Xylitol, an excellent sweetener—especially for patients with unique dental requirements

Note from the author in response to recent study on xylitol:

As an educator in the field of xylitol’s health benefits, I appreciate the continued research into this naturally occurring sugar substitute. It’s crucial to thoroughly examine all aspects of any product’s impact on health. Xylitol has been extensively studied and is widely recognized for its numerous health benefits, particularly in oral health. It helps reduce cavities by inhibiting the growth of cavity-causing bacteria and can improve overall dental hygiene. Additionally, xylitol has a much lower glycemic index than regular sugar, making it a valuable alternative for those managing diabetes.

While it’s important to consider new findings and their implications, the bulk of scientific evidence supports xylitol’s safety and efficacy when used as part of a balanced diet. As with any dietary component, moderation and a holistic approach to health are key. I encourage continued research and dialogue to ensure we fully understand all aspects of xylitol and its role in promoting better health outcomes.

As dental hygienists, we understand the importance of personalized care, recognizing that everyone’s dental needs are distinct. As we delve into our patients’ medical and dental histories, we diligently assess not only their immediate concerns but also their long-term requirements. Factors such as age, motor skills, cognitive abilities, lifestyle choices, and treatment goals all shape our approach. Unlike a standardized protocol generated by a computer algorithm, dentistry embraces the beauty of individualized treatment, drawing upon our expertise and intuition to tailor solutions that cater to diverse needs.

Simplicity is key to ensuring compliance and achieving favorable outcomes, especially for patients with exceptional dental needs. Albert Einstein purportedly aptly stated, “Everything should be made as simple as possible, but not simpler.” In this regard, one outstanding ingredient stands out for its simplicity, efficacy, and pleasant taste—xylitol, a sweetener widely used in dental and nasal hygiene products.

Supports dental health and microbial balance

Xylitol operates on core principles that support dental health and microbial balance:

• Xylitol interferes with the adherence and replication of pathogens.¹
• Xylitol disrupts the energy production processes of Streptococcus mutans, leading to a futile energy consumption cycle, reduces plaque formation and bacterial adherence (i.e., it is antimicrobial), and inhibits enamel demineralization (i.e., it reduces acid production)¹ as well as periodontal disease, inflammation,² oral candidiasis,^3,4 and Streptococcus pneumoniae.⁵
• Xylitol increases saliva flow.⁶
• Xylitol has a pH of 7⁷
• Xylitol increases remineralization of the tooth surface.⁷
  
  

Offers a range of general health benefits

Skin care: Topical application of xylitol reduces moisture loss and improves skin hydration and dermal and epidermal thickness. Dietary exposure has also been found to enhance overall skin thickness.⁵

Digestive health: Acting as a prebiotic, xylitol influences microbiota composition, metabolic activity, and immune function, positively impacting bowel and bone health.⁵

Immune support: Xylitol demonstrates anti-inflammatory properties, potentially aiding in skin inflammation control and reducing intestinal pathogens that contribute to leaky gut.⁵

Weight management: With its low caloric content (nine calories per teaspoon) and low glycemic index of seven, xylitol contributes to weight management by promoting satiety and improving serum cholesterol levels.⁵

Respiratory health: Nasal sprays containing xylitol promote balance of the respiratory microbiota, offering relief from upper respiratory infections, sinusitis, allergies, and acute otitis media. Xylitol also keeps the mucociliary layer moist, which aids the body’s natural defense mechanism.

For patients with extraordinary dental needs, integrating xylitol into their oral care regimen can provide significant comfort and improve overall health. For instance, patients experiencing dry mouth, poor oral hygiene, or gum inflammation can benefit from Spry Dental Defense products, which use xylitol as the active ingredient. Xylitol’s multifaceted action helps raise pH levels, reduce pathogens, increase salivary production, and promote tissue healing. Moreover, using xylitol as a sweetener can be advantageous for those with dietary restrictions or metabolic issues. Also, regarding upper respiratory health, Xlear Nasal Spray utilizes xylitol as a key ingredient in its formulation. Xylitol in nasal spray works to block adherence of viruses and bacteria that lead to more serious respiratory illnesses.

Benefits patients facing health challenges

Mental health conditions: Psychotropic medications are a common therapeutic treatment, but they often lead to oral health complications such as dry mouth, metabolic disease, weight gain, carbohydrate cravings, heart health issues, low motivation, and exhaustion, to mention a few. These are all contributors to an unhealthy biofilm, leading to tooth decay, tooth loss, candidiasis, and periodontal infections.

Autism spectrum disorders: Sensitivities to temperature, texture, taste, touch, poor eating habits, digestive complications, poor sleeping habits, and communication difficulties may hinder good oral hygiene practices.

Dementia/Alzheimer’s: Patients may struggle with oral care due to cognitive decline, impaired motor skills, mood swings, and medication side effects causing dry mouth.

Orthopedic impairments: Limited mobility can impede oral hygiene efforts, underscoring the need for effective, user-friendly oral and nasal products such as those containing xylitol.

