Professor Kauko K. Mäkinen, Institute of Dentistry,University of Turku, Finland Mailing address: Lemminkäisenkatu 2, FI-20520 Turku, Finland. Email: firstname.lastname@example.org
Enamel demineralisation can be the result of erosion or of metabolic activities in the microbial communities (dental plaque) established on the enamel surface.
The role of plaque in the development of dental caries is incontestable and when located near the gingival margin or in subgingival areas can contribute to periodontal disease. Apart from mechanical removal, it is possible to influence plaque growth and plaque virulence by affecting the biochemistry and microbiology of plaque.
Xylitol, a sugar alcohol of the pentitol type, has been shown to reduce the incidence of dental caries. Xylitol associated caries reduction results from the ability of xylitol to modify plaque, i.e. xylitol makes plaque less cariogenic. Indirect evidence suggests that xylitol can also alleviate the inflammatory potential of plaque associated with periodontal disease.
Scientific research has shown that the consumption of relatively small daily quantities of xylitol can be associated with the following advantageous, clinical plaque effects:
• Reduction of the mass (fresh weight) of plaque (determined gravimetrically)
• Reduction in the adhesion of plaque (determined by means of various physical procedures, including planimetry of colour photographs of stained plaque, etc.)
• Reduction in the number of cells of mutans streptococci in plaque (determined microbiologically)
• Reduction in the acidity and acidogenic potential of plaque (determined by means of pH measurements and various chemical methods)
• Reduction in the activity of plaque enzymes presumed to be associated with caries propagation (for example: combined microbial sucrase and invertase activity involved in the exploitation of sucrose (table sugar) and maltose in dental plaque).
One of the objectives of this paper is to report on current recommendations for safe and effective use of xylitol as a plaque-modifying agent, based on endorsements issued by various Finnish regulatory bodies and professional associations. These recommendations are as such currently also adhered to in several Asian countries. Secondly, the aim is to provide scientific and mechanistic explanations for the clinical effects observed.