Polyol-combinant saliva stimulants and oral health in Veterans Affairs patients--an exploratory study

Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years

Background

In 2012, we performed a needs assessment and gap analysis to qualitatively assess providers’ and patients’ knowledge and perceptions regarding preterm birth (PTB). During the study, we identified knowledge gaps surrounding methods to reduce the risk of occurrence of PTB and management options if preterm labor/birth occur. We targeted health messages toward these gaps. The objective of the present study was to assess the impact of our community health worker-based patient education program 3 years after it was implemented.

Methods

Fifteen focus groups including 70 participants were included in the study. The groups comprised either patients/patient couples or health providers. A minimum of two facilitators led each group using 22 a priori designed and standardized lead-in prompts for participants with four additional prompts for providers only. A single researcher recorded responses, and transcript notes were reviewed by the facilitators and interpreters immediately following each group discussion to ensure accuracy.

Results

The understanding of term vs preterm gestation was generally accurate. Every participant knew of women who had experienced PTB, and the general perception was that two to three women out of every ten had this experience. The majority of respondents thought that women should present to their local health clinic if they experience preterm contractions; few were aware of the use of antenatal steroids for promoting fetal lung maturity, but many acknowledged that the neonate may be able to receive life-sustaining treatment if born at a higher level of care facility. The majority of participants were aware that PTB could recur in subsequent pregnancies. All respondents were able to list ways that women could potentially reduce the risk of PTB.

Conclusion

After employing targeted health messages, the majority of participants expressed improved understanding of the definition of PTB, methods to prevent risk of PTB, and management options for preterm labor or PTB.

Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints

Objective. To provide a comprehensive overview of published evidence on the impact of erythritol, a noncaloric polyol bulk sweetener, on oral health. Methods. A literature review was conducted regarding the potential effects of erythritol on dental plaque (biofilm), dental caries, and periodontal therapy. The efficacy of erythritol on oral health was compared with xylitol and sorbitol. Results. Erythritol effectively decreased weight of dental plaque and adherence of common streptococcal oral bacteria to tooth surfaces, inhibited growth and activity of associated bacteria like S. mutans, decreased expression of bacterial genes involved in sucrose metabolism, reduced the overall number of dental caries, and served as a suitable matrix for subgingival air-polishing to replace traditional root scaling. Conclusions. Important differences were reported in the effect of individual polyols on oral health. The current review provides evidence demonstrating better efficacy of erythritol compared to sorbitol and xylitol to maintain and improve oral health.

Comparing the efficacy of xylitol-containing and conventional chewing gums in reducing salivary counts of Streptococcus mutans: An in vivo study

Objective:

Dental caries is among the most common chronic diseases in humans. Streptococcus mutans is generally responsible for most cases of dental caries. The present study sought to compare the effects of xylitol-containing and conventional chewing gums on salivary levels of S. mutans.

Materials and Methods:

This study adopted a crossover design. Two type of chewing gums (one containing 70% xylitol and approved by the Iranian Dental Association, and another containing sucrose) were purchased. The participants were 32 individuals aged 18–35 years whose oral hygiene was categorized as moderate or poor based on a caries risk assessment table. Salivary levels of S. mutans were measured at baseline, after the first and second phases of chewing gums, and after the washout period. The measurements were performed on blood agar and mitis salivarius-bacitracin agar (MSBA). Pairwise comparisons were then used to analyze the collected data.

Results:

Salivary levels of S. mutans in both groups were significantly higher during the two stages of chewing gum than in the washout period or baseline. Moreover, comparisons between the two types of gums suggested that chewing xylitol-containing gums led to greater reductions in S. mutans counts. This effect was more apparent in subjects with poor oral hygiene than in those with moderate oral hygiene.

Conclusions:

Xylitol-containing chewing gums are more effective than conventional gums in reducing salivary levels of S. mutans in individuals with poor–moderate oral hygiene.

