Is Xylitol Better Than Fluoride?

© 2015 by Kate Parker, RDH, BS-DH, RF

xylitol better than fluorideXylitol doesn't just help prevent cavities, but actually changes the DNA of cavity-causing bacteria

Xylitol was discovered in Europe in 1890, and has been used there as a cavity preventative and diabetic sugar alternative since WWII.

It's slowly catching on in the United States, showing up in some mainstream "sugar-free" gums and candies, and a few non-commercial toothpastes and mouthwash products.

With a growing number of people living with diabetes, it's become a sort of underground hit in that population since it's low calorie and doesn't affect blood glucose levels.

Xylitol is a hit in the dental community as well, although it's not nearly as popular in the US as it should be! After all, xylitol doesn't just help prevent cavities, but actually changes the DNA of cavity-causing bacteria. Over time, the bacteria can no longer adhere to the teeth: a main component in cavity formation. And yet this just scratches the surface of xylitol's immense benefits in the mouth. If you've read any of my other articles, you know that a healthy mouth affects the health of the entire body.

What Is Xylitol?

xylitol better than fluorideXylitol is a non-fermentable sugar alcohol that has 2.4 calories/gram and a Glycemic Index of 7

In essence, xylitol is a type of non-fermentable sugar found in the xylem layer of birch trees and other hardwoods. It's also naturally present in corn and in low levels in many fruits and vegetables (including berries, cauliflower, oats, and mushrooms.) Our bodies also produce up to 15 grams of xylitol daily as a byproduct of natural metabolic processes. 

Xylitol sugar has a sweetness comparable to normal table sugars, but with a lot less calories and much lower Glycemic Index (GI.) It can be used in cooking and baking (1:1 ratio with sugar.) However, it cannot be used in fermenting recipes (bread) because it is non-fermentable and yeast cannot process it.

  • Sugar has 4 calories/gram and a GI of 68
  • Xylitol has 2.4 calories/gram and a GI of 7

Billions of cariogenic (cavity-causing) bacteria live in your oral cavity. They consume fermentable sugars, excrete lactic acid, and dump toxic byproducts into the oral environment. When left undisturbed the lactic acid they produce eventually creates cavities.

  • Xylitol is a non-fermentable sugar alcohol and cariogenic bacteria cannot process it. It starves harmful oral bacteria and genetically interferes with the bacteria's ability to attach to the teeth over time. It also allows calcium ions to return to the teeth via saliva and is the best natural product to help remineralize teeth and prevent cavities from forming in the first place

Xylitol Production Process

xylitol better than fluorideBirch trees are tapped for their sap using a method similar to sugar maple tapping

Like just about anything these days, xylitol can either be mass-produced or extracted naturally.

There's a lot of debate online that xylitol sugar is as bad as any other processed sugars. If you purchase the commercially-produced xylitol, this is true. However, if you purchase naturally-derived xylitol, it is of course a different story.

Most commercially-produced xylitol comes from GMO corn cobs and goes through a complicated process of sugar hydrogenation. This form of xylitol is not recommended, but is the most commonly-available and commonly-used, especially in commercially available products like Trident gum.

Naturally-extracted xylitol is not mass-produced, and therefore costs more. However, it's a much more natural process. Birch trees are tapped for their sap using a method similar to sugar maple tapping. The natural xylitol is separated through evaporation and then crystalized in a manner similar to maple sugar production. Though some people say the birch trees are killed in the process, they are as intact as maple trees are after sugar tapping.

Generally anyone selling xylitol knows the difference between corn xylitol and birch xylitol. If they don't tell you which one it is, it's probably sourced from GMO corn. However, most companies that offer birch xylitol will make this fact known as a point of differentiation.

  • Avoid buying GMO corn xylitol that's commercially manufactured
  • Look for xylitol that specifically says "not from corn" or "real birch xylitol"

Is Xylitol Better Than Fluoride?

xylitol better than fluorideXylitol is 5 times more effective at preventing cavities and cavity-causing bacteria than fluoride

Xylitol specifically targets Mutans streptococci (MS) strains of oral bacteria more efficiently and effectively, and for a much longer term, than either chlorhexidine rinse or fluoride varnishes in all studies reviewed.1,2,6,7 MS is the main bacteria responsible for tooth decay in humans.

While fluoride has been seen to strengthen and remineralize teeth, as has xylitol, fluoride has not been adequately shown to actually prevent decay as significantly as xylitol use has.1,2,6,7 

In fact, the differences between xylitol and fluoride are significant. Soderling’s study found a five-fold decrease in oral MS with xylitol use, as compared with fluoride varnish use. The study noted a 71% reduction in caries (cavities) in the xylitol group, as compared to the fluoride group (14%).7

Another, separate study noted five-fold and six-fold decreases in MS colonization on the dentition (teeth) with the use of xylitol, as compared with the fluoride group.6 To further exemplify the anti-cariogenic (anti-cavity) effect of xylitol, Makinen’s large study in Finland states “the use of xylitol chewing gum was found to be as effective as fissure sealants.”4

Overall, MS was reduced in the xylitol groups as compared to the fluoride groups in all of the studies reviewed, in addition to significantly lower caries decay rates in children in the xylitol groups as compared to the fluoride groups.1,2,6,7  

