Meta-analysis on the Effectiveness of Xylitol in Caries Prevention

BACKGROUND: Oral xylitol products have been labeled as a caries preventive measure; however, their use is still limited. This study aims to summarize the evidence on the effectiveness of xylitol-containing products in dental caries prevention with a focus on dental caries as the primary outcome rather than other pseudo outcomes. MATERIALS AND METHODS: A structured literature search was conducted to identify the studies related to the efficiency of products containing xylitol for the prevention of caries. The literature search was conducted through the following databases: Medline, PubMed (Central), SCOPUS, Web of Science (WoS), Open Grey, and the Cochrane Library and included papers published between 1966 and March 2020. Fixed- and random-effect models were used to obtain pooled estimates through meta-analysis. RESULTS: Evidence-based results of this study showed that xylitol is easily available in the form of various products, but clinically tested products are few in markets. The literature review has also concluded that the most effective xylitol product in caries prevention was (100%) xylitol, chewed or consumed three to five times per day, after meals with a total dose of 5–10 g of xylitol per day. Products included xylitol-containing lozenges, candies, and chewing gum, foods based on xylitol, and xylitol-containing toothpaste and mouth rinse. Results showed that xylitol-containing products significantly prevented caries compared with the other (control) non-xylitol products. Pooled estimates using the combined fixed and random effects of standardized mean difference were −0.099 [95% confidence interval (CI): −0.149, −0.049] and −0.089 (95% CI: −2.04, 0.026), respectively. CONCLUSION: This review concluded that xylitol should be part of an overall strategy to decrease and prevent dental caries. Dosage and frequency should be considered strictly when prescribing xylitol as a caries preventive measure.