Xylitol Topical Oral Syrup Prevents Early Childhood Caries: A RCT

Objectives: Xylitol chewing gum and lozenges have been shown to reduce Streptococcus mutans levels and decay in children. No study has examined whether xylitol could prevent Early Childhood Caries when delivered during the eruption of primary dentition in children. Methods: The study was a randomized clinical trial where 102 children averaging 15 months of age (SD=2.7 months) were randomized to three conditions: xylitol syrup 2.67 g/dose at 3x/day; xylitol syrup 4.0 g/dose at 2x/day (8 g total/day for these groups); or positive control (2.67 g xylitol/dose 1x/day) for 12 months. Care-takers gave children topical syrup orally 3x/day (frequency controlled) in a combination of sorbitol and/or xylitol syrups. Results: More than three-quarters (75.8%) and 59.4% of the children who received xylitol either twice or three times per day for a total of 8 g versus 48.3% of the children in a control condition (a single dose of 2.67 g xylitol) were caries free after 12 months. Children in the xylitol 2x/day group were more than 3 times less likely to have tooth decay than children in the control condition. The mean number of decayed teeth was 1.9 vs. 1.0 and 0.6 for control vs. 3x/day (RR=0.50, 95% CI=0.26, 0.96; P=0.037) and 2x/day groups (RR=0.30; 95% CI=0.13, 0.66; P=0.003), respectively. The number of decayed teeth for the treatment groups (8 g xylitol/day) combined was significantly less than the controls (ƒ³2=7.26, P=0.027). The largest difference in decayed teeth was seen in the twice-daily dosing group, but there was no statistical difference between the two xylitol 8 g/day groups (P=0.22). Local Outreach Workers were trained to work with and visited families at least once per week to ensure high adherence. Conclusion: Oral xylitol syrup administered topically was highly effective in preventing Early Childhood Caries.

Supported by MCHB/HRSA grant no. R40-MC03622 and NIDCR no. U54-DE14254.