Earlier this month a study called the “Xylitol for Adult Caries Trial” was published in the American Dental Association Journal. Several of my dental friends contacted me with concerns and to find out what was going on. If you look closely at the study, the results are not surprising, but the shock was how quickly it reached the front page of the New York Times Health Section. I guess the conclusion of the study may seem shocking at first glance, because researchers found that xylitol did not significantly reduce cavities in adults who are at high risk for decay.
The researchers confirmed xylitol has been shown to be successful in reducing cavities for over 50 years in Europe, Asia and even in the US. These studies, however, have mainly focused on children and adolescents, so this new study took a look at adults in the US with a high rate of cavities. The hypothesis was that 5 grams of xylitol could stop new cavities in these selected clinic patients. After two and a half years, the conclusion was that the xylitol had only reduced decay by 10%, which was not significant.
The results did not surprise me, nor a well-respected lecturer, Dr Graeme Milicich from New Zealand. His comment was, “Water can put out a fire, but a cup of water is not going to deal with a house fire. The people selected in this study were high-risk patients, so throwing a cup of water at the problem, without any other intervention, is obviously not going to deal with it”. The patients in this study had serious decay problems and many had half their teeth missing. They experienced about 4 new cavities a year, yet it does not appear anyone addressed their lifestyle or other risk factors.
Xylitol’s main benefit is its alkalizing ability. You can do a pH test in your own mouth and show that 100 percent xylitol (like Zellies) quickly alkalizes your mouth to protect your teeth from acidity and sugars. This is why we recommend you eat Zellies after eating, after drinking and after snacking. If you eat xylitol and then sip diet soda or a 20 oz energy drink, the xylitol will have no chance to protect you. Most Americans snack frequently, particularly when it comes to sipping drinks.
To benefit from xylitol we must understand how teeth become damaged and how xylitol prevents the damage. If 5 pills a day could stop cavities – it assumes “cavities happen”, which is not the case. Acidity is the pivotal risk factor for cavities. Acidity is from plaque and also from foods and especially drinks that lower mouth pH. Older adults with cavities usually have acidic saliva due to hormonal change, pregnancy, stress, medications, or a depressed immune system. In the age-range of this study, many patients would have acidic or insufficient saliva to counter acidic attacks from eating or drinking. Only with the correct xylitol protocol and correct home care regimen could these patients have avoided cavities.
Anyone can test with pH paper and see how xylitol (mints or gum) can alkalize the mouth within minutes of an acidic challenge, to stop acidic damage and help protect teeth. This study used xylitol without any education, which is similar to giving a couple of “diet pills” to obese patients without any dietary advice, and then being shocked that they didn’t work!
Cavities are not a mystery or phenomenon – they are the progressive destruction of teeth to a point where the tooth caves in, allowing an infection to enter and destroy the tooth under the enamel. To prevent cavities, you must get rid of cavity-producing bacteria and protect teeth from acidity that weakens the outer enamel. The amount of daily prevention must outweigh the amount of damage to a tooth. I describe this as being like a bank balance, which is the outcome between how much you deposit each day vs. how much you withdraw. If the amount of damage to teeth exceeds the amount of help you give each day – you will end up with cavities. If you offer more protection than damage, cavities will stop. For adults with decay, it is important to control acidic damage from snacking habits. Zellies offers a simple and delicious tool, but it is the person who must make the effort, use Zellies to limit damage, and understand that even Zellies are not magic pills!
Another benefit of xylitol is that it can loosen plaque and improve daily tooth cleaning. Useful as this is, you still need well-formulated mouth rinses, good toothpaste and effective brushing habits. Additionally, xylitol must reach a minimum daily dosage, and Dr Milgrom’s studies at the University of Washington in 2002 indicated a dosage between 6.5 and 10 grams xylitol is required, and frequency is important. This is why you find so much information about how to use xylitol, how to clean your teeth, and which mouth rinses work with xylitol, etc on our websites.
This study was definitely at odds with the outcome that many of us, as dentists, have professionally witnessed with adult patients. We have prescribed effective protocols with xylitol that have allowed patients to escape a lifetime of cavities and dental problems. When used with proper education and application, xylitol can be an amazing oral health adjunct, especially for mouth acidity or dry mouth issues. The study admitted several problems, including “illogical” reversals, errors in one of the examination sites, and data that was “unusable”. There were some positive results– for example there was a 10-20% reduction in cavities in some groups, and the study showed ethnic variations, which may be interesting and could uncover cultural habits or unknown genetic factors.
