Caries Y Xilitol

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SUMMARY REVIEW/CARIES ORAL CANCER

Weak evidence of caries reduction using xylitol-based lozenges in two of three selected studies
Abstracted from
Antonio AG, Pierro VS, Maia LC. Caries preventive effects of xylitol-based candies and lozenges: a systematic review. J Public Health Dent 2011 71: 117-124. Address for correspondence: Maia, LC Departmentof Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro, Caixa Postal 68066, Cidade Universitaria- CCS. 21941971, Rio de Janeiro, Brazil.

Question: Does caries progress in subjects who consume xylitol based candies or lozenges for at least one year?
Data sources The Medline, PubMed, ISI Web of Science, LILACS, and Cochrane Library databases and articles from the referencesof identified articles. Study selection Controlled clinical trials and randomised controlled clinical trials (RCTs) of at least one year investigating the link between consuming xylitol-based lozenges; and caries increment; when compared with a control, in any population group. Data extraction and synthesis Two examiners independently evaluated the titles and abstracts of all clinical trialsidentified in both the electronic and hand searches. Methodological quality was assessed using methods adapted from Chambrone et al.1 The main outcome was change in caries as measured by WHO criteria and the measure of treatment effect was Prevented Fraction(PF). Results One hundred and twenty-seven non duplicate references were identified. From these, three studies were evaluated. Of the threestudies two found a lower caries increment in the xylitol-based groups. The third found no difference in caries prevention between control and intervention. Conclusions There is a need for well-designed randomised clinical studies with adequate control groups and high compliance by the subjects.

Commentary
There is a growing body of research on Xylitol use in dentistry as shown by the fact that asimple search of PubMed using just the terms ‘xylitol and dental’ reveals more than 560 studies. Traditionally researchers believed that the effectiveness of xylitol was related to its use as a sugar substitute.2 Others believe that chewing-gum sweetened with xylitol reduces caries solely through the chewing-gum’s ability to cause salivary stimulation.3 The European Food and Safety Authority4 (EFSA)stated that despite poor allocation concealment and poor controlling for confounders in the available research, that there was a cause and effect relationship between the use of 100% xylitol sweetened chewing-gum and the reduction of tooth decay in children. The evidence for specific antibacterial properties of xylitol, primarily through its ability to interfere with the metabolism ofStreptococcus mutans, is increasing.5-8 In practice xylitol could be efficacious regardless of the carrier, a number of which have been trialled, these include lozenges, candy (eg gummy bears)9 and syrup.10 Antonio provides a comprehensive review of the current research around xylitol based candies and lozenges. The review question, while not phrased in an exact PICO11 format, is well focused. Acomprehensive abstract is provided with objectives, methods, results and conclusions. PRISMA (www.prisma-statement.org/statement.htm) provides helpful recommendations as to what could be included in an abstract. In this instance a description of the importance of the systematic review and listing the data sources used to search for papers within the abstract would have been helpful. In the body of the reportall information sources and strategies are described, with dates enabling the search to be repeated. The process of selecting studies is well described, and a flow diagram is included with detailed explanations of included or excluded papers, with additional information available online. As the authors note, this review is limited in the fact that grey literature was not reviewed. There is now...