The basis for the answers in this section are taken in large part from excerpts of Sweeten Your Smile, by John Peldyak, DMD.
What is Xylitol?
Xylitol is a natural Sugar-Alcohol produced in small amounts by the human body and found naturally in many fruits, berries, vegetables, and mushrooms. Sometimes called “Birch Sugar”, Xylitol is presently mainly made commercially in Finland by chopping up and rendering “xylan” from the structural wood fiber of birch trees. Present research is under way for other commercially viable sources in the US such as corn husk. Pure Xylitol is a white crystalline substance that looks and tastes like sugar. It is just as sweet as sugar and as bulk sweetener, can be used spoon for spoon in recipes and cooking in place of sugar. On food labels, Xylitol is classified broadly as a carbohydrate and more narrowly as a polyol. Because Xylitol is only slowly absorbed and partially utilized, a lower glycemic value and a reduced calorie claim is allowed: 2.4 calories per gram or 40% less than sugar.
Xylitol has been used in foods since the 1960s. It is a popular sweetener for the diabetic diet in some countries and has been approved in the U.S. as a food additive since 1988.
Over 25 years of testing in widely different conditions confirm that Xylitol is the best sweetener for teeth. Xylitol used regularly reduces tooth decay rates both in high-risk groups (high caries prevalence, poor nutrition, and poor oral hygiene) and in low risk groups (low caries incidence using all current prevention recommendations).
Sugarfree chewing gums and candies made with Xylitol as the principal sweetener (100% xylitol sweetened) have already received official endorsements from six national dental associations.
Why Use Xylitol?
Studies using Xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with arrest and even some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This Xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.
Xylitol is right here, inside, already. Our bodies produce up to 15 grams of Xylitol every day from other food sources using established energy pathways. Xylitol is not a strange or artificial substance, but a normal part of everyday metabolism.
Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms and lettuce. One cup of raspberries contains less than one gram of Xylitol.
Chewing is a natural process and chewing gums provide some exercise lacking in a refined diet. If chewing is uncomfortable, xylitol mints or candies can also stimulate saliva, the natural tooth protector.
The FDA has ruled that Xylitol is safe in any amount. However, there is a laxative effect that must be considered. In the amounts needed to prevent tooth decay and dental health (less than 15 grams per day), Xylitol is safe for everyone. In larger amounts, your digestive tolerance to xylitol, like some fruits and vegetables, (and beans) may require you to start with small amounts, 15-20 grams, and build up slowly. Daily intakes of 30-40 grams of xylitol per day is safe, but can have a laxative effect and cause diarrhea in some people. While there are exceptions and some people have built-up much larger tolerances, daily intakes of over 50 grams of Xylitol per day can have a laxative effect on many people. One Pound of Xylitol crystals = 455 grams and an ounce = 28.4 grams.
Xylitol can be conveniently delivered to your teeth via chewing gum, tablets, or even candy. You can implement your Xylitol program anywhere, anytime. It fits right in with the most frantic schedules. You don’t need to change your normal routine to make room for Xylitol.
Some health regimens require iron willpower, discipline, and commitment. But Xylitol tastes so good that it becomes automatic. Children love it! Nagging is minimized.
It is not necessary to replace all sweeteners to get the dental benefits of Xylitol. Look for Xylitol-sweetened products that encourage chewing or sucking to keep the xylitol in contact with your teeth for at least 4-5 minutes at a time.
Studies show that 4 to 12 grams of xylitol per day are very effective. It’s easy to keep track of your Xylitol intake. The “all Xylitol” mints and gums contain about one gram of xylitol in each piece. You could begin with as little as one piece four times a day for a total of four grams. It is not necessary to use more than 15 grams per day as higher intakes yield only small additional dental benefits.
CONSISTENCY IS IMPORTANT, use daily. If used only occasionally or even as often as once a day, Xylitol may NOT be effective, regardless of the amount.
FREQUENCY IS THE KEY, Use Xylitol at least three, and preferably 5 times every day. The anticariogenic effect of xylitol stems partly from the affected bacteria population in the mouth and partly from the properties of saliva. Xylitol is a natural and convenient way of supplementing daily dental care. Research shows that a mere 5-10g/ day is enough. In practice, this means 5-10 pieces of chewing gum (or mints) a day.
Use immediately after eating and clearing the mouth by swishing water, if possible. The pieces should be chewed immediately after a meal or a snack. If you eat more snacks, you of course need more frequent help from xylitol. Between meals and snacks, replace ordinary chewing gum, breath mints, or breath spray with comparable xylitol products.
What Causes Tooth Decay?
Dental caries (tooth decay) is a multifactorial disease process. Enamel, the mostly inorganic hard outer tooth layer, is dissolved (demineralized) by acids produced from sugars by plaque bacteria. Bacteria can more rapidly invade and eat away the inner dentin layer because it is softer and contains more organic material. The tooth surface is in a dynamic state of flux between demineralization (destruction) and remineralization (repair). Acid conditions (lower pH) favor the loss of calcium and phosphate from the tooth while neutral or alkaline (higher pH) conditions help to replace minerals.
Individuals susceptible to tooth decay tend to have less buffering capacity against plaque acid. Their saliva pH tends to drop lower and recover more slowly. Demineralization predominates at lower pH, beginning at around 5.7. Thicker plaque helps to hold acid against teeth and leads to surface destruction that begins in localized sheltered areas.
Tooth decay occurs at the intersection of the necessary elements: bacterial plaque acids dissolving a susceptible tooth over time. Xylitol interferes with all of the destructive elements and helps to tilt the balance in favor of dental protective factors.
Can Xylitol Prevent Tooth Decay?
Yes, Xylitol is non-acidogenic and non-cariogenic. Xylitol is essentially non-fermentable and therefore cannot be converted to acids by oral bacteria (primarily strep mutans, the main bacteria responsible for tooth decay). Xylitol can even be left on the teeth overnight and not cause any damage. With proper use, xylitol can stop the formation of tooth decay (cariostatic).
Can Xylitol Reverse Tooth Decay?
Yes, to a minor degree. Xylitol is not merely an inert bystander but can exert an active counter force to decay (anticariogenic). This depends upon how the xylitol is used. The delivery method, the amount, the timing, and the frequency are important. (Kept in the mouth for at least 5 minutes after meals and snacks, 4-5 times daily) Xylitol can enhance the remineralization or healing process. This remineralization happens best in small decay spots just beginning in the enamel. Larger holes won’t go away and will still require a filling or restoration, but they can harden and become less sensitive.
Should You Avoid Sugar And Only Use Xylitol?
Dentists recognize the futility of advice to avoid sugars. It is behaviorally unrealistic and besides, any fermentable carbohydrate can contribute to tooth decay. Even folks who claim they eat “no sugar” may expose their teeth to significant sources from honey, malt syrup, rice syrup, fruits and even medications. Given enough time, salivary enzymes can break down starch into simple sugars.
Replacing all dietary sugars, or even just the “accessible” sugars in the diet with xylitol is expensive and impractical. Thankfully it is also unnecessary. Just a little bit of xylitol in chewing gum (or in a form that can be kept in contact with the teeth for awhile), is all that is needed to blunt the “acid attack” after eating.
Consistently using small amounts of xylitol tends to increase protective factors in saliva and help maintain pH in the safe range above 5.7. Oral pH becomes less acidic with continued xylitol use. There is more saliva with greater buffering capacity so demineralizing conditions seldom occur.
Because saliva productions decreases during sleep, xylitol should be used after late-night snacks or medications (syrups and chewable tablets often contain sugar).