Xylitol: Game Changer in Oral Care

XYLITOL—a natural sweetener derived from certain fruits, vegetables, berries, and nutshells—is proven to be safe and effective in preventing and even reversing tooth decay. Research shows that regular use of xylitol-containing products—such as gums, candies, lozenges, and toothpaste—can halt tooth decay in its tracks and even promote the healing of cavities that are already underway. Even more remarkably, xylitol can help ensure lifelong dental health, particularly if young children begin using xylitol-sweetened products before they start to lose their primary teeth.


Xylitol works so well because it interferes with the bacteria that cause tooth decay, halting their growth and preventing them from sticking to tooth surfaces. Anticaries research using xylitol goes back more than 40 years. According to Catherine Hayes, DDS, of the Harvard School of Dental Medicine, the favorable evidence for xylitol is so strong that “it would be unethical” to deprive people of its dental protective effects.1

Controlling Bacteria in Our Mouths

WE LIKE TO THINK of our mouths as clean places, but clean does not mean sterile or bacteria-free. In fact, estimates suggest the average mouth contains more than 400 species of bacteria, amounting to billions and billions of individual organisms.2

   Fortunately, most oral bacteria are completely harmless and even beneficial. We don’t have to rid our mouths of virtually all bacteria, as some antimicrobial mouthwashes do temporarily. Instead, we can focus our antibacterial strategies to just a few species. The microorganisms most responsible for tooth decay are Streptococcus mutans (S mutans), When S mutans feed on carbohydrates and sugars, they metabolize it by fermentation and the primary product is lactic acid. When we chew a piece of sucrose-based gum or candy, our oral bacteria go to work within minutes churning out this acid. This results in a noticeable increase in the acidity (decrease in pH) in our mouths. Bacteria-produced acid dissolves tooth enamel, even though tooth enamel is the hardest tissue in the human body. However, tooth enamel is highly vulnerable to a low pH (acidic) attack. For the same reasons that acid rain corrodes away the details from outdoor marble statues, bacteria-generated acid—in high enough concentrations— can dissolve away tooth enamel by a process known as demineralization.

   Demineralization constantly takes place at a very low level, but it’s balanced by a complementary process called remineralization. Teeth have a limited ability to “remodel” themselves by reincorporating minerals (especially calcium) from saliva into the enamel. Thanks to remineralization, under the right conditions (not much acid concentration), even small caries can be covered over with newly minted enamel. It may not be enough to completely fill in the hole, but it can often seal the cavity from further erosion or infection. For remineralization to succeed, S mutans (which produce the demineralizing acids) must be kept under control.

   While most bacteria cannot live in an acidic environment, S mutans thrives. Their ability to secrete acid and then live in it gives them (and other acid-loving) microorganisms a selective survival advantage.

   Sucrose is particularly a problem because it is the only carbohydrate that can be transformed by S mutans into sweet, gooey substances known as polysaccharides. When S mutans excrete polysaccharides through their cell membranes, they get coated with the sweet, sticky goo, allowing themselves to adhere to anything in their vicinity—especially dental enamel. Polysaccharides produced from sucrose are the glue that holds bacterial colonies together to form dental plaque.

   Plaque concentrates the acid right at the tooth surface, and because there is strength in unity, it also shields the individual bacteria and the acid they produce from contact with neutralizing saliva. If these localized areas of high acidity are allowed to remain in place, they can lead to accumulated demineralization— or caries.

Preventing —and Healing— Dental Caries with Xylitol

XYLITOL IS SCIENTIFICALLY CLASSIFIED as a sugar alcohol, or polyol. Small amounts of xylitol are also produced in the human: body as a result of normal metabolic processes. Other sugar alcohols, including sorbitol and mannitol, offer some anticaries benefits similar to xylitol but are generally less effective.

