Abstract
Data sources
Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science Conference Proceedings, Proquest Dissertations and Theses, US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No language or year restrictions were used.
Study selection
Randomised controlled trials assessing the effects of xylitol products on dental caries in children and adults.
Data extraction and synthesis
Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. Authors were contacted where possible for missing data or clarification where feasible. For continuous outcomes, means and standard deviations were used to obtain the mean difference and 95% confidence interval (CI). Continuous data was used to calculate prevented fractions (PF) and 95% CIs to summarise the percentage reduction in caries. For dichotomous outcomes, reported risk ratios (RR) and 95% CIs were used. As there were fewer than four studies included in the meta-analysis, a fixed effect model was used.
Results
Ten studies were included with a total of 5903 participants. One study was assessed as being at low risk of bias, two were assessed as unclear risk of bias with seven at high risk of bias. Over 2.5–3 years, low quality evidence demonstrated that with 4216 children analysed, a fluoride toothpaste with 10% xylitol (exact dosage unsure) reduced caries by 13% when compared to a fluoride only toothpaste. (PF −0.13, 95% CI −0.18 to −0.08. Remaining evidence of the use of xylitol in children has risk of bias and uncertainty of effect and was therefore insufficient to determine a benefit from xylitol. Four studies reported that there were no adverse effects from any of the interventions. Two studies reported similar rates of adverse effects between study arms. The remaining studies either mentioned adverse effects but did not report any usable data, or did not mention them at all. Adverse effects include sores in the mouth, cramps, bloating, constipation, flatulence and loose stool or diarrhoea.
Conclusions
Low quality evidence suggested that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it was derived from two studies that were carried out by the same authors in the same population. The remaining evidence was low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children or adults.
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References
Scottish intercollegiate guidelines. Prevention and Management of dental decay in the pre-school child. Available at: http://sign.ac.uk/guidelines/fulltext/83/index.html. [Accessed 9th May 2015]
Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. Third edition. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/367563/DBOHv32014OCTMainDocument_3.pdf [Accessed 9th May 2015]
Scottish intercollegiate guidelines. Dental interventions to prevent caries in children. Available at: http://sign.ac.uk/guidelines/fulltext/138/index.html [Accessed 9th May 2015]
Scheinin A, Makinen KK, Ylitalo K . Turku sugar studies. V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man. Acta Odontol Scand 1976; 34: 179–216.
Consort statement. Available at: http://www.consort-statement.org/ [Accessed 9th May 2015]
Clinical Trials database. Maternal Consumption of Xylitol to Reduce Early Childhood Decay (MaXED Study). Available at: https://clinicaltrials.gov/ct2/show/NCT01038479 [Accessed 9th May 2015]
Thorild L, Lindau B, Twetman S . Caries in 4-year-old children after maternal chewing of gums containing combinations of xylitol, sorbitol, chlorhexidine and fluoride. Eur Arch Paediatr Dent 2006; 7: 241–245.
Richards D, Duane B, Sherriff A . Maternal consumption of xylitol for preventing dental decay in children (Protocol). Cochrane Database Syst Rev 2012, Issue 11. Art. No. CD010202.
Author information
Authors and Affiliations
Additional information
Address for correspondence: Luisa Fernandez Mauleffinch, Managing Editor, Cochrane Oral Health Group, School of Dentistry, The University of Manchester, JR Moore Building, Oxford Road, Manchester, M13 9PL, UK. E-mail: luisa.fernandez@manchester.ac.uk
Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev 2015; 3: Art. No.: CD010743. DOI: 10.1002/14651858.CD010743.pub2.
This paper is based on a Cochrane Review published in the Cochrane Library 2015, issue 3 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
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Duane, B. Xylitol and caries prevention. Evid Based Dent 16, 37–38 (2015). https://doi.org/10.1038/sj.ebd.6401088
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DOI: https://doi.org/10.1038/sj.ebd.6401088
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