What the Heck is Xylitol, and Will It Save My Baby’s Teeth?

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.

Look at all those pretty little teeth!

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 [1], 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 [2]. 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 [3].

The American Academy of Pediatric Dentistry supports the use of xylitol for cavity-prevention in children [4]. 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 [5]. 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.

Making me long for a lab with an analytical balance

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.

REFERENCES

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.

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27 thoughts on “What the Heck is Xylitol, and Will It Save My Baby’s Teeth?

  1. Thanks for the scoop! We just started with the “training” toothpaste and it seems to extend the brushing session. Curious how “hands on” you are with the brushing? I’ve tried being a bit aggressive with getting in there but then we get lots of tears. She is happy to chew on the brush while sliding it around her mouth, hopefully hitting a few teeth along the way (she is 18 months.) I know she’s going through a “I want to do it myself” phase (or maybe it’s not a phase!). So I stand there and brush my teeth for her to model, and she seems to be trying to do as I do. I guess we can’t hope for much more at this age?

    • Our kiddos are the same age! I insist on brushing BabyC’s teeth myself at some point during the process, even if I just briefly hit all the teeth and the gum line. I usually let her start by “brushing” herself for two rounds of the “Brush ‘em brush ‘em” song, and then I take over. Sometimes it turns into a battle, and I hate that, but I guess I’m hoping that by being consistent in my expectations we’ll end up with fewer battles in the long run. There were no tears tonight:) BabyC was busy brushing my teeth while I brushed hers. She is actually a little rough with me, which makes me realize how uncomfortable it must be to have someone else brushing your teeth, particularly when you are squirming around! I’m a little more lenient during her morning brushing and often let her do it herself while I brush my own teeth.

  2. Keep in mind that the American Academy of Pediatric Dentistry does recommend using a smear of fluoride toothpaste for kids under age two years and a pea-size amount for those who are between two and five years.

    I didn’t look hard, but couldn’t find a xylitol tooth gel with fluoride to meet this recommendation.

    • Thanks for pointing this out – you’re right that it is important to look at the complete picture of dental care. I’ve been doing some research on fluoride and will probably write about it soon. Our city water is not fluoridated, and our pediatrician recommends fluoride drops, so that is what we are currently using. We give BabyC the drops after she brushes at bedtime, without any rinsing afterwards. If we weren’t giving the drops, I would definitely choose a fluoride toothpaste over a xylitol tooth gel. And I’m considering switching to a fluoride toothpaste, because it does seem like that method would mean that more fluoride would sit on the teeth for longer. Thanks for your comment! And if anyone is interested, check out the AAPD page for lots more info. The fluoride toothpaste recommendation is in the “Policy on Early Childhood Caries: Classifications, Consequences, and Preventive Strategies.”

  3. Great post, makes me wonder on the dosages and percent in the Xylitol food items. And a big thanks for including the bit on toxicities in dogs. It’s nasty stuff for them, it stimulates insulin release without actually providing glucose leaving the poor pup in a dangerous state of hypoglycemia and it has some yet unknown directly toxic effects on the dog liver. Not fun stuff for fido.

    • Not good at all, and it is a serious warning. I know from experience that my dog will surprise me with his sudden interest in something that I had assumed was out of his reach and/or undesirable.

  4. My pediatric practice just finished enrolling some children for a study being conducted by the University of Boston to see if xylitol can decrease the number of acute otitis media (AOM). The thought is that if xylitol decreases caries and that the bacteria that cause otitis media reach the middle ear via the oropharynx, perhaps if there is less of a bacterial load in the oropharynx, there will be less AOM. We will see what this double blinded placebo controlled study shows….

  5. My little guy is just about teething anytime now so this is of particular interest to me now and even more so very soon. Thanks for posting this and gives me something to look out for when shopping for toothpastes for him later!
    I did an online search for xylitol ingredient toothpastes and this one provided a breakdown of ingredients: http://www.dentinox.de/toothpaste-program.html. Unfortunately I couldn’t find an online store in the US that carries this brand. Surprisingly, outside of The Netherlands where the product is from, this brand also seems quite popular in South East Asian countries.

