At first I felt like a kook. Then it became clear that I was obsessed about it. Now it has become an everyday way of life, including that of my family. The ways in which to incorporate xylitol usage into daily life has taken hold. What started as a discovery developed into knowledge through research, and has now spawned a way of life that I feel good about. And I feel good about passing it along to my patients.
When one googles xylitol, so many pages come up it’s overwhelming. The science behind xylitol says it is natural, safe, and effective against oral bacteria. Numerous studies have been conducted in the United States as well as Europe. Xylitol is considered a sugar alcohol, or sugar substitute, that our own bodies can produce daily.1 It was FDA approved in 1963,2 yet is still relegated to the “health food” stores. Because it is a sugar substitute, there is a certain mind-set that says, “I don’t have much sugar anyway.” Personally, I would fall into that category. I like something sweet with my morning coffee, but I am able to resist most other forms of sweets. I tried substituting Splenda® for sugar in recipes, but I didn’t care for the texture and it was still recommended that half sugar be used.
Since I discovered xylitol, at a dental convention no less, I have been convinced that it is the answer to decay and plaque. Since then, I have also discovered that it can be effective against sinus infections too.3
The way xylitol works is that bacteria in the mouth and nasal sinuses do not recognize it as a sugar. Therefore, the bacteria do not proliferate and actually die back. That is a very simplified explanation. Xylitol is a five-carbon sugar instead of a six-carbon sugar like fructose and sucrose, but it is as sweet as table sugar. The best part is that it is diabetic-safe in any quantity. The “catch,” if there is one, is how to incorporate the use of xylitol into daily life, because it takes six to 10 grams daily for over a period of six months to have an effect on oral bacteria that causes decay (Streptococcus mutans).4
Part of the problem in using xylitol is thinking of it as sugar. At first, it is easy to approach the eight or so grams daily as a substitute for sugar that we may have consumed anyway. Then we discover that most xylitol is only available in mints or gum. Personally, before xylitol, I couldn’t tell you the last decade I had chewed a piece of gum! Now, I chew probably one to two pieces daily, for about seven minutes each. I have been doing this for more than a year now, but I am always on the lookout for ways around it. Gum is available online as well as in most health food stores. The brand that Wal-Mart carries called Ice Breakers® Ice Cubes is manufactured by Hershey’s.TM It comes in peppermint, spearmint, and dragonfly fruit. Many manufacturers have added xylitol to their gum, but unless it’s the first ingredient listed, one would have to chew multiple pieces to get enough to make it worth chewing. The U.S. Army “Look for Xylitol First” campaign focuses on educating soldiers to check ingredient lists.5
Besides gum and mints, xylitol may be substituted for sugar in recipes. I enjoy banana bread, cranberry bread, blueberry muffins, or zucchini bread for breakfast. Because xylitol may have a negative gastroenteritis effect if consumed in large quantities, I don’t use more than one cup of “sugar” per recipe. I also add it to pancake and waffle recipes. If I don’t have any freshly baked bread or muffins on hand, I enjoy cinnamon-sugar (xylitol) toast. Mixing cinnamon and xylitol as one would mix cinnamon and sugar is a great way to use bulk xylitol. And what child doesn’t like cinnamon-sugar? I also eat low-sugar breakfast cereals and sprinkle xylitol on top. Remember, xylitol has fewer calories (2.4 vs. 4 calories per gram) than sugar. One needs to look at it as therapeutic - something you want to add to your diet. The neat thing is that your teeth actually feel clean after consuming something you would call sweet.
I must point out that one has to exercise caution around pets. Xylitol acts to increase insulin in dogs, which can be very dangerous.6 But, remember that our pets generally aren’t given toothpaste, muffins, and the like.
Sweetening coffee with xylitol is a “no-brainer” to me. For those who prefer their coffee black, BriteShots (www.BriteShots.com) has developed a coffee and tea chaser to help prevent stained teeth. It is marketed in a two-ounce bottle that contains water, xylitol, and peppermint flavoring. It is different than other mouthwashes in that it is so safe it can be swallowed! Since I have xylitol on hand in my sugar bowl now, I can put about half a teaspoon of plain xylitol in my mouth and let it melt if I don’t want to chew gum. Some people put xylitol in their drinking water. This accounts for about five calories or one to two pieces of gum, depending on the brand. Again, think of it as a nutritional bonus and NOT as sugar. I wouldn’t dare think of following a meal with a teaspoon of sugar - ice cream maybe, but not plain sugar. Mints are also abundantly available online. One Web site (www.epicdental.com) guarantees that if you follow their program, you will never have another cavity.
Xylitol use has been widely researched. It is shown to be effective for even the youngest children. Xylitol-flavored wipes for babies’ teeth are already available.7 From infancy through adulthood, products containing xylitol can be found. It is available in toothpastes, and even CrestTM Multi-Care Fresh Mint and Cool Mint contain xylitol. Tom’s of Maine, Biotene, Xylifresh, Spry, and Now also contain xylitol. Using some of these toothpastes can account for up to six grams of xylitol just brushing twice a day. Another benefit for symptoms of xerostomia is that xylitol increases salivary flow. This explains why Biotene products contain xylitol.
I would encourage everyone to develop his or her own xylitol regimen to share with patients. I have already had patients return for six-month check-ups who have incorporated xylitol into their diets. I have heard positive testimonials about the effects of xylitol on those prone to sinus infections. For patients who chew gum already, what a great way to go! But it only works if you use it.
The biggest hurdle I see in xylitol becoming one’s first choice is the mind-set. Just as we try to eat the recommended amount of fruits and vegetables, we can also get the necessary amount of xylitol. It has been reported that two years of xylitol use in children gives them up to six years of protection.8 Xylitol also aids in the absorption of calcium from the intestines.9 Consequently, it is being used to combat osteoporosis. The more you read, the more you learn, and the more we can educate the public, our patients, and our families. I say, “Let there be xylitol!”