You know it's in chewing gum but now it's in toothpaste? What is it supposed to do, fight cavities or make you want to brush more?
Table of Contents
What is xylitol?
It is commonly known as an artificial sweetener alongside stevia but that is technically incorrect because it is naturally extracted from plant materials. Most commonly extracted from birch tree sap and sometimes known as birch sugar. It was first synthesized in 1891 somewhere in Europe but didn't make its appearance in the commercial market until later part of the 1900s. Here are some additional facts:
It is a sugar alcohol.
It is a non-nutritive sweetener. It means that it does not provide much energy when it is consumed vs regular sugar like sucrose.
Commonly found in toothpastes, chewing gum, lozenges, tablets, and breath mints.
Can xylitol toothpaste prevent cavities?
According to a 2015 Cochrane study that analyzed 10 different clinical trials, a fluoride toothpaste with 10% xylitol may reduce cavities by about 13% when compared to a regular fluoridated toothpaste.
However the evidence appears to be of low quality but they did conclude that such a toothpaste did not cause any adverse effects. Recommendation was to conduct further large scale studies since evidence is weak. Two of the studies that reported favorable results were conducted by the same author and also on the same population. The rest of the studies were insufficient to determine any effects.
Xylitol toothpaste with or without fluoride?
Based on the conclusion from the study above, a fluoride toothpaste with xylitol may be more effective than just a fluoridated one in preventing caries. There was no evidence that a non-fluoridated one would be more effective.
Here are a couple of common brands of xylitol toothpaste that contain fluoride:
Spry Xylitol toothpaste with fluoride
Epic Dental Xylitol toothpaste with fluoride
Cleure Original toothpaste
Here are a couple of brands without fluoride:
Xyliwhite
Xylibrite
Spry without fluoride
Epic dental without fluoride
Forget the toothpaste, can Xylitol reverse cavities and how does it work?
Since the Cochrane study was of low quality and weak evidence for the toothpaste, what about plain old xylitol. Has there been studies that show it can fight teeth decay?
According to this study: Apparently xylitol does disrupt the energy production process for mutans streptococci, which are bacteria that are present in plaque and saliva.
The mechanism the bacteria processes the sugar alcohol results in a net energy loss.
Reduces the adhesion of the bacteria to tooth surfaces.
Reduces their acid production potential.
Basically, for the bacteria to process the xylitol, it ends up starving itself to death since it loses energy from trying to do so. The final product is also not acid producing, so the byproducts are not harmful to the tooth enamel either.
Additional benefit
Lastly, a big benefit of xylitol chewing gum is that it significantly increases the salivary flow, thereby increasing the pH level of the oral environment which is detrimental to the bacteria.
The critical pH level of when bacteria can start causing cavities is around 5.5 pH
The saliva acts as a buffer and raises the pH so that the bacteria cannot work as efficiently nor effectively.
This is an indirect effect of xylitol but it has more to do with our parasympathetic nervous system entering Rest and Digest. Any type of non-sugar containing food will also elicit the same effects so it is not exclusive to the non-nutritive sweetener.
How much xylitol do you need?
It seems as if the sugar alcohol does have a positive direct effect and also an indirect effect on preventing cavities. The only caveat is that in order to achieve the stated results, you would need to consume or chew about 5-6 grams of xylitol three times a day for about 20 minutes each time.
That amount of xylitol may be problematic because the xylitol that can be found in trident gum is approximately 0.17-0.20 g for each piece. You would need to be chewing a LOT of gum in order to reach the desired results. The study showed that any level below the 5-6 g mark did not produce any noticeable cavity prevention effects.
Chewing more than 10 grams also did not produce a significant increase in cavity prevention either.
It appears as if the threshold for effect was around 5-6 grams and anymore was not beneficial.
To reach the threshold, you would need to chew approximately 2 entire packs of trident gum. Each pack contains 14 pieces. That's a lot of chewing gum.
Is it safe to take that much?
It is not processed completely by our gut so it does tend to cause flatulence or farting.
For children, at 45 grams it may cause diarrhea.
For adults, at 100 grams it may cause diarrhea.
It would be highly unlikely and quite difficult for us to consume enough xylitol to cause intestinal problems since the gum contains so little of it. This gives us a wide window of safety in using this product. It was also concluded in the first study that it was quite safe in toothpaste and the high threshold explains why.
Therefore it is very safe for humans but unfortunately for pets it is a different story. According to the FDA, xylitol is extremely toxic to dogs so you shouldn't leave it near your pet. Cats seem to be unaffected by it.
Discussion
Overall, a xylitol toothpaste does not appear to have any detrimental effects and it may be helpful in preventing cavities. It does not have strong evidence for it though but at the same time, it doesn't hurt.
A non-fluoridated xylitol toothpaste would not be recommended because there are no appreciable benefits vs a fluoridated one. Xylitol does not remineralize tooth enamel like fluoride does so you lose out on that benefit.
Fluoride ions replace the hydroxyl group of hydroxyapatite to form fluoroapatite, which is more stable, harder, and more acid resistant.
Hydroxyapatite is what 90% of teeth are made out of.
If you wanted an alternative, we would recommend a hydroxyapatite toothpaste if you wanted a fluoride free option. Just xylitol wouldn't cut it on a dentist's A-List.
Conclusion
Overall, nothing bad about this sweetener added to a fluoride toothpaste so if you want to use it go for it! There is no harm, just make sure there is fluoride in it.
If anything, it may make you want to brush more since it could potentially taste better. Our dentists at 1311 Jackson Ave Dental have always encouraged our patients to just pick whatever toothpaste will make them want to brush more. Although we do think that it would be good psychologically to ween off of the sugary taste. I guess that would be the downside to being dependent on this sugar alcohol.
