1. Institute of Dentistry, University of Turku, Turku, Finland
Prevention of mother-child transmission of mutans streptococci with xylitol
Eva Söderling
Institute of Dentistry, University of Turku, Turku, Finland

2. Contents
Xylitol and dental caries
Mechanisms of action of xylitol
Mother-child transmission of mutans streptococci
Mother-child study: study design and results

3. Diet and dental caries A healthy diet as such is no threat to teeth
Constant snacking is a risk to dental health!

4. Diet and dental caries…
Sugarfree products are useful in improving poor snacking habits
Xylitol is the most beneficial sugar substitute – suitable for self-care!

5. Xylitol/clinical studies
Xylitol is most effective in the caries prevention of eruptive teeth (Ylivieska 1988, Belize 1996, Estonia 2000)
The ”therapeutic” effects of xylitol appear only in habitual use and with high enough frequencies/doses

6. Estonian xylitol study (Alanen et al. 2000)

7. Xylitol adds to caries prevention obtained with fluorides, advice on diet and oral hygiene

8. Contents
Xylitol and dental caries
Mechanisms of action of xylitol
Mother-child transmission of mutans streptococci
Mother-child study: study design and results

9. Xylitol: a 5-carbon polyol
Xylitol is found in nature; fruits, berries...
Sweetness equal to sucrose
Natural component of the human metabolic pathways

10. Mechanisms of action No acid production
Reduces plaque by suppressing formation of adhesive macromolecules, especially glucans
Selects for less virulent mutans streptococci (oral flora?)
Xylitol:C5

11. No acid production from xylitol
No acid production in plaque even after long-term consumption
Creates conditions favouring remineralisation
specific effects on remineralisation?
Xylitol:C5

12. No acid production from xylitol

13. No acid production from xylitol

14. The amount of plaque Xylitol reduces plaque
”Xylitol-plaque” shows low adhesiveness to the teeth, xylitol makes plaque easier to brush off
Xylitol suppresses formation of adhesive macromolecules, especially glucans

15. Xylitol reduces plaque

16. Xylitol reduces plaque formation

17. Xylitol chewing gum does not replace toothbrushing

18. Mutans streptococci Xylitol selectively suppresses mutans streptococci
The effect on mutans streptococci is transient
Xylitol selects for less virulent mutans streptococci

19. Xylitol inhibits growth of mutans streptococci

20. Effect of xylitol pulsing on oral streptococci
S.milleri
S.mutans
ADJ, 1991,36,213-5

21. Xylitol selects for mutans streptococci not inhibited by xylitol
Naturally occuring ms which do not form xylitol-5-P from xylitol can ”ignore” xylitol
These Xr cells form a small percentage of the ms if no xylitol is consumed
During regular xylitol consumption the Xr ms can multiply normally while ms inhibited by xylitol (Xs cells) decrease
Xr less virulent than Xs??

22. Effect of habitual xylitol consumption on plaque vs
Effect of habitual xylitol consumption on plaque vs. saliva mutans streptococci levels
Log CFU

23. Xylitol makes mutans streptococci to shed more easily to the saliva

24. Contents
Xylitol and dental caries
Mechanisms of action of xylitol
Mother-child transmission of mutans streptococci
Mother-child study: study design and results

25. S.mutans infection in infants
S. Mutans infection in infants with and without oral development nodules (ODN). N children with nodules = 103, N without nodules = 85.
Wan et al. JDR 2001.

27. The window of infectivity for mutans
streptococci

29. The earlier the mutans streptococci are colonised, the higher is the risk for caries

32. Transmission of mutans streptococci
The mother (infecting person) has high salivary mutans streptococci counts
Several daily saliva contacts between the child and the mother must take place

34. Reducing mutans streptococci in the mother during eruption of primary teeth:
Reduces on long-term basis the the mother-child transmission of mutans streptococci
Influences beneficially the future caries experience of the child

35. Methods to prevent the acquisition of mutans streptococci
Information on mother-child transmission of ms, advice on diet and oral hygiene
Chemical methods (chlorhexidine)
Xylitol

36. Contents
Xylitol and dental caries
Mechanisms of action of xylitol
Mother-child transmission of mutans streptococci
Mother-child study: study design and results

37. Mother-child study Eva Söderling and Pauli Isokangas
Institute of Dentistry, Turku
Ylivieska Health Centre, Ylivieska

39. Subjects At baseline 195 mothers with high salivary ms counts
2-year examination: 169 mother-child pairs
6-year examination: 147 children

40. Study groups
Xylitol group: xylitol chewing gum (65%) appr.4 times a day
Fluoride (F; control) group: fluoride varnish (2.26%) treatments 2 times a year
Chlorhexidine (CHX) group: CHX varnish (40%) treatments 2 times a year
All interventions discontinued when the child was 2 years old

41. Xylitol chewing gum

42. CHX and F varnishes

43. Study design
Child 3 months: xylitol consumption starts in Xylitol group
Biannually: F or CHX varnish treatments in the F and CHX groups
Child 2 years: Xyl/F/CHX interventions discontinue
Annual follow-up of dental health
Microbiological follow-up

44. Microbiological methods
Saliva/mothers and plaque/children annually until the
3-year examination
Saliva/children at the 6-year examination
Plate culturing on MSB agar of both salivary and plaque mutans streptococci

45. Results

46. Mutans streptococci of the mothers:7 . 5 6 4 P r e g n a c y 1 2 A o f h i l d ( s ) F C H X
High salivary mutans streptococci counts in all groups throughout the study
No differences between the study groups

47. Mother-child transmission of mutans streptococci
At two years of age, the children in the Xylitol group showed significantly less ms colonisation as compared to the control groups
At six-year of age, the Xylitol group still showed the lowest ms counts

48. Children showing mutans streptococci colonisation (%)

49. Childrens salivary mutans streptococci counts at 6 years
Söderling et al.,2001

50. The results of plate culturing of mutans streptococci and the chairside SM Strip mutans test were in good agreement

51. Dental health
The differences between the groups found in the early ms colonisation (2 years) were reflected in the caries occurence
At the age of 5 years the need of restorative treatment was 71-74% lower in the Xylitol group as compared to the F and CHX groups
CHX was not effective in the study design used

53. Results of the mother-child study have been confirmed by an independent, also federally funded study from Sweden (unpublished)

54. Xylitol recommendations:

55. Recommended target groups
Children with erupting teeth
Subjects with high caries risk
Caries-active individuals
Elderly dentate subjects
Patients with xerostomia
Mothers of infants

56. Recommended intake of xylitol: forms and frequency
Chewing gums and lozenges give maximal oral retention and contain no components ”disturbing” the effects of xylitol
Products with a high xylitol concentration recommendable
For optimal preventive effects 3-5 daily intakes, preferably after each meal

57. Recommended intake of xylitol: chewing gum
Chewing until the sweet taste disappears (appr. 5 min)
Children: one chewing gum pellet 3-5 times a day
Adults: two chewing gum pellets 3-5 times a day

59. Thank you! Kam-Sa-Ham-Ni-Da! Kiitos!
Institute of Dentistry, Turku