Arje Scheinin

Turku sugar studies V: Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man

The purpose was to study differences in the caries increment rate as influenced by various sugars. The trial involved almost complete substitution of sucrose (S) by fructose (F) or xylitol (X) during a period of 2 years. There were no significant initial differences as to caries status between the prospective sugar groups; 35 subjects in the S-group, 38 in the F-group, and 52 in the X-group. During the entire study 10 subjects discontinued or were excluded. The clinical and radiographical observer error was reported and discussed. After 2 years the mean increment of decayed, missed and filled tooth surfaces was 7.2 in the S-group, 3.8 in the F-group, and 0.0 in the X-group. The weakness of the DMFS-index in not showing the development of new secondary caries and the increase in size of the lesions was overcome by expressing the caries activity in terms of indices showing the total quantitative and qualitative development. The results showed a massive reduction of the caries increment in relation to xylitol consumption. Fructose was found to be less cariogenic than sucrose. It was suggested that the non- and anticariogenic properties of xylitol principally depend on its lack of suitability for microbial metabolism and physico-chemical effects in plaque and saliva.

Turku sugar studies XVIII: Incidence of dental caries in relation to 1-year consumption of xylitol chewing gum

A longitudinal study was carried out in order to evaluate the caries incidence as affected by partial substitution of dietary sucrose (S) with xylitol (X), the effects of S- or X-containing chewing gums being compared during one year. The material comprised initially 102 young adults, predominantly dental and medical students, divided randomly into S- and X-groups. During the study 2 subjects were excluded, one due to lack of cooperation, the other not being allowed to enter the assigned S-group due to excessive caries prevalence. The subjects consumed 4.0 chewing gums per day in the S-group and 4.5 in the X-group. The frequency of sucrose intake was 4.2 times per day in the S-group, and 4.9 in the X-group. The caries incidence, assessed independently by clinical and radiographical means, expressed as the mean increment of decayed, missed and filled tooth surfaces, was 2.92 in the S-group, and --1.04 in the X-group. The corresponding values, when considering additionally the secondary caries reverals, were 3.76 in the S-group, and 0.33 in the X-group. The caries incidence was also expressed in combined quantitative and qualitative terms by considering in addition to the above parameters, also the changes in lesion size. The caries activity index thus calculated was 4.96 in the S-group, and 0.88 in the X-group. The results show a profound difference in the caries increment rate between the two experimental groups. The findings clearly indicate a therapeutic, caries inhibitory effect of xylitol.

Turku sugar studies I. An intermediate report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man

The present report covers the results after the first year of a 2-year trial, carried out in order to evaluate eventual differences in the caries incidence as influenced by sucrose (S), fructose (F) and xylitol (X) consumption. The initial material comprised 125 persons, mean age 27.5 yrs., divided according to individual preference and randomly into three groups. The S-group included 35, the F-group 38, and the X-group 52 persons, the latter group rendered oversize due to fear of loss of material. Initially no significant differences were found between the groups with regard to age, sex, number of primary and secondary carious surfaces with and without defect, number of filled surfaces and extracted teeth, and the DMFS-index. During the first 12 months of diet only 1 participant in the X-group discontinued due to diarrhoea. In addition, 2 were excluded due to lack of cooperation. Caries activity was expressed in quantitative, qualitative and combined terms through clinical and radiographic assessment. Ir...

Collaborative WHO xylitol field studies in Hungary I. Three-year caries activity in institutionalized children

The aim of this 3-year field study was to assess the value of partial substitution of sucrose with peroral xylitol (14-20 g/day) as a caries-preventive measure (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment procedures solely (C group). An F dentifrice was used unsupervised in the X and F groups, the former containing 10% xylitol. The C group used customary, predominantly F-free dentifrices distributed by the local health authorities. The final material consisted of 689 institutionalized children (6-11 years). Caries was scored yearly in duplicate by two continuously calibrated teams. At base line the X group had a significantly higher caries prevalence than the F and C groups. The 3-year DMFS increment was 4.2 in the X group, 6.5 in the F group, and 7.7 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSx, 4.9; RSF, 6.6; and RSC, 8.6. It is concluded that dietary xylitol in solid sweets resulted in a lower increment of caries than obtained in the F and C groups (p less than 0.001, covariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants).

