Xylitol was introduced to the world of dentistry in the late 20th century. Even before that, it was used as a sweetener in many parts of the world. In dentistry, many studies have shown potential benefits of xylitol in caries prevention and plaque formation. Streptococcus mutans, a type of caries-causing bacteria, requires sugar to proliferate, but studies such as this one have shown that it cannot use xylitol for energy production and will eventually die when exposed to it. Xylitol also weakens the adhesion of plaque-causing microorganisms and thereby helps in preventing plaque formation.
While xylitol has gathered attention in dentistry due to the above mentioned benefits, several other studies have shown some promising effects of xylitol beyond the realm of oral health.
Gut-friendly. Once absorbed, xylitol is converted into glycogen and can be used as an energy source. Unabsorbed xylitol acts as a dietary soluble fiber, helping the gut function. In fact, a 2015 study of bowel motility shows that chewing xylitol gum after laparoscopy can help in postoperative gastrointestinal recovery. Be careful, though – consumption of large amounts of xylitol may cause gas or osmotic diarrhea due to its laxative effects, so the dose should be gradually increased.
Ear, nose and throat. Xylitol inhibits the growth and adhesion of microorganisms such as Streptococcus pneumoniae involved in respiratory infections. It may help in preventing various respiratory infections. Xylitol seems to enhance the body’s natural defenses, and it has been used to prevent ear and sinus infections, according to a 2014 literature review. Another study using xylitol and water for sinus irrigation showed it to be more effective than saline.
Bone volume and density. Several studies have indicated positive effects of xylitol administration on bones in aged rats. This could hint toward applications in protecting against osteoporosis. One study demonstrated that xylitol supplements given to aging rats increased their bone volume and mineral content.  showed that oral administration of xylitol appears to increase bone density in rat femurs. These studies using rats may pave the way for future studies focusing on possible benefits for humans.
Effects on man’s best friend. Although xylitol has no known toxic effects on most mammals, one major drawback is that it is harmful for dogs. It can cause fatal hypoglycemia in dogs at low doses and liver failure at higher doses. If a dog accidentally ingests xylitol, it is best to consult a vet. Supportive care with I.V. glucose and hepatic monitoring is crucial. More information on xylitol toxicity in dogs, its prevention and treatment can be found here.
Forms of xylitol. Xylitol is available as a sweetener in the form of powder and syrup. Some dental products, such as toothpaste, rinses and mouth wipes for babies, contain xylitol. It can also be found in tablets or lozenges, tooth varnish and sprays for relieving dry mouth. To aid in caries prevention, it is often recommended to use a xylitol gum or a candy after meals. The optimal dose of xylitol for caries prevention is about 6 grams per day. Unfortunately, very few products on the market inform consumers how much xylitol they contain. Moreover, many gums containing xylitol also contain other substances that may interfere with its effectiveness in caries prevention. Xylitol-containing dental products are still somewhat hard to find in supermarkets, so keep an eye out for them or look online.
Recent innovations. In a recent study conducted in 2014, a mucoadhesive spray containing sodium bicarbonate and xylitol was shown to help in controlling the drop in pH after sugar consumption. In a world where we constantly expose our teeth to snacks and sugars on the go, methods of easy and effective caries prevention could become very important.
While many studies in past two decades have shown various potential benefits and positive effects of xylitol administrations in different forms, there are also many trials that question the usefulness of xylitol for caries prevention in adults. One study even suggests that prolonged use of xylitol caused resistance in salivary S. mutans in some patients.
Delicious Tip: 1 g of xylitol has 33% fewer calories than 1 g of sugar. Xylitol also has a very low glycemic index of 7, meaning it does not cause a dramatic spike in blood sugar. This is good news for people with a sweet tooth like mine. If you are a fan of desserts, you can find ideas and recipes for various desserts using xylitol here and here. It was even shown that formulating green tea with vitamin C and xylitol can increase the absorption of flavanols, enhancing the tea’s antioxidant effects. Try xylitol-sweetened green tea lemonade for refreshment on a sunny afternoon.
Xylitol is a hot topic for dental health. This overview can help you find some information to share with patients and loved ones. Keep your eye out for new research and innovations in the years ahead!
~ Hetal Trivedi, predental