Post on 12-Nov-2014
description
“Sweet Success with Xylitol”
Thank You CSPD! San Francisco April 9th 2011
DDS, CNC, ND
My Contact InformationMy Contact Information
lbybee@kiddsdental.com 208-478-5437208-478-5437
Sugar
Sucrose sugar is the Sucrose sugar is the standard for comparisonstandard for comparison
““sugar substitutes”sugar substitutes”
Attempt to duplicate the taste Attempt to duplicate the taste
And some functional And some functional propertiesproperties
Sucrose “Sugar” on food ingredients labels,
ordinary table sugar, cane sugar, beet sugar disaccharide 12-carbon
Glucose (D-glucose, dextrose, corn sugar, blood sugar, monosaccharide, 6-carbon)
Fructose (fruit sugar) monosaccharide, 6-carbon)
Maltose (malt sugar) disaccharide, 12-carbon)
Glucose (D-glucose, dextrose, corn sugar, blood sugar) monosaccharide, 6-carbon)
Maltodextrin
Oligosaccharide 3 – 19 glucose units
StarchStarch
Polymer, Polysaccharide, Amylose200 – 1000 glucose units
SugarSugar
Glucose (dextrose)Glucose (dextrose)
Fructose (fruit sugar)Fructose (fruit sugar)
GalactoseGalactose
Xylose (wood sugar)Xylose (wood sugar)
Maltose (malt sugar)Maltose (malt sugar)
Sucrose (table sugar)Sucrose (table sugar)
Lactose (milk sugar)Lactose (milk sugar)
Starch HydrolysateStarch Hydrolysate
PolyolPolyol
SorbitolSorbitol
MannitolMannitol
GalactitolGalactitol
XylitolXylitol
Maltitol (glu-sorbitol)Maltitol (glu-sorbitol)
Isomalt (glu-mann/sor)Isomalt (glu-mann/sor)
Lactitol (glu-galactose)Lactitol (glu-galactose)
HSH (hydrogenated SH)HSH (hydrogenated SH)
Sugar alcohols are reduction products of sugars
MonoSaccharides
Di or Poly Saccs
SweetenersSweeteners
• Bulk -- Functional PropertiesBulk -- Functional Properties• Sugars (mono- and di-saccharides)Sugars (mono- and di-saccharides)• Polyols (Sugar alcohols)Polyols (Sugar alcohols)
• Intense -- Intense -- High PotencyHigh Potency• ArtificialArtificial• NaturalNatural
SweetenersSweeteners
Intense (High potency super sweeteners)Intense (High potency super sweeteners)•Aspartame (200x)Aspartame (200x)•Sucralose (600x)Sucralose (600x)•Saccharine (400x)Saccharine (400x)•Acesulfame Potassium (Ace K) (200x)Acesulfame Potassium (Ace K) (200x)•Licorice (glycyrrhizin) (30-50x)Licorice (glycyrrhizin) (30-50x)•Stevia (steviosides, reboudisides)(300x)Stevia (steviosides, reboudisides)(300x)•Neotame (up to 13,000 x)Neotame (up to 13,000 x)
Sugar “-ose” by Other NamesSugar “-ose” by Other Names
““ose” ending (major dietary sugars are ose” ending (major dietary sugars are sucrose, glucose, fructose, lactose)sucrose, glucose, fructose, lactose)
Syrup (sugars dissolved in water)Syrup (sugars dissolved in water) Corn syrup Corn syrup HFCS High Fructose Corn SyrupHFCS High Fructose Corn Syrup Starch (processed and cooked)Starch (processed and cooked) MaltodextrinMaltodextrin
Corn SyrupWater, glucose
High Fructose Corn SyrupGlucose converted to fructose by enzymes
Water, glucose, fructose (42-95%)
FructoseFructose
Fast sugarFast sugar Most water solubleMost water soluble Liver metabolic bottleneckLiver metabolic bottleneck Maillard reaction rapid non-Maillard reaction rapid non-
enzymatic browningenzymatic browning
GlycationGlycation
Non-enzymatic glycosylationNon-enzymatic glycosylation
Maillard Reaction: Modification of Maillard Reaction: Modification of protein =browningprotein =browning
Leads to formation of (AGE’s Leads to formation of (AGE’s Advanced Glycation End-products)Advanced Glycation End-products)
AGE’sAGE’s
ToastToast
Glycated hemoglobin (diabetes) Glycated hemoglobin (diabetes) • Hba1c testHba1c test
Collagen -- wrinklesCollagen -- wrinkles
Why is sucrose so Why is sucrose so harmful?harmful?
EnergyEnergy
AcidAcid
Food storageFood storage
Sugar Increases the BugsSugar Increases the Bugs
Watch for “Hidden Sugar”Watch for “Hidden Sugar”
Cough Drops
Chewable vitamins
Breath mints
Fruit juices
Dried fruits
Sports Drinks
Syrup medicines
But Don’t Forget the ObviousBut Don’t Forget the Obvious
Too Much SugarToo Much Sugar
Way to Much SugarWay to Much Sugar
GermsGerms SugarSugar
AcidAcid PlaquePlaque
Way Way Way to Much SugarWay Way Way to Much Sugar
…. But
On TeethOn TeethIt is all just SugarIt is all just Sugar
American Heart American Heart AssociationAssociation
Recommends less than 100 calories from Recommends less than 100 calories from added sugars (6.2 sugar cubes) per day for added sugars (6.2 sugar cubes) per day for
adult women adult women
From sugar cane From sugar cane or sugar beetsor sugar beets
It’s all just SugarIt’s all just Sugar
Conflicts of InterestConflicts of Interest
Spry Dental – Consultant 2001-2004Spry Dental – Consultant 2001-2004 My Xylitol My Xylitol
• www.myxylitol.com Academy of Dental ResourcesAcademy of Dental Resources
• www.adrdental.com Designs for HealthDesigns for Health
• www.designsforhealth.com
Professional Education Professional Education Dental Practice 1978-1995 General 1997-Dental Practice 1978-1995 General 1997-
present Children onlypresent Children only EducationEducation
• General Dentist – Practice limited to KidsGeneral Dentist – Practice limited to Kids• CCN – Certified Nutritional ConsultantCCN – Certified Nutritional Consultant• NART – Nutrition Autonomic Response TestingNART – Nutrition Autonomic Response Testing• ND – Naturopathic DoctorND – Naturopathic Doctor• ACIMD American College of Integrative ACIMD American College of Integrative
Medicine and DentistryMedicine and Dentistry PublicationsPublications
• Practical Application of XylitolPractical Application of Xylitol• Finnish Dental Journal Supplement 1,2006Finnish Dental Journal Supplement 1,2006
My Personal Xylitol HistoryMy Personal Xylitol History
Fall of 1999 Dr. Russ MisnerFall of 1999 Dr. Russ Misner KlearChoice Chewing GumKlearChoice Chewing Gum 2001-2003 Xlear Dental Consultants2001-2003 Xlear Dental Consultants 2002 Developed ToothGel2002 Developed ToothGel 2004 Created ADR Xylitol CE Course2004 Created ADR Xylitol CE Course 2005-2007 Patent pending gels and TP’s2005-2007 Patent pending gels and TP’s 2004-2009 Office Implementation2004-2009 Office Implementation 2011 Orthodontic Module Release2011 Orthodontic Module Release
Our Xylitol Journey Begins 1999Our Xylitol Journey Begins 1999
Dr. Larry Bybee
Dr. Russ Misner
KlearChoice KlearChoice
1999-20001999-2000 They packaged the gum with our They packaged the gum with our
labellabel We spoke with individual dental We spoke with individual dental
officesoffices Pretty soon we were moving 500-600 Pretty soon we were moving 500-600
tubs a monthtubs a month
Xylitol ConsultantsXylitol Consultants
2001 2001 Teamed with XlearTeamed with Xlear 15-20 Dental show per year15-20 Dental show per year Tons of fun but a lot of travelTons of fun but a lot of travel
Toothgel 2002Toothgel 2002
Formulated in Dr. Misner’s KitchenFormulated in Dr. Misner’s Kitchen
=
+
Calcium Glycerylphosphate
Xylitol +
+
Today's PackagingToday's Packaging
ADRADR
CE Course on XylitolCE Course on Xylitol DVD’sDVD’s ManualManual Forms CDForms CD BrochuresBrochures
Orthodontic Module ReleaseOrthodontic Module Releaseall 2011 all 2011
(I Hope (I Hope ))
Sweet Success with Sweet Success with XylitolXylitol
Changing Ideas and ConceptsChanging Ideas and Concepts
In a learning environment you don’t need to agree with anything that is said….
We learn from each other by listening and doing, NOT from argument.
ReframingReframing
From “manage the damage or drill From “manage the damage or drill and fill” to health promotion and and fill” to health promotion and
self care decay preventionself care decay prevention
From helpless victim to proactive From helpless victim to proactive self-careself-care
We sometimes find ourselvesWe sometimes find ourselves changing our mind changing our mind without any resistance or heavy emotion, but if we without any resistance or heavy emotion, but if we are told we are wrong we resent the imputation and are told we are wrong we resent the imputation and harden our hearts. We are incredibly heedless in harden our hearts. We are incredibly heedless in the formation of our beliefs but find ourselves filled the formation of our beliefs but find ourselves filled with an illicit passion for them if someone should with an illicit passion for them if someone should rob us of their companionship. It is obviously not rob us of their companionship. It is obviously not the ideas themselves that are dear to us but our the ideas themselves that are dear to us but our self esteem that is threatened.self esteem that is threatened.
We like to continue to believe what we have We like to continue to believe what we have been accustomed to accept as true and the been accustomed to accept as true and the resentment aroused when doubt is cast resentment aroused when doubt is cast upon any of our assumptions leads to seek upon any of our assumptions leads to seek out every manner of excuse to continue out every manner of excuse to continue clinging to them. The result is that much of clinging to them. The result is that much of our so called reasoning consists in finding our so called reasoning consists in finding arguments to go on believing as we already arguments to go on believing as we already do.do.
James Harvey RobinsonJames Harvey Robinson
DEMODEMO
Why Xylitol?Why Xylitol?
Tastes goodTastes good• Delightful sugary tasteDelightful sugary taste• Cooling effect Cooling effect
It worksIt works• Helps prevent dental cariesHelps prevent dental caries• and upper respiratory infectionsand upper respiratory infections
What is Xylitol?What is Xylitol?
