Sorbitol compared with xylitol in prevention of dental caries

A concise review of chewing gum as an anti-cariogenic agent

Chewing gum has been endorsed as a caries preventive agent by the FDI World Dental Federation, the American Dental Association, and the European Food Safety Authority. This review discusses the mechanism and provides an update of the use of chewing gum for caries prevention. Chewing gum typically consists of a water-insoluble gum base, water-soluble added ingredients, and active ingredients. It can be classified as sugar-containing or sugar-free, as well as nonmedicated or medicated. Chewing gum prevents dental caries through a range of mechanisms, including the clearance of the oral cavity, neutralization of oral acidity, inhibition of cariogenic bacterial growth, remineralization of enamel, and reduction of appetite. Recent clinical studies have evaluated the efficacy of sugar-free chewing gum for caries prevention, with most demonstrating positive results, although some studies have reported contradictory outcomes. To achieve optimal caries prevention, it is generally recommended that individuals chew sugar-free gum for five minutes after meals, three times daily.

Non-targeted and targeted metabolomics profiling of tea plants (Camellia sinensis) in response to its intercropping with Chinese chestnut

BACKGROUND

Intercropping is often used in the tea producing areas where land resources are not so abundant, and the produced green tea is tasted more delicious through a tea-Chinese chestnut intercropping system according to the experience of indigenous farmers. The length and weight of tea leaf increase under this intercropping system and their root systems are stratified vertically and coordinate symbiosis. However, the delicacy mechanism under the intercropping is not fully understood.

RESULTS

Green tea from the Chinese chestnut-tea intercropping system established in the 1980s ranked highest compared with a pure tea plantation from the same region. Based on the non-targeted metabolomics, 100 differential metabolites were upregulated in the tea leaves from intercropping system relative to monoculture system. Twenty-one amino acids were upregulated and three downregulated in response to the intercropping based on the targeted metabolomics; half of the upregulated amino acids had positive effects on the tea taste. Levels of allantoic acid, sugars, sugar alcohols, and oleic acid were higher and less bitter flavonoids in the intercropping system than those in monoculture system. The upregulated metabolites could promote the quality of tea and its health-beneficial health effects. Flavone and flavonol biosynthesis and phenylalanine metabolism showed the greatest difference. Numerous pathways associated with amino acid metabolism altered, suggesting that the intercropping of Chinese chestnut-tea could greatly influence amino acid metabolism in tea plants.

CONCLUSIONS

These results enhance our understanding of the metabolic mechanisms by which tea quality is improved in the Chinese chestnut-tea intercropping system and demonstrate that there is great potential to improve tea quality at the metabolomic level by adopting such an intercropping system.

The effects of funoran-containing xylitol chewing gum on dental plaque

The aim of the study was to investigate the efficacy of the addition of funoran to xylitol chewing gum in dental plaque. In a double-blinded randomized controlled clinical trial, 36 health adults (21–30 years old), who volunteered after informed consent, with >105 colony-forming units/ml mutans streptococci (MS) at baseline, were assigned randomly into one of three parallel study groups: xylitol+funoran gum (group A), sucrose gum group (group B), and control group (no gum have been provided; group C). The pH value, flash weight, and MS of dental plaque were recorded at baseline and after 2 weeks of treatment. A statistically significant reduction (p<0.05) of salivary MS was displayed in group A after the intervention when compared with baseline. The weight of plaque was reduced after 2 weeks of treatment (p=0.032) in group A. There was no significance in plaque pH value before and after the treatment in any group. Daily funoran-containing xylitol chewing gum application significantly reduced the dental plaque volume and caries pathogen counts in the oral cavity, suggesting that the use of funoran-containing xylitol chewing gum may be a useful adjunct for caries control.

Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials

OBJECTIVES

This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol.

METHODS

Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries-related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger's regression and funnel plotting were used to investigate risk for publication bias.

RESULTS

Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta-analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger's regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol.

CONCLUSIONS

The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.

The use of sorbitol- and xylitol-sweetened chewing gum in caries control

BACKGROUND

The author compared the caries-inhibitory action of sorbitol- and xylitol-sweetened chewing gum and assessed the role of these products in caries prevention.

TYPES OF STUDIES REVIEWED

The author reviewed studies including randomized field trials with substantial numbers of participants and observational studies. He did not review case studies. He found studies through a MEDLINE search and by hand searching.

RESULTS

When compared with sugar-sweetened gum, sorbitol-sweetened gum had low cariogenicity [corrected] when it was chewed no more than three times per day. Xylitol-sweetened gum was noncariogenic in all of the protocols tested. Some studies claimed that xylitol-sweetened gum had an anticariogenic effect, though these claims need further study. There also is good evidence that when mothers of infants and young children chew xylitol-sweetened gum, it will block transmission of mutans streptococci from mother to child.

CLINICAL IMPLICATIONS

The evidence is strong enough to support the regular use of xylitol-sweetened gum as a way to prevent caries, and it can be promoted as a public-health preventive measure. Chewing xylitol-sweetened gum, especially for patients who like chewing gum, can be fitted readily into a regimen that includes frequent fluoride exposure, good oral hygiene and regular dental appointments.

Effect of xylitol on growth of Streptococcus pneumoniae in the presence of fructose and sorbitol

Xylitol is effective in preventing acute otitis media by inhibiting the growth of Streptococcus pneumoniae. To clarify this inhibition we used fructose, which is known to block similar growth inhibition observed in Streptococcus mutans. In addition, we evaluated the efficacy of sorbitol in inhibiting the growth of pneumococci, as sorbitol is widely used for indications similar to those for which xylitol is used. The addition of 5% xylitol to the growth medium resulted in marked growth inhibition, an effect which was totally eliminated in the presence of 1, 2.5, or 5% fructose but not in the presence of 1 or 5% glucose, 1% galactose, or 1% sucrose. This finding implies that xylitol-induced inhibition of pneumococcal growth is mediated via the fructose phosphotransferase system in a way similar to that in which mutans group streptococcal growth is inhibited. The addition of sorbitol at concentrations of 1, 2.5, or 5% to the growth medium did not affect the growth of pneumococci and neither inhibited nor enhanced the xylitol-induced growth impairment. Thus, it seems that xylitol is the only commercially used sugar substitute proven to have an antimicrobial effect on pneumococci.