title: Effectiveness of Xylitol in Reducing Dental Caries in Children.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness of xylitol in reducing dental caries in children compared to no treatment, a placebo, or preventive strategies.
  
  
  METHODS
  MEDLINE via PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from January 1, 1995 through Sept. 26, 2016 for randomized and controlled trials on children consuming xylitol for at least 12 months. The primary endpoint was caries reduction measured by mean decayed, missing, and filled primary and permanent surfaces/ teeth (dmfs/t, DMFS/T, respectively). The I2 and chi-square test for heterogeneity were used to detect trial heterogeneity. Meta-analyses were performed and quality was evaluated using GRADE profiler software.
  
  
  RESULTS
  Analysis of five randomized controlled trials (RCTs) showed that xylitol had a small effect on reducing dental caries (standardized mean difference [SMD] equals -0.24; 95 percent confidence interval [CI] equals -0.48 to 0.01; P = 0.06) with a very low quality of evidence and considerable heterogeneity. Studies with higher xylitol doses (greater than four grams per day) demonstrated a medium caries reduction (SMD equals -0.54; 95 percent CI equals -1.14 to 0.05; P = 0.07), with these studies also having considerable heterogeneity and very low quality of evidence.
  
  
  CONCLUSIONS
  The present systematic review examining the effectiveness of xylitol on caries incidence in children showed a small effect size in randomized controlled trials and a very low quality of evidence that makes preventive action of xylitol uncertain.
authors.affiliation: Fellow, in the Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md., USA;, Email: Marghalani.a@gmail.com.
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Marghalani
authors.affiliation: Chief of pediatric dentistry at Malama I Ka Ola Health Center, Wailuku, Hawaii and clinical faculty for NYU Lutheran Pediatric Dentistry program-Hawaii site, Wailuku, Hawaii, USA.
authors.forename: Emilie
authors.initials: E
authors.lastname: Guinto
authors.affiliation: Pediatric dentist in private practice, Main Street Children's Dentistry and Orthodontics, Glen Burnie, Md., USA.
authors.forename: Minhthu
authors.initials: M
authors.lastname: Phan
authors.affiliation: Associate professor, in the Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md., USA.
authors.forename: Vineet
authors.initials: V
authors.lastname: Dhar
authors.affiliation: Professor, in the Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md., USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Tinanoff
mesh_terms: D000293:Adolescent; D002327:Cariostatic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004245:DMF Index; D019140:Dental Care for Children; D003731:Dental Caries / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D016032:Randomized Controlled Trials as Topic; D014993:Xylitol / Q000627:therapeutic use*
chemical_list: D002327:Cariostatic Agents; D014993:Xylitol