Carbohydrate with uncommon structure
Five carbon atoms
Found in small amounts in a wide variety of fruits and vegetables
Metabolic intermediate
Used as a substitute for sugar
xylitol
Xylitol (polyol) 5-carbon
PropertiesProperties
Relative SweetnessRelative Sweetness
010
20
30
4050
60
70
8090
100
Xylitol Sucrose Maltitol Sorbitol Isomalt Lactitol
Other Xylitol PropertiesOther Xylitol Properties
Hydrophilic – Draws MoistureHydrophilic – Draws Moisture Increases Salivary FlowIncreases Salivary Flow Decreases acid strength in the MouthDecreases acid strength in the Mouth Low Glycemic Index (Diabetic Safe)Low Glycemic Index (Diabetic Safe) Yeasts and Fungus Can’t Grow in Yeasts and Fungus Can’t Grow in
XylitolXylitol Cooling and RefreshingCooling and Refreshing
Xylitol Is HydrophilicXylitol Is Hydrophilic
Cooling and RefreshingCooling and Refreshing
Xylitol IsXylitol Is
Non- Cariogenic: Non- Cariogenic: Does not cause cavitiesDoes not cause cavities
Cariostatic: Cariostatic: Arrests or Halts the decay ProcessArrests or Halts the decay Process
Anti-Cariogenic: Anti-Cariogenic: Can reverse the caries Can reverse the caries Process and Repair Incipient DecayProcess and Repair Incipient Decay
Things To RememberThings To Remember
Xylitol Tastes Good, Like SugarXylitol Tastes Good, Like Sugar Lower Calorie = Less WeightLower Calorie = Less Weight Lower Glycemic = Weight LossLower Glycemic = Weight Loss Can Replace All or Part of Your SugarCan Replace All or Part of Your Sugar Good For TeethGood For Teeth Prevents Tooth DecayPrevents Tooth Decay Prevents Ear InfectionsPrevents Ear Infections Too Much = Laxative EffectToo Much = Laxative Effect
I only Ate the Parts with XylitolI only Ate the Parts with Xylitol
YUMMY
Xylitol can help keep them Xylitol can help keep them smiling!smiling!
WhereWhere
Finland – From WoodFinland – From Wood China – From Corn StocksChina – From Corn Stocks USA – New Source Discovered Very USA – New Source Discovered Very
Recently in Lead North DakotaRecently in Lead North Dakota
Xylitol HarvestXylitol Harvest
Wow! Xylitol is Everywhere Wow! Xylitol is Everywhere
Xylitol WonderlandXylitol Wonderland
Plant Mangers HomePlant Mangers Home
Xylitol Makes You SmileXylitol Makes You Smile
No Matter How you Stack it Xylitol No Matter How you Stack it Xylitol is Good for Teethis Good for Teeth
Things To RememberThings To Remember
Xylitol Tastes Good, Like SugarXylitol Tastes Good, Like Sugar Lower Calorie = Less WeightLower Calorie = Less Weight Lower Glycemic = Weight LossLower Glycemic = Weight Loss Can Replace All or Part of Your SugarCan Replace All or Part of Your Sugar Good For TeethGood For Teeth Prevents Tooth DecayPrevents Tooth Decay Prevents Ear InfectionsPrevents Ear Infections Too Much = Laxative EffectToo Much = Laxative Effect
Dental Caries ProcessDental Caries Process
General Plaque HypothesisGeneral Plaque Hypothesis
Specific Plaque HypothesisSpecific Plaque Hypothesis
Ecological Plaque HypothesisEcological Plaque Hypothesis
Ecological Plaque HypothesisEcological Plaque Hypothesis Dental plaque is a biofilm: attach, Dental plaque is a biofilm: attach,
multiply, organize, adaptmultiply, organize, adapt
Organized, diverse multi-specie Organized, diverse multi-specie microbial community in a polymer microbial community in a polymer matrixmatrix
Biofilms less susceptible to Biofilms less susceptible to antimicrobialsantimicrobials
Ecological Plaque HypothesisEcological Plaque Hypothesis Bacterial competition – more than 600 Bacterial competition – more than 600
varieties varieties
Acidic conditions favor harmful bacterial Acidic conditions favor harmful bacterial communities (only about two dozen communities (only about two dozen harmful)harmful)
““Acid Germs” tolerate acid Acid Germs” tolerate acid
““Acid Germs” process sugars and generate Acid Germs” process sugars and generate acidacid
Repeated sugar/acid cycles demineralize Repeated sugar/acid cycles demineralize teeth and select for harmful “Acid Germs”teeth and select for harmful “Acid Germs”
PlaquePlaque
PlanktonicPlanktonic• Free FloatingFree Floating• Single CellSingle Cell• Easier to removeEasier to remove
Bio-filmBio-film• Organized Organized
CommunityCommunity• Hard to killHard to kill• 1000X Antibiotics1000X Antibiotics
Biofilm DevelopmentBiofilm Development
Why is sucrose so Why is sucrose so harmful?harmful?
EnergyEnergy
AcidAcid
Food storageFood storage
PolysaccharidePolysaccharide
IntracellularIntracellular• Food StorageFood Storage• Give them XylitolGive them Xylitol
Gorge themGorge them Wear them outWear them out
ExtracellularExtracellular• PlaquePlaque• Acid FormationAcid Formation• Give Them Xylitol Give Them Xylitol (Slicky instead of Sticky)(Slicky instead of Sticky)
Xylitol Keeps Unwanted Bugs OutXylitol Keeps Unwanted Bugs Out
Effects of xylitol on plaque…Effects of xylitol on plaque…
Xylitol is not easily Xylitol is not easily metabolized by metabolized by BacteriaBacteria
Non-CariogenicNon-Cariogenic CariostaticCariostatic Anti-CariogenicAnti-Cariogenic Reduces MS levelsReduces MS levels
Söderling et al., 1997
Effects of xylitol on plaque: "xylitol-plaque" is Effects of xylitol on plaque: "xylitol-plaque" is thinner than regular plaque, contains less thinner than regular plaque, contains less
adhesive polysaccharidesadhesive polysaccharides
courtesy of Eva Soderling
Tooth EruptionTooth Eruption
Xylitol Enhances Early Xylitol Enhances Early Mineralization.Mineralization.
Xylitol Inhibits Initial Colonization Xylitol Inhibits Initial Colonization by MS.by MS.
An Opportunity To Establish Long-Term Protection
How much? How often?How much? How often?
It depends.It depends. Daily range is between 4 grams Daily range is between 4 grams
(teaspoon) and 12 grams (teaspoon) and 12 grams (tablespoon).(tablespoon).
Use at least 3 times each day.Use at least 3 times each day. Strive for 5Strive for 5
How much? How often?How much? How often?
Frequency more important than Frequency more important than amountamount
Strive for five uses each dayStrive for five uses each day
After each meal and snackAfter each meal and snack
Toothpaste morning and nightToothpaste morning and night
Mouth & NoseMouth & Nose
Xylitol reduces Xylitol reduces bacterial adhesion in bacterial adhesion in the mouth (oral care the mouth (oral care products) & nose products) & nose (nasal spray)(nasal spray)
Xylitol enhances Xylitol enhances natural defensesnatural defenses
Where Health Begins
Dental Disease & HealthDental Disease & Health
Studies show a correlation between poor Studies show a correlation between poor dental health and dental health and cardiovascular diseasecardiovascular disease
Many systemic health problems averted Many systemic health problems averted with good dental healthwith good dental health
XylitolXylitol supports our natural defenses supports our natural defensesby promoting protective factorsby promoting protective factors
stimulates saliva
increases salivary pH
promotes remineralization
suppresses acid bacteria such as mutans strep (MS)
Glycemic IndexGlycemic IndexBlood Sugar Response
0
1
2
3
4
5
6
-30 0 30 60 90 120 150 180
Time (minutes)
<Blo
od G
luco
se>
Glucose
Xylitol
Xylitol supplies a steady flow of energy
Adapted from SS Natah et alAm J Clin Nutr (65) 1997
Xylitol’s Role in DiabetesXylitol’s Role in Diabetes
Good Taste-Refreshing and CoolingGood Taste-Refreshing and Cooling Displacing Equal Amounts of Fast Displacing Equal Amounts of Fast
SugarsSugars Low Glycemic IndexLow Glycemic Index Fewer Calories – Zero Net CarbsFewer Calories – Zero Net Carbs Lowers Serum Fatty Acid LevelsLowers Serum Fatty Acid Levels No Known Harmful Effect on CNS, No Known Harmful Effect on CNS,
HormonesHormones
SafetySafety
Don’t overdo a good thingDon’t overdo a good thing
This is Overdoing ItThis is Overdoing It
This is Too Much!!This is Too Much!!
Don’t Eat the Yellow XylitolDon’t Eat the Yellow Xylitol
Don’t make lemonadeDon’t make lemonade
Xylitol Is HydrophilicXylitol Is Hydrophilic
Who Can Use XylitolWho Can Use Xylitol
Orthodontic PatientsOrthodontic Patients Adults and ElderlyAdults and Elderly Persons with DisabilitiesPersons with Disabilities Persons with Dry MouthPersons with Dry Mouth AthletesAthletes
• Increases Fat UtilzationIncreases Fat Utilzation• Fights Muscle FatigueFights Muscle Fatigue
Everyone Except mans best friendEveryone Except mans best friend
Don’t give to dogsDon’t give to dogs
Hey Dogs Xylitol is NOT for YOU!Hey Dogs Xylitol is NOT for YOU!
Good DoggieGood Doggie
Thanks for Keeping Me SafeThanks for Keeping Me Safe
Make New Friends with XylitolMake New Friends with Xylitol
Protecting Man’s Best Friend From Protecting Man’s Best Friend From Xylitol is exhaustingXylitol is exhausting
Break Time
Xylitol ReviewXylitol Review
Susceptible ToothAttacked and DemineralizedBy AcidMade by Germs From the fermentation of sugars
Decay Process:
result is cavities – holes in the teeth
Mutans streptococci on enamel
De-Mineralization De-Mineralization (Caries v. Cavities)(Caries v. Cavities)
Caries? Cavities?Caries? Cavities?
