Thirty-nine-month xylitol chewing-gum programme in initially 8-year-old school children: a feasibility study focusing on mutans streptococci and lactobacilli.

AIM: To investigate the use of xylitol-containing chewing-gums in public elementary schools as a means to affect the growth of salivary and plaque mutans streptococci and salivary lactobacilli. DESIGN: Over a period of 24 months, 750 8- to 9-year-old children chewed xylitol (X group; n = 255) or xylitol-sorbitol (XS group; n = 264) gum on school days (454 days over 2 years), or chewed no gum at all (C group; n = 231). Consumption of xylitol in the X and the XS groups was 6.6 and 5.4g per day, respectively. Use of gum took place at school in four daily episodes of which three were supervised by teachers. Following the 24-month chewing-gum period, the subjects were re-examined after 15 months (total follow-up period: 39 months) at which time an extraneous comparison group (ExC; n = 117) was also examined. The numbers of subjects examined after 39 months were: X, 239; XS, 248; C3 217. METHODS: Salivary and plaque levels of mutans streptococci and the salivary levels of aerobically cultured aciduric bacteria (mostly representing lactobacilli) were determined using the Orion Diagnostica Dentocult SM and LB test kits, respectively. RESULTS: There were statistically significant differences after 24 and 39 months between the two xylitol chewing-gum groups and the C group with regard to salivary and plaque mutans streptococci and salivary lactobacilli: the use of xylitol-containing chewing-gums significantly reduced these bacterial scores. The reductions were statistically more significant in the X group than in the XS group. The bacterial scores of groups C and ExC were similar. CONCLUSIONS: Long-term use of xylitol-containing chewing-gum can reduce the growth of mutans streptococci in saliva and dental plaque, and lactobacilli-type bacteria in saliva, even if xylitol is used only on school days. The results also suggest that xylitol gum use can have a long-term, delayed growth-retarding effect on these micro-organisms, since reduced bacterial growth was still observed 15 months following the termination of xylitol use. The results indicate a close biochemical relationship between xylitol and mutans streptococci, and suggest that a similar relationship may exist regarding aerobically cultured aciduric bacteria present in saliva.

Six-month polyol chewing-gum programme in kindergarten-age children: a feasibility study focusing on mutans streptococci and dental plaque.

AIM: To investigate the use of polyol-containing chewing gums in a day-care centre (kindergarten) setting as a means to affect the growth of mutans streptococci and dental plaque. DESIGN: Over a period of six months, 123 five-year-old children chewed xylitol (X group), sorbitol (G group), or did not chew gum (C group). Consumption of xylitol, and sorbitol was 4.5 to 5.0 g per day and subjects consumed in five supervised daily chewing episodes four at the day-care centres and one at home. METHODS: Interproximal dental plaque was sampled at baseline and after six months for a laboratory study of mutans streptococci counts. The Quigley & Hein plaque index procedure was used. Interviews and questionnaires elucidated the acceptability of the programme. RESULTS: Parents and kindergarten personnel regarded the programme as an important, additional procedure to promote better oral health. The children regarded the use of chewing gum as a pleasurable experience. Compared with groups G and C, there was a statistically significant reduction of mutans streptococci in the interproximal plaque in the X group. The Quigley & Hein plaque index scores tended to decrease in the X group, while no such trend was observed in the G group. CONCLUSIONS: Habitual use of relatively small daily quantities of polyol-containing chewing gum by young children may be regarded as an important additional caries-preventive procedure in a combined day-care centre and home setting. Especially xylitol-containing chewing gum may significantly reduce the growth of mutans streptococci and dental plaque which may be associated with dental caries.

The effect of polyol-combinant saliva stimulants on S. mutans levels in plaque and saliva of patients with mental retardation.

The effect of chewable saliva-stimulants on Streptococcus mutans levels in dental plaque and paraffin-stimulated whole saliva among participants who were mentally disabled was investigated. Over 64-days, 98 participants chewed one of four saliva-stimulating tablets five times/day. The tablets contained one of the following: xylitol (X) or sorbitol (S), or 1:1 mixtures of xylitol and erythritol (XE) or sorbitol and erythritol (SE). Consumption of xylitol and sorbitol in Groups X and S was 5.4 grams/day/ subject, and of each polyol in Groups XE and SE, consumption was 2.7 g/day/subject. Interproximal dental plaque and stimulated whole saliva were sampled at baseline, at Day 36, and Day 64. There was a statistically significant reduction of S. mutans in plaque and saliva counts in Groups X and XE. The percentage of S. mutans in total streptococci increased significantly in dental plaque in Group S but decreased in the other groups. The results suggest that xylitol-containing saliva stimulants may be more effective than sorbitol-containing products in controlling some caries-associated parameters in people who are mentally disabled. Also a relationship may exist between the pentitol-type xylitol and S. mutans, and erythritol may exert a specific biochemical effect on this organism, although further studies are needed.