Cochrane · intervention · CD010743

Xylitol‐containing products for preventing dental caries in children and adults

Riley, P, Moore, D, Ahmed, F, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library

Oral Health Dental caries2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 1 · 5.9%Ungraded 9 · 52.9%Very low 3 · 17.6%Low 4 · 23.5%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Children and adults. Exclusion: majority of participants undergoing fixed or removable orthodontic treatment; intervention provided for less than one year; participants selected on the basis of having underlying health conditions	7969 participants randomised (5903 analysed) across 10 studies (n=10); 1 study in adults (n=1), 9 studies in children aged 1 month to 13 years (n=9)
Intervention	Xylitol-containing products compared with placebo or no intervention (which includes routine care), provided for at least 1 year. Appropriate comparators: non-cariogenic placebos (e.g. sorbitol) or no intervention	Xylitol lozenges (n=669); Xylitol candy (n=252); Xylitol syrup 8 g/day (n=94); Xylitol sucking tablets (n=118); Fluoride toothpaste with 10% xylitol (n=4216); Xylitol tablets via pacifier (n=62); Xylitol wipes (n=44)
Comparison	Placebo or no intervention (which includes routine care); non-cariogenic placebo (e.g. sorbitol); or another xylitol-containing product. Cariogenic sweeteners (sucrose, glucose, fructose) and anti-cariogenic agents (e.g. erythritol) were inappropriate comparators	Control lozenges (sucralose placebo) (n=669); Control (sorbitol) candy (n=252); Control (low-dose 2.67 g/day xylitol) syrup (n=94); No treatment (children/infants); Fluoride toothpaste (n=4216); Control (sorbitol) tablets (n=62); Control wipes (n=44)
Outcomes	Primary: Change in dental caries increment (DFT/DFS or DMFT/DMFS for permanent teeth; dmfs/d(e)fs, dmft/d(e)ft for deciduous teeth; permanent and deciduous analysed separately); Number of participants with and without dental caries increment. Secondary: Quality of life (QOL); Patient satisfaction; Cost; Adverse effects (e.g. gastrointestinal complaints, discolouration of teeth, pain and discomfort)	Caries increment / caries in primary teeth (n=10 studies); Number of participants with a caries increment (n=4 studies); Adverse effects (n=7 studies mentioned, mostly not in a usable format)
Study designs	Randomised controlled trials (RCTs), including cluster randomised trials but excluding cross-over trials	Randomised controlled trials (8 parallel, 2 cluster-randomised) (n=10)
Timing	Interventions provided for at least 1 year; longest-term data (follow-up nearest to 3 years) preferred	1 to 3 years

Search date: 2014-08. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCOhost; Web of Science Conference Proceedings; ProQuest Dissertations and Theses

Questions and results

Current version only

Xylitol lozenges (5 g/day) vs Control lozenges (sucralose-sweetened placebo, no xylitol)

Population: Adults

CD010743.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Caries increment (DFS) 33 months same question in other reviews	PF 0.08 [-0.03, 0.20] -0.64 [-1.58, 0.30] DFS (mean difference in caries increment)	1 study · 669 participants	Low Downgraded: imprecision
Adverse effects (sores in the mouth, cramps, bloating, constipation, flatulence, loose stool or diarrhoea) 33 months same question in other reviews	Patterns of adverse effects (sores in the mouth, cramps, bloating, constipation, flatulence, and loose stool or diarrhoea) were similar for both groups. Bader 2013.	1 study · 669 participants	Ungraded

Xylitol candy (7.5 g/day) vs Control (sorbitol) candy

Population: Children (mixed dentition; baseline about 8 years)

CD010743.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects 36 months same question in other reviews	The authors reported that there were no adverse effects for either group. Honkala 2014.	1 study · 252 participants	Ungraded
Caries increment (dmfs, primary and permanent teeth combined) 36 months same question in other reviews	One study (252 children) compared xylitol (7.5 g/day) candy with control (sorbitol) candy over 36 months. The data could not be used in analysis because the authors combined primary/deciduous and permanent teeth and…	1 study · 252 participants	Ungraded

Xylitol lozenges (4.7 g/day) vs No treatment

Population: Children (permanent teeth; baseline 8 to 10 years)