Caries is the disease Caries is the disease process initiated process initiated predominately by predominately by the Strept Mutans the Strept Mutans bacteriabacteria
Cavities are the Cavities are the result of the caries result of the caries disease process disease process
Caries vs. CavitiesCaries vs. Cavities
CariesCaries• ProcessProcess• Presence of Presence of
BacteriaBacteria Mutans StreptMutans Strept LactobacillusLactobacillus
• Low Salivary FlowLow Salivary Flow• Low Salivary phLow Salivary ph• Gingival BleedingGingival Bleeding
CavitiesCavities• Physical Physical
manifestation of manifestation of the caries the caries processprocess
Cavities
Caries
Caries to Cavities ProgressionCaries to Cavities Progression 1- Healthy Tooth1- Healthy Tooth 2- White Spot Lesion The 2- White Spot Lesion The Caries Process Caries Process 3- Caries Process with 3- Caries Process with
CavitationCavitation 4- Filling with Caries 4- Filling with Caries Process and CavitationProcess and Cavitation 5- Continued5- Continued Demineralization andDemineralization and Undermined EnamelUndermined Enamel 6- Fractured Tooth6- Fractured Tooth
1996-2002 production by Douglas Bratthall
Damaging vs. ProtectiveDamaging vs. Protective Sugar and Sugar and
Fermentable Fermentable CarbohydrateCarbohydrate
AcidAcid XerostomiaXerostomia Virulent “Acid” Virulent “Acid”
BacteriaBacteria
XylitolXylitol Neutral, alkaline pHNeutral, alkaline pH SalivaSaliva Calcium, FluorideCalcium, Fluoride Non-Acidogenic Non-Acidogenic
Bacteria Bacteria
Damaging vs. Protective FactorsDamaging vs. Protective Factors
DemineralizationRemineralization
Tooth decay progresses Tooth decay progresses when damaging factors when damaging factors prevail over protective prevail over protective
factorsfactors
More More demineralization demineralization
than remineralizationthan remineralization
Risk FactorsRisk Factors
Factors of Dental DiseaseFactors of Dental Disease A pH of 6.3 to 6.7 is a cautionary environmentA pH of 6.3 to 6.7 is a cautionary environment A pH of ≤6.2 is a red light (Non-stimulated A pH of ≤6.2 is a red light (Non-stimulated
salivary flow).salivary flow). GBI > 3-4 Primary or Permanent GBI > 3-4 Primary or Permanent OHI of Poor or FairOHI of Poor or Fair High def – dMf – DMFHigh def – dMf – DMF Negative Periodontal AssessmentNegative Periodontal Assessment
• Localized or Generalized Gingivitis or worseLocalized or Generalized Gingivitis or worse Salivary Flow rate of <0.7 ml/minSalivary Flow rate of <0.7 ml/min History of Cavities or Periodontal problemsHistory of Cavities or Periodontal problems Active Caries Process Noted (Staining) Active Caries Process Noted (Staining)
(Diagnodent)(Diagnodent)
High Risk Factors of Decay for KidsHigh Risk Factors of Decay for Kids Systemic DiseasesSystemic Diseases Compromised Immune Compromised Immune
SystemSystem Mouth BreathingMouth Breathing
• Use of Xlear Nasal Wash to Use of Xlear Nasal Wash to maintain patent airwaymaintain patent airway
Gums Bleed when BrushingGums Bleed when Brushing Sweetened MedicinesSweetened Medicines Family members with Family members with
CavitiesCavities Insufficient Fluoride in non Insufficient Fluoride in non
fluoridated areasfluoridated areas Irregular Dental VisitsIrregular Dental Visits
Deep unsealed teeth – Deep unsealed teeth – Primary and PermanentPrimary and Permanent
Bottles and Sippy Cups Bottles and Sippy Cups filled with milk and filled with milk and sugary liquidssugary liquids
High intake of High intake of fermentable high density fermentable high density Carbs between mealsCarbs between meals
Raisins – Cereals - Sugar Raisins – Cereals - Sugar treats between meals treats between meals
History of ECCHistory of ECC History of FillingsHistory of Fillings
Eruption Period – Early Mixed Eruption Period – Early Mixed DentitionDentition
Eruption Period – Late Mixed Eruption Period – Late Mixed DentitionDentition
High Risk Factors of Decay for AdultsHigh Risk Factors of Decay for Adults Systemic DiseasesSystemic Diseases Compromised Immune Compromised Immune
SystemSystem Mouth BreathingMouth Breathing Gums Bleed when Gums Bleed when
Brushing Orthodontic Brushing Orthodontic AppliancesAppliances
White spot lesions or White spot lesions or incipient lesions on X-incipient lesions on X-RaysRays
Sporadic Dental VisitsSporadic Dental Visits Failing RestorationsFailing Restorations High Family Caries High Family Caries
RateRate
DiseaseDisease Poor DexterityPoor Dexterity Inadequate Fluoride UseInadequate Fluoride Use Frequent Intake of Frequent Intake of
Fermentable High Density Fermentable High Density CarbohydratesCarbohydrates
More than two cavities in the More than two cavities in the last year or active caries.last year or active caries.
Use of Chewing TobaccoUse of Chewing Tobacco Xerostomia by itself or with Xerostomia by itself or with
Exposed Root SurfacesExposed Root Surfaces Radiation TherapyRadiation Therapy
Tooth decay progresses Tooth decay progresses when damaging factors when damaging factors prevail over protective prevail over protective
factorsfactors
More More demineralization demineralization
than remineralizationthan remineralization
The Caries Risk Test aids in establishing RiskThe Caries Risk Test aids in establishing Risk
Inactive/No Disease:Inactive/No Disease:(Caries -) (Caries -) (Cavities -)(Cavities -) Low Risk Low Risk
Post-Manifest Disease: Post-Manifest Disease: (Caries -)(Caries -) (Cavities +)(Cavities +) Moderate Risk Moderate Risk
Pre-Manifest Disease: Pre-Manifest Disease: (Caries +)(Caries +) (Cavities -)(Cavities -) High Risk High Risk
Manifest Disease: Manifest Disease: (Caries +)(Caries +) (Cavities +) (Cavities +) High Risk High Risk
Caries Risk Levels 1 & 2Caries Risk Levels 1 & 2 Level 1 Inactive No Disease (Caries -) Level 1 Inactive No Disease (Caries -)
(Cavities -)(Cavities -)• Anticipatory GuidanceAnticipatory Guidance
Home Care and Regular Dental Home Care and Regular Dental Check-upsCheck-ups
Level 2 Post-Manifest Disease (Caries -) Level 2 Post-Manifest Disease (Caries -) ((Cavities +Cavities +))• Maintain suppression of caries processMaintain suppression of caries process
Restore LesionsRestore Lesions
Caries Risk Levels 3 & 4Caries Risk Levels 3 & 4 Level 3 Pre-Manifest Disease Level 3 Pre-Manifest Disease ((Caries+)Caries+) (Cavities -)(Cavities -)
• Arrest Caries Process prior to CavitationArrest Caries Process prior to Cavitation
Level 4 Manifest Disease Level 4 Manifest Disease ((Caries +)Caries +) (Cavities + (Cavities +))
• ART Arrest and RestoreART Arrest and Restore Caries Removal, Mutans Cultures, Anticipatory Caries Removal, Mutans Cultures, Anticipatory
guidanceguidance Counseling / InstructionCounseling / Instruction Restoration or OtherRestoration or Other
Non-active disease caries risk level Non-active disease caries risk level L1: L1:
Low RiskLow Risk Complete Oral Hygiene and Place Sealants if indicated. Complete Oral Hygiene and Place Sealants if indicated. Recommend xylitol sweetened dental products (Tooth Gel, Chewing Recommend xylitol sweetened dental products (Tooth Gel, Chewing
Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Replacer) and have them available for purchase.Replacer) and have them available for purchase.
Recommend and prescribe appropriate fluoride containing products Recommend and prescribe appropriate fluoride containing products or have available for purchase.or have available for purchase.
Reduce or eliminate fermentable high density carbohydrates Reduce or eliminate fermentable high density carbohydrates between meals. We believe this makes good nutritional sense for the between meals. We believe this makes good nutritional sense for the whole body.whole body.
Evaluate their ability to maintain mechanical plaque control and Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other make appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids.oral hygiene aids.
Suggest concern for the need of disease control for immediate and Suggest concern for the need of disease control for immediate and close family members to decrease the probability of transmission, close family members to decrease the probability of transmission, i.e., if other members of the family have a high propensity for dental i.e., if other members of the family have a high propensity for dental disease it may be only a matter of time until everyone shares the disease it may be only a matter of time until everyone shares the problem.problem.
Maintain appropriate follow-up and/or testing to be confident that Maintain appropriate follow-up and/or testing to be confident that the patient or the parents are engaged in managing to maintain the the patient or the parents are engaged in managing to maintain the non-disease state non-disease state
Non-active disease caries risk level Non-active disease caries risk level L2: L2:
Moderate RiskModerate Risk See that the necessary mechanical dental treatment such as fillings, See that the necessary mechanical dental treatment such as fillings,
sealants etc. are rendered. This will remove the source of possible re-sealants etc. are rendered. This will remove the source of possible re-infection locally in their mouths.infection locally in their mouths.
Recommend appropriate xylitol sweetened dental products (Tooth Gel, Recommend appropriate xylitol sweetened dental products (Tooth Gel, Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Replacer) and have available for purchase.Saliva Replacer) and have available for purchase.
Recommend or prescribe appropriate fluoride containing products or Recommend or prescribe appropriate fluoride containing products or have available for purchase.have available for purchase.
Have the patient reduce or eliminate fermentable high density Have the patient reduce or eliminate fermentable high density carbohydrates (p. 99) especially between meals. This makes good carbohydrates (p. 99) especially between meals. This makes good nutritional sense for the whole body.nutritional sense for the whole body.
Evaluate their ability to maintain mechanical plaque control and make Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other oral appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids.hygiene aids.
Suggest concern for the need of disease control for immediate and Suggest concern for the need of disease control for immediate and close family members to decrease the probability of transmission, i.e., close family members to decrease the probability of transmission, i.e., if other members of the family have a high propensity for dental disease if other members of the family have a high propensity for dental disease it may be only a matter of time until everyone shares the problem.it may be only a matter of time until everyone shares the problem.