Tooth-surface-specific effects of xylitol: randomized trial results

The Xylitol for Adult Caries Trial was a three-year, double-blind, multi-center, randomized clinical trial that evaluated the effectiveness of xylitol vs. placebo lozenges in the prevention of dental caries in caries-active adults. The purpose of this secondary analysis was to investigate whether xylitol lozenges had a differential effect on cumulative caries increments on different tooth surfaces. Participants (ages 21-80 yrs) with at least one follow-up visit (n = 620) were examined at baseline, 12, 24, and 33 months. Negative binomial and zero-inflated negative binomial regression models were used to estimate incidence rate ratios (IRR) for xylitol's differential effect on cumulative caries increments on root and coronal surfaces and, among coronal surfaces, on smooth (buccal and lingual), occlusal, and proximal surfaces. Participants in the xylitol arm developed 40% fewer root caries lesions (0.23 D2FS/year) than those in the placebo arm (0.38 D2FS/year; IRR = 0.60; 95% CI [0.44, 0.81]; p < .001). There was no statistically significant difference between xylitol and control participants in the incidence of smooth-surface caries (p = .100), occlusal-surface caries (p = .408), or proximal-surface caries (p = .159). Among these caries-active adults, xylitol appears to have a caries-preventive effect on root surfaces (ClinicalTrials.gov NCT00393055).

Prevention of root caries: a literature review of primary and secondary preventive agents

PURPOSE

This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly.

METHOD

Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010.

RESULTS

In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%.

CONCLUSION

For 1° prevention of root caries the recommended "best choice" is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended "best choice" is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.

Vitamin D and dental caries in controlled clinical trials: systematic review and meta-analysis

Vitamin D has been used to prevent and treat dental caries. The objective of this study was to conduct a systematic review of controlled clinical trials (CCTs) assessing the impact of vitamin D on dental caries prevention. Random-effects and meta-regression models were used to evaluate overall and subgroup-specific relative-rate estimates. Twenty-four CCTs encompassing 2,827 children met the inclusion criteria. Twenty-two of the 24 CCTs predated modern clinical trial design, some of which nonetheless reported characteristics such as pseudo-randomization (n = 2), blinding (n = 4), or use of placebos (n = 8). The relative-rate estimates of the 24 CCTs exhibited significant heterogeneity (P < 0.0001), and there was evidence of significant publication bias (P < 0.001). The pooled relative-rate estimate of supplemental vitamin D was 0.53 (95% CI, 0.43-0.65). No robust differences were identified between the caries-preventive effects of vitamin D(2) , vitamin D(3) , and ultraviolet radiation (Prob > F = 0.22). The analysis of CCT data identified vitamin D as a promising caries-preventive agent, leading to a low-certainty conclusion that vitamin D may reduce the incidence of caries.

The potential benefits of sugar-free chewing gum on the oral health and quality of life of older people living in the community: a randomized controlled trial

OBJECTIVES

To determine the effects of prescribing sugar-free chewing gum on the oral health and quality of life of dentate older people living in the community and attending for routine dental care.

METHODS

A randomized controlled trial was conducted on 186 older people who were not regular chewers of gum, (aged 60 years and over with ≥ 6 teeth) recruited from primary care clinics. Participants were randomly allocated to a gum-chewing group (chewing xylitol-containing gum twice a day for 15 min; n = 95) or a control group (no gum; n = 91). Both groups were examined at baseline and at the end of the study (6 months later). The primary outcome measure for the study was increased in stimulated saliva flow rate. Secondary measures included improvements in Plaque and Gingival Indices, and self-perceived change in oral health.

RESULTS

The retention rate for the study was 78.5% (n = 146 at follow-up); reported compliance with the protocol was 84% (ranged between 12% and 100%). There was no significant change in the saliva flow of the gum-chewing group (1.20-1.17 ml/min), while the control group experienced an increase in flow rate (1.06-1.32 ml/min; P = 0.001). The gum-chewing group, however, demonstrated significant improvement in Plaque and Gingival Index scores over the control group. For the Plaque Index, the mean scores (±SD) were 0.29 (±0.29) and 0.56 (±0.46) for the gum-chewing group and control groups, respectively (P < 0.001), at the second examination, which remained significant after controlling for age and saliva flow rate. For the Gingival Index, the scores were 0.73 (±0.30) and 0.92 (±0.32), respectively (P < 0.001), which persisted after controlling for age. A significantly higher proportion of participants in the gum-chewing group perceived that their oral health had improved during the study period in comparison with the control group (40% cf 21%; P = 0.016).

