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Study finds no effect of xylitol for patients with braces

By Dental Tribune International
October 27, 2015

IOWA CITY, IOWA, USA: Patients with fixed orthodontic appliances are more prone to oral health problems such as dental caries. As xylitol has been shown to have decay-preventive qualities, especially for people at moderate to high risk of decay, orthodontic patients are sometimes advised to chew xylitol-containing gums or mints. A recent study, however, has found that xylitol has no clinical or bacterial benefit in these patients.

The study sought to investigate the long-term effects of xylitol on plaque and saliva mutans streptococci, which play a major role in the development of dental caries. It included 41 female and male adolescents and young adults aged 12–30 who underwent orthodontic treatment with fixed appliances between January and December 2009.

The participants were divided into three groups. Those in the first group consumed six pieces of xylitol chewing gum per day for three months after each meal, resulting in a total daily intake of 6 g of xylitol. The second group ate 12 xylitol chewable mints per day for the same period, also resulting in a total daily intake of 6 g of xylitol. Participants in the third group served as controls and did not receive any xylitol. In addition, all of the participants were instructed in oral hygiene, regular cleaning and topical fluoride application.

Clinical examination at three, six and 12 months after baseline showed that all three groups had a reduction in plaque scores. However, there was no significant difference between the groups. In addition, all of the groups exhibited a reduction in plaque mutans streptococci counts, with a significant reduction in the mint group. At three months after baseline, the control group had lower values than the other two groups. The researchers also found no significant difference in DMFT scores or broken brackets between the groups throughout the study period, indicating that xylitol did not increase the risk of developing caries or debonded orthodontic appliances.

As most plaque bacteria lack the ability to ferment xylitol into cariogenic end-products and it could thus inhibit bacterial growth, a number of dental organizations recommend using xylitol in the prevention of dental caries. The California Dental Association, for instance, considers a total intake of 5 g of xylitol in the form of gum or mints three to five times a day optimal.

However, based on their findings, the researchers were unable to advocate its use as a caries prevention measure, since it did not provide any additional measurable benefit. They concluded that oral hygiene instructions and fluoride application were effective in study participants whether or not xylitol was consumed.

The study, titled "Long-term clinical and bacterial effects of xylitol on patients with fixed orthodontic appliances," was published in the October issue of the Progress in Orthodontics journal.

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