School-based Xylitol Gummy Bears Snacks: a Pilot Study

Xylitol is a natural sweetener that has been shown to reduce S. mutans level in plaque and tooth decay. The degree of reduction is dependent on consumption dose and frequency. For xylitol to be successfully used in prevention programs, an effective means of delivering xylitol at therapeutic dose and frequency must be identified. Objective: This study compared response of S. mutans levels in plaque to two xylitol doses delivered in gummy bear (GB) snacks. Methods: Children (1st–5th grade) from two elementary schools in rural Washington State participated in the study. Participants (n=154) were randomized to one of two active groups (15.6 g [n=53] and 11.7 g [n=49] xylitol/day) or a positive control (44.7 g maltitol/day [n=52]). Xylitol and/or maltitol GB were pre-packaged in units of 4 GB and labeled with ID numbers. Unit-packages were distributed 3 times per day during school. No GB was sent home for any reasons. Plaque samples were taken at baseline and six-weeks and cultured on modified Mitis Salivarius agar for S. mutans enumeration. Results: There were no significant differences in S. mutans levels across the groups at baseline. At six-weeks, there were significant mean reductions in S. mutans levels for all three groups: 1.13 log10 (p=.0001) for 15.6 g xylitol/day; 0.89 log10 (p=.0001) for 11.7 g xylitol/day; and 0.91 log10 (p=.0001) for maltitol control. There were no significant differences between active groups compared to control (p=0.57). Debriefing suggested teachers and students adjusted well to the GB program with minimal disruption to classroom activities. Conclusions: Significant reductions in S. mutans level were observed in xylitol and positive control groups; the higher xylitol dose had the largest reduction. Maltitol also appears to reduce S. mutans level. Further study is needed to confirm the observed results. It is feasible to implement a school-based gummy bear snacks program. Supported by Grant No. NIDCR U54DE14254. kietaly@u.washington.edu