Is Xylitol Good for You?

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Xylitol will help you to improve oral health

What Is Xylitol?

Well I was going to write about xylitol but when collecting facts I run into an article that comprehensively and distinctly gives you the relevant information on xylitol. Why produce something somebody else has done so well? So ladies and gentlemen please read through this article:

Xylitol: Everything You Need to Know (Literally) by Kris Gunnars, BSc at www.authoritynutrition.com

What I will add from an experience to this great article is that always choose a product that is sweetened by xylitol only. This will minimise the possibility of having stomach problems. It is not necessarily the xylitol that is culprit for the enhanced bowel movements but the other sweeteners like maltitol syrup. Trust me, I know from my personal experience. All I need to have is 3 or more pastilles sweetened with both xylitol and maltitol syrup and rest of my family will suffer from consequences – if you know what I mean…

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Use chewing gum or pastilles sweetened 100% with xylitol

Here are couple of sites that sell products (chewing gum, pastilles) sweetened 100% by xylitol:

Peppersmith

Sweetlife – Spry brand

Fazer

Word of Warning

Even though the xylitol is absolutely harmless to us human beings (both children and adults), it can be fatal to dogs. So do not leave any xylitol product in the reach of your dog.

Controversy

Like mouthwashes and sparkling water divide us dental professionals, so does the xylitol. Some don’t know enough about it and some dental professionals take guidance from studies that are low of quality.

In 2015 the Cochrane released a review about xylitol which concluded that the xylitol has not been proven to be effective in prevention of decay. Many of us dental professionals most likely only read the abstract of the review, am I right? Very few of us had enough time or attention span long enough to go through the full version of the review. I mean really go through it – all the 10 studies they had included in their review.

Well I am going to make it easier for you now. I have looked into the full review and have simplified it in the next paragraph.

Cochrane Review and It’s Flaws

There are hundreds of studies about xylitol and caries (decay). In PubMed alone has over 500 of these publications. But yet the Cochrane review has been put together by using only ten of them.

In five of these studies the daily dosage of xylitol was lower than what is known and proofed by several clinical studies to be effective – that is 5 g per day.

Three out of these five studies were studies over toothpastes containing fluoride and xylitol. The levels of xylitol in toothpaste are always lower than the recommended, effective daily dosage of xylitol.

Clinical studies have concluded that the daily dosage and the frequency of use are the key factors in the effectiveness of xylitol. The xylitol should be spread throughout the day into small doses – preferably to 3-4 doses per day. As the xylitol is not antimicrobial compound, it needs to be used this 5 g per day to be effective in reducing the level of bacteria in mouth and therefore caries.

Let me repeat – five of out of ten studies included in the Cochrane review did not use sufficient dosage of xylitol. One out of these five studies wasn’t even a study over xylitol but probiotics – the xylitol was merely used as an adhesive (in milligrams – far from the 5 gram recommended daily dosage).

One out of these five studies did not even state the dosage of xylitol used. So why did they choose them for the review? I will try to find the answer in the Conclusion paragraph.

Ok, enough of those five questionable studies. Lets have a look at some of the remaining studies.

One of them the reviewers themselves think it has a “high overall risk of bias”. Well, they said it themselves – why include it?

Another study was conducted on kids with good oral health – how would you see if the xylitol is effective if there is nothing to improve in oral health? The ones executing this kind of study have been silly in the first place but the Cochrane reviewers are even sillier to include it in the review. What was the point?

Two studies had excellent results in the effectiveness of xylitol (see the other study here). Both of these studies used high enough dosage of xylitol.

Conclusion

It remains to be seen what magnitude of damage on public health one badly executed review has had. There are signs already that it has done great deal of damage. I did just a quick browse through the blogs and the internet and found several articles that were already declaring that the xylitol is useless referring to this Cochrane review. Some even state xylitol is harmful to us.

One must question the motives behind the Cochrane review on xylitol.

Has there been an involvement of the huge sugar industry that feels easily threatened by any alternative (and healthier) option for sugar as a sweetener? It is perhaps one reason why it is difficult to find xylitol products from many countries, especially the further west you go from Europe the more difficult it becomes.

Or was the review put together too hastily and with personal prejudices?

There are several food safety authorities worldwide that have accepted xylitol as food additive. The Joint (WHO/FAO) Expert Committee on Food Additives (JECFA) allocated xylitol’s ADI (acceptable daily intake) already in 1983 to “not specified” which is the most favourable ADI possible. Also the European Food Safety Authority concluded in 2006:

sugarfree chewing gum sweetened with xylitol is sufficiently characterised in relation to the claimed effects

(See the link for the full article at the bottom of this post)

Why produce a review that undermines the effectiveness of the xylitol when clearly there is no harm using it? Quite contrary, it most likely is beneficial to dental health when used appropriately and can have a positive impact on children suffering from middle ear infections.

The Cochrane reviewers are only emphasising their own self-importance and pettiness by this trivial review which will be in the world wide web forever and ever, with their names on it. It is an achievement I do not envy at all.

The Cochrane Library: Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults.

European Food Safety Authority (EFSA) on xylitol

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Still or Sparkling?

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Is sparkling water harmful to the teeth?

Erosion is a growing problem in dental health and our lifestyle is much to blame. Fizzy and fruity drinks are the biggest culprit but also diets high of sugar and starches. Fashionable and seemingly healthy diets like juicing do play their part as well in dental erosion (I will tell you more about juicing later on this post).

