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Caries as a Process and Transmissible Disease

Dr. Eva Soderling from the University of Turku, is best known for her work on mother child transmission. Her presentation was titled “Caries as a Process and Transmissible Disease,” and she started by briefly outlining the importance of diet in caries prevention. It was pointed out that the frequency of food intake is more important than the amount of sucrose in the diet. With Italy being the home of the pizza, it was fitting that she used it as an illustration. Most of the topping, she explained, was fine for the teeth. But the heated carbohydrate base was not much better for the teeth than the arch-criminal, sucrose.

Most common carbs and other sugars are readily transformed to plaque acids by pathogenic oral bacteria, with one notable exception: xylitol. Products sweetened exclusively with xylitol have considerably better dental health benefits than other sugar free products. And they can, and should be used, after meals and snacks to stop the acid production in plaque.

This is because of the unique effect that xylitol has on the oral bacteria, and not just because of salivary stimulation. The use of xylitol is the perfect adjunct to current caries prevention methods and not necessarily replacement.

She then began talking of the parent to child transmission.  Of the various factors that that affect the parent to child transmission, one of the most important is that the salivary mutans count in the parent needs to be greater than 100,000 per millimeter.  This might sound like a lot, but is actually quite common, even in people with beautiful teeth.

With reference to the mechanism of action, Dr. Soderling pointed out that all polyols reduce acid production in the plaque, whereas xylitol produces no acid at all. Furthermore, it decreased the actual amount of plaque. It substantially reduces, not only the Strep Mutans count, but also its transmission from mother to child, and has an extremely important re-mineralization effect.

Referring to one of her earlier studies, she demonstrated that xylitol inhibits plaque accumulation as well as its subsequent regrowth by up to 50%. The subjects found that the xylitol plaque, containing fewer adhesive polysaccharides, was far easier to remove and that their teeth felt much cleaner.

This reduction of plaque, combined with a decrease in its stickiness, is extremely important for the inhibition of caries and periodontal diseases. Dr. Soderling referred to various studies by Dr. Makinen, Alanon, and Milgram, showing that with caries control or prevention xylitol should be used at least 3 times a day after meals and snacks, and that the optimal daily dosage should ideally be between 5 to 6 grams.

Her own ground breaking mother child study was done to find out if a mother’s xylitol use could affect the vertical transmission of Strep Mutans. 195 mothers were divided into 2 groups: the xylitol group and the fluoride group.

The xylitol group used 100% xylitol gum at 6 to 8 grams of xylitol per day during the period where their children were 3 to 24 months old. The children themselves received no preventatives.

At the end of the period in the fluoride control group, slightly fewer than 50% of the children were colonized with strep mutans. By contrast in the xylitol group, the colonization level was just under 10%. The study didn’t end there however, the children continued to be monitored for caries occurrence and by the age of 5 the need for restorative treatment in the xylitol group was 71% lower than in the fluoride group. Most importantly, it was only the colonized 10% in the xylitol group that had any caries at all. The other 90% were caries free.

Dr. Soderling then referred to the Swedish mother-child study by Thorild where a similar process was followed. There were three groups: xylitol, fluoride, and chlorhexadine, all in chewing gum form. However the daily dose of xylitol was only 2 grams. Nevertheless, at both the 18 month and 4 year stages, both Mutans colonization and caries occurrence were lowest in the xylitol group by a significant margin.

In closing, Dr. Soderling identified which groups of people would benefit most from xylitol use. She stressed the importance of xylitol being the main ingredient and preferably the only sweetener. She also discussed some new approaches to presenting xylitol in combination with other functionally synergistic substances like fluoride, plant extracts, and probiotics. Final recommendations were then made with regard to effective dosages and frequency under different conditions.

Learn more about our line of Spry xylitol oral care products here.