Long-term Tolerance of Pregnant Women To Xylitol Chewing Gum

Objectives: Transient gastrointestinal discomfort, laxation and diarrhea are believed to be the predominant side effects induced by excessive xylitol consumption. Fatigue of masticatory muscles and TMJ pain are also anticipated when gum is chewed excessively. As a part of caries prevention program in pregnant women, this study determined the frequency of occurrence of the side effects described above on a long-term basis. Methods: After screening, 51 pregnant women aged 21-40 years (mean: 30.8 y, SD=4.5) were instructed to chew gum containing 100% xylitol (1.3 g) as a sweetener at least 4 times/day. Maternal chewing started at their 6th month of pregnancy and terminated 13 months later. They were provided with “Xylitol Calendar” in which actual amount of xylitol chewing gum consumed and their symptoms (such as normal, loose stool, diarrhea, excessive gas, and constipation) are reported daily. The presence of masticatory muscle fatigue and TMJ pain were also reported. Frequency of the side effects occurrence was compared among the amounts of xylitol consumption. Results: After excluding missing items, total record for 16048 days (mean 314.7 days/subject) was used in the analyses. Mean frequency of xylitol consumption was 2.9 times/day (SD=1.5, range 0-10). Both median and mode of consumption was 3 times/day. Frequency of each gastrointestinal symptom was; normal (81.4%), loose stool (2.2%), diarrhea (1.2%), excessive gas (2.0%) and constipation (13.2%) during intervention period. Both frequency of masticatory muscle fatigue and TMJ pain was 0.09%. Significant difference was found on frequency of gastrointestinal symptoms among the amounts of xylitol consumption (p<0.001). Frequency of diarrhea did not increase, while frequency of loose stool and excessive gas slightly increased, and constipation decreased with the increased consumption of xylitol. Conclusions: The results showed low frequency of gastrointestinal symptoms associated with low xylitol doses, and suggest that xylitol chewing gum is well-tolerated by pregnant women.