Guideline on Xylitol Use in Caries Prevention

Council on Clinical Affairs. Guideline on xylitol use in caries prevention. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2011. 4 p. [51 references]

Clinicians may consider recommending xylitol use to moderate or high caries risk patients. Those recommending xylitol should be familiar with the product labeling and recommend age-appropriate products. They should routinely reassess (not less than once every 6 months) a patient for changes in caries-risk status and adjust recommendations accordingly.
There is accumulating evidence that total daily doses of 3 to 8 grams of xylitol are required for a clinical effect with the currently available delivery methods of syrup, chewing gum, and lozenges. Dosing frequency should be a minimum of 2 times a day, not to exceed 8 grams per day. Although tables of clinically effective xylitol containing products have recently been published, the products are continually changing.
Chewing gum has been the predominant modality for xylitol delivery in clinical studies. Studies that have utilized xylitol-containing mints and hard candies have shown them to be as effective as xylitol-containing chewing gum. The American Academy of Pediatrics (AAP) does not recommend use of chewing gum, mints, or hard candy by children less than 4 years of age due to the risk of choking. A randomized trial of xylitol syrup (8 g/day) reduced early childhood caries by 50 to 70 percent in children 15 to 25 months of age. Another study showed that gum or lozenges consumed by children at 5 grams total dose per day at about age 10 resulted in 35 to 60 percent reductions of tooth decay, with no differences between the delivery methods. Xylitol containing gummy bears, other confections, and even milk have been studied as delivery vehicles, but they are neither well established scientifically nor available commercially at present. A pacifier with a pouch containing slow release xylitol in tablet form, not yet available in the United States, has shown high salivary xylitol concentrations and may be a potential delivery vehicle for infants. Currently, xylitol-containing chewing gum, mints, energy bars and foods, nasal sprays, and oral hygiene products (e.g., mouth rinse, gels, wipes, floss) are commercially available through retail or online venues. However, they may not contain the necessary therapeutic level, xylitol as the only sweetener, or adequate labeling.
Studies using toothpaste formulations with 10% xylitol (dose of 0.1 g/brushing) have shown reduction in m