The researchers in this study admitted decades of powerfully positive results using xylitol for preventing cavities in kids’ teeth. Hundreds of good and Evidence Based studies have shown it works to protect children and adolescents (see for yourself – go to Google Scholar and type in “xylitol” and “caries” and you will see 300+ studies showing xylitol’s incredible effect on preventing and reversing tooth decay). Isn’t it fascinating that the ADA and the media appear to have completely ignored those great stories, but picked a negative one and raced it to the NY Times in one day! I wish the media had been excited in the 1970s to tell mothers how xylitol prevents transmission of cavities to children (how many teeth would we have saved?) or the study last year that shows how wiping baby teeth during eruption can give long-term protection from cavities. I wonder why the ADA could not have commented on this most recent article – explaining what was lacking and using this as the perfect platform to discuss the dental dangers of sipping energy drinks, fruited waters, athletic drinks, juices and sodas.
Today we have an epidemic of tooth decay in 2 year olds, 52 million school hours are lost to dental disease annually, 80% of teenagers have fillings and 50% of 30 year olds have gum disease. NOW is the time to start encouraging the American public to improve their oral health and use xylitol to help reduce the staggering burden of disease in the US. Xylitol offers an easy and exciting method to help raise our standard of oral health – yet the unfortunate NY Times headlines will surely push us backwards on this path.
This is why we at Zellies will continue on our mission to educate followers about the powerful benefits of xylitol combined with good oral health education to stop, prevent and even reverse dental disease, cavities and gum problems.
Read the JADA Article here
Read the NY Times article here
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How can you make all these claims when the above (credible) study states that xylitol doesn’t reduce plaque buildup?
The aim of this study was to test the hypothesis that the chewing of xylitol- or xylitol/sorbitol-containing chewing gum reduces plaque formation and the acidogenic potential of dental plaque. Thirty healthy volunteers aged from 19 to 28 yrs were randomly allocated to one of three test groups, chewing either xylitol-, xylitol/sorbitol-, or sucrose-sweetened gums. A three-day plaque accumulation period of no oral hygiene was instituted prior to and at the termination of the chewing gum program, which lasted 33 days. Plaque quantity was assessed on the basis of protein content of individual plaque samples collected by a standardized technique. Acidogenic potential of individual baseline and test plaque samples was assessed by the quantity of various organic acids formed from D-(U-14C)glucose. Identification of extracellular and intracellular metabolites was performed by HPLC. Statistical evaluation of data was performed according to paired comparisons of individual baseline and post-chewing data. Plaque formation, acidogenic potential, and glycolytic profiles were similar at baseline and after the gum-chewing periods. Also, there was no intracellular accumulation of glycolytic metabolites within the plaque bacteria to indicate the inhibition of glycolysis. The study thus leads to the conclusion that, in young adults with low caries experience, exposure of the oral cavity to acceptable doses of xylitol or xylitol and sorbitol has no effect on the microbial deposits on the teeth.
There is no magic pill for any medical condition. The most useful application of xylitol is to promote healthy bacteria, stimulate mineralization of teeth and limit the “formation” of plaque by making it less sticky and keeping the mouth less acidic. All these conditions are promoted by the use of xylitol. You can believe whatever you like. Is there a reason you do not want to believe in xylitol?
I want to believe. However, when you make claims saying that it can reduce pre-existing plaque while studies exist proving that it has no effect, it hurts the credibility of xylitol.
I’ve been using it as a mouthwash lately but I’ve yet to see any results. I don’t think it can hurt but I’ll get a second opinion from my dentist.
You’ve also advised ingesting xylitol saying that it’s good for digestive health. The tiniest amount gives me diarrhoea and based on that I don’t think it’s a good idea at all to ingest it. After all, we’ve evolved to use natural sugar, not xylitol, so who knows what else it does to our bodies.
Yeah there’s no magic pill, that’s what I’m getting at. Xylitol isn’t the miracle you make it out to be. I just want people to be more wary when reading this and not believe everything they read on the internet.
The study you selected is quite old and ignores the caveats to the success of using xylitol. We need at least 3 grams of xylitol per day to have oral health benefit and this is definitely most effective as a mint or gum.
In mints and gum, xylitol creates a hygroscopic effect that stimulates a flow of natural saliva. Your own saliva is ultimately the best liquid for mineralization of teeth.
As a mouthwash, or when used in water, you will not get this effect and it will fall short of the 3-gram minimum.
In 2002 (some years after the study you mention) Dr. Peter Milgrom showed for plaque reduction in adults, we need between 6.5 – 10 grams of xylitol per day. This is best achieved in divided small doses.