Pulmonary diseases: Oral health is closely linked to overall well-being and, more specifically, respiratory well-being. Conditions such as COPD inflammation are aggravated when cavity-causing bacteria are inhaled into the lungs. Additionally, the medications to treat these conditions can cause severe dry mouth and thrush (candidiasis).

Multiple sclerosis: Fatigue, weak grip, low coordination, lack of sensation, tremors, mood swings, trigeminal neuralgia, dry mouth, oral thrush, TMJ disorders, clenching, numb tongue, speech and swallowing issues, and numb lips are symptoms that can hinder or even prohibit good oral health care routines.

Parkinson’s disease: Oral cavity disorders include increased prevalence of gingivitis and dental diseases, drooling, dry mouth, orofacial pain, burning mouth syndrome, and bruxism.⁸

Diabetes: Imperative to treating diabetes is keeping inflammation and infection levels low. Additionally, patients with diabetes require a very low sugar intake.

HIV/AIDS: Some of the most common oral health problems for people with HIV/AIDS are chronic dry mouth, gum disease (gingivitis), bone loss around the teeth (periodontitis), canker sores, oral warts, fever blisters, thrush (oral candidiasis), hairy leukoplakia (which causes a rough, white patch on the tongue), and tooth decay. Some of these oral lesions are ulcerative and painful, which can cause a loss of taste, alter speech, and make chewing and swallowing difficult.⁹

Cancer treatment: Head and neck radiation and chemotherapy can cause oral issues ranging from dry mouth to severe infections. These can occur during treatment or even prolonged periods after treatment. Offering xylitol products before cancer treatment creates a healthy environment that helps mitigate the harmful effects of chemotherapy and radiation on the oral tissues. Mouth sores can occur because chemotherapy and radiation kill both cancer cells and healthy cells that are fast-growing, such as the cells that line the mouth. Radiation to the head and neck can damage the salivary glands, greatly reducing the amount of saliva that’s produced.¹⁰

From diabetes management to cancer treatment support, there continues to be strong clinical data regarding xylitol and how it offers versatile, holistic, and effective solutions for a myriad of health concerns. Using xylitol in oral and nasal hygiene can serve as a critical ally in maintaining dental and upper respiratory wellness. Implementing care with xylitol products offers a good option for regular oral and nasal hygiene care. By empowering patients with knowledge and practical tools—such as xylitol—we can make a meaningful difference in their well-being and enhance their quality of life.

References

1. Janakiram C, Deepan Kumar CV, Joseph J. Xylitol in preventing dental caries: a systematic review and meta-analyses. J Nat Sci Biol Med. 2017;8(1):16-21. doi:10.4103/0976-9668.198344
2. Park E, Na HS, Kim SM, Wallet S, Cha S, Chung J. Xylitol, an anticaries agent, exhibits potent inhibition of inflammatory responses in human THP-1-derived macrophages infected with Porphyromonas gingivalis. J Periodontol. 2014;85(6):e212-e223. doi:10.1902/jop.2014.130455
3. Talattof Z, Azad A, Zahed M, Shahradnia N. Antifungal activity of xylitol against Candida albicans: an in vitro study. J Contemp Dent Pract. 2018;19(2):125-129. doi:10.5005/jp-journals-10024-2225
4. Pizzo G, Giuliana G, Milici ME, Giangreco R. Effect of dietary carbohydrates on the in vitro epithelial adhesion of Candida albicans, Candida tropicalis, and Candida krusei. New Microbiol. 2000;23(1):63-71.
5. Salli K, Lehtinen MJ, Tiihonen K, Ouwehand AC. Xylitol’s health benefits beyond dental health: a comprehensive review. Nutrients. 2019;11(8):1813. doi:10.3390/nu11081813
6. Llop MR, Jimeno FG, Acién RM, Dalmau LJB. Effects of xylitol chewing gum on salivary flow rate, pH, buffering capacity and presence of Streptococcus mutans in saliva. Eur J Paediatr Dent. 2010;11(1):9-14.
7. Miake Y, Saeki Y, Takahashi M, Yanagisawa T. Remineralization effects of xylitol on demineralized enamel. J Electron Microsc (Tokyo). 2003;52(5):471-476. doi:10.1093/jmicro/52.5.471
8. Zlotnik Y, Balash Y, Korczyn AD, Giladi N, Gurevich T. Disorders of the oral cavity in Parkinson’s disease and parkinsonian syndromes. Parkinson’s Dis. 2015;2015:379482. doi:10.1155/2015/379482
9. Lomelí-Martínez SM, González-Hernández LA, de Jesús Ruiz-Anaya A, et al. Oral manifestations associated with HIV/AIDS patients. Medicina (Kaunas). 2022;58(9):1214. doi:10.3390/medicina58091214
10. Harris JA, Ottaviani G, Treister NS, Hanna GJ. An overview of clinical oncology and impact on oral health. Front Oral Health. 2022;3:874332. doi:10.3389/froh.2022.874332