   A Finnish study evaluated xylitol in school-aged children who had been participating in a rigorous dental hygiene program that included regular brushing and flossing, dietary instruction, systematic checkups, and use of fluorides. Interestingly, because this program was so involved, the local dental and school authorities believed that the addition of xylitol to this regimen would have little or no benefit. It turns out, the children that chewed xylitol gum daily demonstrated significantly increased protection by nearly 50 percent. Children whose final permanent teeth grew during the trial were best protected.3

   In a double-blind study conducted in Belize, 1,277 schoolchildren were instructed to chew gum several times per day. One group chewed ordinary gum sweetened with sucrose, while others chewed gum sweetened with either xylitol or sorbitol. After up to 40 months of daily gum chewing (including weekends and vacations), the xylitol group experienced 73 percent fewer caries, compared with a reduction of 26 percent in the sorbitol group and an increase of 120 percent in the sucrose group.4

   Similarly, researchers in Estonia evaluated the use of xylitol gums and candies in ten-year-old school children. Overall, three years of xylitol gum chewing, compared to a no-gum control group, resulted in a 53.5 percent reduction in caries, while sucking on xylitol candy led to a 33 percent to 59 percent reduction.5

   Most xylitol research has tested gums or candies, but one study from Costa Rica compared a xylitol-sweetened toothpaste with a control toothpaste. Both products contained fluoride. After three years of twice-daily brushing, the xylitol group had statistically significantly fewer caries (10.5-12.3 percent), depending on the tooth surface examined.6

Reversing Tooth Decay with Xylitol

MANY OF US think that once caries get started, the only solution is a dentist’s drill, but research has shown that xylitol can arrest the progress of caries and eventually restore their enamel coating.7 This was clearly demonstrated in another study in school children based in Belize. The xylitol group had the highest percent of arrested caries (27 percent), compared with the sorbitol (seven percent) and no-gum control (nine percent) groups.8

Long-Term Effectiveness

ONE OF THE MORE REMARKABLE FEATURES about the caries protection provided by xylitol is that, to a large degree, it is permanent. In a school-based study, children chewed gum for two years—it was sweetened with either xylitol or sorbitol, while a control group had no gum. Then, five years later, their teeth were examined by dentists who did not know which treatment they had received.

   The xylitol group had a mean of only 1.5 new caries, compared with 2.5 for the sorbitol group, and 4.0 for the no-gum group. Overall, use of xylitol was associated with a statistically significant 59 percent reduction in caries risk.

   The long-term caries risk depended strongly on when the children’s permanent teeth erupted. Those teeth that erupted during the second year of xylitol gum chewing were almost completely protected from caries (93 percent risk reduction). Even teeth that erupted after the children stopped chewing xylitol gum had substantial (88 percent) protection.9

   This was a very important study because it showed that if children get in the habit of chewing xylitol gum (and/or using other xylitol products) at an early enough age—at least one year before their permanent teeth erupt—they will likely be protected from tooth decay for the rest of their lives.

Mothers, Children, and Tooth Decay

TO A LARGE DEGREE, tooth decay is a transmissible disease, at least when it comes to mothers and babies. Research from the University of Turku, in Finland, demonstrates this in a study published in the Journal of Dental Research.

   The Finnish dental investigators recruited 169 pregnant women who had high oral levels of S mutans and placed them all on a standard oral health care program. In addition, the women were divided into three groups: xylitol, fluoride, and chlorhexidine.

   The results left no doubt that mothers with S mutans in their mouths are capable of passing the bacteria onto their babies, such as through kissing or tasting/pre-chewing foods. However, if mothers take steps to minimize S mutans in their own mouths, they're doing their children a big favor as well.

   Maternal chlorhexidine treatments had a small effect, resulting in S mutans growing on the teeth of nearly one child in three. Compare that with the xylitol moms, where only one child’s mouth in ten eventually harbored S mutans. This was five times better than the fluoride group, where the treatments may have helped the mother some, but were ineffective for the child.