CD010743.PUB2 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects 24 months (48-month follow-up) same question in other reviews	There were no usable data presented for adverse effects. Lenkkeri 2012.	1 study	Ungraded
Caries increment (DMFS) 24 months (48-month follow-up) same question in other reviews	PF -0.10 [-0.59, 0.39] 0.28 [-0.99, 1.55] DMFS (mean difference in caries increment; higher with xylitol)	1 study · 200 participants	Very low Downgraded: risk of bias, imprecision
Number of children with a caries increment 24 months (48-month follow-up) same question in other reviews	RR 1.02 [0.83, 1.26]	1 study · 200 participants	Ungraded

Xylitol syrup (high dose, 8 g/day) vs Control (low-dose xylitol, 2.67 g/day) syrup

Population: Infants (primary teeth; baseline about 9 to 15 months)

CD010743.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Caries in primary teeth (mean number of decayed primary teeth) 12 months same question in other reviews	PF 0.58 [0.33, 0.83] -1.10 [-2.03, -0.18] decayed primary teeth (mean difference in number)	1 study · 94 participants	Low Downgraded: imprecision
Adverse effects (loose stools, diarrhoea) 12 months same question in other reviews	Adverse effects were not reported in a usable format, but the reported rates of loose stools and diarrhoea were very similar between groups. There were no serious adverse effects during the study. Milgrom 2009.	1 study · 94 participants	Ungraded

Xylitol sucking tablets (1 g/day) vs No treatment

Population: Infants/young children (primary teeth; baseline about 1 to 3 years)

CD010743.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Number of infants with a caries increment 18 months (24-month follow-up) same question in other reviews	RR 0.72 [0.35, 1.45]	1 study · 118 participants	Ungraded
Caries increment (dmfs) 18 months (24-month follow-up) same question in other reviews	PF 0.53 [0.001, 1.04] -0.42 [-1.12, 0.28] dmfs (mean difference in caries increment)	1 study · 118 participants	Very low Downgraded: risk of bias, imprecision

Fluoride toothpaste containing 10% xylitol vs Fluoride toothpaste (fluoride-only, no xylitol)

Population: Children with permanent teeth (schoolchildren)

CD010743.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse effects 2.5 to 3 years same question in other reviews	Adverse effects: both studies reported that there were no adverse effects in either the xylitol or control group.	2 studies · 4216 participants	Ungraded
Caries increment (DFS), prevented fraction at 2.5 to 3 years 2.5 to 3 years same question in other reviews	PF 0.13 [0.08, 0.18] -0.28 [-0.42, -0.14] DFS (mean caries increment; fewer with xylitol)	2 studies · 4216 participants	Low Downgraded: risk of bias, indirectness

Xylitol tablets (200 to 600 mg/day) via slow-release pacifier/dummy vs Control (sorbitol) tablets

Population: Infants (primary teeth; from about 1 month of age)

CD010743.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Number of infants with a caries increment (dmfs) 24 months (48-month follow-up) same question in other reviews	RR 3.08 [0.69, 13.65]	1 study · 62 participants	Very low Downgraded: risk of bias, imprecision

Xylitol wipes (4.2 g/day) vs Control wipes (no xylitol)

Population: Infants (primary teeth)

CD010743.PUB2 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Number of infants with a caries increment (dmfs) 12 months same question in other reviews	RR 0.14 [0.02, 1.07]	1 study · 44 participants	Low Downgraded: imprecision
Adverse effects 12 months same question in other reviews	The authors reported that there were no adverse effects for either group. Zhan 2012.	1 study · 44 participants	Ungraded

Xylitol chewing gum vs No treatment or non-cariogenic control

Population: Children and adults

CD010743.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR At least 1 year same question in other reviews	It was surprising that there were no eligible randomised trials testing xylitol chewing gums against either no treatment or a non-cariogenic control.	0 studies	No studies

Xylitol-containing products (gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays), provided for at least one year vs Placebo or no intervention (which includes routine care)

Population: Children and adolescents below 18 years of age (permanent or deciduous teeth, or both)

CD010743 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR At least 1 year	Protocol only; no results reported. Planned comparison of xylitol-containing products versus placebo or no intervention for preventing dental caries.	0 studies	No studies

One xylitol-containing product (gel, toothpaste, varnish, mouthrinse, chewing gum or spray) vs Another xylitol-containing product

Population: Children and adolescents below 18 years of age (permanent or deciduous teeth, or both)

CD010743 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR At least 1 year	Protocol only; no results reported. Planned head-to-head comparison of one xylitol-containing product versus another.	0 studies	No studies