Maintain appropriate follow-up and/or testing to be confident that the Maintain appropriate follow-up and/or testing to be confident that the patient or the parents are engaged in managing to maintain a non-patient or the parents are engaged in managing to maintain a non-disease state.disease state.
Active Disease Caries Risk Level L3 or L4: Active Disease Caries Risk Level L3 or L4:
High RiskHigh Risk Treat the disease process (caries) and the necessary mechanical dental Treat the disease process (caries) and the necessary mechanical dental
treatment (cavities) such as fillings, sealants etc. Note: Prior to placement of treatment (cavities) such as fillings, sealants etc. Note: Prior to placement of orthodontic appliances make sure that the disease process is under control.orthodontic appliances make sure that the disease process is under control.
Recommend appropriate xylitol sweetened dental products (Tooth Gel, Recommend appropriate xylitol sweetened dental products (Tooth Gel, Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Chewing Gum, Mints, Toothpaste, Mouth Rinse, and/or tooth gel as a Saliva Replacer) and have available for purchase.Replacer) and have available for purchase.
Recommend or prescribe appropriate fluoride containing products or have Recommend or prescribe appropriate fluoride containing products or have available for purchase.available for purchase.
Treat the active caries disease process as a bacterial infection with an Treat the active caries disease process as a bacterial infection with an antimicrobial agent, (105-107) xylitol, and fluoride products.antimicrobial agent, (105-107) xylitol, and fluoride products.
Have the patient reduce or eliminate fermentable high density carbohydrates Have the patient reduce or eliminate fermentable high density carbohydrates (p.99) especially between meals. We believe this makes good nutritional (p.99) especially between meals. We believe this makes good nutritional sense for the whole body.sense for the whole body.
Evaluate their ability to maintain mechanical plaque control and make Evaluate their ability to maintain mechanical plaque control and make appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene appropriate suggestion, i.e., mechanical tooth brush and other oral hygiene aids.aids.
Suggest concern for the need of disease control for immediate and close Suggest concern for the need of disease control for immediate and close family members to decrease the probability of transmission, i.e., if other family members to decrease the probability of transmission, i.e., if other members of the family have a high propensity for dental disease it may be members of the family have a high propensity for dental disease it may be only a matter of time until everyone shares the problem.only a matter of time until everyone shares the problem.
Maintain appropriate follow-up and retesting until the patient or the parents Maintain appropriate follow-up and retesting until the patient or the parents are engaged in managing the disease.are engaged in managing the disease.
Before and AfterBefore and After
Results obtained in our office Results obtained in our office with Xylitol with Xylitol
100% Xylitol Gum Only100% Xylitol Gum Only
Before After 1 Week
100% Xylitol Gum Only100% Xylitol Gum Only
Before After 3 Weeks
Xylitol Reduces Bacterial Regrowth Xylitol Reduces Bacterial Regrowth After Oral DisinfectionAfter Oral Disinfection
0
20
40
60
80
100
Time Since Oral Disinfection
Mea
n Bac
terial
Lev
els
(%
Tim
e 0)
XylitolSorbitolPlacebo
Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression with xylitol chewing gum. J Am Dent Assoc. 2000;131:909-916
| 3 Months
100% Xylitol Gum and 100% Xylitol Gum and ChlorhexidineChlorhexidine
Before After 1 Week
100% Xylitol Gum and 100% Xylitol Gum and ChlorhexidineChlorhexidine
Before After 2 Weeks
AJS 2-26-2003
Initial examination with oral hygiene
and xylitol recommendations
AJS 3-4-2003
After using xylitol for one week
WF 2-26-2003
Inadequate hygiene for fixed orthodontic appliances
WF 3-11-2003
Improvement after two weeks of Xylitol Hygiene
PeriodonticsPeriodontics Xylitol hygiene can benefit patients with Xylitol hygiene can benefit patients with
gingivitis or periodontitis.gingivitis or periodontitis.
Regular Xylitol use helps reduce plaque Regular Xylitol use helps reduce plaque quantity.quantity.
Plaque becomes less adhesive, less acidic, less Plaque becomes less adhesive, less acidic, less inflammatory, and less harmful than sucrose inflammatory, and less harmful than sucrose plaque.plaque.
Xylitol helps block re-emergence of cariogenic Xylitol helps block re-emergence of cariogenic organisms during periodontal therapy, such as organisms during periodontal therapy, such as after full-mouth disinfection.after full-mouth disinfection.
Dry MouthDry Mouth Many Prescription Drugs Cause Dry Many Prescription Drugs Cause Dry
MouthMouth UncomfortableUncomfortable Lack of Saliva Leads to CariesLack of Saliva Leads to Caries Root CariesRoot Caries
Factors Affecting Salivary FlowFactors Affecting Salivary Flow
PharmaceuticalsPharmaceuticals Radiation TherapyRadiation Therapy Water IntakeWater Intake XylitolXylitol
• The caries controlling/preventing The caries controlling/preventing effect of xylitol is not based on effect of xylitol is not based on
saliva stimulation onlysaliva stimulation only
Effects of xylitol on plaque…Effects of xylitol on plaque…
Xylitol is not easily Xylitol is not easily metabolized by metabolized by BacteriaBacteria
Non-CariogenicNon-Cariogenic CariostaticCariostatic Anti-CariogenicAnti-Cariogenic Reduces MS levelsReduces MS levels
Söderling et al., 1997
Staff ResponsibilitiesStaff Responsibilities
Assess and RecordAssess and Record• pHpH• Salivary FlowSalivary Flow• Gingival Bleeding IndexGingival Bleeding Index• Debris IndexDebris Index• Calculus IndexCalculus Index• Calculate Oral Hygiene IndexCalculate Oral Hygiene Index
Brushing and Flossing InstructionsBrushing and Flossing Instructions
Caries Risk TestCaries Risk Test Provide a basis for evidence based CareProvide a basis for evidence based Care Provide a basis for customized Provide a basis for customized
TreatmentTreatment• EvaluationEvaluation
FindingsFindings
• In Office TreatmentIn Office Treatment Dental PracticeDental Practice
• Home Care MeasuresHome Care Measures At HomeAt Home
In cooperation with the Polyclinic for Preventive Dentistry, Erfurt, Dental School, Friedrich-Schiller University of Jena, Germany
VIVADENT
Caries Risk TestCaries Risk Test Based on Clinical Based on Clinical
JudgmentJudgment Great Parent/Patient Great Parent/Patient
motivatormotivator Confirms clinical Confirms clinical
diagnosisdiagnosis Ivoclar/Vivadent Ivoclar/Vivadent
incubatorincubator Test Kit – CRT Test Kit – CRT
Bacteria StandardBacteria Standard Salivary Flow RateSalivary Flow Rate
Mutans Strep
Lactobacillus
Mutans Strep ≥ 100,000 Colony Forming Units
Caries Risk Test
Lactobacillus ≥100,000 Colony Forming Units
Caries Risk Test
Gold Standard in Clinical Trials (MS)Gold Standard in Clinical Trials (MS)
Growth medium
Bacitrasin
SM-strips
Paraffin
Ten tests
Flossette
Mother – Child TransmissionMother – Child Transmission
What do the Clinical Trials ShowWhat do the Clinical Trials Show
Stefan’s Curve
Breakfast Lunch Dinner
Snacks
Mutans streptococci Mutans streptococci
Why are mutans streptococci Why are mutans streptococci (MS) so important?(MS) so important?
TheThe caries bacteria caries bacteria MS form sticky plaque and MS form sticky plaque and
produce efficiently acidsproduce efficiently acids
Mutans streptococci on enamel
Xylitol consumption decreases amounts and the adhesivity Xylitol consumption decreases amounts and the adhesivity of MS. Mutans streptococci of habitual xylitol consumers of MS. Mutans streptococci of habitual xylitol consumers
are easily shed to the saliva.are easily shed to the saliva.
Söderling et al., 1991; Trahan et al., 1992courtesy of Eva Soderling
The effects of xylitol on MS The effects of xylitol on MS are based on its 5-carbon are based on its 5-carbon structurestructure
Clinical studies support the Clinical studies support the idea that MS is targeted by idea that MS is targeted by xylitolxylitol (Vadeboncoeur et al., 1983; (Vadeboncoeur et al., 1983; Loesche et al., 1984)Loesche et al., 1984)
The MS counts remain low The MS counts remain low as long as the use of xylitol as long as the use of xylitol lasts lasts
Xylitol
Effects of xylitol on mother-child Effects of xylitol on mother-child transmission of mutans streptococcitransmission of mutans streptococci
SWEDEN
FINLAND
, February 2011)
Japan
Finland
Sweden
Finnish, Swedish, Japanese Studies (Courtesy of Eva Soderling Feb. 2011
Protect Your Child with Xylitol –Protect Your Child with Xylitol –It’s Pretty Cool StuffIt’s Pretty Cool Stuff
Protected Child
Xylitol gel in pacifier for babyXylitol gel in pacifier for baby
Mother uses xylitol chewing gum
Caufield et al., 1993
The window of infectivity for mutans streptococci
Caries as an infectious disease:Caries as an infectious disease: Early colonisation of mutans streptococci Early colonisation of mutans streptococci
(caries bacteria) increases the risk of caries (caries bacteria) increases the risk of caries occurence in the future!occurence in the future!
courtesy of Eva Soderling
Transmission of mutans Transmission of mutans streptococcistreptococci
• The timing of the window of The timing of the window of infectivíty can differ in different infectivíty can differ in different populations populations (Florio et al., 2004)(Florio et al., 2004)
• Factors affecting the transmission: Factors affecting the transmission: 1.1. The mutans counts of the "infecting" The mutans counts of the "infecting"
person (>100 000 per ml saliva – person (>100 000 per ml saliva – common!)common!)
2.2. Number of daily saliva contactsNumber of daily saliva contacts3.3. Individual susceptibitily of the child Individual susceptibitily of the child (Smith et (Smith et
al., 1998),al., 1998), mode of delivery mode of delivery (Li et al., 2005)(Li et al., 2005)
courtesy of Eva Soderling
If we can reduce the risk of this If we can reduce the risk of this transmission could we lower tooth transmission could we lower tooth decay in children?decay in children?
Lets look at some of the Studies to Lets look at some of the Studies to find out.find out.
Finland:Effects of xylitol on mother-Finland:Effects of xylitol on mother-child transmission of mutans child transmission of mutans
streptococIstreptococI
YES!