Xylitol’s anti-cariogenic (anti-cavity) and cariostatic (cavity inhibition) effects were much more long-term and were far superior to fluoride varnishes.6 Five years after xylitol use was discontinued, children’s salivary MS levels were still significantly lower in the xylitol groups than in the fluoride varnish groups.

xylitol better than fluoride6. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J

The Alamoudi article states that “several studies have shown xylitol to reduce the amount, adhesiveness, and acidogenic potential of dental plaque.”1 Xylitol use has also been shown to retard the regrowth of dental plaque, reduce the amount of plaque that is produced, and to significantly inhibit plaque formation in the first place.7

In addition, and with continued and habitual use of xylitol products daily, “resistant” strains of the MS bacteria present themselves and begin to replace all “normal” strains of MS in the mouth. Xylitol-resistant strains of MS begin to develop within weeks of habitual daily use. No detrimental effects of “xylitol-resistant” bacteria were noted in any of the studies reviewed.6-8

These resistant strains of MS have characteristics that are positive for the oral cavity as a whole. For example, they have diminished adhesive properties, meaning that rather than bonding to the tooth surface, MS and other bacteria shed out from the plaque and into the saliva. These xylitol-resistant strains form from a seemingly natural mutation when MS colonies are exposed to xylitol on an ongoing basis. These changes to the MS appear to be permanent, or at the very least, the effects may last for many years after xylitol use has been discontinued (5 years has been documented.)6-8

  • Xylitol is 5-6 times more effective at decreasing cavity-causing oral bacteria than fluoride
  • Xylitol is 5 times more effective at preventing cavities than fluoride (xylitol: 71% caries reduction, vs. fluoride: 14% caries reduction)
  • Xylitol use changes cavity-causing bacteria's DNA, affecting their ability to adhere to the tooth surface 
  • Even short-term use of xylitol can have positive anti-cavity effects for up to 5 years

Xylitol Dosage & Side Effects

Dosage:

For the anti-cavity effect to be as effective as possible, at least 6-10 grams of xylitol should be used and/or consumed daily.

This can be in the form of xylitol gumsmintscandiesxylitol sugar crystals, or foods and drinks made with xylitol. Xylitol can be used topically by brushing with xylitol toothpaste or swishing with xylitol mouthwash.

Side Effects & Warnings:

xylitol better than fluorideXylitol can be toxic or poisonous to dogs

Over-consumption of xylitol can cause gastrointestinal issues like gas, bloating, and diarrhea. Every person is different and will react differently to xylitol consumption. I've never personally had a problem, but it depends on the state of your gut. In one study, participants consumed a diet containing a monthly average of 3 pounds of xylitol with a maximum daily intake of 430 g with no apparent ill effects. However, most things are better in moderation, so that's what I advise.

If you have SIBO (Small Intestinal Bacterial Overgrowth) avoid consuming xylitol. People with SIBO can't digest small chain carbohydrates and will get quite ill when consuming xylitol. However, they can still use xylitol toothpastes and mouthwashes topically to help prevent cavity-causing oral bacteria.

  • Dogs should never be allowed to eat xylitol. Much like chocolate or grapes, xylitol can be toxic or poisonous to dogs, and even fatal in extreme cases

However, xylitol is great for helping cats maintain their oral health. A teaspoon of xylitol can be mixed into their water bowl. This will naturally help decrease dental plaque in their mouths and help prevent cavities. 

Xylitol Products

With the growing popularity of xylitol, many products of all kinds have become available, especially in the last decade. 

Reminder: make sure to avoid GMO corn xylitol and opt for natural birch xylitol when consuming xylitol products. Topical applications don't matter as much since they aren't being consumed. One may argue that xylitol of any type is better for the health of the body than commercial sugar or agave.

Here are some products that you should consider adding to your daily regimen.

All sorts of products now exist in the xylitol market. They are all sweet and range from toothpaste, mouthwash, mints, candies, gums, xylitol sugar crystals, to delicious baked goods

Sources

1. Alamoudi NM, Hanno AG, Sabbagh HJ, Masoud MI, Almushayt AS, El Derwi DA. Impact of maternal xylitol consumption on mutans streptococci, plaque, and caries levels in children. Int J Clin Pediatr Den. 2012;37(2):163-6.

2. Burt BA. The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Am Dent Assoc. 2006 Feb;137:190-6.

3. Hopper BL, Garcia-Godoy F. Plaque reduction in school children using a disposable brush pre-pasted with xylitol toothpaste. J Tenn Dent Assoc. 2014 Fall-Winter;94(2):25-8; quiz 29-30.

4. Makinen KK, Jarvinen KL, Anttila CH, Luntamo LM, Vahlberg T. Topical xylitol administration by parents for the promotion of oral health in infants: a caries prevention experiment at a Finnish Public Health Centre. Int Dent J. 2013;63:210-24.

5. Nakai Y, Shinga-Ishihara C, Kaji M, Moriya K, Murakami-Yamanaka K, Takimura M. Xylitol gum and maternal transmission of mutans streptococci. J Dent Res. 2010 Jul;89(1):56-60.

6. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res. 2000;79(3):882-7.

7. Soderling EM. Xylitol, mutans streptococci, and dental plaque. Adv Dent Res. 2009;21:74-8.

8. Thorild I, Lindau B, Twetman S. Effect of maternal use of chewing gums containing xylitol, chlorhexidine or fluoride on mutans streptococci colonization in the mothers’ infant children. Oral Health Prev Dent. 2003;1:53-7.


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