Dental News - Interview: “Xylitol is here to stay”

Dental Tribune International

Tue. 9. June 2015

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TURKU, Finland: During the early 1970’s, xylitol and other natural sweeteners were extensively tested in Finland as potential replacements for sugar. The series of over 20 research reports, published together in Acta Odontologica Scandinavica in 1975, became collectively known as the “Turku Sugar Studies”. Approaching the 40th anniversary of the publication, Dental Tribune Online had the opportunity to speak with Professor Emeritus Kauko K. Mäkinen, who led the original Turku research together with Arje Scheinin, about xylitol’s impact on caries levels, its popularity in Finland and the sweetener's future prospects.

Dental Tribune Online: Prof. Mäkinen, you were involved in the first extensive studies of xylitol in the seventies – how far has the sweetener come since then?
Prof. Emeritus Kauko K. Mäkinen: The awareness of xylitol among consumers and healthcare professionals has increased significantly since the early 1970's. However, knowledge about xylitol is not equally distributed across the world. Although awareness may approach 100 per cent in Finland, the situation is different in other countries and the level of awareness depends on the level of dental and medical education in each country.

As you mentioned, in Finland, xylitol seems to be a part of daily life?
Xylitol is indeed known by virtually all Finns and is also used by most people in Finland on a daily basis. Parents and grandparents have adopted a habit of buying xylitol gum, pastilles or lozenges for their children and grandchildren. At many day-care centres, children learn to use xylitol after lunch.

In Germany, for example, you can buy xylitol as a sweetener and it is also added in gum, but it is not widely known to the public as a mainstream product. Why do you think there is such a difference in “popularity”?
You are right about the situation in Germany. I cannot help but wonder why this could be, since xylitol was discovered by German chemists and its medical use in infusion therapy is best known by German physicians. It is possible that German dentists do not value early caries prevention as much as the dentists and the authorities do in Scandinavia. One would need a strong and committed distributor and an official endorsement from the German Dental Association.

When you did your research for the Turku studies, did you expect to find xylitol to be so beneficial, especially for oral health?
We did not anticipate the magnitude of this preventative effect. We considered it a welcome surprise. Later, of course, after learning how xylitol works and after we learned to understand the chemical mechanisms involved, we started to regard the findings as natural and expected.

Is there a measureable impact on caries levels and dental health that can be attributed to the sweetener?
We cannot give any figures of the effect of xylitol in caries incidence in the above instances. Overall caries prevention takes place as a result of multi-faceted efforts and programs, xylitol being a part of the whole. It is impossible to differentiate between the effect of each individual preventative measure since all of them are in action simultaneously, such as tooth brushing, the use of fluorides, the application of sealants, etc.

The caries preventative effects of xylitol that were reported in the literature are based on clinical trials. Xylitol does, however, significantly increase the efficacy of overall caries prevention, provided that the use of xylitol is habitual and is based on the consumption of sufficiently-large daily amounts that are taken at least three to five times a day.

Do you have any data on how much xylitol is consumed in Finland or worldwide?
These figures are possessed by xylitol manufacturers and they do not provide any production-related information to us. However, the annual production worldwide must be tens of thousands of tons since xylitol is produced in China, Russia and in other countries. The first true xylitol plant in the world was in Finland and was sold to DuPont a few years ago. When production started in Finland in the 1970’s, 3,000 to 50,000 tons were made during the first few years, but overall, production is by far much larger now.

How should the sweetener be used in daily life?
My current recommendation is about 7–10g per day, evenly distributed throughout the day. The first dose in the morning, the last after oral hygiene at bedtime. Always after meals and sugary snacks. Use it about 5 times a day, not less. Use two pellets or one stick of gum but the gum must be 100% xylitol. One may "tolerate" some maltitol in it, but no sorbitol, unless the sorbitol amount is very small (<5%). Some companies use only 5–10% xylitol and call their product "a xylitol gum", which is false.

Are there any known side effects?
Regular consumers who use xylitol for dental purposes have no side effects. If somebody accidentally consumes larger single doses, for example, 20–30g, some individuals may have transient diarrhoea. However, sorbitol, mannitol and common milk causes much more severe symptoms. Of course, small children must use xylitol gum under parental guidance.

Do you think xylitol could be playing a greater role in the future, maybe in developing countries?
Xylitol is here to stay. We are already using xylitol in developing countries. Vietnam is one example and, in thinking, it is still a developing country. Xylitol is currently being used in hundreds of dental, medical, cosmetic and other products all over the world. Its popularity is increasing steadily, but not abruptly.

Thank you very much for the interview.

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