Wow! This is good!Wow! This is good!
Finland: Effects of xylitol on childhood Finland: Effects of xylitol on childhood cariescaries
Isokangas et al., 2000
Caries occurence until 5 yrs
YES!
Yum!Yum!
Mother’s Dental CareMother’s Dental Care
05
101520253035404550
Perc
enta
ge C
olon
izat
ion
Fluoride Xylitol
Mothers Dental CareSoderling E, IsokangasP, PienhakkinenK, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 200;79:1885-9
Chlorhexidine
YES!
Soft Banana brush with xylitol gelSoft Banana brush with xylitol gel
When Mothers Use Xylitol, When Mothers Use Xylitol, Children Have Fewer CavitiesChildren Have Fewer Cavities
00.5
11.52
2.53
3.54
2 3 4 5
Years
DM
F XylitolChlorhexidineFluoride
Isokangas P, Soderling E, Pienikakkinen, Alanen P. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0-5 years of age. J Dent Res. 2000;79:1885-9
YES!
She likes it!She likes it!
Xylitol Reduces Bacterial Regrowth Xylitol Reduces Bacterial Regrowth After Oral DisinfectionAfter Oral Disinfection
0
20
40
60
80
100
Time Since Oral Disinfection
Mea
n Bac
terial
Lev
els
(%
Tim
e 0)
XylitolSorbitolPlacebo
Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression with xylitol chewing gum. J Am Dent Assoc. 2000;131:909-916
| 3 Months
YES!
Baby gets cariogenic Baby gets cariogenic bacteria from motherbacteria from mother
Mothers who use Mothers who use xylitol transmit non-xylitol transmit non-cariogenic microfloracariogenic microflora
With All this Xylitol Your Teeth are With All this Xylitol Your Teeth are SafeSafe
XYLITOL’SXYLITOL’S
Role in Re-mineralizationRole in Re-mineralization
Remineralization / Cosmetic Enhancement Remineralization / Cosmetic Enhancement InventionInvention
Hypomineralized areas on #8,9
Status before any treatment
Status immediately following treatment
Example # 1
Treatment Time: 5-7 minutes
Status before any treatment Status immediately following treatment
Example #2
Status before treatment. # 8, 9 are to be treated. Note
generalized demineralization on maxillary posteriors that will not
be professionally treated.
Example #3 - Slide 1 of 2
Status of # 8,9 immediately following professional
treatment. Please note no change to hypo-mineralized areas in Maxillary posteriors.
Slide 2 of 2
5 months after initial professional treatment to # 8,9. Patient was instructed to use an at-home solution daily. Please note
remineralization effects of home solution on maxillary posteriors.
Photos illustrating possible Photos illustrating possible treatment process ~ Slide 1 of 2treatment process ~ Slide 1 of 2
Status before any treatment Slight microabrasion of surface
Slide 2 of 2Slide 2 of 2
Chemical Etch Status immediately following treatment
Initial Condition
Same Day After In Office Treatment
““Xylitol gum enhanced remineralization Xylitol gum enhanced remineralization reduced plaque and improved gingival reduced plaque and improved gingival health.” health.”
Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, and plaque andand plaque and
anti-gingivitis effect of xylitol and sorbitol sweetened chewing anti-gingivitis effect of xylitol and sorbitol sweetened chewing gum gum Clinical Clinical
NutritionNutrition (supplement) 1995 pp. 275-283. (supplement) 1995 pp. 275-283.
XYLITOL’SXYLITOL’S
Role in MaintenanceRole in Maintenance
Medical ModelMedical ModelDiagnosis
Treat Caries
Treat Cavities
Maintenance Home / Professional
Health
Caries+
Cavities +
Cavities -
Caries -
Cavities -Cavities +
L1L2
L3
L4
L4
Medical Model information Adapted from A Comprehensive Review of Pediatric Dentistry Manual, San Diego September 2002.
Elements of ManagementElements of Management DateDate Eruption PeriodsEruption Periods Salivary phSalivary ph GBI - Gingival Bleeding GBI - Gingival Bleeding
IndexIndex Decayed, missing, filled Decayed, missing, filled DI/CI – Debris DI/CI – Debris
Index/CalculusIndex/Calculus OHI - Oral health IndexOHI - Oral health Index BFI/Pro-Flo Brushing, BFI/Pro-Flo Brushing,
Flossing Instructions/ Flossing Instructions/ ProphyProphy
Caries RiskCaries Risk Periodontal ConditionPeriodontal Condition PhotographsPhotographs
CRT/SF Caries Risk Test/ CRT/SF Caries Risk Test/ Salivary Flow Salivary Flow
CRT Mutans Strep/Lacto CRT Mutans Strep/Lacto BacBac
100% Xylitol Chewing 100% Xylitol Chewing GumGum
100% Xylitol Product 100% Xylitol Product Reco’sReco’s
Fluoride Reco’sFluoride Reco’s CHX – ChlorhexidineCHX – Chlorhexidine Nutritional InformationNutritional Information Treat CavitiesTreat Cavities Follow-up Treatment Follow-up Treatment
DateDate ReferralReferral
MaintenanceMaintenance Regular xylitol use should be encouraged Regular xylitol use should be encouraged
as a routine healthy habit, a continuing as a routine healthy habit, a continuing part of a normal oral hygiene regimen.part of a normal oral hygiene regimen.
““The best use of xylitol is as an addition The best use of xylitol is as an addition to other oral hygiene recommendations.”to other oral hygiene recommendations.”
Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention. Prevention. Journal of Dental HygieneJournal of Dental Hygiene Volume 67 Number IV Fall Volume 67 Number IV Fall 2002, pp. 276-285.2002, pp. 276-285.
How To Use XylitolHow To Use Xylitol ““Xylitol should be used immediately after Xylitol should be used immediately after
every meal and snack.every meal and snack. 3-5 Times a Day3-5 Times a Day
Gum or Mint should be used for at least 3-Gum or Mint should be used for at least 3-5 minutes5 minutes
Can be Used at any other time you desire.Can be Used at any other time you desire.
Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention. Peldyak, John DMD; Makinen, Kauko K. PhD: Xylitol for Caries Prevention.
Journal of Dental Hygiene Journal of Dental Hygiene Volume 67 Number IV Fall 2002, pp. 276-285.Volume 67 Number IV Fall 2002, pp. 276-285.
Long-term effect of xylitol.Long-term effect of xylitol.
When Used for 2 YearsWhen Used for 2 Years
Cavity Reducing Effect lasts Cavity Reducing Effect lasts for 3-5 Yearsfor 3-5 Years
Peldyak John DMD, Makinen Kauko K PhD: Xylitol for Caries Peldyak John DMD, Makinen Kauko K PhD: Xylitol for Caries Prevention. Prevention.
Journal of Dental Hygiene Volume 76 Number IV Fall 2002; pp. 276-Journal of Dental Hygiene Volume 76 Number IV Fall 2002; pp. 276-285.285.
Who Can Use XylitolWho Can Use Xylitol
Orthodontic PatientsOrthodontic Patients Adults and ElderlyAdults and Elderly Persons with DisabilitiesPersons with Disabilities Persons with Dry MouthPersons with Dry Mouth AthletesAthletes
• Increases Fat UtilizationIncreases Fat Utilization• Fights Muscle FatigueFights Muscle Fatigue
Everyone Except DogsEveryone Except Dogs
Caries process successfully Caries process successfully managed whenmanaged when
Salivary Mutans stays low.Salivary Mutans stays low. No gingival inflammation.No gingival inflammation. Caries excavation complete, Caries excavation complete,
lesion appearance changed lesion appearance changed (arrested).(arrested).
Patients or Parents of patients Patients or Parents of patients engaged in managing disease. engaged in managing disease.
Historical factors for low risk.Historical factors for low risk. Opposite of high risk factors Opposite of high risk factors Dental health awareness.Dental health awareness. No cavities within the last year or two.No cavities within the last year or two. Regular dental visits.Regular dental visits. History of few cavities in the rest of the family.History of few cavities in the rest of the family. For adults and children no tobacco use.For adults and children no tobacco use. Good regular use of fluoride products.Good regular use of fluoride products. Adequately restored surfaces on a minimal number of teeth Adequately restored surfaces on a minimal number of teeth
no foiling or creeping restorations.no foiling or creeping restorations. Deep pit and fissures are sealed.Deep pit and fissures are sealed. Low dietary intake of Fermentable High Density Low dietary intake of Fermentable High Density
Carbohydrates.Carbohydrates. In Children no history of Early Childhood Caries, no or little In Children no history of Early Childhood Caries, no or little
history of medicines high in sucrose or syrup, no fluids in history of medicines high in sucrose or syrup, no fluids in bottle or sippy cups that contain any form of sugar especially bottle or sippy cups that contain any form of sugar especially between regular feedings or left in bed with bottle or allowed between regular feedings or left in bed with bottle or allowed to carry the vessel around except with water.to carry the vessel around except with water.
Carbonated drinks are the single biggest source of refined sugars in the American diet.
According to dietary surveys, soda pop provides the average American with 7 teaspoons of sugars per day, out of a total of about 20 teaspoons.
Teenage boys get 44 percent of their 34 teaspoons of refined sugars a day from soft drinks.
Teenage girls get 40 percent of their 24 teaspoons of sugars from soft drinks.
Because some people drink little or no soda pop, the percentage of refined sugars provided by pop is higher among actual drinkers.
Would You Like To Significantly:Would You Like To Significantly:
Decrease Decay In Your Mouth?Decrease Decay In Your Mouth? Decrease Decay In Your Kids Mouths?Decrease Decay In Your Kids Mouths? Decrease Decay In Your Grandkids Decrease Decay In Your Grandkids
Mouths?Mouths?