    • Wow, you found a product that reports their xylitol concentration! They say 12 and 13% depending on the product, so I wasn’t too far off. Who knows about these products here in the U.S. Xylitol may be regulated differently in Europe, so perhaps they have to report the concentration. I’m annoyed that they don’t have to report it here. For all I know, I’m paying extra for something that is 99.5% water.

      • true. although the reported concentration in the dutch brand also seems low compared to what was found to be the effective amount from the adult research you quoted. but yeah, let’s wait for the results from the unpublished study to make any conclusions.

  6. I was just getting ready to buy more toddler toothpaste and specifically bought the one brand that had xylitol, as recommended by my own dentist. I, too, have struggled mightily with cavities my whole life. I didn’t realize how little xylitol they might be getting compared to the studies, though. Interesting. I’ll be curious what the next step is with the xylitol wipes, too. Thanks for the heads up.

  7. Oh good–I ‘m glad you’re writing about this! I’m also concerned about the lack of fluoride in our water source. I have been surprised by how scared people are by water fluoridation, when it’s come up in conversations with other moms.

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  9. Pingback: Are Cavities Contagious from Mom to Baby? | Science of Mom

  10. Hi
    Just came across your discussion- my husband and I have launched a new Natural Kids Toothpaste called Jack N’ Jill. We have five different Organic fruit flavours and have just been rated safest kids toothpaste by EWG/Skindeep.
    I can tell you in this forum- we have 40% Xylitol in our formulation- the more the better for kids teeth. Also the yummier it makes it for them!!
    We are aiming to launch our US based website in Sept 2012. At present parents are ordering from our Australian website
    http://www.jackandjillkids.com

    Best
    Rachel

  11. Hello there, I recently discovered your site via Google … You have posted an interesting and informative blog… The title alone makes us interesting to go through the blog….I hope people will find this blog more helpful… good job…

  12. This was a great article – and thank you for including the warning about Xylitol toxicity in dogs. It truly is nasty stuff for them and even a relatively small amount can be devastating. (I’ve previously written about the dangers of xylitol on my own blog at ThePreventiveVet.com, here’s the shortened link… http://bit.ly/LesserKnownPetToxins). My wife and I have two young girls – fortunately the 3 year old loves to brush her teeth, but the 1 1/2 year old hates it! I’m thinking about the spiffy wipes – with all the precautions, of course ;-) Curious to know if the wipes paper has been published yet? Thanks again and have a wonderful New Year! – Jason

  13. we’ve been giving our toddler this M18 probiotic to help with oral/dental health as well. The scientific research on this stuff is pretty amazing. Let me know if you want me to pass on the studies.

  14. Thank you for posting such a great article! It helped me a lot. My daughter is about 2 and a half. Around the age of 1, I noticed her 2 front top teeth started eroding away. I knew it was because I was giving her a bottle at night so I stopped. I started using a tiny amount of children’s fluoride toothpaste while brushing her teeth. Before that, I would just use water on her toothbrush. It didn’t help because around 2, the 2 teeth started getting cavities. I felt so horrible, and still do :( I did some research about cavities in toddlers and I came across xylitol. I just bought some fluoride free training toothpaste with xylitol in it. Do you think it would fix the cavities if I brushed her teeth 3 times a day? Or more?

    Also, do you think I should get toothpaste with fluoride and xylitol?

    Thanks!

  15. Why don’t you just purchase xylitol, granulated, dissolve in water and use that. If you have a scale you can even weigh it out. Why use a product that may have who knows what else in it when you can go straight to the source. You can even google how to make your own toothpaste using xylitol.

  16. My pediadentist gave me straight xylitol to rub on daughters teeth and it worked. It’s a diabetic sweetener like sugar, wet your finger first. No need to purchase diluted over priced products.

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