CONCLUSIONS

Prescription of sugar-free chewing gum to dentate older people living in the community and attending routine dental services was not associated with a significant increase in stimulated saliva flow. There were, however, significant improvements in Plaque and Gingival Index scores, and in self-perceived oral health.

No evidence of caries reduction found in a school xylitol and erythritol lozenge programme

DESIGN

A double-blind, cluster-randomised, double-blinded clinical trial was conducted.

INTERVENTION

All children within a fluoridated area with low caries received oral health programmes based on their estimated risk of caries. The children were divided into five groups. Four groups received three times daily xylitol/maltitol (4.7g/4.6g) lozenges or erythritol/maltitol (4.5g/4.2g) lozenges for either one or two school years. One group did not receive lozenges. Clinical examination was undertaken at baseline and after 48 months primarily by one dentist who was blinded to the assignment of each child. Radiographical examination was undertaken at 48 months, with two calibrated dentists undertaking the analysis.

OUTCOME MEASURE

Change in caries: decayed missing or filled surfaces at dentinal level (ΔD3MFS).

RESULTS

Forty-eight months after commencement of the research there were no statistically significant differences between the proportion of ΔD3MFS=0 (clinically or radiographically) within the groups (xylitol/maltitol or erythritol/maltitol lozenges). Seventy-five of the children were lost to follow up, seven discontinued through other reasons.

CONCLUSIONS

The use of xylitol-maltitol or erythritol-maltitol lozenges within a cohort of low caries children either over nine months or 21 months were not effective in reducing dental caries in primary school children.

Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials

OBJECTIVES

This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol.

METHODS

Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries-related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger's regression and funnel plotting were used to investigate risk for publication bias.

RESULTS

Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta-analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger's regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol.

CONCLUSIONS

The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.

Are sugar-free confections really beneficial for dental health?

BACKGROUND

Various sugar substitutes have been introduced and are widely used in confections and beverages to avoid tooth decay from sugar and other fermentable carbohydrates. One group of sugar substitutes are sugar alcohols or polyols. They have been specifically used in foods for diabetic patients because polyols are not readily absorbed in the intestine and blood stream, preventing post-prandial elevation of glucose level. Additionally they may lower caloric intake.

METHODS

We searched PubMed, Cochrane Controlled Trials Registry, Cochrane Oral Health Review, Centre for Reviews and Dissemination in the UK, National Library for Public Health and a Centre for Evidence Based Dentistry website up to the end of October 2010, using the search terms 'sugar alcohol' or 'sugar-free' or 'polyols' and combined with a search with terms 'dental caries' or 'dental erosion'.

RESULTS

Xylitol, a polyol, has been approved by the US Food and Drug Administration for its non-cariogenic properties that actually reduce the risk of dental decay and recently, the European Union also officially approved a health claim about xylitol as a 'tooth friendly' component in chewing gums. Although the presence of acidic flavourings and preservatives in sugar-free products has received less attention, these additives may have adverse dental health effects, such as dental erosion. Furthermore, the term sugar-free may generate false security because people may automatically believe that sugar-free products are safe on teeth.

CONCLUSION

We concluded that polyol-based sugar-free products may decrease dental caries incidence but they may bring another dental health risk, dental erosion, if they contain acidic flavouring. There is a need for properly conducted clinical studies in this area.

Sugar alcohol sweeteners as alternatives to sugar with special consideration of xylitol

INTRODUCTION

Dental caries is a diet-associated disease which continues to be a serious health problem in most industrialized and developing countries. Strategies to maximize caries prevention should automatically consider the use of sugar substitutes. It is important that public health authorities are made cognizant of the availability of new polyol-type sugar substitutes.

