Tooth brushing is not fun in our house these days. Twice per day, we go through this ritual of misery. Every once in a while, BabyC tolerates it while I sing a silly song or she brushes my teeth, but most of the time she fights off the toothbrush with all of her might. I know this stage will pass eventually. Regardless of how BabyC feels about it, I consider tooth brushing to be non-negotiable. I have had issues with cavities all of my life, and I want to save BabyC from the dentist’s chair as much as possible. If you need a healthy dose of fear on this topic, see this article from the New York Times.
One thing that has eased the struggle of brushing time just slightly is flavored toddler tooth gel. When we started brushing BabyC’s teeth, I didn’t understand why anyone would use this stuff. We just used water, and BabyC loved her toothbrush at first. And then one day, she hated it, especially when I insisted on brushing for her. I suddenly understood what the strawberry-banana flavored toddler tooth gel was all about.
As I shopped around for kids’ toothpaste, I found many that advertised xylitol as an active ingredient, particularly among the “natural” brands. I wondered: What is xylitol, and will it do anything to protect BabyC from tooth decay?
Xylitol is a naturally occurring sugar alcohol found in fruit and vegetable fibers. It has been used for many years as a sugar substitute. It is about as sweet as table sugar but is metabolized to fewer calories and has a lower glycemic index , making it ideal as a sweetener for diabetics. Xylitol’s sweet taste also makes it appealing to toddlers. It is considered safe, the only recognized side effect being upset stomach and diarrhea due to osmotic effects. However, this can be minimized with a gradual rather than abrupt transition to using xylitol.
The FDA approved xylitol for use as a food additive in 1963, and multiple studies have also shown that it is effective at preventing tooth decay . Xylitol works by inhibiting the growth of some of the most common cavity-causing bacteria, mutans streptococci. It also decreases the ability of these bacteria to stick to teeth and can even promote remineralization of tooth enamel. Chewing gum and lozenges delivering 4-10 grams of xylitol per day have been shown to be effective at preventing tooth decay in adults .
The American Academy of Pediatric Dentistry supports the use of xylitol for cavity-prevention in children . The problem is that xylitol chewing gum and lozenges would pose a choking hazard in babies and toddlers. Several recent studies have investigated alternative xylitol vehicles for use in young children, though xylitol toothpaste has not been studied in this age group.
A xylitol syrup was tested in a double-blind randomized trial conducted in the Marshall Islands, where the incidence of early childhood tooth decay is very high . Children were enrolled in the study between 9 and 15 months of age, and they received the xylitol treatments for 12 months, thus targeting the most intense period of primary tooth eruption. Children randomized to the xylitol group received a total of 8 grams per day, while the control group received 2.7 grams of xylitol per day. (I thought this was interesting – the paper states, “The internal review committee appointed by the Secretary of Health, Republic of the Marshall Islands, required that the control group receive a small amount of xylitol, although it was understood that a placebo control would be more ideal and that evidence does not suggest a single dose of xylitol (2.67 g/d) would have an effect.” In other words, the study authors would have preferred that the placebo group not receive any xylitol, but that was deemed unethical by the review committee.) The results of this study were striking. The children receiving the full 8 g/d xylitol dose had up to 70% fewer decayed teeth than the control children.
I also ran across a press release from UCSF about a small study of xylitol wipes used in infants. The study was presented by Ling Zhan of UCSF at a conference this past January and will be published later this year in the Journal of Dental Research. I don’t usually write about unpublished studies, but these results were intriguing. When infants’ teeth and gums were wiped with xylitol 3 times per day for 12 months, they reportedly had 8 times fewer cavities than those cleaned with placebo wipes. Unfortunately, the press release doesn’t tell us exactly how much xylitol was contained in the wipes, although I can’t imagine that it would be more than a gram or two. I’ll wait to see the published paper before I get too excited, though.
So, we have a couple of recent studies that have shown very impressive reductions in the incidence of cavities in babies and toddlers receiving daily xylitol via syrup or wipe. But what about BabyC’s xylitol toothpaste? Is it likely to have beneficial effects?
The issue is one of dosing. The Marshall Islands study delivered 8 grams of xylitol per day and found a significant benefit over the control dose of 2.7 grams per day. This is consistent with the adult literature, which suggests that 4-10 grams is required to have an effect. However, the unpublished wipes study suggests that a smaller dose might be beneficial in babies. Further muddying the waters is that none of the xylitol products I found in my grocery store were labeled with any information about how much xylitol is actually included in the formulation. BabyC’s toddler toothpaste just claims to be “rich in cavity-fighting xylitol.” I think this wishy-washy labeling must be allowed because the FDA has approved xylitol as a food additive, not a drug, so companies are not required to report the actual concentration used.
Out of curiosity, I weighed the pea-size amount of xylitol toddler tooth gel I give to BabyC twice per day: 0.2 grams. So BabyC probably exposed to about 0.4 grams of xylitol tooth gel per day. If I take a wild guess that it has 10% xylitol (a number I’ve actually seen in some of the research papers on xylitol toothpaste tested in adults), she’s getting about 0.04 g or 40 mg of xylitol per day. That’s just 1% of the dose thought to actually decrease cavities.
So, this yummy toddler tooth gel probably doesn’t do much to prevent cavities for BabyC. I’ll be keeping an eye out for the xylitol wipes paper to see how much was delivered in the wipes and how significant the data really were. It may be that this study will reveal that a much lower dose can be effective in infants during tooth eruption. In the meantime, I’ll continue to use the xylitol toothpaste with BabyC. After all, she likes the taste, it makes tooth brushing just slightly less traumatic for both of us, and there is no reason to believe that it will hurt her.
While browsing toddler toothpaste, I also found some Spiffies xylitol wipes for infants. They cost about $1/day. I’m not quite ready to shell out that kind of money. I’ll wait to see the study, thanks.
An important word of warning: Xylitol can be toxic to dogs. If you have xylitol products in your home, keep them out of reach of your furry friends, and never use xylitol toothpaste on your dog’s teeth.
1. Natah, S.S., et al., Metabolic response to lactitol and xylitol in healthy men. Am J Clin Nutr, 1997. 65(4): p. 947-50.
2. Soderling, E.M., Xylitol, mutans streptococci, and dental plaque. Adv Dent Res, 2009. 21(1): p. 74-8.
3. Milgrom, P., K.A. Ly, and M. Rothen, Xylitol and its vehicles for public health needs. Adv Dent Res, 2009. 21(1): p. 44-7.
4. American Academy of Pediatric Dentistry, Policy on the Use of Xylitol in Caries Prevention, 2010: Reference Manual, Oral Health Policies, http://www.aapd.org/policies/.
5. Milgrom, P., 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(7): p. 601-7.