There are, as I mentioned, many different benefits from consuming small and frequent amounts of xylitol. One is that plaque is promoted by acidity, and we can use xylitol to limit the duration of acidity in the mouth after meals, snacks, and drinks.
As a dentist for over 40 years, and having seen the benefits of xylitol for oral health, I feel it is my duty to help people understand this product and how to use it for dental health benefits. As a mother and grandmother – this is a product I share with my family all the time.
I assure you that I am not random “internet” advice. I have talked ( and still give ) public seminars about xylitol, give webinars to dental peers and have worked with supportive holistic practitioners for over 30 years. Many of these people avidly support my work and will give video testimonials about the benefits they have witnessed personally or for their patients who follow my advice.
Below is a link that may be helpful. I’d also suggest you check the ingredients and quality of the xylitol that is causing you digestive upset. Thanks for your interest and for this discussion!
I have no doubts about the use of sugar free gum promoting saliva, which is the natural way teeth clean themselves. Sugar free gum like Extra and Xylitol based gums are the only foods on the Australian market that can claim being beneficial for teeth because they don’t use sugar and they promote saliva.
I’ve been using Now foods xylitol sugar, and looking on the internet I see many people experiencing similiar discomfort after consuming xylitol. So from that I would say you and others are more tolerant to the side effects of it. Others like myself cannot ingest even a little bit. I will still use it to make a strong mouth rinse so it won’t go to waste at least.
Thanks for the link.
Thank-you for your detailed answer and for putting things straight.
Dr Ellie, I eat half a tea spoon of Xylitol after every meal and rinse with the fluid before swallowing.
I have been reading a few posts and a study that mentions S. Mutans becoming resistant to Xylitol, what are your thoughts on that?
I ask because I have some caries on 3 rear Molars. I do PH test everything I drink and often my saliva to make sure I stay at least 7 on the scale. Some of the rinses I do (salt, magnesium, MSM) raise my saliva PH to 8 for a while.
There is no such thing as resistance to xylitol. Anyone who thinks this is confused and thinking that xylitol works in the same way as an old-fashioned bug-killing drug like an antibiotic.
You see, xylitol FEEDS all the bacteria in the mouth. This includes good and bad and there are 900 kinds of good bacteria that are perfectly happy to enjoy xylitol!! (I guess you say that these good ones are “resistant” if you wanted to).
Only harmful strains of Strep mutans are affected by xylitol. When these bacteria absorb or “consume” xylitol they are unable to process or use xylitol as a source of energy because it is a five-carbon molecule (sugar is their fuel source – which is a six-carbon molecule).
This is why xylitol does not give harmful strains of Strep-mutans the ability to reproduce. Instead, they run out of energy, stop making acids, and stop being sticky.
Xylitol does not KILL any mouth bacteria – it feeds them all. What we know is that in the end, the harmful plaque cannot grow, cannot produce acids and cannot stick to teeth. This means when you go to brush your teeth in the morning and at the end of the day – bad bacteria will come away from your teeth and leave your mouth healthier.
I recommend my complete mouth care system be used with xylitol – for maximum effect.
Also, don’t be confused about pH. The reason we need to know about pH is that acidity damages mouth health. Also when YOUR SALIVA is at an ideal pH between 7.0 and 7.4 it will be able to donate minerals to your teeth to harden them. Ensure that your teeth get “face time” with your SALIVA. This exchange of minerals does not happen when you are drinking other liquids – even mineral waters. These other liquids are not equipped to mineralize teeth in the way that YOUR SALIVA does. Liquids that we drink too often actually dilute our saliva – so give your mouth a break – especially in the afternoon hours when saliva is at its best quality.
[…] Here is a link to another blog article on this subject: http://ultimateoralhealthguide.com/2013/01/28/xylitol-in-the-news-reading-beyond-the-headlines […]
[…] The fluoride debate has been ongoing for 50 years. In the past few months I sense a renewed vigor on the side of organized dentistry to promote water fluoridation. For example, a recent study from Australia showed a 10% reduction in cavities and was heralded “Water fluoridation good for adults as well as kids”. I have never seen such a headline for the 85% reduction in cavities from using xylitol. The only attention to xylitol came after a poorly designed xylitol study supposedly showed “scant benefits” – which were in fact the same 10% reduction in decay. (Read more about this study in “Xylitol in the News: Reading Beyond the Headlines“.) […]
Hey Dr. Ellie,
I have black lines on my last back molar. The tooth is not sensitive to hot or cold and doesn’t hurt when I bite down. I want to know what causes this. I have read that it could stains or cavities. I have been using the complete program for about 7 months. I have a cleaning and an extraction coming up. I was curious what you think about the black lines. Also I have notice over the past month, rough tan to brown spots on some teeth. I was curious if this was the staining you talk about or the dead plaque.
