Substitute for sugar may save baby teeth

Los Angeles Times

Squirting the sugar substitute xylitol on infants’ teeth could help prevent tooth decay, a disease that afflicts an estimated 28 percent of U.S. children age 2 to 5, according to a new study.

Severe tooth decay occurs when bacteria such as Streptococcus mutans proliferate in the mouth and attack enamel. Largely preventable, it strikes poor children twice as often as wealthier ones. The problem is compounded because decay is more likely to go untreated in low-income communities.

The study, by researchers of the University of Washington, Seattle, was conducted in the Republic of the Marshall Islands, where early childhood tooth decay occurs at two to three times that of the average U.S. mainland community. Just over half of all 2-year-olds have at least one decayed tooth.

Researchers instructed parents, aided by community health-care workers, to give xylitol in a topical oral syrup to infants aged 9 months to 15 months over a period of about a year. The 94 children in the study were divided into three groups: One received a single 2.6-gram dose of xylitol a day; another, 8 grams a day delivered in two doses; the third, 8 grams delivered in three doses.

Of the first group, 51.7 percent had some tooth decay. In the two-dose-a-day and three-dose-a-day groups, rates were 24.4 percent and 40.6 percent, respectively.

In addition, numbers of decayed teeth were significantly fewer in the latter two groups. No adverse effects of xylitol were reported.

The results, published in July in the Archives of Pediatrics & Adolescent Medicine, suggest that using an oral syrup with xylitol while baby teeth are growing could prevent up to 70 percent of tooth decay, the authors said.

Xylitol is a naturally occurring sugar approved for use in foods since 1963. It can be found in chewing gum, gum drops and hard candy. It has been used effectively in chewing gum or lozenges in older children to prevent decay in permanent teeth.

The sugar reduces the number of decay-causing bacteria by impeding their ability to produce the lactic acid that damages teeth and substances that allow bacteria to stick to teeth.

“In our current state, where so many of pathogenic bacteria become drug resistant, using novel approaches to prevent infectious diseases needs to be ... thought about a lot more,” said study coauthor and University of Washington professor Marilyn Roberts.

Also, Roberts said, xylitol affects only the tooth-decay-causing bacteria, leaving other “good” bacteria alone.

Xylitol is at least twice as effective as fluoride in preventing tooth decay, said study coauthor Dr. Peter Milgrom, also of the University of Washington.

Fluoride repairs teeth by rebuilding them with calcium and phosphate in the mouth.