Does Xylitol influence gingivitis and periodontitis?

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.

Systematic use of xylitol helps to reduce the accumulation of dental plaque. Heavier plaque deposits favor the development of gingival problems, in part by shielding the deeper plaque layers from natural cleansing actions. More dangerous “anaerobic” germs are allowed to thrive.

With long-term xylitol consumption, the bacterial populations tend to shift into less damaging “communities”. The 5-carbon structure of xylitol cannot be utilized by oral bacteria to form the sticky polymer meshwork that holds the bacterial biofilm together. Consequently, the “xylitol plaque” tends to be less sticky, less acidic, less inflammatory, and less harmful than ordinary “sucrose (sugar) plaque.”

Xylitol is not a food source for any of the pathogenic bacteria associated with periodontal disease. More recently, xylitol has been shown to inhibit the growth and harmful effects of Porphyromonas gingivalis, an important periodontal pathogen.

Professional cleanings can drastically reduce the total number of adherent bacteria. It is possible to inadvertently shift the regrowing bacterial community to a more cavity-causing (cariogenic) population. Xylitol has been shown to block re-emergence of cariogenic bacteria during periodontal therapy, such as after full-mouth disinfection procedures.

A lack of saliva (xerostomia) can be a contributing factor in gingivitis, periodontitis, dental caries, and halitosis. Xylitol is an excellent saliva stimulant. Xylitol-stimulated saliva also contains more natural protective factors and is less acidic than unstimulated saliva.

Xylitol indirectly supports other protective factors. In animal models, xylitol helps to prevent osteoporosis. Loss of tooth-supporting jawbone is one early sign of osteoporosis. Xylitol also helps to preserve the integrity of collagen molecules. Collagen is an important structural protein that keeps the gingival tissues strong and healthy. Degeneration of collagen is associated with wrinkles and aging.

A recent trial in Brazil showed that xylitol can provide some adjunctive support in periodontal therapy. Additionally, it indicated that xylitol may be of some benefit in delaying or inhibiting colonization by harmful periodontal bacteria in infants.

All-in-all, there is already enough evidence to recommend xylitol as a beneficial adjunct for the prevention and treatment of gingivitis and periodontitis. Xylitol is compatible with, and complementary to, all current periodontal therapies.

-- by Dr. John Peldyak