Milk Sweetened with Xylitol: A Proof-of-Principle Caries Prevention Randomized Clinical Trial.
OBJECTIVE
To evaluate the efficacy of xylitol-sweetened milk as a caries-preventive strategy.


METHODS
In this nine-month prospective proof-of-principle trial, Peruvian schoolchildren were randomized to one of five different milk groups: (1) eight g of xylitol per 200 mL milk once per day; (2) four g of xylitol per 100 mL milk twice per day; (3) eight g of sorbitol per 200 mL milk once per day; (4) four g of sorbitol per 100 mL milk twice per day; or (5) eight g of sucrose per 200 mL milk once per day. The primary outcome was plaque mutans streptococci (MS) at nine months. A secondary outcome was caries incidence. We hypothesized that children in the xylitol groups would have a greater MS decline and lower caries incidence.


RESULTS
One hundred fifty-three children were randomized in the intent-to-treat analyses. Children receiving xylitol had a greater decline in MS than children receiving sucrose (P=0.02) but were not different from children receiving sorbitol (P=0.07). Dental caries incidence for xylitol once per day or twice per day was 5.3±3.4 and 4.3±4.0 surfaces, respectively, compared to sorbitol once per day, sorbitol twice per day, or sucrose (4.1±2.8, 3.7±4.2, and 3.2±3.4 surfaces, respectively). There were no differences in caries incidence between xylitol and sucrose (rate ratio [RR] = 1.51; 95 percent confidence interval [CI] = 0.88, 2.59; P=0.13) or between xylitol and sorbitol (RR = 1.28; 95 percent CI = 0.90, 1.83; P=0.16).


CONCLUSIONS
Xylitol-sweetened milk significantly reduced mutans streptococci levels compared to sucrose-sweetened milk, but differences in caries incidence were not detected.
Department of Oral Health Sciences, University of Washington, Seattle, Wash., USA. dchi@uw.edu.
Donald L
DL
Chi
Department of Pediatric Dentistry, Universidad Alas Peruanas, Arequipa, Perú.
Graciela
G
Zegarra
Department of Pediatric Dentistry, Universidad Católica de Santa Maria, Arequipa, Perú.
Elsa C
EC
Vasquez Huerta
Department of Oral Health Sciences, University of Washington, Seattle, Wash., USA; Department of Stomatology for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.
Jorge L
JL
Castillo
Department of Oral Health Sciences, University of Washington, Seattle, Wash., USA.
Peter
P
Milgrom
Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Wash., USA.
Marilyn C
MC
Roberts
Department of Stomatology for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.
Ailin R
AR
Cabrera-Matta
Department of Stomatology for Children and Adolescents, Universidad Peruana Cayetano Heredia, Lima, Peru.
Ana P
AP
Merino
D000284:Administration, Oral; D000818:Animals; D002648:Child; D002675:Child, Preschool; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control*; D003773:Dental Plaque / Q000188:drug therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008892:Milk; D009042:Motivation; D064406:Patient Harm; D011446:Prospective Studies; D013012:Sorbitol / Q000008:administration & dosage / Q000627:therapeutic use; D013295:Streptococcus mutans / Q000187:drug effects; D013549:Sweetening Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014993:Xylitol / Q000008:administration & dosage / Q000627:therapeutic use*
D013549:Sweetening Agents; D013012:Sorbitol; D014993:Xylitol