Can xylitol help prevent cavities?

Xylitol dental benefits on oral health has been recognized by The American Academy of Pediatric Dentists (AAPD) to include a significant reduction in tooth decay, as well as contributing to the reversal of cavity formation. The benefits of xylitol on oral health are due to the inability to break down Xylitol, a natural sweetener derived from plants, into simple sugars that feed bacteria. Research shows that xylitol has many health benefits, including dramatically reducing tooth decay, however, the amount of xylitol contained in many foods is inadequate to produce a positive impact on dental health. Xylitol use has been found to significantly reduce tooth decay in both high and low risk groups concerning cavity occurrence. The bacteria are unable to feed on xylitol and are essentially starved and cannot grow. Studies show that Xylitol dental benefits include effectively decrease acid-producing bacteria by up to 90%. Because xylitol does not break down as sugar does, the pH level in the saliva is raised and acid does not form. Xylitol can stimulate saliva production which is beneficial in repairing damaged enamel and remineralizing teeth. Keeping xylitol in contact with the teeth as frequently as possible will help obtain the optimum dental benefits it can provide. Consuming xylitol only occasionally has not shown to provide significant oral health benefits.

Some research suggests that xylitol toothpaste may benefit your teeth, such as preventing cavities. Xylitol may be an effective defense against the bacteria Streptococcus mutans (S. mutans). Xylitol is an unfermentable sugar alcohol that the bacteria can’t process. That means no lactic acid is produced to damage the enamel. Xylitol may also help prevent dental plaque, which may lead to cavities. A 2023 study found that using 25% xylitol toothpaste twice daily for 24 months significantly reduced levels of S. mutans in the mouth. The researchers concluded that xylitol toothpaste may be an effective home remedy for preventing cavities. The AAPD did note that consuming 5 to 10 grams (g) of xylitol three times daily may help reduce cavities by up to 80%. Some studies have found that xylitol toothpaste may be an effective strategy for reducing cavities in kids. Xylitol helps protect the teeth from damage, and fluoride helps repair any damage that the teeth might sustain. When children used xylitol-fluoride toothpaste for 2.5 to 3 years, their cavities were reduced by an additional 13%.

Xylitol is a naturally occurring sweetener, whose effect on dental caries is linked to increased saliva production, especially when used in a chewing gum. It also likely decreases counts of bacteria associated with caries. This systematic review concluded that incorporating xylitol chewing gum daily has a caries reducing effect, based on the statistically significant results of the 10 included studies which investigated this product, clinically significant preventative fractions in 9 included studies and other systematic reviews that have been conducted in this area. The authors of this review suggest adding xylitol chewing gum to the daily diet of children at high or moderate caries level at baseline has a caries reducing effect. The authors highlight that xylitol is one component in caries prevention, and should be used in conjunction with dietary changes and fluoride toothpaste in those at risk of dental caries. This topic area is important as it can identify products which may help prevent tooth decay, and provide guidance to dentists and allied professionals on the effectiveness of xylitol-containing products for their patients. However, only 5 of these studies were RCTs and there was variation in the proportion of xylitol in the delivered intervention, what the control group received, participant ages, and follow up periods, amongst other factors. There was not a consistent caries reducing effect for the studies investigating the use of xylitol-containing sweets, with 5 RCTs included. This review focused on the paediatric population, those 18 years old and younger.

Xylitol is a popular sugar substitute in sweets and it is already known to cause less damage to teeth than sugar. It has also been suggested that the addition of xylitol to products may help to prevent tooth decay by stopping the growth of decay-producing bacteria. However, according to new evidence published in the Cochrane Library there is little high quality evidence that it is beneficial in the fight against tooth decay, which affects up to 90% of children and most adults worldwide. Based on information from 4,216 school children who took part in two Costa Rican studies, they found low quality evidence that levels of tooth decay were 13% lower in those who used a fluoride toothpaste containing xylitol for three years, compared to those who used a fluoride-only toothpaste. For other xylitol-containing products, such as xylitol syrup, lozenges and tablets, there was little or no evidence of any benefit. The evidence we identified did not allow us to make any robust conclusions about the effects of xylitol, and we were unable to prove any benefit in the natural sweetener for preventing tooth decay. The limited research on xylitol-containing toothpastes in children may only be relevant to the population studied. We were unable to determine whether they were beneficial.