Benefits of Xylitol for PatientsBenefits of Xylitol for Patients
EffectiveEffective
ConvenientConvenient
EnjoyableEnjoyable
Result is improved Result is improved cooperation and cooperation and excellent oral excellent oral hygienehygiene
Xylitol on a picnic…
Xylitol at the big game
Product TypesProduct Types
Product Types Product Types
Toothpaste
Oral Rinse
Dental Cleansing Gel
MintsGumMoisturizing
breath freshener
Spiffies Infant WipesSpiffies Infant Wipes
Banana BrushBanana Brush
Joint Venture ProductJoint Venture Product
Joint VentureJoint Venture
UltradentUltradent
EnjoyEnjoy
Old wayOld way
Find a BugFind a Bug
Use a DrugUse a Drug
New WayNew Way
With XylitolWith Xylitol
Show ’em the doorShow ’em the door
Makes plaque Slicky instead of Sticky
Slam it shutSlam it shut
Xylitol
LivesHere
Xylitol blocks the tooth-damagingXylitol blocks the tooth-damaging factorsfactors
Xylitol FeaturesXylitol Features
Sweet, cooling, no aftertasteSweet, cooling, no aftertaste Naturally-occurring in human metabolismNaturally-occurring in human metabolism Low calorie Low calorie (40% less than sugar)(40% less than sugar) Low Glycemic Low Glycemic (about 10% of Glucose)(about 10% of Glucose) Low insulin usage to metabolizeLow insulin usage to metabolize No Maillard reactionNo Maillard reaction Slows stomach emptying – increases satiety Slows stomach emptying – increases satiety (feelings (feelings
of fullness)of fullness) Energy source Energy source (Used in IV Nutrition)(Used in IV Nutrition) Enhances Calcium absorptionEnhances Calcium absorption Helps prevent tooth decayHelps prevent tooth decay Helps prevents ear and upper respiratory infectionsHelps prevents ear and upper respiratory infections
Things To RememberThings To Remember
Xylitol Tastes Good, Like SugarXylitol Tastes Good, Like Sugar Lower Calorie = Less WeightLower Calorie = Less Weight Lower Glycemic = Weight LossLower Glycemic = Weight Loss Can Replace All or Part of Your SugarCan Replace All or Part of Your Sugar Good For TeethGood For Teeth Prevents Tooth DecayPrevents Tooth Decay Prevents Ear InfectionsPrevents Ear Infections Too Much = Laxative EffectToo Much = Laxative Effect
How much? How often?How much? How often?
Frequency more important than amount Frequency more important than amount 4 to 12 grams 4 to 12 grams (teaspoon is 4 grams)(teaspoon is 4 grams) 6 to 10 pieces of gum/day6 to 10 pieces of gum/day
• Active Strep Mutans infections in adults Active Strep Mutans infections in adults require at least 6 grams require at least 6 grams (8 or more pieces of (8 or more pieces of gum)gum)
Aim for five uses each dayAim for five uses each day After each meal and snackAfter each meal and snack Toothpaste morning and nightToothpaste morning and night
Use 100% Xylitol ProductsUse 100% Xylitol Products
Xylitol Keeps Them SmilingXylitol Keeps Them Smiling
5 Levels of Caries Control5 Levels of Caries Control
RemineralizationRemineralization DisinfectDisinfect Oral HygieneOral Hygiene XylitolXylitol EnvironmentEnvironment
Environment, Whole Food and Whole Food Supplements
Xylitol protocols and Products
Office Oral Hygiene Program
Oral Disinfection
Remineralization
Ease of M
anagement
Effect on O
ral Health
Least
Most
Easy
Hard
Whole Food – Level 1Whole Food – Level 1
Diet – Real Food Diet – Real Food • Less Processed ProductsLess Processed Products
SupplementsSupplements And EnvironmentAnd Environment
• ToxinsToxins• AirAir• WaterWater• StressStress• Change in habits and life styleChange in habits and life style
Adapted from the book: From Here to Longevity by Dr. Mitra Ray Ph.D. with Patricia Cannon Childs
Saliva
CalciumPhosphorus
Xylitol Gum
Adapted with permission from the book: From Here to Longevity by Dr. Mitra Ray Ph.D. with Patricia Cannon Childs
S. Mutans
Essential Nutrient Needs of Our Essential Nutrient Needs of Our BodiesBodies
Macro Nutrients: Macro Nutrients: Air, Water, Protein, Fats, Air, Water, Protein, Fats, Carbohydrates, and Fiber. Carbohydrates, and Fiber.
Micro Nutrients:Micro Nutrients: Vitamins, Minerals, Essential Vitamins, Minerals, Essential Fatty Acids, Amino Acids, Fatty Acids, Amino Acids,
Enzymes, Pre and Pro Biotics.Enzymes, Pre and Pro Biotics.
What We’ve LearnedWhat We’ve Learned What you eat affects the health of your mouth, body, and What you eat affects the health of your mouth, body, and
lifelife That it is best to avoid sugar, white flour products, That it is best to avoid sugar, white flour products,
vegetables oils, and trans-fatsvegetables oils, and trans-fats That it is best to drink pure filtered water and eat fresh That it is best to drink pure filtered water and eat fresh
proteins, fresh vegetables, and saladsproteins, fresh vegetables, and salads That it is better for you to eat foods less processed foodThat it is better for you to eat foods less processed food That it is best for you to eat foods closest to their natural That it is best for you to eat foods closest to their natural
statestate That it is essential to support your nutrition with That it is essential to support your nutrition with
concentrated whole food supplements, because the foods concentrated whole food supplements, because the foods we consume today are not as nutrient dense as they were we consume today are not as nutrient dense as they were 100 years ago. 100 years ago.
To Summarize:To Summarize:
We believe that We believe that whole food nutritionwhole food nutrition, as close, as close
to the natural state that one can obtain,to the natural state that one can obtain,
supplemented by the use of supplemented by the use of concentrated concentrated
whole food supplementswhole food supplements is the essential is the essential
foundation for a healthy mouth and body.foundation for a healthy mouth and body.
Food to Choose (Organic)Food to Choose (Organic)
Home grown in your own garden or Home grown in your own garden or pasturepasture
Fresh picked (Farmers Markets)Fresh picked (Farmers Markets) Fresh frozen Fresh frozen Fresh as it can be in grocery store Fresh as it can be in grocery store
meat, fish, and produce sectionmeat, fish, and produce section
Xylitol – Level IIXylitol – Level II
Things To RememberThings To Remember
Xylitol Tastes Good, Like SugarXylitol Tastes Good, Like Sugar Lower Calorie = Less WeightLower Calorie = Less Weight Lower Glycemic = Weight LossLower Glycemic = Weight Loss Can Replace All or Part of Your SugarCan Replace All or Part of Your Sugar Good For TeethGood For Teeth Prevents Tooth DecayPrevents Tooth Decay Prevents Ear InfectionsPrevents Ear Infections Too Much = Laxative EffectToo Much = Laxative Effect
Oral Hygiene – Level IIIOral Hygiene – Level III
Cleaning, x-rays, Exam, FluorideCleaning, x-rays, Exam, Fluoride• 1. Report Card Presentation1. Report Card Presentation• 2. Findings2. Findings• 3. Reason for follow-up3. Reason for follow-up• 4. Objective Data and assessment4. Objective Data and assessment• 5. Provider Recommendations5. Provider Recommendations
1. Report Card1. Report Card
Cavity RiskCavity Risk Gum HealthGum Health ReferralReferral
2. Dental Exam Findings2. Dental Exam Findings
Dental NeedsDental Needs Head and NeckHead and Neck Intro Oral Soft TissuesIntro Oral Soft Tissues Intra Oral TeethIntra Oral Teeth X-RaysX-Rays
3. Follow up Care - Recall3. Follow up Care - Recall
Preventative CarePreventative Care Early Cavity DetectionEarly Cavity Detection X-Rays for Cavity DetectionX-Rays for Cavity Detection Monitor EruptionMonitor Eruption Monitor Stained AreasMonitor Stained Areas Monitor Spots between TeethMonitor Spots between Teeth Soft Tissue CheckSoft Tissue Check Monitor SpacersMonitor Spacers Check Crowns/FillingsCheck Crowns/Fillings
4. Objective Data and Assessment4. Objective Data and Assessment
DateDate Eruption PeriodEruption Period pHpH Bleeding GumsBleeding Gums Plaque Plaque Oral Hygiene InstructionOral Hygiene Instruction Cleaning and FluorideCleaning and Fluoride Gum Disease Gum Disease Cavity RiskCavity Risk
5. Provider Recommendations5. Provider Recommendations
Daily XylitolDaily Xylitol Daily FluorideDaily Fluoride Professional CareProfessional Care
Oral Disinfection – Level IVOral Disinfection – Level IV
Perioguard - ChlorhexidinePerioguard - Chlorhexidine Betadyne – Povidone IodineBetadyne – Povidone Iodine CloSysII – Chlorine DioxideCloSysII – Chlorine Dioxide
Remineralization – Level VRemineralization – Level V
Ionizable mineralsIonizable minerals• Calcium LactateCalcium Lactate• Calcium CitrateCalcium Citrate• Calcium Glycerol PhosphateCalcium Glycerol Phosphate
FluorideFluoride• Listerine, Act, Fluoguard….Listerine, Act, Fluoguard….• Prevent 5000Prevent 5000
Slide Show ReviewSlide Show Review
Thank YouThank You
QuotesQuotes
Xylitol Is:Xylitol Is:
•Non-Cariogenic:Non-Cariogenic:
Does not contribute to the caries disease process.Does not contribute to the caries disease process.
•Cariostatic:Cariostatic:
The caries disease process does not occur in the presence ofThe caries disease process does not occur in the presence of Xylitol.Xylitol.
•Anti-Cariogenic:Anti-Cariogenic:
The caries disease process may be reversed through The caries disease process may be reversed through appropriate exposure to appropriate exposure to Xylitol.Xylitol.
Xylitol is Anti-CariogenicXylitol is Anti-Cariogenic
““The highest caries reduction The highest caries reduction rates were observed in subjects rates were observed in subjects using Xylitol.”using Xylitol.”
Hayes, Catherine D.M.D. D.M.Sc: The effect of Non-Hayes, Catherine D.M.D. D.M.Sc: The effect of Non-Cariogenic Sweeteners on the Prevention of Dental Caries: Cariogenic Sweeteners on the Prevention of Dental Caries: A review of the evidence A review of the evidence Journal of Dental EducationJournal of Dental Education October 2001/Vol.65/No. 10pp. 1106-1109. October 2001/Vol.65/No. 10pp. 1106-1109.
““Studies are remarkably consistent, in Studies are remarkably consistent, in the terms of the magnitude of the the terms of the magnitude of the effect observed as well as the effect observed as well as the consistent demonstration of the consistent demonstration of the superiority of Xylitol compared to superiority of Xylitol compared to sorbitol in decreasing the risk of sorbitol in decreasing the risk of dental caries.”dental caries.”
