Can xylitol reduce the risk of caries in patients with orthodontic appliances?

Anyone who’s had a fixed orthodontic appliance knows how frustrating oral hygiene can become. Fixed appliances often make the perfect breeding ground for bacteria and plaque, which can accumulate under the appliance. In an attempt to abort development of plaque-causing bacteria, researchers recently examined if daily doses of xylitol could make a difference.

Recent caries research has discovered that many plaque bacteria are unable to ferment xylitol, a caloric sugar substitute used as a sweetener, into cariogenic end products. Due to this, xylitol inhibits bacterial growth. With this in mind, researchers hoped to discover if certain delivery methods of xylitol would be more effective in reducing plaque, and evaluate the long-term effects of xylitol on plaque.

The study examined 41 young adults and adolescents who were undergoing orthodontic treatment. The study participants all had a full fixed appliance and no active dental decay. Divided into three groups, the first group of patients was given xylitol chewing gum and was instructed to chew six pieces of the gym per day for three months, for no less than five minutes.

The second received xylitol chewable mints, of which they had to consume 12 per day for three months.  The third group acted as a control, and was not given any xylitol. All three groups were put on a six-month-long topical fluoride and cleaning schedule, and received oral hygiene instructions. Clinical examinations were performed at the start of the study, and at three, six and 12 months to evaluate caries, plaque and gingival scores and labial decalcification.

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After the last evaluation, researchers did not see a pronounced difference in plaque scores or other indicators between the groups taking xylitol and the control group. Ultimately, it was determined that xylitol does not have a bacterial benefit to patients with fixed orthodontic appliances. Conversely, the study did find that xylitol did not increase the risk of dental caries, and had no negative effects on orthodontic appliances.

Although xylitol did not make a difference in caries development rates, the study found that the oral hygiene instructions and the topical fluoride applications did reduce plaque and bacterial counts across the board, proving the importance of oral hygiene education and proper oral hygiene routines.

The Deanship of Scientific Research at King Abdulaziz University in Saudi Arabia funded the research. Entitled "Long-term clinical and bacterial effects of xylitol on patiente with fixed orthdontic appliances," the study will be published in the December issue of the journal Progress in Orthodontics.