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).

Animals↗

PubMed1985

Collaborative WHO xylitol field studies in Hungary. II. General background and control of the dietary regimen.

The consumption of sucrose and xylitol and the exposure to fluoride (F) were analyzed in a field study aimed at assessing the value of peroral xylitol as a caries-preventive measure. The coverage of the general background referred to the conditions of 689 institutionalized children observed for a 3-year-period. The material in the dietary substudy consisted of 286 subjects aged 8-13 years. The intake and excretion of F was monitored at all institutions in a total of 380 children. The frequency of the consumption of sucrose was high, its intake increasing over the weekend in comparison with weekdays. The consumption of the xylitol-containing products did not reduce the frequency of sucrose intake. Varying and fluctuating levels of exposure to systemic F was registered, as also reflected in the urinary F/creatinine quotient.

Adolescent↗

PubMed1985

Collaborative WHO xylitol field studies in Hungary. III. Longitudinal counts of lactobacilli and yeasts in saliva.

The levels of salivary lactobacilli and yeasts were determined annually in half of the subjects of the xylitol (X) and fluoride (F) groups of a 3-year caries study. These measurements were carried out with Dentocult (DC) and Oricult (OC) dip-slide methods. A high level of lactobacilli prevailed throughout the study in these subjects. Significant changes were registered in some subgroups--that is, improvement in one of the X institutions and worsening in one of the F and one of the X institutions. At base line the counts of OC were worse in the X than in the F group. In the total material some improvement occurred during the course of the study, mainly in the X group. The changes associated with the preventive program should also be considered as related to the improvement in oral hygiene, restorative treatment, and the mere study effect.

Animals↗

PubMed1985

Collaborative WHO xylitol field studies in Hungary. IV. Saliva levels of Streptococcus mutans.

Salivary Streptococcus mutans was quantified to detect possible age-, sex-, and group-dependent differences at the end of a 3-year field study assessing the value of partial substitution of sucrose with xylitol (X group) in comparison with systemic administration of fluoride (F group) and restorative treatment solely (C group). The material of this substudy consisted of 390 institutionalized children aged 9-14 years. S. mutans was determined through the spatula technique and grouped into categories 0, less than 10(5), 10(5)-10(6), and and greater than 10(6) CFU/ml saliva. Zero to less than 10(5) values included more than 80% of the subjects of the X group. The cross-sectional comparison between groups showed lower S. mutans values in the X group than in the F and C groups. These differences between groups were highly significant. S. mutans was not dependent on age or sex.

Adolescent↗

PubMed1985

Collaborative WHO xylitol field studies in Hungary. V. Three-year development of oral hygiene.

The oral hygiene conditions were evaluated within a 3-year field study aimed at assessing the cariostatic value of partial substitution of sucrose by xylitol (X group) in comparison with systemic fluoride (F group) and restorative treatment only (C group). Parallel to caries and further associated studies the visible plaque index, based on the total number of permanent and deciduous teeth, was determined longitudinally at annual examinations in 688 institutionalized children, initially 6 to 11 years old. The observations were analyzed with regard to sex, age, experimental grouping, and total development. The oral hygiene conditions were generally poor. At the base-line examination only 26% of the children had acceptable oral hygiene; at the end this level was reached by 42%. A definite improvement was measured only in the X group, in which the final values differed significantly (p less than 0.001) from the base-line values and also from the end situation in the F and C groups. It is concluded that the development was influenced by several factors, such as different snacking habits and access to sweets, the study per se, and xylitol-induced effects.

Age Factors↗

PubMed1985

Collaborative WHO xylitol field studies in Hungary. VI. Changes in the carbohydrate to protein ratio of dental plaque.

The carbohydrate to protein ratio of dental plaque was analyzed in a field study assessing the effect of partial substitution of dietary sucrose by xylitol (X group) in comparison with systemic fluoride (F group) and restorative treatment solely (C group). The biochemical analysis was supplemented by quantitative assessment of plaque through the visible plaque index (VPI). The present substudy was carried out cross-sectionally and longitudinally (n = 83) in initially 6- to 11-year-old children. Missing base-line values for the carbohydrate to protein ratio were partly compensated for through reexamination of the carbohydrate to protein ratio 15 months after termination of the trial. The latter series served as reference to indicate the base-line situation. A lower carbohydrate to protein ratio was measured in the X and F groups than in the C group. Improvement of the VPI values was obtained only in the X group. Our results suggest the potential value of parallel quantitative and qualitative assessment of plaque.

Carbohydrates↗

PubMed1985

Collaborative WHO xylitol field studies in Hungary. VII. Two-year caries incidence in 976 institutionalized children.

The aim was to assess caries increment as influenced by partial substitution of sucrose by xylitol (X group) over a 2-year period in comparison with systemic fluoride (F group) and restorative treatment only (C group). The study differed from the 3-year field study of the same series primarily in that existing base-line differences were eliminated because the protocol required that all the new subjects entering the institutions in the 1st year were to be included for a 2-year trial. During this period the number of dropouts was 243 (19.9% of all subjects), the final material consisting of 976 children (6-12 years old). The 2-year DMFS increment was 3.8 in the X group, 4.8 in the F group, and 6.0 in the C group. The corresponding ratio (RS) between caries incidence and the tooth surface population at risk was RSX, 4.5; RSF, 5.5; and RSC, 7.5. The xylitol regimen resulted in a lower increment of caries than measured in the F and C groups (p less than 0.001; convariance analysis, with base-line prevalence, number of permanent teeth, and visible plaque index as covariants.

Cariostatic Agents↗

PubMed1985

Xylitol and caries: the collaborative WHO oral disease preventive programme in Hungary.

The aim of this study was to assess the practical value of peroral xylitol at low to moderate dosage as a caries preventive measure. The trial was planned as a field study to test the feasibility of partial sucrose substitution in the relatively uniform conditions expected to occur in institutionalized children. The caries increment in the experimental group (X-group) was compared with the increments in other groups following the systemic administration of fluoride in milk or drinking water (F-group), and conventional dental treatment procedures alone (C-group). Conventional treatment was also provided for children in the X- and F-groups who used in an unsupervised manner a fluoride-containing dentifrice. The dentifrice used by the X-group also contained 10 per cent xylitol. The C-group used predominantly fluoride-free dentifrices. At baseline there were 990 children in the study. At the end of the 3-year study period there were 689 subjects. The caries scoring into four main categories was carried out yearly according to WHO criteria. The analysis of the data showed highly significant differences between the X-, F- and C-groups when measuring caries activity as the increment of DMF teeth and tooth surfaces, and also as the increment rate assessing the true caries incidence in a biostatistical sense. These results were obtained in conditions where caries prevalence and incidence continued to be high. The observations indicate that peroral xylitol has a cariostatic effect.

Administration, Oral↗

PubMed1985

Field studies on sugar substitutes.

Four field studies assessing the caries preventive value of partial substitution of sucrose by xylitol or a mixture of xylitol and sorbitol were recently conducted. The trials (in Thailand, Hungary and two in French Polynesia) had certain common features, i.e. protocols approved by the WHO; low intake of polyol(s); non-randomized young study populations, differing baseline caries prevalences between groups; and planned duration of 32-36 months. Analysis of the findings was facilitated through the use of rates to measure caries increments expressed as DMF teeth and surface counts in relation to the numbers of teeth at risk. Irrespective of baseline differences, all studies revealed, in comparison to known methods, that partial substitution of sucrose was associated with a preventive effect.

Adolescent↗

PubMed1985