Hayes, Catherine D.M.D D.M.S c: The effect of Non-Cariogenic SweetenersHayes, Catherine D.M.D D.M.S c: The effect of Non-Cariogenic Sweeteners
on the Prevention of Dental Caries: A review of the evidence on the Prevention of Dental Caries: A review of the evidence Journal of Dental Journal of Dental
EducationEducation October 2001/Vol.65/No. 10pp. 1106-1109. October 2001/Vol.65/No. 10pp. 1106-1109.
Xylitol is non-acidogenic and non-Xylitol is non-acidogenic and non-cariogenic.cariogenic.
Xylitol is essentially non-fermentable Xylitol is essentially non-fermentable and therefore cannot be converted to and therefore cannot be converted to acids by oral bacteria.acids by oral bacteria.
Xylitol can be left on teeth overnight Xylitol can be left on teeth overnight and not cause any damage.and not cause any damage.
All from Peldyak John DMD: All from Peldyak John DMD: Xylitol Sweeten Your SmileXylitol Sweeten Your Smile; Advanced ; Advanced Developments, Inc. Mt. Pleasant, MI p.8.Developments, Inc. Mt. Pleasant, MI p.8.
How Safe is XylitolHow Safe is Xylitol ““In the amounts needed to prevent In the amounts needed to prevent
tooth decay (less than 15 grams per tooth decay (less than 15 grams per day), Xylitol is safe for everyone.”day), Xylitol is safe for everyone.”Peldyak, John D.M.D, Peldyak, John D.M.D, Xylitol Sweeten Your SmileXylitol Sweeten Your Smile Advanced Advanced Developments, Inc. Mt Pleasant, MI 48804-1010.Developments, Inc. Mt Pleasant, MI 48804-1010.
““Xylitol with adaptation is well Xylitol with adaptation is well tolerated and safe to levels of at least tolerated and safe to levels of at least 90 grams/day, with no subjective or 90 grams/day, with no subjective or objective adverse findings.”objective adverse findings.”
Brin M, Miller ON: The safety of oral xylitol in: Brin M, Miller ON: The safety of oral xylitol in: Sugars in NutritionSugars in Nutrition Sipple HL Sipple HL (ed) Academic Press New York 1974 pp. 591-605.(ed) Academic Press New York 1974 pp. 591-605.
..
““Xylitol gum enhanced Xylitol gum enhanced remineralization remineralization reduced plaque and reduced plaque and improved gingival improved gingival health.” health.”
Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, Steinberg LM, Odusola F, Mandel ID: Remineralizing potential, and plaque andand plaque and
anti-gingivitis effect of xylitol and sorbitol sweetened chewing anti-gingivitis effect of xylitol and sorbitol sweetened chewing gum gum Clinical Clinical
NutritionNutrition (supplement) 1995 pp. 275-283. (supplement) 1995 pp. 275-283.
Xylitol’s Main Side EffectXylitol’s Main Side Effect
Xylitol is very hydrophilic and a Xylitol is very hydrophilic and a side effect may be slight gastric side effect may be slight gastric distress and slight osmotic distress and slight osmotic diarrhea. Consider starting with diarrhea. Consider starting with a slight dose then increasing or a slight dose then increasing or informing the patient if they informing the patient if they have any problem to cut back for have any problem to cut back for a while and build up to level a while and build up to level recommend as toleratedrecommend as tolerated
Dr. John Peldyak DMD in his book “Dr. John Peldyak DMD in his book “Xylitol Sweeten Your SmileXylitol Sweeten Your Smile”; ”; Advanced Developments, Inc. Mt. Pleasant, MI. 48804-1010, 1996, Advanced Developments, Inc. Mt. Pleasant, MI. 48804-1010, 1996, pp.5-6.pp.5-6.
Xylitol StudiesXylitol Studies
Caries prevention by xylitol compared to a control group
-90-80-70-60-50-40-30-20-10
0
% Reduction in Caries for Xylitol vs. Control
Caries prevention by xylitol compared to a control group
-90-80-70-60-50-40-30-20-10
0
% Reduction in Caries for Xylitol vs. Control
Chart, outline and references 1-15 are courtesy of Dr. John Peldyak Mt. Pleasant Michigan.
ReferencesReferences
www.ADRdental.com
1.1. Turku, Finland (1)Turku, Finland (1) -- Xylitol (67g/day) replaced dietary -- Xylitol (67g/day) replaced dietary sugar (sucrose), 1sugar (sucrose), 1
2.2. Turku, Finland (2)Turku, Finland (2) -- Xylitol (6.7g/day) was used only in -- Xylitol (6.7g/day) was used only in chewing gum.1chewing gum.1
3.3. Soviet UnionSoviet Union -- Control group also had more severe -- Control group also had more severe “deep” lesions and pulpitis.2“deep” lesions and pulpitis.2
4.4. French PolynesiaFrench Polynesia -- Both control group and xylitol group -- Both control group and xylitol group received basic oral hygiene with fluoride toothpaste. ³received basic oral hygiene with fluoride toothpaste. ³
5.5. HungaryHungary -- The xylitol group also had lower caries rate than -- The xylitol group also had lower caries rate than a group which received fluoride.4, 5a group which received fluoride.4, 5
6.6. Montreal, CanadaMontreal, Canada -- Chewing gum contained a mixture of -- Chewing gum contained a mixture of xylitol and sorbitol.6, 7 xylitol and sorbitol.6, 7
7.7. Ylivieska, FinlandYlivieska, Finland -- Comprehensive prevention program -- Comprehensive prevention program was improved by the addition of xylitol gum. Long-term was improved by the addition of xylitol gum. Long-term benefit of xylitol was established.8-10benefit of xylitol was established.8-10
8.8. BelizeBelize -- Chewing gum sweetened exclusively with xylitol -- Chewing gum sweetened exclusively with xylitol was more effective in preventing caries than sorbitol or was more effective in preventing caries than sorbitol or xylitol-sorbitol mixtures. Sucrose gum increased caries xylitol-sorbitol mixtures. Sucrose gum increased caries incidence.11, 12 incidence.11, 12
9.9. Stann CreekStann Creek -- Five year follow-up of Belize trial -- Five year follow-up of Belize trial demonstrated lasting benefit of xylitol use.13demonstrated lasting benefit of xylitol use.13
10.10. DaytonDayton -- Supragingival root surface caries were studied.14 -- Supragingival root surface caries were studied.1411.11. EstoniaEstonia -- Xylitol candy was as effective as xylitol chewing -- Xylitol candy was as effective as xylitol chewing
gum in reducing caries.15gum in reducing caries.15
1.1. Galiullin AN: Evaluation of the caries-prevention action of Galiullin AN: Evaluation of the caries-prevention action of xylitolxylitol. Kazan Med. J . Kazan Med. J 1981:67:16-18. 1981:67:16-18.
2.2. Kandelman D, Bär A, Hefti A: Collaborative WHO xylitol Kandelman D, Bär A, Hefti A: Collaborative WHO xylitol field study in French Polynesia. 1. Baseline prevalence and field study in French Polynesia. 1. Baseline prevalence and 32 month caries increment. 32 month caries increment. Caries ResCaries Res 1988; 2:55-62. 1988; 2:55-62.
3.3. Scheinin A, Banóczy J, Szóke J, et al: Three-years caries Scheinin A, Banóczy J, Szóke J, et al: Three-years caries activity in institutionalized children. activity in institutionalized children. Acta Odont ScandActa Odont Scand 1985; 43:327-347.1985; 43:327-347.
4.4. Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Acta Acta Odont Scand 1975; Odont Scand 1975; 33:suppl 70, 1-348.33:suppl 70, 1-348.
5.5. Scheinin A, Pienihäkkinen K, Tiekso J, Banóczy J, et al: Scheinin A, Pienihäkkinen K, Tiekso J, Banóczy J, et al: Collaborative WHO xylitol field studies in Hungary. VIII. Collaborative WHO xylitol field studies in Hungary. VIII. Two-year caries incidence in 976 institutionalized children. Two-year caries incidence in 976 institutionalized children. Acta Odont ScandActa Odont Scand 1985; 43:381-387. 1985; 43:381-387.
6.6. Kandelman D, Gagnon G: Clinical results after 12 months Kandelman D, Gagnon G: Clinical results after 12 months from a study of the incidence and progression of dental from a study of the incidence and progression of dental caries in relation to consumption of chewing gums caries in relation to consumption of chewing gums containing xylitol in school preventive programs. containing xylitol in school preventive programs. J Dent J Dent ResRes 1987; 66:1407-1411. 1987; 66:1407-1411.
7.7. Kandelman D, Gagnon A: A 24-month clinical study of the Kandelman D, Gagnon A: A 24-month clinical study of the incidence and progression of dental caries in relation to incidence and progression of dental caries in relation to consumption of chewing gums containing xylitol in school consumption of chewing gums containing xylitol in school preventive programs. preventive programs. J Dent ResJ Dent Res 1990; 69:1771-1775. 1990; 69:1771-1775.
8.8. Isokangas P Alanen P, Tiekso J, Mäkinen KK: Xylitol chewing Isokangas P Alanen P, Tiekso J, Mäkinen KK: Xylitol chewing gum in caries prevention: a field study in children. gum in caries prevention: a field study in children. J Am Dent J Am Dent AssocAssoc 1988; 17:315-320 1988; 17:315-320
9.9. Isokangas P, Tiekso J, Alanen P, Mäkinen KK: Long-term effect Isokangas P, Tiekso J, Alanen P, Mäkinen KK: Long-term effect of xylitol chewing gum in the prevention dental caries. of xylitol chewing gum in the prevention dental caries. Comm Comm Dent Oral EpidemiolDent Oral Epidemiol 1989; 17:200-203. 1989; 17:200-203.
10.10. Isokangas P, Mäkinen KK, Tiekso J, Alanen P: Long-term effect Isokangas P, Mäkinen KK, Tiekso J, Alanen P: Long-term effect of xylitol chewing gum in the prevention dental caries: A of xylitol chewing gum in the prevention dental caries: A follow-up five years after termination of a prevention program. follow-up five years after termination of a prevention program. Caries ResCaries Res 1993; 27:495-498. 1993; 27:495-498.