REVIEW SUMMARY

Clinical studies have shown that xylitol, a natural, physiologic sugar alcohol of the pentitol type, can be used as a safe and effective caries-limiting sweetener. Habitual use of xylitol-containing food and oral hygiene adjuvants has been shown to reduce the growth of dental plaque, to interfere with the growth of caries-associated bacteria, to decrease the incidence of dental caries, and to be associated with remineralization of caries lesions. Numerous public regulatory bodies have endorsed the use of xylitol as a caries-limiting agent. Other sugar alcohols that have been successfully used as sugar substitutes include D-glucitol (sorbitol), which, however, owing to its hexitol nature, normally has no strong effect on the mass and adhesiveness of bacterial plaque and on the growth of mutans streptococci. A tetritol-type alditol, erythritol, has shown potential as a non-cariogenic sugar substitute. Combinations of xylitol and erythritol may reduce the incidence of caries more effectively than either alditol alone.

CONCLUSIONS

Partial sugar substitution with polyols is an important dietary tool in the prevention of dental caries that should be used to enhance existing fluoride-based caries prevention programmes. The most effective method of conveying this information to the public is through a proper health claim for these alditols in food labelling. The present review summarizes clinical and biochemical aspects of the above three dietary polyols and emphasizes the role of sugar substitution as a potential health-promoting strategy.

Sugar alcohols, caries incidence, and remineralization of caries lesions: a literature review

Remineralization of minor enamel defects is a normal physiological process that is well known to clinicians and researchers in dentistry and oral biology. This process can be facilitated by various dietary and oral hygiene procedures and may also concern dentin caries lesions. Dental caries is reversible if detected and treated sufficiently early. Habitual use of xylitol, a sugar alcohol of the pentitol type, can be associated with significant reduction in caries incidence and with tooth remineralization. Other dietary polyols that can remarkably lower the incidence of caries include erythritol which is a tetritol-type alditol. Based on known molecular parameters of simple dietary alditols, it is conceivable to predict that their efficacy in caries prevention will follow the homologous series, that is, that the number of OH-groups present in the alditol molecule will determine the efficacy as follows: erythritol >/= xylitol > sorbitol. The possible difference between erythritol and xylitol must be confirmed in future clinical trials.

Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth

Polypharmacy is a common cause of salivary hypofunction, producing symptoms of dry mouth or xerostomia, especially among older populations. As the number of older people continues to increase, polypharmacy-induced salivary hypofunction is becoming an increasing problem. Many over-the-counter products are available for relieving symptoms of dry mouth, but few have been tested in controlled clinical investigations. The purpose of this investigation was to evaluate the safety and efficacy of a group of topical dry mouth products (toothpaste, mouth rinse, mouth spray and gel) containing olive oil, betaine and xylitol. Forty adults were entered into this single-blinded, open-label, cross-over clinical study and 39 completed all the visits. Subjects were randomly assigned at baseline to using the novel topical dry mouth products daily for 1 week, or to maintain their normal dry mouth routine care. After 1 week, they were crossed over to the other dry mouth regimen. The results demonstrated that the use of the novel topical dry mouth products increased significantly unstimulated whole salivary flow rates, reduced complaints of xerostomia and improved xerostomia-associated quality of life. No clinically significant adverse events were observed. These data suggest that the daily use of topical dry mouth products containing olive oil, betaine and xylitol is safe and effective in relieving symptoms of dry mouth in a population with polypharmacy-induced xerostomia.

Chewing chitosan-containing gum effectively inhibits the growth of cariogenic bacteria

OBJECTIVE

We have already reported that chitosan inhibited the growth of cariogenic bacteria in vitro. This study was designed to evaluate whether chewing gum, containing chitosan, can effectively suppressed the growth of oral bacteria (total bacteria, total Streptococci, mutans streptococci (MS)) in saliva.

