Tooth decay can be halted and even reversed by a diet that eliminates sugar and uses xylitol as the primary sweetener. Besides sugar replacement, the food choices in the experimental diet were essentially identical. The obvious problem with this approach is that a conventional diet provides an enormous volume of added sugar. The scarcity and expense of xylitol make widespread sugar replacement impractical.

This problem of expense was recognized early on by the researchers. The oral health success of the “Total Xylitol Diet” was obvious and conclusive, but could only be continued on a limited small scale.

It was time to try a new approach.

Perhaps smaller amounts of xylitol could counteract some of the damage of a high-sugar diet. Volunteers consuming a normal diet were given a little bit of xylitol in the form of chewing gum. Keep in mind that a “normal diet” is very rich in sugar, since sugar is so common in modern processed foods.

The results were surprising and exciting. Just a tiny amount of xylitol – about one teaspoon per day in the chewing gum – provided essentially the same dental protection as a “Total Xylitol Diet.”

This was the real breakthrough toward utilizing xylitol in widespread dental prevention efforts. Small, economical amounts of xylitol can protect teeth from the damaging effects of sugar in a “normal” diet.

-- by Dr. John Peldyak

Xylitol and other natural sweeteners were tested extensively in Finland as potential replacements for sugar during the early 1970’s. A series of over 20 research reports (edited by Professors Arje Scheinin and Kauko Makinen) was published together in Acta Odontologica Scandinavica, Supplement 70, in 1975. These investigations became known collectively as the “Turku Sugar Studies.”

Sweeteners were tested for their effects on dental and general health. The main trials involved the long-term substitution of either fructose or xylitol for sucrose (ordinary table sugar). This involved a huge cooperative effort between scientists and food producers. Separate fructose and xylitol versions of common food items were provided for the volunteers.

These trials (including blood and urine tests) established the safety of relatively large amounts of xylitol (often 70 grams per day or more) consumed regularly over a period of years. The xylitol group reported that xylitol-sweetened foods were comparable to the familiar sugar flavors.

Read more: Turku Sugar Studies

More Than Tooth Decay: Gingivitis and Periodontitis

Gingivitis is an inflammation of the tissues around the teeth, which may be noticed with easily bleeding gums. Periodontitis is progressive destruction of tooth-supporting tissues characterized by deeper pockets forming along with loss of supporting bone. Periodontal disease can lead to tooth loss and has even been associated with systemic problems such as heart disease.

Gingival recession can expose the root surfaces (getting “long in the tooth”). These areas are susceptible to cervical or “root surface” caries which form around the neck of the tooth. These root caries can develop rapidly and be very difficult to restore. In a study in a Veterans’ Affairs Medical Center in Dayton, Ohio, xylitol prevented root surface caries much more effectively than sorbitol, another substitute for sugar. The xylitol group also had improved gingival health.

Most of the xylitol research has focused concentrated on tooth decay. From early on, it was known that xylitol is not harmful to the soft tissues and to the supporting structures around the teeth. Over the years evidence has accumulated that suggests xylitol provides some additional benefit to promote gingival and periodontal health.

Read more: Does Xylitol influence gingivitis and periodontitis?

Abstract: Click here for more information

Effect of polyol gums on dental plaque in orthodontic patients.

Sixty 11- to 15-year-old children wearing fixed orthodontic appliances were given chewing gums containing polyol for daily use after meals and snacks, to study whether the chewing of gums that contained slowly fermentable polyols (xylitol and sorbitol) affects the amount of dental plaque and the number of mutans streptococci present in plaque and saliva. The 60 subjects were randomly divided into four groups, each of which was provided with a supply of 1.35 gm pellet-shaped gums for a period of 1 month, as follows: (1) xylitol; (2) sorbitol; (3) xylitol-sorbitol mixture I (3:2); and (4) xylitol-sorbitol mixture II (4:1). In each group, two pellets with a total initial gum mass of 2.7 gm (maximum polyol dose per day: 10.5 gm), were used six times a day.

The fresh and dry weight of dental plaque, collected at baseline and 28 days later from incisors, canines, and premolars from the area between gingival margin and the bracket, reduced in all groups, but most significantly (by 43% to 47%) in children receiving xylitol gum. The plaque and saliva levels of mutans streptococci did not change in the sorbitol group, but was significantly (in most cases) reduced by 13% to 33% in groups that received gum containing xylitol. Provided that the quantity of dental plaque and the plaque and salivary levels of mutans streptococci can be regarded as risk factors in dental caries, these results suggest that regular use of polyol gum--and especially gum that contains xylitol as the predominant sweetener--can reduce the caries risk in young patients wearing fixed orthodontic appliances.