Xylitol is the alcohol form of xylose, which is used as a sweetener in chewing gums and other dietetic products. Xylitol has less effect on blood sugar or insulin levels compared with sucrose,1 so it may be a useful sugar substitute for diabetics.2 In addition, xylitol inhibits the growth of several types of bacteria, including those that cause tooth decay and ear infections.3 , 4 , 5 , 6
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8.4 grams daily divided into several doses of chewing gum
Xylitol, a natural sugar found in fruit, helps control mouth bacteria that cause ear infections.
Xylitol , a natural sugar found in some fruits, interferes with the growth of some bacteria that may cause ear infections.7 , 8 , 9 In double-blind research, children who regularly chewed gum sweetened with xylitol had a reduced risk of ear infections.10 , 11 However, when they only chewed the gum while experiencing respiratory infections, no effect on preventing ear infections was found.12
Chew gum containing xylitol regularly
Chewing gum with xylitol, a sugar substitute, may reduce the activity of cavity-causing bacteria.
Certain sugar substitutes appear to have anti-caries benefits beyond that of reducing sugar intake. Children chewing gum containing either xylitol or sorbitol for five minutes five times daily for two years had large reductions in caries risk compared with those not chewing gum. Sorbitol is only slowly used by oral bacteria, and it produces less caries than sucrose.13
Xylitol gum was associated with a slightly greater risk reduction than sorbitol gum.14 Bacteria in the mouth do not ferment xylitol, so they cannot produce the acids that cause tooth decay from xylitol.15 A double-blind study found 100% xylitol-sweetened gum was superior to gum containing lesser amounts or no xylitol.16 Another study found xylitol-containing gums gave long-term protection against caries while sorbitol-only gum did not.17
Other research has confirmed the anti-caries benefits of xylitol in various forms, including gum,18 chewable lozenges, toothpastes, mouthwashes, and syrups.19 Mothers typically transmit one of the decay-causing bacteria to their infant children, but a double-blind trial found that the children of mothers who regularly chewed xylitol-containing gum for 21 months, starting 3 months after delivery, had a greatly reduced risk of acquiring these bacteria,20 , 21 and also had 70% less tooth decay.22 , 23
For prevention of dental caries (cavities), 7 to 20 grams per day are given, divided into several doses in candies or chewing gum. For prevention of ear infections, 1.7 to 2.0 grams are given fives times per day in gum, lozenges, or syrup.
Xylitol occurs naturally in straw, corncobs, fruit, vegetables, cereals, mushrooms, and some seaweeds. For use in food manufacturing, xylitol is extracted from birch wood chips. Xylitol may be found in many foods labeled as "sugar-free," including hard candies, cookies, chewing gums, soft drinks, and throat lozenges.
Xylitol is not an essential nutrient; therefore, no deficiencies are possible.
Xylitol is recognized as a safe food additive by the U.S. government.24 Large amounts (30 to 40 grams) taken all at once can produce diarrhea and intestinal gas.
1. Hassinger W, Sauer G, Cordes U, et al. The effects of equal caloric amounts of xylitol, sucrose and starch on insulin requirements and blood glucose levels in insulin-dependent diabetics. Diabetologia 1981;21:37-40.
2. Bakr AA. Application potential for some sugar substitutes in some low energy and diabetic foods. Nahrung 1997;41:170-5.
3. Trahan L. Xylitol: a review of its action on mutans streptococci and dental plaque—its clinical significance. Int Dent J 1995;45(1 Suppl 1):77-92 [review].
4. Tapiainen T, Kontiokari T, Sammalkivi L, et al. Effect of xylitol on growth of Streptococcus pneumoniae in the presence of fructose and sorbitol. Antimicrob Agents Chemother 2001;45:166-9.
5. Kontiokari T, Uhari M, Koskela M. Antiadhesive effects of xylitol on otopathogenic bacteria. J Antimicrob Chemother 1998;41:563-5.
6. Kontiokari T, Uhari M, Koskela M. Effect of xylitol on growth of nasopharyngeal bacteria in vitro. Antimicrob Agents Chemother 1995;39:1820-3.
7. Tapiainen T, Kontiokari T, Sammalkivi L, et al. Effect of xylitol on growth of Streptococcus pneumoniae in the presence of fructose and sorbitol. Antimicrob Agents Chemother 2001;45:166-9.
8. Kontiokari T, Uhari M, Koskela M. Antiadhesive effects of xylitol on otopathogenic bacteria. J Antimicrob Chemother 1998;41:563-5.
9. Kontiokari T, Uhari M, Koskela M. Effect of xylitol on growth of nasopharyngeal bacteria in vitro. Antimicrob Agents Chemother 1995;39:1820-3.
10. Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ 1996;313:1180-4.
11. Uhari M, Kontiokari T, Niemela M. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics 1998;102:879-84.
12. Tapiainen T, Luotonen L, Kontiokari T, et al. Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics 2002;109:E19.
13. Harel-Raviv M, Laskaris M, Chu KS. Dental caries and sugar consumption into the 21st century. Am J Dent 1996;9:184-90 [review].
14. Harel-Raviv M, Laskaris M, Chu KS. Dental caries and sugar consumption into the 21st century. Am J Dent 1996;9:184-90 [review].
15. Trahan L. Xylitol: a review of its action on mutans streptococci and dental plaque—its clinical significance. Int Dent J 1995;45(1 Suppl 1):77-92 [review].
16. Touger-Decker R. Nutrition in dental health. In: Mahan LK, Escott-Stump S, eds. Food, Nutrition, and Diet Therapy. 9th ed. Philadelphia: Saunders, 1996, 585.
17. Touger-Decker R. Nutrition in dental health. In Mahan LK, Escott-Stump S, eds. Food, Nutrition, and Diet Therapy. 9th ed. Philadelphia: Saunders, 1996, 583.
18. Campus G, Cagetti MG, Sale S, et al. Six months of high-dose xylitol in high-risk caries subjects - a 2-year randomised, clinical trial. Clin Oral Investig 2013;17:785–91.
19. Edgar WM. Sugar substitutes, chewing gum and dental caries—a review. Br Dent J 1998;184:29-32 [review].
20. Soderling E, Isokangas P, Pienihakkinen K, et al. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Res 2001;35:173-7.
21. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res 2000;79:882-7.
22. Isokangas P, Soderling E, Pienihakkinen K, Alanen P. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. J Dent Res 2000;79:1885-9.
23. Milgrom P, Ly KA, Tut OK, et al. Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy. Arch Pediatr Adolesc Med 2009;163:601-7.
24. Xylitol. Code of Federal Regulations, Title 21, Volume 3. U.S. Government Printing Office, 2003: 21CFR172.395.
Last Review: 07-08-2014
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