METHODS

Fifty healthy subjects, ranging in age from 19 to 32 years, were recruited from among the staff and students of Nagasaki University School of Dentistry. For the slab of gum study, the subjects chewed gum for 5 min and then rested for 5 min. Each subject chewed a total of eight pieces of gum, which was either supplemented with or without chitosan, for a total of 80 min. Two different types of gums were examined with at least 1 week as a rest period in between treatments. This in vivo study was carried out by the double blind comparison test.

RESULTS

The amount of oral bacteria was found to significantly decrease in the chitosan group. Especially, the number of MS were maintained at about a 20% level in comparison to that before gum chewing, even at 1h after gum chewing.

CONCLUSION

These findings suggest that a supplementation of chitosan to gum is an effective method for controlling the number of cariogenic bacteria in situations where it is difficult to brush one's teeth, such as when an individual is away from home all day or participating in outdoor training.

The use of sorbitol- and xylitol-sweetened chewing gum in caries control

BACKGROUND

The author compared the caries-inhibitory action of sorbitol- and xylitol-sweetened chewing gum and assessed the role of these products in caries prevention.

TYPES OF STUDIES REVIEWED

The author reviewed studies including randomized field trials with substantial numbers of participants and observational studies. He did not review case studies. He found studies through a MEDLINE search and by hand searching.

RESULTS

When compared with sugar-sweetened gum, sorbitol-sweetened gum had low cariogenicity [corrected] when it was chewed no more than three times per day. Xylitol-sweetened gum was noncariogenic in all of the protocols tested. Some studies claimed that xylitol-sweetened gum had an anticariogenic effect, though these claims need further study. There also is good evidence that when mothers of infants and young children chew xylitol-sweetened gum, it will block transmission of mutans streptococci from mother to child.

CLINICAL IMPLICATIONS

The evidence is strong enough to support the regular use of xylitol-sweetened gum as a way to prevent caries, and it can be promoted as a public-health preventive measure. Chewing xylitol-sweetened gum, especially for patients who like chewing gum, can be fitted readily into a regimen that includes frequent fluoride exposure, good oral hygiene and regular dental appointments.

Xylitol in the prevention of oral diseases

Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution. Primary prevention to maintain oral comfort and function for these patients is a priority to support their quality of life. Typical oral health problems of these patients include hyposalivation, root-surface caries, poor oral hygiene, a high prevalence of periodontal disease and dental caries. The purpose of this paper is to review information for the inclusion of xylitol in primary preventive regimens as an adjunct for the prevention of oral diseases for special needs patients.

Can the pentitol-hexitol theory explain the clinical observations made with xylitol?

The natural dietary carbohydrate xylitol has been used as a source of energy in infusion therapy and found to act curatively in certain clinical situations. Xylitol has also been used as a sweetener in the diabetic diet and as a non- or anticariogenic agent. Xylitol is a sugar alcohol (polyhydric alcohol) of the pentitol type. The various advantageous clinical effects associated with enteral and parenteral administration of xylitol can be considered to result from the five-carbon (pentitol) nature of the molecule and from the molecule's special configuration even when compared with other pentitols. Such effects may be regarded as simple consequences of evolutionary expediency in a situation where human nutrition and man's significant energy-yielding metabolic pathways are associated with the six-carbon nature of D-glucose and the close derivatives and polymers of D-glucose and related sugars, and the physiologic involvement of the five-carbon xylitol in several ancillary pathways. Consequently, most clinical effects occasioned by xylitol cannot be expected to be caused by six-carbon hexitols such as D-mannitol and D-glucitol. A simple pentitol-hexitol theory seems to explain most of the clinical effects associated with the administration of xylitol. This theory is in congruence with the general evolutionary development in which the metabolism of C(6)-based carbohydrates is often inhibited by C(5)-based ones (as manifested in certain bacterial infections in man), or where the presence of the C(5)-based xylitol forwards therapeutically significant metabolic pathways (as observed in parenteral nutrition and treatment of certain enzyme deficiencies). The validity of the theory can be verified in controlled clinical trials.

