Xerostomia, Xylitol & Xylophones! By: Christian Brennan, Kenia Pereda, and Wendy Li

Learning objectives Xylitol – What is it? Research on efficacy and MOA Video Xerostomia – What is it? Research on artificial saliva substitute and causes OTC products available Quiz!!!!

Xylitol: What is it? It is a 5 carbon alcohol, sugar sweetener Derived from various tree bark, plants, and in fruit fibers Naturally produced in our bodies Literally means “wood” in greek

How Xylitol Works Xylitol bacterial uptake inhibits metabolism through cell structure incorporation (energy consuming process) Xylitol anticariogenic effects: 1. Inhibits growth of strep mutans 2. Reduces dental plaque accumulation 3. Reduces acid formation

Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli By: Çaglar E, Kavaloglu S, Kuscu O, Sandalli N, Holgerson P, Twetman S, 2007 Purpose: - Xylitol chewing gum effects on MS and LB bacteria - Anti-cariogenic effects of xylitol - Synergistic effect of xylitol with probiotics

Oral mutans streptococci levels following use of a xylitol mouth rinse: a double-blind, randomized, controlled clinical trial By: Gary Hildebrandt, DDS, MS; Ignatius Lee, DDS, MS; James Hodges, PhD, 2010

Clinical Efficacy and Effects of Xylitol Wipes on Bacterial Virulence By: L Zhan, JD Featherstone, J Lo, et al. 2012

Results from the Xylitol for Adult Caries Trial (X-ACT) By: James D. Bader, William M. Vollmer, Daniel A. Shugars, et al. 2013

The The Trick is…. To consume around 6-10g of xylitol throughout your day, NOT all at once. Only effective when used continuously Only an adjunct therapy with fluoride

Video

What is it? Medical term used for “dry mouth” Occurs when there is a reduced or absent salivary flow May lead to speech and eating difficulties, halitosis, and an increase in dental caries!

Who suffers the most? Side effect of many medications (cardiovascular, antidipressants, diuretics, antihistamines, etc.) Radiation therapy Sjogren syndrome Diabetics, smokers, elderly…

Signs and Symptoms of Xerostomia - Bad breath - Cheilitis - Cracked lips - Cracking and fissuring of the oral mucosa - Dryness in mouth - Dysgeusia (taste disorders) - Fungal infections in mouth (i.e. Thrush) - Glossodynia (painful tongue) - Increased need to drink water, especially at night - Inflammation of the tongue, tongue ulcers - Lipstick sticking to teeth - More frequent gum disease - More tooth decay and plaque - Problems with speech - Problems swallowing and chewing - Sialadenitis (salivary gland infection) - Sore throat - Sticky and/or stringy saliva

Effects of carboxymethylcellulose (CMC)-based artificial saliva in patients with xerostomia. By: D. Oh, J. Lee, Y. Kim, H. Kho.,2008 Purpose: - Assess the effects of CMC- based artificial saliva in patients - Standardized questionnaire and measurements of salivary flow rates.

Statistically significant differences in questionnaire: - oral dryness at night or on awakening - oral dryness at other times of the day - effect of oral dryness on daily life Dry mouth symptoms improved after the use of the CMC-based artificial saliva Implications of the study: - not asking enough information to assess dry mouth - salivary flow rate was not attainable from certain patients - the CMC-based saliva did not affect all symptoms Results and Conclusion

Major salivary gland output differs between users and non-users of specific medication categories By: Andy Wolff, Limor Zuk-Paz and Ilana Kaplan, 2008

Xerostomia Products ACT Dry Mouth Rinse, $7.78 Walmart Indications for use: Patients with dry mouth Directions: Rinse 10 ml twice a day, one-minute after brushing. Do not eat for 30 minutes after use Product safety information: If swallowed, contact Poison Control Center right away Contra-indications: None

Xylitol Products Dr. John’s Sugar Free Xylitol Lollipops, $12.49/lb Amazon Indications for use: Patients with high caries risk Directions: Take the therapeutic dose of 6-10g daily, throughout the day, after meals Product safety information: Supervise young children to prevent any choking hazards Contra-indications: May cause slight GI disturbance

References Hildebrandt G, Lee I, Hodges J. Oral mutans streptococci levels following use of a xylitol mouth rinse: a double-blind, randomized, controlled clinical trial. Spec Care Dentist Mar; 30(2): L Zhan, JD Featherstone, J Lo, et al. Clinical Efficacy and Effects of Xylitol Wipes on Bacterial Virulence. IADR Sep; 24(2): Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X- ACT). J AM DENT ASSOC Jan; 144(1): Wolff A, Zuk-Paz L, Kaplan I. Major salivary gland output differs between users and non-users of specific medication categories. Gerodontology Dec; 25(4):210-6 Çaglar E, Kavaloglu S, Kuscu O, Sandalli N, Holgerson P, Twetman S. Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli. Clinical Oral Investigations [serial online]. December 2007;11(4): Oh D, Lee J, Kim Y, Kho, H. Effects of carboxymethylcellulose (CMC)-based artificial saliva in patients with xerostomia. International Association of Oral Maxillofacial Surgeons, Darby ML, Walsh MM. Dental Hygiene Theory and Practice. 3rd ed. St. Louis (MO): Saunders; c2010. p National Instituted of Dental and Craniofacial Research. Dry Mouth (Xerostomia) [Internet]. Bethesda (MD.): NIH; 2013 Mar 6 [cited 2013 Mar 6]. Available from: Images from: Google

Quiz time! Name at least 3 signs and symptoms suffered by the old man in the video.

Quiz time! Name at least 3 signs and symptoms suffered by the old man in the video. Is xylitol as effective as fluoride and why? What is xylitol’s mode of action?