You talk about soda after useing xylitol reduces effects.what if somebody drank water or seltzer or the like after using xylitol, would it reduce the effectiveness?
What about if somebody used act after using xylitol?
Is their a time limit after using xylitol products (granules,mints,gum,etc.) to wait before drinking non acidic drinks so its not diluted?or it doesnt matter?
The health of your mouth is always improved when your mouth is alkaline, and the health of your mouth worsens when your mouth is dry or acidic. There are many reasons for your mouth to be acidic – but drinks are a big concern. Seltzer water, carbonated water, flavored water, vitamin water etc. are all acidic, like citrus drinks, juices and even some juiced vegetables.
Xylitol is useful to alkalize your mouth – but how long this benefit will last, will depend on the flow rate and acidity of your own saliva. If stress or hormones make your saliva acidic, you will need xylitol more frequently than if you have naturally alkaline saliva. I will try to write more about this subject in my next post. Basically we need to limit the amount of time teeth are damaged by acidity all day – every day.
Wow, this information about xylitol will really help me in my dental clinic I am running. Thanks for the informative article here
Please let us know if we can ever offer you personalized help about the use of xylitol in your clinic. Our goal is to educate and help medical and dental professionals to help their patients – particularly anyone with severe dental disease or those who cannot afford dental treatments.
It happens in so many fields. Studies are set up not to learn something, but to “prove” someone’s or some funding organization’s bias.
Since finding your work in 2009, I had been using plain listerine and xylitol gum and mints to fix a chronic gum problem around a couple of huge old fillings. I would treat the problem until it subsided, then quit. It wasn’t until I came back last fall and reread a number of your posts that I got with the complete brushing and rinsing system, plus enough xylitol to be effective. (Somehow, I missed that magic 6.5-10 gr. earlier.) I don’t have a lot of dental problems, but both I and my two large fillings are getting older, and I’m hoping I can prevent the “inevitable next step.” I’m optimistic, now that I have a better understanding of the problem, and a better feel for the on-goingness of the solution to that problem.
I’m glad you discovered Listerine should never be used alone! Listerine has an acidity of pH 4.2. which means if you go to bed with Listerine on your teeth, there is potential for your teeth to be demineralized and acidic damage to occur. If you ask Listerine, they will point you to a study that shows saliva washes the acidity away. The people chosen for their study were young, healthy men with lots of alkaline saliva. They did not select pregnant ladies or seniors with dry mouth – who would have been unable to “wash” the acidity away! This is another example of a study that must be properly interpreted, because things may work for some people, but not for others. As you learn about the chemistry and biology of the mouth – the more you will understand the apparent contradictions – and know the key to oral health is protecting teeth from harm – all day and all night!
Don’t give up on the system. I too had sever gum issues – it’s funny how the several dentists I went to didn’t find it necessary to something more preventative before I had to have the gum flap and rebuilding the bone. After all that and my quarterly visits, I wound up getting a cavity, I decided to be more proactive and found Dr. Ellie’s system. It’s taken me several years to get to the point where I don’t have plaque buildup and I only require 6 month visits, but I feel I have some control now. The cavity issue was healed within a couple of months. I wish I could fix the areas where my gums have receded, but unfortuantely I’m told that is due to having a bad bite.
No, Joyce, I won’t give up on the system. My problem has always been intermittent and not terribly serious. One of the two molars would become sensitive to hot and cold, would seem to be “high” when I bit down, and the gum line would be puffy. I realized at some point that it seemed to happen after I had vigorously scrubbed back and forth along the gum line, so if I deliberately stayed away from the gum line while brushing, and used plain listerine, the problem would resolve fairly promptly. When I look back at the fact that I was using copious amounts of whatever freebie toothpaste was on the rack at the dentist’s office, or stuff I got at the healthfood store — all stuff that turned to concrete in the toothbrush and regularly caused the bathroom sink to plug up — I guess I”m not surprised that the toothbrush probably never got clean when I rinsed it out. I also learned fairly soon that the sorbitol in flavored listerine caused my problem gums to balloon, and the first time I tried Dr. Ellie’s system, the same thing happened with the ACT, so I dumped it all out. So far, so good this time. There’s some small puffiness when I get up in the morning, but a cup of warm coffee puts things in order. 🙂 I have noticed, too, that a space between a couple of crowded teeth, where things alway got jammed, has healed up and nothing much gets stuck in that space any more. I hadn’t expected that. I figured it was a situation that just “was.”