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Previous What's New Articles
- April 2008 - Exercise, Nutrition, Dental Health
- September 2006 - Osteonecrosis
- August 2006 - Lasers in Dentistry
- July 2005 - Decay Prevention with Xylitol
- June 2005 - Periodontal Disease
New Concepts in Decay Prevention
For a cavity to develop, decay causing bacteria must be present, there must be a food source (carbohydrate) for the bacteria, and the food source must stay around long enough for the bacteria to develop the acid plaque that causes the destruction of tooth structure. Traditional dental preventive care has focused on mechanically removing the acid plaque through brushing and flossing, and advising patients to avoid carbohydrate foods that feed the bacteria. While these are effective methods of halting decay, new understanding of the biology or cavity development is leading to alternative methods of prevention aimed at other steps in the decay process. Products and techniques are now available that reduce the decay causing bacterial populations in the mouth, neutralize the acid environment that causes the decay, or remineralize weakened tooth structure to stop cavity formation in its early stages. Below we have detailed some of these new ideas and how they work.
Xylitol – a natural sugar that halts decay
It seems amazing that a naturally occurring sugar could actually be a major deterrent to decay, but that is what is being shown with xylitol. Xylitol is a five carbon sugar found in hardwood such as birch and beech, in nut shells, grains, and some vegetables and fruits. It was discovered in the late 1800’s and was used in Europe during World War 2 as a sugar substitute. After the war, its use was limited to hospital use for diabetics. In the 1970’s Finland developed large scale production of xylitol for use as a sweetener in chewing gum, and research regarding its dental benefits began.
How does xylitol work?
- It reduces and alters the bacterial population of strep mutans.
Xylitol is a five carbon sugar which strep mutans recognizes as a sugar, actually preferring it to sucrose. Whereas sucrose (the most common sugar in food) has six carbons and is readily metabolized by the bacteria, xylitol’s different chemical structure keeps it from being metabolized by the bacteria. The result is an interruption of protein synthesis and an alteration of the bacteria population in the mouth of strep mutans. The xylitol does not actually kill bacteria; it inhibits their growth and causes the bacteria to be less virulent.
- It reduces the acid nature of the mouth Because the bacteria can not utilize xylitol as a food source, they can not produce the acid byproduct that causes tooth destruction. This results in a neutral condition in the mouth that is not conducive to the decay process.
- It affects the characteristics of plaque present from other sources Xylitol has properties that lead to a change in overall plaque in the mouth, causing the plaque that does develop from other sources to be less adhesive and hence easier to remove.
- It stimulates saliva flow and leads to remineralization of damaged tooth enamel The sweet, cool taste of xylitol is highly effective at stimulating saliva flow, and this in turn helps dilute any acids in the mouth. Increased saliva flow also facilitates remineralization of damaged tooth enamel by delivering to the tooth site minerals contained in the saliva such as calcium, phosphate, or fluoride. Xylitol also can combine with calcium to form calcium-xylitol complexes that aid in remineralization.
- It helps reduce the passing of bacteria from person to person
Two amazing studies in Finland found that xylitol can actually help prevent cavities in young children if it administered to their mothers. Infants do not have the bacteria strep mutans in their mouths until the bacteria is passed to them, most likely through close contact with parents. If parents can lower their population of strep mutans by using xylitol, their infant is less likely to acquire the bacteria and hence less likely to develop cavities. In the Finnish study, children whose mothers consumed xylitol had much lower colonization by strep mutans, and at age five, showed 70% less cavities than other groups, even groups who received other recognized methods of decay prevention such as fluoride application.
Is xylitol safe?
Xylitol is a naturally occurring sugar present in many foods and is metabolized as a normal carbohydrate, being converted to glucose and stored as glycogen or oxidized to carbon dioxide and water. It is absorbed more slowly than other carbohydrates. The only side effect of xylitol ingestion may be diarrhea when a large quantity - about 40 grams or more - is ingested. The amount of xylitol needed to provide dental benefits is small – 6 – 12 grams. Diabetics can safely consume up to 70g of xylitol per day, and infants can also safely metabolize xylitol. It should be noted that xylitol can be dangerous for dogs, so make sure you keep any xylitol products out of reach of family pets. For a more thorough discussion of the metabolism and safety of xylitol, go to http://xylitol.org/drmakinen.asp.
How can xylitol products be found? How is xylitol administered as a decay preventive?
Xylitol has been in use in Europe and Japan as a sugar substitute for many years. It has been less available in the United States because this country has utilized other suagar substitute products such as aspartame instead. As the research has shown xylitol’s benefits regarding dental health, it is gaining acceptance, but there is no widespread U.S. distribution of xylitol products at this time.
Xylitol is also available in the rinse Biotene available at drug stores, and in some toothpastes.
Other xylitol products such as mints and xylitol sugar are available in health food stores or can be purchased through Internet providers. At this time, our office staff is taste testing various xylitol products to provide recommendations, and we are looking into providing xylitol products in out dental office. If you are interested in obtaining xylitol products here, please email us at drkayesfrontdesk @gmail.com and we will inform you when we have products available.
To be effective, xylitol should remain in the mouth for five minutes, and is best if it is consumed three times a day. Gum or other products that remain in the mouth are therefore the preferred method of delivery, but if a person can not chew gum, rinses or mints are still appropriate. Xylitol can be especially effective if consumed immediately after eating or immediately after consuming acidic products such as sodas or fruit drinks. This makes gum the preferred method of delivery.
Calcium Phosphate – a new remineralization product
Whenever teeth are exposed to acid through bacterial action or through acidic food or drink, they experience a minute loss of enamel. In the case of bacterial action the result is decay, but there is a different problem that occurs from the chemical acid attack from acidic foods or beverages. Chemical acid attack can result in eroded enamel if a person’s diet habits cause repeated exposures. Sodas and drinks with phosphoric acid, including diet sodas, are the worst contributors to this problem. Consumption of xylitol products listed above can help neutralize the acid in the mouth, but there are additional products available to help restore enamel that has been lost to erosion or decay.
The key to remineralization is to provide the minerals necessary for strengthening enamel before the attack has progressed to produce a cavity or severe erosion. Therefore, to be effective, remineralization should begin as soon as a potential problem is noted. Remineralization products include fluoride products and calcium phosphate products.
Fluoride is a long recognized method of remineralizing teeth and can be delivered through the water supply, in toothpastes, rinses, or supplements, or at the dental office through fluoride treatment or fluoride varnish. A discussion of various fluoride products may be found in the dental health section of this website.
Calcium phosphate and other calcium products delivered directly to the teeth are new ways to help achieve remineralization. When a tooth is attacked by acidic food or drink, bacteria, calcium and phosphate are removed. In addition, if saliva flow is reduced, the calcium and phosphate that is normally contained in saliva is less available for remineraliztion. Fluoride works at remineralization, but calcium and phosphate are additional components of enamel and in cases of erosion, dry mouth, or tendency towards severe decay, adding these products can improve remineralization.
Few over the counter products exist that utilize calcium. Arm and Hammer Enamel care toothpaste is one product that may be helpful particularly with acid caused eroison to restore luster to the teeth. Trident whitening gum with Recaldent is another product containing calcium phosphate. A special polishing paste available at our dental office may also aid in improving remineralization.
It should be noted that regular consumption of calcium rich foods can help insure an adequate amount of calcium in saliva to aid in remineralization.