Xylitol and adults: What regimen can provide an optimal level of tooth decay protection?

An overview of the findings of prominent xylitol studies.

Since there are no formal dosing recommendations for the use of xylitol as a preventive for the formation of tooth decay, one must evaluate research articles that have be published and then draw conclusions from them. Towards this type of review, we provide the following table. It is similar to that published by Makinen (2000) in his paper "The Rocky Road of Xylitol to its Clinical Application" which documented the tribulations of dental health professionals over the years as they have promoted the use of xylitol. This table details various dose exposures researchers evaluated in their studies and the reduction in tooth decay rates they attributed to it.

Study	Xylitol Dosing (grams per day)	Duration (in years)	Tooth Decay Reduction
Isokangas (1988)	7 to 10	3	59 to 84%
Scheinin (1975)	6.7	1	>82%
Makinen (1996)	up to 8.5	1.8	80%
Galiullin (1981)	30	2	73%
Makinen (1995)	up to 10.7	3.3	up to 73%
Makinen (1996)	up to 10.7	2	up to 65%
Kandelman (1988)	up to 20	3	58 to 62%
Alanen (2000)	5	2 to 3	50 to 60
Isokangas (1988)	7 to 10	2	30 to 57%
Kandelman (1990)	1 to 3.9	1 to 2	52%
Scheinin (1985)	14 to 20	2 to 3	37 to 45%

Beyond a point, taking elevated amounts of xylitol does not produce a higher level of cavity prevention.

The table above has been organized by way of reduction in incidence of tooth decay. Notice that the studies that reported the greatest anti-cavity effect dosed their subjects with just moderate levels of xylitol, typically on the order of 10 grams per day or less. This maximum target range for xylitol consumption was confirmed by Milgrom (2006). This study evaluated varied xylitol exposures in regards to their ability to produce changes in the level of cariogenic bacteria found in dental plaque and saliva. Its conclusions were that a plateau effect came into play where doses exceeding 10.3 grams per day were not likely to increase effectiveness. This study also concluded that doses of 3.5 grams or less per day were not likely to produce changes in cariogenic bacteria populations. Overall it suggested that an effective xylitol dosing for preventing tooth decay lay between 6.9 and 10.3 grams per day.

Long-term consumption of xylitol is typically tolerated quite well by people.

Take notice that at minimum these studies were performed over a one year time period and, at the other extreme, for as long as 3.3 years. We included this information in the table above so to show evidence that long-term consumption has been evaluated at the levels shown and has not been found to pose a health risk or create significant side effects.

Xylitol's anti-cavity effect takes time to develop.

The chosen time frames for the studies listed above reflect on the fact that the preventive effects of xylitol consumption are not immediate. A person's xylitol regimen needs to be continued for several consecutive months, and preferably a year, before its optimal cavity prevention effects can be assumed to exist.

Suggested xylitol dosing for adults:

While no formal recommendation for xylitol dosing exists, from research such as that referenced on this page, conclusions can be drawn. For an adult, the following regimen would seem to be reasonable and one expected to produce an optimal anti-cavity effect.

Six to ten grams per day.

Divided up into three to five doses throughout the day.

This regimen needs to be continued for six months to a year before it can be assumed that an optimal level of cavity protection has been created.

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Cavity prevention: What is an appropriate xylitol regimen for adults?