Cavities, technically called dental caries, are caused by a bacteria called Streptococcus mutans. This bacteria lives in the mouth and thrives on sugar and other carbohydrates. In the presence of carbohydrates, S. mutans produces acids that dissolve the enamel of teeth, causing cavities.
Strong evidence indicates that fluoride toothpastes help prevent cavities. These toothpastes are so widely used, in fact, that water fluoridation is probably of little to no value except in poorer, less developed countries where use of fluoride toothpastes is not so universal.23
Double-blind studies enrolling almost 4,000 people, mostly children, have found that the natural sugar xylitol can prevent cavities.3-8 These trials used xylitol-sweetened gum, candies, or toothpaste. The best evidence regards xylitol gum. One study suggested that gummi bears may be an effective alternative method of administering xylitol to children.24
In one of the largest of these trials, researchers tested gum sweetened with various concentrations of xylitol and/or sorbitol against gum sweetened with sucrose and a control group receiving no gum.4 This 40-month trial was completed by 861 children. Gum containing 100% xylitol reduced the incidence of cavities the most. However, all of the xylitol and sorbitol gum groups showed significant reductions in cavities as compared to the control group. In contrast, the children receiving sucrose-sweetened gum had a slight increase in cavities compared to the control group.
A double-blind, placebo-controlled study of 1,677 children compared a standard fluoride toothpaste with a similar toothpaste that also contained 10% xylitol.8 Over the 3-year study period, children given the xylitol-enriched toothpaste developed significantly fewer cavities than those in the fluoride-only group. Studies in adults and children have shown similar results for xylitol gum and candy.6,9
Another series of studies suggests that children acquire cavity-causing bacteria from their mothers, and that regular use of xylitol by a mother of a newborn child may provide long lasting protection to the child as well.10-12
Xylitol is thought to prevent cavities by inhibiting the growth of the Streptococcus mutans bacteria.13
For more information, including dosage and safety issues, see the full Xylitol article.
Another sugar substitute called sorbitol may work as well as xylitol for the prevention of cavities in children.3 However, xylitol appears to work better than sorbitol for preventing cavities in adults.
Friendly bacteria ( probiotics) have been proposed for the prevention of cavities, on the ground that they can fight harmful cavity-causing bacteria.17 The best evidence regards a probiotic product called Lactobacillus GG (LGG). In a double-blind, placebo controlled trial, 594 children aged 1-6 years old were given either normal milk or milk with LGG had been added.14 After the 7-month trial, the results showed significantly fewer cavities in the children receiving LGG.
One study failed to find benefit through the use of calcium-rich chewing gum.21
1. Marinho VC, Higgins JP, Sheiham A, et al. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278.
2. Marinho VC, Higgins JP, Logan S, et al. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2002;(3):CD002279.
3. Gales MA, Nguyen T-M. Sorbitol compared with xylitol in prevention of dental caries. Ann Pharmacother. 2000;34:98-100.
4. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res. 1995;74:1904-1913.
5. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study. Caries Res. 1996;30:408-417.
6. Makinen KK, Pemberton D, Makinen P-L, et al. Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients—an exploratory study. Spec Care Dent. 1996;16:104-115.
7. Isokangas P, Alanen P, Tiekso J, et al. Xylitol chewing gum in caries prevention: a field study in children. J Am Dent Assoc. 1988;117:315-320.
8. Sintes JL, Escalante C, Stewart B, et al. Enhanced anticaries efficacy of a 0.243% sodium fluoride/10% xylitol/silica dentrifrice: 3-year clinical results. Am J Dent. 1995;8:231-235.
9. Alanen P, Isokangas P, Gutmann K. Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol. 2000;28:218-224.
10. Soderling E, Isokangas P, Pienihakkinen K, et al. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Res. 2001;35:173-177.
11. Isokangas P, Soderling E, Pienihakkinen K, et al. Occurrence of dental decay after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. J Dent Res. 2000;79:1885-1889.
12. Soderling E, Isokangas P, Peinihakkinen K, et al. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 2000;79:882-887.
13. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998;102:879-884.
14. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res. 2001;35:412-420.
15. Dodes JE. The amalgam controversy. An evidence-based analysis. J Am Dent Assoc. 2001;132:348-56.
16. Marinho VC, Higgins JP, Logan S, et al. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;CD002284.
17. Nikawa H, Makihira S, Fukushima H, et al. Lactobacillus reuteri in bovine milk fermented decreases the oral carriage of mutans streptococci. Int J Food Microbiol. 2004;95:219-223.
18. Hong SJ, Jeong SS, Song KB, et al. Effects of sanguinaria in fluoride-containing dentifrices on the remineralisation of subsurface carious lesion in vitro. Int Dent J. 2005;55:128-132.
19. Weiss EI, Kozlovsky A, Steinberg D, et al. A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro adhesion to hydroxyapatite. FEMS Microbiol Lett. 2004;232:89-92.
20. Hayashi Y, Ohara N, Ganno T, et al. Chewing chitosan-containing gum effectively inhibits the growth of cariogenic bacteria. Arch Oral Biol. 2006 Nov 15 [Epub ahead of print]
21. Schirrmeister JF, Seger RK, Altenburger MJ, et al. Effects of various forms of calcium added to chewing gum on initial enamel carious lesions in situ. Caries Res. 2007;41:108-114.
22. Tagashira M, Uchiyama K, Yoshimura T, et al. Inhibition by hop bract polyphenols of cellular adherence and water-insoluble glucan synthesis of mutans streptococci. Biosci Biotechnol Biochem. 1997;61:332-335.
23. Pizzo G, Piscopo MR, Pizzo I, et al. Community water fluoridation and caries prevention: a critical review. Clin Oral Investig. 2007;11:189-193. Epub 2007 Feb 27.
24. Ly KA, Riedy CA, Milgrom P, et al. Xylitol gummy bears snacks: a school-based randomized clinical trial. BMC Oral Health. 2008 Jul 25.
Last reviewed September 2014 by EBSCO CAM Review Board
Last Updated: 9/18/2014
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