Are we ready for definitive clinical guidelines on xylitol/polyol use?
In the past decades, numerous studies have looked at the anticaries effects of polyols, particularly xylitol, and a great many studies have focused on xylitol's antimicrobial properties. Researched vehicles have mostly included chewing gums, followed by lozenges/candies, toothpastes, and others (e.g., syrup). Good evidence supports the claims that xylitol is non-cariogenic and has a dose-/frequency-dependent antimicrobial effect on dental plaque/mutans streptococci, and that polyol use is very safe. However, interpretation of caries data has been controversial, due in part to variability in study designs, formulations/dosages tested, and outcomes reported (e.g., many caries studies have a "no gum" control, limiting the interpretation of the polyol's benefit; few studies have compared different polyols side-by-side, or in adults). Even when the level/strength of high-quality anticaries evidence is still limited, most recent systematic reviews have consistently concluded that the habitual use of sucrose-free xylitol or polyol-combination chewing gum/ lozenges is an effective adjunct in coronal caries prevention. Consequently, many health organizations worldwide are supporting this recommendation for at-risk populations. However, most experts agree that well-designed, placebo-controlled randomized clinical trials (RCTs) (focusing on efficacy, feasibility, adherence, dosage, vehicle, synergism with other preventive strategies, and cost) are still needed in target populations worldwide to reach definitive caries-preventive/therapeutic recommendations.
Department of Cariology and Restorative Sciences, University of Michigan School of Dentistry, 1011 North University, Room 2393, Ann Arbor, Michigan 48109, USA. mfontan@umich.edu
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González-Cabezas
D002327:Cariostatic Agents / Q000627:therapeutic use*; D002638:Chewing Gum; D003731:Dental Caries / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D017410:Practice Guidelines as Topic; D013549:Sweetening Agents / Q000627:therapeutic use*; D014993:Xylitol / Q000627:therapeutic use*
D002327:Cariostatic Agents; D002638:Chewing Gum; D013549:Sweetening Agents; D014993:Xylitol