Sorbitol compared with xylitol in prevention of dental caries

OBJECTIVE

To summarize published data on the comparative efficacy of sorbitol and xylitol for prevention of dental caries.

DATA SOURCES

Published double-blind comparative trials, using sorbitol and xylitol products, identified by MEDLINE (January 1966-December 1998) and International Pharmaceutical Abstracts (January 1970-December 1998) searches.

DATA SYNTHESIS

Clinical trials generally used sorbitol and xylitol gums, which patients chewed three to five times daily for 20-40 months. Xylitol was superior to sorbitol in two longer, secondary dentition trials (30-63% reductions), but not in two primary dentition trials.

CONCLUSIONS

The data suggest that xylitol-containing gums may provide superior efficacy in reducing caries rates in high-risk populations.

Attitudes of carers and the elderly occupants of residential homes to antimicrobial chewing gum as an aid to oral health

OBJECTIVE

The aim of this study was to investigate the attitudes of elderly residents to using an antimicrobial chewing gum as an aid to oral health, and the opinion of their carers on such a procedure.

DESIGN

A cross-sectional, multi-centre survey using a structured interview/questionnaire conducted with elderly residents and their carers.

SETTING

In January 1998, 9 residential/nursing homes were chosen at random from all the homes in West Hertfordshire, 207 residents were asked to chew two pieces of gum twice daily for 7 days.

SUBJECTS

The participants, 148 women and 59 men, were aged between 53-100 years (mean age 82.23 +/- 9.62 years). 47 carers, all female, were involved in distributing and collecting the gum.

RESULTS

122 residents (58.9%) were edentulous and 85 (41%) of the participants were partially dentate. Of those with teeth 23 (27%) had 21 teeth or more. 73 (35.2%) residents found that chewing the gum was difficult with 37 (17.9%) of this group being unable to chew (P < 0.0001 for those residents with no teeth/dentures or dentures unopposed by teeth or other dentures). 32 (18.6%) subjects disliked the flavour of the gum. Of the 170 residents who chewed the gum 99 (57.2%) found it reduced oral dryness and 78 (45.1%) reported it made their mouth feel healthy. 34 (53.6%) of the dentate and 47 (40.9%) of the edentate residents wished to keep using the gum (P < 0.05). 35 (74.5%) of the carers found it easy to distribute the gum and 29 (61.7%) thought that chewing gum was an acceptable method of maintaining oral health for residents.

CONCLUSION

The antimicrobial gum investigated in this study was acceptable to many elderly occupants and their carers, significantly improving perceived oral health and oral dryness of residents.

Xerostomia and hyposalivation: causes, consequences and treatment in the elderly

Xerostomia and salivary gland hypofunction (SGH) are prevalent in elderly populations, causing much discomfort and even difficulties in eating. SGH also increases the occurrence and severity of oral diseases and makes the patient susceptible to candidiasis. The principal causes of SGH and xerostomia are systemic diseases and drugs used daily. The diagnosis of SGH and xerostomia is based on simple methods, of which measuring both unstimulated and stimulated salivary flow rate is the most important. Treatment calls for proper management of underlying disease, avoidance of all unnecessary medications, and topical remedies such as artificial saliva substitutes. However, good hydration is essential in the elderly with SGH and xerostomia, and water is the drink of choice. In extremely difficult cases, for instance in patients receiving radiotherapy for cancer of the head and neck regions, parasympathomimetic drugs may be administered if no contraindications exist.

Xylitol in caries prevention: what is the evidence for clinical efficacy?

Xylitol has attracted much attention as an alternative sweetener. Essentially all clinical studies concerning the effect of xylitol on caries development consent to its non-cariogenicity and to the beneficial effect of substituting sucrose with xylitol in chewing gums and sweets. However, claims of anti-caries or therapeutic effects, and superiority of xylitol over other polyols are still to be confirmed by well designed and conducted studies from independent research groups.