11.11. Mäkinen KK, Bennett CA, Hujoel PH, it al: Xytiltol chewing Mäkinen KK, Bennett CA, Hujoel PH, it al: Xytiltol chewing gums and caries rates: a 40-month cohort study. gums and caries rates: a 40-month cohort study. J Dent ResJ Dent Res 1995; 74 1904-1913.1995; 74 1904-1913.
12.12. Mäkinen KK, Hujoel PH, Bennett CA, Isotupa KP, et al: Polyol Mäkinen KK, Hujoel PH, Bennett CA, Isotupa KP, et al: Polyol chewing gums and caries rates in primary dentition: a 24 chewing gums and caries rates in primary dentition: a 24 month cohort study. month cohort study. Caries ResCaries Res 1996; 30:408-417. 1996; 30:408-417.
13.13. Mäkinen KK, Allen P, Bennett CA, et al: Stabilization of Mäkinen KK, Allen P, Bennett CA, et al: Stabilization of rampant caries: polyol gums and arrest of dentin caries in two rampant caries: polyol gums and arrest of dentin caries in two long-term cohort studies in young subjects. long-term cohort studies in young subjects. Int Dent JInt Dent J 1995; 1995; 45: 93-107.45: 93-107.
14.14. Mäkinen KK, Pemberton D, Mäkinen P-L et al: Polyol-combinant Mäkinen KK, Pemberton D, Mäkinen P-L et al: Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--saliva stimulants and oral health in Veterans Affairs patients--an exploratory study. an exploratory study. Spec Care DentSpec Care Dent 1996; 16:104-116. 1996; 16:104-116.
15.15. Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries prevention: results of a field study in Estonian children. prevention: results of a field study in Estonian children. Community DentCommunity Dent Oral EpidemiolOral Epidemiol 2000; 28:218-224. 2000; 28:218-224.
1.1. Turku, Finland (1)Turku, Finland (1) -- Xylitol (67g/day) replaced dietary -- Xylitol (67g/day) replaced dietary sugar (sucrose), 1sugar (sucrose), 1
2.2. Turku, Finland (2)Turku, Finland (2) -- Xylitol (6.7g/day) was used only in -- Xylitol (6.7g/day) was used only in chewing gum.1chewing gum.1
3.3. Soviet UnionSoviet Union -- Control group also had more severe -- Control group also had more severe “deep” lesions and pulpitis.2“deep” lesions and pulpitis.2
4.4. French PolynesiaFrench Polynesia -- Both control group and xylitol group -- Both control group and xylitol group received basic oral hygiene with fluoride toothpaste. ³received basic oral hygiene with fluoride toothpaste. ³
5.5. HungaryHungary -- The xylitol group also had lower caries rate than -- The xylitol group also had lower caries rate than a group which received fluoride.4, 5a group which received fluoride.4, 5
6.6. Montreal, CanadaMontreal, Canada -- Chewing gum contained a mixture of -- Chewing gum contained a mixture of xylitol and sorbitol.6, 7 xylitol and sorbitol.6, 7
7.7. Ylivieska, FinlandYlivieska, Finland -- Comprehensive prevention program -- Comprehensive prevention program was improved by the addition of xylitol gum. Long-term was improved by the addition of xylitol gum. Long-term benefit of xylitol was established.8-10benefit of xylitol was established.8-10
8.8. BelizeBelize -- Chewing gum sweetened exclusively with xylitol -- Chewing gum sweetened exclusively with xylitol was more effective in preventing caries than sorbitol or was more effective in preventing caries than sorbitol or xylitol-sorbitol mixtures. Sucrose gum increased caries xylitol-sorbitol mixtures. Sucrose gum increased caries incidence.11, 12 incidence.11, 12
9.9. Stann CreekStann Creek -- Five year follow-up of Belize trial -- Five year follow-up of Belize trial demonstrated lasting benefit of xylitol use.13demonstrated lasting benefit of xylitol use.13
10.10. DaytonDayton -- Supragingival root surface caries were studied.14 -- Supragingival root surface caries were studied.1411.11. EstoniaEstonia -- Xylitol candy was as effective as xylitol chewing -- Xylitol candy was as effective as xylitol chewing
gum in reducing caries.15gum in reducing caries.15
1.1. Galiullin AN: Evaluation of the caries-prevention action of Galiullin AN: Evaluation of the caries-prevention action of xylitolxylitol. Kazan Med. J . Kazan Med. J 1981:67:16-18. 1981:67:16-18.
2.2. Kandelman D, Bär A, Hefti A: Collaborative WHO xylitol Kandelman D, Bär A, Hefti A: Collaborative WHO xylitol field study in French Polynesia. 1. Baseline prevalence and field study in French Polynesia. 1. Baseline prevalence and 32 month caries increment. 32 month caries increment. Caries ResCaries Res 1988; 2:55-62. 1988; 2:55-62.
3.3. Scheinin A, Banóczy J, Szóke J, et al: Three-years caries Scheinin A, Banóczy J, Szóke J, et al: Three-years caries activity in institutionalized children. activity in institutionalized children. Acta Odont ScandActa Odont Scand 1985; 43:327-347.1985; 43:327-347.
4.4. Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Scheinin A, Mäakinen KK: Turku sugar studies I-XXI. Acta Acta Odont Scand 1975; Odont Scand 1975; 33:suppl 70, 1-348.33:suppl 70, 1-348.
5.5. Scheinin A, Pienihäkkinen K, Tiekso J, Banóczy J, et al: Scheinin A, Pienihäkkinen K, Tiekso J, Banóczy J, et al: Collaborative WHO xylitol field studies in Hungary. VIII. Collaborative WHO xylitol field studies in Hungary. VIII. Two-year caries incidence in 976 institutionalized children. Two-year caries incidence in 976 institutionalized children. Acta Odont ScandActa Odont Scand 1985; 43:381-387. 1985; 43:381-387.
6.6. Kandelman D, Gagnon G: Clinical results after 12 months Kandelman D, Gagnon G: Clinical results after 12 months from a study of the incidence and progression of dental from a study of the incidence and progression of dental caries in relation to consumption of chewing gums caries in relation to consumption of chewing gums containing xylitol in school preventive programs. containing xylitol in school preventive programs. J Dent J Dent ResRes 1987; 66:1407-1411. 1987; 66:1407-1411.
7.7. Kandelman D, Gagnon A: A 24-month clinical study of the Kandelman D, Gagnon A: A 24-month clinical study of the incidence and progression of dental caries in relation to incidence and progression of dental caries in relation to consumption of chewing gums containing xylitol in school consumption of chewing gums containing xylitol in school preventive programs. preventive programs. J Dent ResJ Dent Res 1990; 69:1771-1775. 1990; 69:1771-1775.
8.8. Isokangas P Alanen P, Tiekso J, Mäkinen KK: Xylitol chewing Isokangas P Alanen P, Tiekso J, Mäkinen KK: Xylitol chewing gum in caries prevention: a field study in children. gum in caries prevention: a field study in children. J Am Dent J Am Dent AssocAssoc 1988; 17:315-320 1988; 17:315-320
9.9. Isokangas P, Tiekso J, Alanen P, Mäkinen KK: Long-term effect Isokangas P, Tiekso J, Alanen P, Mäkinen KK: Long-term effect of xylitol chewing gum in the prevention dental caries. of xylitol chewing gum in the prevention dental caries. Comm Comm Dent Oral EpidemiolDent Oral Epidemiol 1989; 17:200-203. 1989; 17:200-203.
10.10. Isokangas P, Mäkinen KK, Tiekso J, Alanen P: Long-term effect Isokangas P, Mäkinen KK, Tiekso J, Alanen P: Long-term effect of xylitol chewing gum in the prevention dental caries: A of xylitol chewing gum in the prevention dental caries: A follow-up five years after termination of a prevention program. follow-up five years after termination of a prevention program. Caries ResCaries Res 1993; 27:495-498. 1993; 27:495-498.
11.11. Mäkinen KK, Bennett CA, Hujoel PH, it al: Xytiltol chewing Mäkinen KK, Bennett CA, Hujoel PH, it al: Xytiltol chewing gums and caries rates: a 40-month cohort study. gums and caries rates: a 40-month cohort study. J Dent ResJ Dent Res 1995; 74 1904-1913.1995; 74 1904-1913.
12.12. Mäkinen KK, Hujoel PH, Bennett CA, Isotupa KP, et al: Polyol Mäkinen KK, Hujoel PH, Bennett CA, Isotupa KP, et al: Polyol chewing gums and caries rates in primary dentition: a 24 chewing gums and caries rates in primary dentition: a 24 month cohort study. month cohort study. Caries ResCaries Res 1996; 30:408-417. 1996; 30:408-417.
13.13. Mäkinen KK, Allen P, Bennett CA, et al: Stabilization of Mäkinen KK, Allen P, Bennett CA, et al: Stabilization of rampant caries: polyol gums and arrest of dentin caries in two rampant caries: polyol gums and arrest of dentin caries in two long-term cohort studies in young subjects. long-term cohort studies in young subjects. Int Dent JInt Dent J 1995; 1995; 45: 93-107.45: 93-107.
14.14. Mäkinen KK, Pemberton D, Mäkinen P-L et al: Polyol-combinant Mäkinen KK, Pemberton D, Mäkinen P-L et al: Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--saliva stimulants and oral health in Veterans Affairs patients--an exploratory study. an exploratory study. Spec Care DentSpec Care Dent 1996; 16:104-116. 1996; 16:104-116.
15.15. Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries prevention: results of a field study in Estonian children. prevention: results of a field study in Estonian children. Community DentCommunity Dent Oral EpidemiolOral Epidemiol 2000; 28:218-224. 2000; 28:218-224.
FindingsFindings
““Xylitol was clinically proven to be Non-Xylitol was clinically proven to be Non-Cariogenic.”Cariogenic.”
Scheinin A, Mäkinen KK: Turku sugar studies I-XXI Acta Odontologica Scandinavia 33 (suppl 70): 1975
FindingsFindings
““Results suggest… that high-xylitol Results suggest… that high-xylitol content chewing gum usage can content chewing gum usage can retard or arrest rampant dentine retard or arrest rampant dentine caries.”caries.”
Mäkinen KK, Mäkinen PL, Pape HR.: Stabilization of rampant caries: polyol gums and arrest of dentine caries in two long-term cohort studies in young subjects. Int. Dent J 1995b; 45:93-107