   In a follow-up to this study, the researchers found that this mother-child bacterial reduction led to healthier teeth. They examined the children’s teeth each year up to age five. Neither maternal fluoride nor chlorhexidine had any lasting benefit for the children once their mothers stopped using them. However, the children of the mothers who chewed xylitol gum continued to be protected against tooth decay at least through age five, despite practicing nothing more than normal dental hygiene.10

Preventing Tooth Decay in Adults

ALTHOUGH MOST OF THE RESEARCH on xylitol has been carried out in children, adults can derive real benefits as well. The adults at greatest risk are those who have poor oral hygiene due to illness, advanced age, or poor habits.

   Adults who suffer from a condition known as “dry mouth” syndrome are also at risk because their ability to salivate is impaired. People who do not salivate sufficiently are at increased risk for dental caries because saliva normally helps neutralize bacterial acids and rinse bacteria and carbohydrates away from the teeth and out of the mouth.

   Incidentally, dry mouth can be a side effect of many medications, and it can also occur as a result of certain diseases, such as Sjogren’s syndrome, and radiation therapy to the head or neck. Chewing xylitol gum or sucking on xylitol candy is an effective and pleasant way to stimulate salivation and has been shown to significantly reduce the incidence of caries in adults who use it regularly.11

Getting the Most Out of Xylitol

XYLITOL IS AVAILABLE in. chewing gums, candies, toothpastes, breath sprays, breath mints, mouthwashes, calcium supplements, and chewable medications and vitamins. The delivery systems that produce the best anticaries effects are those that permit xylitol to come in direct contact with the teeth for the longest period of time. These include chewing gums, especially “pellet-type” gums that have pure xylitol candy coating.

How Much Xylitol is Enough?

STUDIES SHOW that using about four to 12 grams of xylitol per day is very effective for preventing dental caries. If a piece of gum contains one gram of xylitol, then chewing four pieces per day should be sufficient. Children can usually tolerate up to 45 grams per day.

Does Using Xylitol Mean We Can Safely Eat Sucrose-Containing Products at Will, Too?

XYLITOL WORKS BEST when it is the only sugar present. Thus, it is still best to avoid foods that contain sucrose or a mixture of xylitol and sucrose or other caries-promoting carbohydrates, like starches. The old advice of limiting sweets still applies, as does brushing and flossing daily. Xylitol is a very effective product but it’s not a guaranteed “get-out-of-caries-free card.”

How Safe Is Xylitol?

IN THE AMOUNTS FOUND in (and recommended for) dental health, xylitol is extremely safe. However, if xylitol is consumed in large amounts (more than 20 grams (0.7 ounces) per meal or more than 60 grams (2.17 ounces per day), it can cause diarrhea, but even sensitive individuals can eventually adapt to these high levels. ‘The amounts recommended for dental protection (up to 12 grams per day) should not cause problems.

“Third World” Research, “First World” Benefits

VIRTUALLY ALL THE RESEARCH we have discussed regarding xylitol has been conducted in countries like Belize, Estonia, Hungary, and Costa Rica. One reason for this is chat “third world” or “developing” countries, which often lack the resources for good public health programs, are always looking for effective, safe, easy-to-use, and inexpensive ways to improve health. Xylitol as a treatment for tooth decay fits perfectly into this model.

With all of this scientific evidence, in 2002 the Journal of the American Dental Association published an article recognizing xylitol as “an effective preventive agent against dental caries.”13

About the Author:

Jonathan V Wright, MD, graduate of Harvard University (1965) and University of Michigan Medical School (1969), is a forerunner in research and application of natural treatments for healthy aging and illness at the Tahoma Clinic. Author and co-author of 13 books (including the bestsellers Book of Nutritional Therapy and Guide to Healing with Nutrition) and numerous articles, he also writes Green Medicine Newsletter a popular monthly nutritional and naturally-based medicine newsletter.

Well Being Journal adapted this article from the previously published original article at Green Medicine Newsletter titled “Xylitol: A Sweet Natural Sugar is More Effective Than Fluoride in Preventing and Even Reversing Tooth Decay,” published May 2022.

This article was published in the Well Being Journal - Vol 31, Fall 2022.

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