Xylitol Candies in Caries Prevention: Six Year Xylitol Study in Estonia among School Children

Study conducted by Pentti Alanen, Pauli Isokangas, and Kristjan Gutmann

First published in Community Dentistry and Oral Epidemiology, Volume 28, Issue 3, pages 218-224, June 2000


All field studies have unequivocally reported significant reductions in dental caries occurrence associated with the use of chewing gum containing xylitol (what is xylitol?). No other xylitol products besides chewing gum have so far been tested in field trials. A 5-year follow-up study with 2- or 3-year xylitol consumption periods began in Estonia in 1994 with 740 10-year-old children in 12 schools at baseline examinations. For the study, 3 clusters each including 3–5 schools were formed on the basis of baseline caries experience. The products were used under the supervision of the teachers 3 times per day during school days but not during weekends or during the 3-month summer holiday. The daily dose of xylitol was 5 g in all groups. The children were examined every year in September by two experienced clinicians. Dental caries was recorded according to World Health Organization criteria. After 3 years, all xylitol groups showed a highly significant 35%–60% reduction in caries incident, compared with the corresponding control groups. The differences between candies, between candies and chewing gum, and between 2- and 3-year users in the xylitol groups were non-systematic, indicating no trends between the groups. The results suggest that not only xylitol chewing gum but also xylitol candies are effective in caries prevention, and that a school-based delivery system seems to offer a practical way to distribute and control the use of the xylitol products.


This was the first clinical study that evaluated different delivery vehicles side by side. The study evaluated three xylitol containing products – two different candies and a chewing gum. All of the xylitol study groups resulted in a 35% to 60% reduction in caries incidence after 3 years. This study clearly shows that xylitol continues to have a significant effect in a vehicle where the physical action of chewing is far less pronounced. It can therefore be concluded that it is the action of xylitol (even at a dose of only 5g per day), and not just the mechanism of consuming a sugar free chewing gum, that is responsible for this dramatic reduction in caries incidence.

After two years of use, caries reduction in all xylitol groups was approximately 50% compared with the control group. In the study, xylitol was used only on schooldays, approximately 200 days a year. Despite the three-month summer holiday, the prevention effect achieved was as good as in previous xylitol studies, where xylitol for the most part had been used on a daily basis. The study supported that when xylitol is used regularly for a sufficient period, even a three-month break did not reduce its effect.

In conclusion, stop eating so much regular sugar! Feed xylitol to your kids. Show the studies to other people and get folks talking about how to keep our communities healthier! For more information about xylitol and where you can buy it locally, please read more on how xylitol works to protect your teeth and kill bacteria in your mouth.

We offer xylitol products — gums, mints, mouthwash, toothpaste, and granulated xylitol (as a sugar replacement)– at at-cost prices in our dental office in Ellicott City, MD. So come on in to take your pick and take oral health fortification more seriously!


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