Effectiveness of xylitol toothpaste in preventing dental caries among young children

Abstract

Dental caries is one of the most prevalent preventable diseases affecting many children worldwide. Toothpaste containing at least 1000 ppm fluoride is recommended for home care to prevent dental caries in children. However, concerns with fluorosis have led to the introduction of non- or low-fluoride toothpaste, one of which is xylitol toothpaste.

A systematic review (Paper 1) was undertaken to determine the effectiveness of xylitol toothpaste in caries prevention. Ten studies with 5296 participants informed the review, and the evidence was weak and inconsistent. Only five studies showed a significant reduction in caries experience (P<0.001), or S. Mutans level in plaque (P<0.001) or saliva (P<0.001) after using xylitol toothpaste. More well-designed clinical trials are needed.

Subsequently, a two-year double-blind, paralleled arm randomised controlled trial (RCT) was conducted to evaluate the effectiveness of xylitol toothpaste in caries prevention among young children with high caries risk.

A cross-sectional analysis of baseline data from the RCT was performed (Paper 2). The paper evaluated the relationships between parental oral health attitude and knowledge and their children’s oral health-related behaviours and oral health conditions. There were 579 parent-infant dyads. Almost all the infants (mean age: 14.3±1.0 months) (99.5%) did not have a dental home. Better parental oral health attitudes (P<0.05) and knowledge (P=0.023) were associated with appropriate oral hygiene practices and hence, better oral hygiene, which suggests the importance of early oral health education for parents. Paper 3 reported the oral microbiome of the infants at baseline. Their S. Mutans level in plaque and saliva were investigated using DNA extraction and real-time PCR analysis. Infants with cavitated carious lesions (P=0.016) had a higher proportion of S. Mutans level in plaque. No significant association was found in S. Mutans level in saliva.

The clinical findings of the RCT to evaluate the effectiveness of xylitol toothpaste in preventing dental caries compared to fluoride toothpaste among 472 high caries risk young children was described in Paper 4. The children were randomly assigned to use 25% xylitol (xylitol group, n=240) or 1000 ppm fluoride toothpaste (fluoride group, n=232) for toothbrushing twice a day for two years. The children were regularly monitored to review their oral condition and to reinforce their oral hygiene. The incidence of dental caries at two-year follow-up was 9.5%, with a relative risk value of 0.92 (95%CI: 0.50, 1.69). There was no significant difference in caries incidence between the groups (xylitol group: 9.2%, fluoride group: 9.9%; P=0.876). Children in the xylitol group had a lower mean visual plaque index (xylitol group: 0.27±0.25, fluoride group: 0.31±0.30; P=0.034).

The genetic variation of bacteria in the plaque of the children with or without caries after using xylitol or fluoride toothpaste was described (Paper 5). Selected plaque samples collected at baseline, 1-year and 2-year follow-up were analysed using next-generation sequencing.

The effectiveness of toothbrushing twice daily with 25% xylitol toothpaste in caries prevention among young children was comparable to the current recommended standard 1000 ppm fluoride toothpaste. Xylitol toothpaste could modulate the oral S. Mutans level.