The six-year study in Estonia:

Xylitol pastilles effectively prevent dental caries

Several Finnish and international long-term clinical studies have demonstrated that the regular use of xylitol chewing gum helps in caries prevention. The field study in Estonia, which commenced in 1994, is the first study on the effects of the use of xylitol pastilles on dental caries among children. The results of the study show that regular use of xylitol pastilles did reduce caries occurrence by 50% compared to the control group.

The Estonian field study was headed by Dr. Pentti Alanen, Professor at the University of Turku, Institute of Dentistry, and Dr. Pauli Isokangas of the Health Care Centre in Ylivieska. The six-year study in Estonia examined the effectiveness of 100% xylitol chewing gum and xylitol pastilles in caries prevention.

School distribution

Altogether 740 children from 12 schools in the regions of Tallinn and Tartu took part in the study. Most of the children were born in 1984. It was estimated that the selected schools should give an overview of the condition of children's teeth in Estonia. Caries prevalence in the study groups ranged from low to average and high.

After a clinical examination at the beginning of the field study, the 12 schools were divided into four groups: a control group, which received no xylitol, a xylitol chewing gum group and two xylitol pastille groups. Each group included all levels of caries prevalence; low, average and high.

The study used 100% xylitol-sweetened chewing gum and two different xylitol- sweetened pastilles, all provided by Leaf. The study was blinded between the two pastilles.

The daily xylitol dosage was five grammes, consisting of six xylitol gum pellets or eight pastilles. The children were given xylitol three times during the school day. On weekends and during the three month summer break, xylitol was not provided.

The children's teeth were examined annually, and caries was registered at three levels. The researchers were blinded in the clinical examination, and did not know what product the groups had used. In each annual examination, 20-30 children were examined by both researchers in order to account for variations in caries registrations between the researchers.

Significant caries reduction

After two years' use, caries reduction in all xylitol groups was approximately 50% compared with the control group. In the study, xylitol was used only on schooldays, approximately 200 days a year. Despite the three-month summer holiday, the prevention effect achieved was as good as in previous xylitol studies, where xylitol for the most part had been used on a daily basis. The study proved that when xylitol is used regularly for a sufficient period, even a three-month break did not reduce its effect.

References: Alanen P, Isokangas P, Gutmann K: Xylitol candies in caries prevention: results of a field study in Estonian children. Community Dent Oral Epidemiol 2000; 28: 218-24