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Cochrane Database Syst Rev.2015 Mar;(3):CD010743. doi: 10.1002/14651858.CD010743.pub2.Epub 2015-03-26.


Xylitol-containing products for preventing dental caries in children and adults.

  • Philip Riley
  • Deborah Moore
  • Farooq Ahmed
  • Mohammad O Sharif
  • Helen V Worthington
PMID: 25809586 DOI: 10.1002/14651858.CD010743.pub2.




BACKGROUND: Dental caries is a highly prevalent chronic disease which affects the majority of people. It has been postulated that the consumption of xylitol could help to prevent caries. The evidence on the effects of xylitol products is not clear and therefore it is important to summarise the available evidence to determine its effectiveness and safety.



OBJECTIVES: To assess the effects of different xylitol-containing products for the prevention of dental caries in children and adults.


以下の電子データベースを検索した:Cochrane Oral Health Group Trials Register(2014年8月14日まで),Cochrane Central Register of Controlled Trials(CENTRAL)(The Cochrane Library, 2014, Issue 7),MEDLINE via OVID(1946年~2014年8月14日),EMBASE via OVID(1980年~2014年8月14日),CINAHL via EBSCO(1980年~2014年8月14日),Web of Science Conference Proceedings(1990年~2014年8月14日),Proquest Dissertations and Theses(1861年~2014年8月14日)。進行中の試験については,米国国立衛生研究所のTrials Register(http://clinicaltrials.gov)およびWHO Clinical Trials Registry Platformを検索した。電子データベースを検索する際、言語や発表日に制限は設けなかった。

SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 14 August 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 7), MEDLINE via OVID (1946 to 14 August 2014), EMBASE via OVID (1980 to 14 August 2014), CINAHL via EBSCO (1980 to 14 August 2014), Web of Science Conference Proceedings (1990 to 14 August 2014), Proquest Dissertations and Theses (1861 to 14 August 2014). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.



SELECTION CRITERIA: We included randomised controlled trials assessing the effects of xylitol products on dental caries in children and adults.



DATA COLLECTION AND ANALYSIS: Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference and 95% confidence interval (CI). We used the continuous data to calculate prevented fractions (PF) and 95% CIs to summarise the percentage reduction in caries. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. As there were less than four studies included in the meta-analysis, we used a fixed-effect model. We planned to use a random-effects model in the event that there were four or more studies in a meta-analysis.


10件の研究を対象とし、合計5903名の参加者を分析した。レビューの主な結果は、2.5~3年間の使用で、キシリトールを10%含むフッ素入り歯磨き粉は、フッ素のみの歯磨き粉と比較して、う蝕を13%減少させる可能性があるというものであった(PF -0.13, 95% CI -0.18 to -0.08, 分析された4216人の子供, 低質エビデンス)。子供に関する残りのエビデンスは、バイアスのリスクがあり、効果推定値に大きな不確実性が伴う小規模な単一研究から得られたもので、キシリトール製品の有益性を判断するには不十分であった。ある研究では、低用量のキシリトールシロップ(1日2.67g)を1年間摂取した場合と比較して、キシリトールシロップ(1日8g)がう蝕を58%(95%CI 33%~83%、分析対象は94人の乳児、低質エビデンス)減少させたと報告しています。次の結果の95%CIは、キシリトールに関連したう蝕の減少と増加の両方に適合していました:キシリトールトローチ対小児の無処置(非常に質の低いエビデンス)、キシリトール吸水タブレット対乳児の無処置(非常に質の低いエビデンス)、乳児のキシリトールタブレット対対照(ソルビトール)タブレット(非常に質の低いエビデンス)、乳児のキシリトール拭い対対照拭い(質の低いエビデンス)。成人におけるキシリトールトローチの効果を対照トローチと比較した研究は1件のみでした(低質エビデンス)。4件の研究では、いずれの介入も副作用はなかったと報告されています。4つの研究では、どの介入も副作用はなかったと報告されています。残りの研究では、副作用について言及しているが、使用可能なデータを報告していないか、まったく言及していない。副作用には、口内炎、けいれん、腹部膨満感、便秘、鼓腸、緩い便または下痢などがある。

MAIN RESULTS: We included 10 studies that analysed a total of 5903 participants. One study was assessed as being at low risk of bias, two were assessed as being at unclear risk of bias, with the remaining seven being at high risk of bias.The main finding of the review was that, over 2.5 to 3 years of use, a fluoride toothpaste containing 10% xylitol may reduce caries by 13% when compared to a fluoride-only toothpaste (PF -0.13, 95% CI -0.18 to -0.08, 4216 children analysed, low-quality evidence).The remaining evidence on children, from small single studies with risk of bias issues and great uncertainty associated with the effect estimates, was insufficient to determine a benefit from xylitol products. One study reported that xylitol syrup (8 g per day) reduced caries by 58% (95% CI 33% to 83%, 94 infants analysed, low quality evidence) when compared to a low-dose xylitol syrup (2.67 g per day) consumed for 1 year.The following results had 95% CIs that were compatible with both a reduction and an increase in caries associated with xylitol: xylitol lozenges versus no treatment in children (very low quality body of evidence); xylitol sucking tablets versus no treatment in infants (very low quality body of evidence); xylitol tablets versus control (sorbitol) tablets in infants (very low quality body of evidence); xylitol wipes versus control wipes in infants (low quality body of evidence).There was only one study investigating the effects of xylitol lozenges, when compared to control lozenges, in adults (low quality body of evidence). The effect estimate had a 95% CI that was compatible with both a reduction and an increase in caries associated with xylitol.Four studies reported that there were no adverse effects from any of the interventions. Two studies reported similar rates of adverse effects between study arms. The remaining studies either mentioned adverse effects but did not report any usable data, or did not mention them at all. Adverse effects include sores in the mouth, cramps, bloating, constipation, flatulence, and loose stool or diarrhoea.



AUTHORS' CONCLUSIONS: We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children, and that there are no associated adverse-effects from such toothpastes. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population. The remaining evidence we found is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults.