the antibacterial monomer [2-(Methacryloyloxy)ethyl] trimethylammonium chloride (MADQUAT) to an adhesive used to bond orthodontic brackets.

METHODS

Experimental adhesives were formulated with addition of 0% (control), 5%, or 10% MADQUAT followed by measurement of the degree of conversion. These adhesives were used to lute brackets to the enamel of premolars (n = 30). Biofilm from a microcosm model was cultivated in half of the specimens under cariogenic challenge for 5 days. The brackets were subjected to a shear bond strength test followed by measurement of the internal hardness of the enamel around the brackets to calculate the integrated mineral loss.

RESULTS

The addition of MADQUAT slightly increased the degree of conversion. Adhesive containing 10% MADQUAT significantly reduced the integrated mineral loss around the bracket but also resulted in the lowest values of bond strength. No effects on bond strength and integrated mineral loss were observed with the addition of 5% MADQUAT to the adhesive. The cariogenic challenge did not affect the bond strength and the failure mode.

CONCLUSIONS

MADQUAT was effective to reduce the integrated mineral loss only when added to the adhesive at a concentration of 10% despite the reduction of bond strength.

[Effectiveness of Paradontax toothpaste in patients undergoing orthodontic treatment]

The purpose of this study was to determine the effectiveness of toothpaste Parodontax in patients undergoing orthodontic treatment. The results showed that fixed orthodontic appliances deteriorated oral hygiene, increased the viscosity of saliva and reduced mineralizing capacity of saliva (MCS). Use of Parodontax toothpaste based on sodium bicarbonate improved OHI-S, reduced the viscosity of saliva, increased MCS and normalized oral microbiota.

Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry

STATEMENT OF PROBLEM

It is clear the contemporary dentist is confronted with a blizzard of information regarding materials and techniques from journal articles, advertisements, newsletters, the internet, and continuing education events. While some of that information is sound and helpful, much of it is misleading at best.

PURPOSE

This review identifies and discusses the most important scientific findings regarding outcomes of dental treatment to assist the practitioner in making evidence-based choices. This review was conducted to assist the busy dentist in keeping abreast of the latest scientific information regarding the clinical practice of dentistry.

MATERIAL AND METHODS

Each of the authors, who are considered experts in their disciplines, was asked to peruse the scientific literature published in 2015 in their discipline and review the articles for important information that may have an impact on treatment decisions. Comments on experimental methodology, statistical evaluation, and overall validity of the conclusions are included in many of the reviews.

RESULTS

The reviews are not meant to stand alone but are intended to inform the interested reader about what has been discovered in the past year. The readers are then invited to go to the source if they wish more detail.

CONCLUSIONS

Analysis of the scientific literature published in 2015 is divided into 7 sections, dental materials, periodontics, prosthodontics, occlusion and temporomandibular disorders, sleep-disordered breathing, cariology, and implant dentistry.