Effect of Xylitol and Sorbitol on Polysaccharide Production by and Adhesive Properties of Streptococcus mutans

Batch culture techniques were used to study the effect of sorbitol and xylitol on the aggregation, adhesion and solubility of the polysaccharides produced by Streptococcus mutans in

Turku sugar studies VII:Principal biochemical findings on whole saliva and plaque

Plaque and whole saliva samples of the subjects of the Turku sugar studies were analyzed for several enzymes and biochemical compounds. Strict xylitol diet maintained throughout the study a 50% lower quantity of plaque than the sucrose of fructose diets. Decreased plaque and whole saliva lactate concentration, diminished activity of salivary amylase, and reduced hydrolysis rate of sucrose in plaque and whole saliva were observed in relation to xylitol consumption. The xylitol diet also reduced the ratio of glucose to proteins in plaque. On the other hand, increased activity in plaque of alpha- and beta-glycosidases (against p- and o-nitrophenyl derivatives), fucosidase and aspartate transaminase, as well as increased activity of proteinases and lactoperoxidase in saliva were found in connection with xylitol consumption. The fructose diet caused less clear differences when compared to sucrose, but the experiments indicated a selectivity of the effects of dietary carbohydrates on the biochemistry of whole saliva, plaque and salivary glands. The results contribute in explaining the cariostatic effects of xylitol and the lower coriogenicity of fructose when compared to sucrose.

Assessment of single risk indicators in relation to caries increment in adolescents

Base-line data on a series of risk indicators were related to 11-month caries increment in 181 subjects with a mean age of 13 years and 3 months. A caries increment equalling or exceeding one tooth surface was recorded in 21% of the subjects. The risk indicators consisted of past caries experience, white spot lesions, visible plaque and gingivitis, and six salivary tests: secretion rate, buffer effect, sucrase, mutans streptococci, lactobacilli, and Candida. Significant associations between caries increment and past caries experience (p = 0.002), white spot lesions (p = 0.01), lactobacilli (p = 0.02), Candida (p = 0.006), and sucrase (p = 0.02) were observed. The ensuing odds ratios were thus recorded: past caries experience, 3.6; white spot lesions, 2.9; salivary sucrase activity, 2.9; lactobacilli, 2.5; and Candida, 2.8.

Xylitol-Induced Increase of Lactoperoxidase Activity

Persons who were fed a strict diet with regard to the type of sweeteners used (sucrose, fructose, and xylitol) displayed differences in salivary peroxidase activity. Xylitol consumption considerably increased the salivary lactoperoxidase activity. Persons habitually consuming a xylitol-containing diet may avoid certain oral inflammatory processes because of the antibacterial properties of the enzyme.

Turku sugar studies VI: The administration of the trial and the control of the dietary regimen

125 voluntary subjects, divided into three groups, were originally chosen to participate in a two-year trial in which the dental and general effects of the consumption of sucrose (S 35), fructose (F 38) and xylitol (X 52) were elucidated through an extensive clinico-chemical analysis plan. Additionally 2 edentulous subjects were included in the X-group for survey of the general metabolic effects only. The subjects were given free of charge a versatile assortment of foodstuffs sweetened with either S, F or X. Using special distribution and control systems, the subjects were handled and controlled so that an almost comparable consumption of the products was achieved throughout the trial. The mean individual monthly intake of S, F and X was 2.2, 2.1 and 1.5 kg, respectively. The highest daily amounts of S, F and X per person varied between 200--400 g. The cooperation of the subjects completing the study in the F- and X-groups was 97%, expressed as the intake frequency of the correct sugar. Ten persons discontinued or were otherwise excluded for a diversity of reasons. No health problems were observed, except for transient osmotic diarrhoea in the X-group. These symptoms gradually disappeared and occurred later in the trial in the X-group almost to the same extent as in the S- and F-groups.

Effect of a xylitol chewing gum on plaque quantity and quality

The aim of the present study was to further investigate the plaque-reducing effect of a xylitol-containing chewing gum. Ninety-six dental students were divided randomly into three groups: a sucrose group (n = 32), a xylitol group (n = 36) and a control group (n = 28), using a sucrose-containing chewing gum, a xylitol-containing chewing gum, or no chewing gum, respectively, during a three-day experimental plaque growth period with restricted oral hygiene. The fresh weight of plaque collected in the xylitol group was 40% lower than in the sucrose group, along with a significantly lower mean plaque index. The use of the xylitol chewing gum induced low invertase-like activity in plaque extra-cellular phase together with low carbohydrate content. These results concur to indicate advantageous effects through the use of a xylitol-containing chewing gum.