A multi-disciplinary expert panel, convened by the American Dental Association (ADA) Council on Scientific Affairs, issued a report this month containing clinical recommendations that sugar-free chewing gum, lozenges and hard candy including xylitol [see below] or polyol combinations, and a prescription varnish with chlorhexidine and thymol could be beneficial in preventing cavities when used as adjuncts to a comprehensive cavity prevention program which includes the use of fluoride-containing products.

The panel noted in its report that these nonfluoride options could provide an extra benefit to prevent cavities in patients at high risk for developing cavities when used in addition to products such as toothpaste, dental sealants and varnishes that contain fluoride as well as community water fluoridation and good eating habits.

The full report is available on the ADA’s Center for Evidence-Based Dentistry (EBD) website. The executive summary of the report entitled, “Nonfluoride Caries Preventive Agents,” is published in the September issue of The Journal for the American Dental Association and is available on the EBD website (http://jada.ada.org/content/142/9/1065.full.pdf ). The clinical recommendations from the expert panel were reviewed and approved by the ADA’s Council on Scientific Affairs.

The ADA recommends that clinicians determine a patient’s risk for developing cavities by conducting a caries risk assessment, which includes completing a caries risk assessment form that can be used as a communications tool with their patients. The Caries Form (Patients Ages 0–6 Years) (http://jada.ada.org/content/142/9/1065.full.pdf ) and the Caries Form (Patients Over 6 Years) (http://jada.ada.org/content/142/9/1065.full.pdf) are available on ADA.org.

Nonfluoride agents

In addition to a comprehensive cavity-prevention program which includes the use of fluoride, the scientific panel recommended that clinicians consider applying a mixture of cholrhexidine-thymol varnish to the teeth of high-risk adults and the elderly every three months to reduce cavities developing in the root of the tooth.

The panel encouraged clinicians to consider advising parents and caregivers of healthy children older than 5 years who are at higher risk for cavities to chew sugar-free polyol gum after meals for 10 to 20 minutes to prevent cavities.

A polyol is a low-calorie sweetener such as xylitol [see below], sorbitol or mannitol, which is not broken down by the bacteria in the mouth and therefore does not contribute to tooth decay. The panel also recommended that sucking xylitol-containing sugar-free lozenges or hard candy after meals may reduce cavities in children.

The panel’s recommendations are based on a review of evidence from 71 published articles that described 50 randomized controlled trials and 15 nonrandomized studies to assess the effectiveness of various nonfluoride agents in preventing cavities.

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Some brief notes on xylitol from Fluoride Action Network:

• J Am Vet Med Assoc. 2006 Oct 1;229(7):1113-7.
Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs
• Vet Hum Toxicol. 004 Apr;46(2):87-8.
Hypoglycemia following canine ingestion of xylitol-containing gum
• Top 10 Dog Poisons
Dog poison No. 3: People food.
Included in this category is:
Xylitol. This sweetener is found in many products, including sugar-free gum and candy. It causes a rapid drop in blood sugar, resulting in weakness and seizures. Liver failure also has been reported in some dogs.
• New findings on the effects of xylitol ingestion in dogs
By Eric K. Dunayer, MS, VMD, DABT, DABVT
Veterinary Medicine, December 2006
… While xylitol consumption is considered safe in people, dogs can develop serious, even life-threatening, signs from xylitol ingestion. Xylitol’s ability to cause hypoglycemia in dogs has been recognized for almost 40 years, but a recent study has found that xylitol also can cause acute hepatic necrosis.
• Feb 10, 2011, USA Today
Vet’s view: Xylitol can be deadly to dogs

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