The reason I wanted to bring this subject up is that dental professionals do agree on the fact that fizzy drinks like coke and energy drinks, juices and alcohol are harmful to our teeth. But there seems to be a division amongst us when it comes to the sparkling water.

I have read health news in my country’s largest newspaper where dental professionals state that carbon dioxide in sparkling water is not harmful to the teeth as long as it is plain sparkling water, no flavours or lemon added. In my opinion and in my experience it’s not so black and white situation.

So is sparkling water harmful to our teeth? This is something I hope to find out by bringing this subject into discussion.

What Is Erosion?

To keep it short, the erosion is permanent loss of tooth structure caused by non-bacteria originated acids. These acids come e.g. from our diet, medications or medical conditions like gastric-reflux (heart burn) or bulimia.

The first structure on teeth to take the hit from these acids is the enamel. And when the enamel gets thinner this is what will follow:

  • teeth get more prone to decaying and hypersensitivity
  • the colour of the enamel gets yellower as the bone (dentin) under the enamel is darker in colour and starts to show through the thinning enamel
  • the tips of the teeth start to chip more easily and the tips become transparent and can make the tips look darker in colour as the oral cavity does not have very good lighting and this is what is showing through the thin tip of the tooth
  • the bite will become imbalanced as the tooth structure is eroding away. This might result in jaw joint problems

None of the above you should take lightly and all of them are costly to fix.

Why Do Some People Get Erosion on Teeth and Some Don’t?

Well, there are many variables that play a role in dental erosion. These are:

  • saliva’s buffering capacity – the ability to neutralise the acids. This is different with each person
  • the saliva flow. People with reduced saliva flow (dry mouth sufferers) are more at risk of erosion from acidic drinks. But even with healthy people the saliva flow increases and decreases over 24-hour period
  • the pH of the drink

Remember that the plain water’s pH is somewhere around 7 and it is not harmful to the teeth at any way.

Sparkling Water and Demineralization pH <5,5

Sparkling water has carbon dioxide which will become carbon acid when it comes in contact with our mouths. The pH of the sparkling water varies but normally it is between 4-6 (click here to one bottled water company’s info page).

It is rare to find the information on the bottle about the pH of the water and often very cleverly they mention that the pH at the source is 7 which can be misleading.

Us professionals are familiar with the fact that demineralisation happens when the pH in the mouth drops below 5,5. This is a fact. And when knowing this, it is difficult to accept that the sparkling water is not harmful.

An example.

If the sparkling water has pH of 4,5 and the person keeps the bottle next to him at work and sips away every now and then (and perhaps even swishes it around in the mouth) then surely it is harmful to the teeth?

Another example.

Person is exercising at the gym and has sparkling water as a drink. She is dehydrated from the exercising and the saliva flow is poor due to this (= no saliva or very little saliva to neutralise the acids). She drinks sparkling water and swishes it around the mouth to ease the sense of dryness in the mouth. It must do a damage if this happens in weekly basis.

Please note that this same scenario with any other fizzy or otherwise acidic drink is even worse situation. Still water (tap) would be the best option.

Juicing

For those who are not familiar with this diet, it is a diet where the juices are extracted from the fruits and vegetables. It is not blending where you put everything in the blender and blend it away to a smoothie. Juicing is drinking fruits and vegetables as a juice.

From dental professional’s aspect this is very worrying diet. Let’s think about the worst kind of scenario where juicing can harm the teeth.

Person wakes up and makes a juice from various fruits for breakfast. One of the fruits is lemon. Then she drinks it and swishes (I use this word a lot in this post so people would get the idea what is harmful) the juice around the mouth to get a fresh feeling after night. Then she goes and brushes her teeth – meticulously. What did she do that was harmful to her teeth?

  1. When we sleep the saliva flow decreases. When we wake up you have dry mouth and if you pour a very acidic drink (the pH of lemon juice is 2-2,6) in there, the damage is great. There is no saliva protecting and neutralising the acids.
  2. It takes a while before the saliva starts flowing again in the morning. This normally happens when we chew our breakfast and start hydrating ourselves with drinks. Drinking juice won’t activate your saliva flow and acids can cause damage to the teeth in peace when there is no saliva around.
  3. Brushing the teeth every morning after breakfast – especially after acidic juice breakfast – will wear off the enamel of the teeth for sure. You are brushing away the softened enamel.

My Experience

Every once in a while I see a patient whose teeth are hypersensitive. I go through the patient’s diet, oral hygiene habits and medical history. Often the reason for hypersensitivity is snacking and poor oral hygiene (lack of fluoride and build up of plaque) but sometimes there is no other reason than the patient drinking sparkling water between the meals. Devices like SodaStream at home make it possible to carbonate drinks like water at home. Some people use them many times a day.

I once had a patient who had read the same article (mentioned in the beginning of the post) in the newspaper in which dental professionals were saying it is ok to drink sparkling water. This patient had done research on the subject and was already in defensive mode about it. So there was no way for me to convince him otherwise. But then again I am merely a channel of information and it is patient’s right to choose whether to take the information on board.

It is easy to make people understand that flavoured sparkling water is very acidic due to the acidity of the flavouring. But many reject the suggestion that plain sparkling water could be damaging to the teeth as well. I don’t blame them as many of us dental professionals do the same. What I wonder is that how did these dental professionals come to this conclusion?

My experience in the clinical field has proven that it is not all that simple when it comes to erosion. It is damaging to the patient’s dental health to suggest that it is.