Effect of Xylitol Chewing Gum on Presence of Streptococcus mutans in Saliva


  • Nguyen Thi Hong Minh Department of Periodontology, National Hospital of Odonto-Stomatology, Hanoi, Vietnam
  • Le Hai Department of Poly-Clinical, 108 Military Central Hospital, Hanoi, Vietnam; Faculty of Odonto-Stomatology, 108 Institute of Clinical Medical and Pharmaceutical Sciences, Hanoi, Vietnam
  • Tran Thi Nga Lien Department of Periodontology, National Hospital of Odonto-Stomatology, Hanoi, Vietnam
  • Tran Cao Binh Department of Periodontology, National Hospital of Odonto-Stomatology, Hanoi, Vietnam




Streptococcus mutans, Tooth decay, Xylitol gum, saliva


BACKGROUND: Oral disease ranks third among the most serious diseases in the world, after cancer and cardiovascular disease. Vietnamese population has suffered from various dental and oral diseases, of which the most common have been identified to be cavities and inflammation around the teeth.

AIM: The aim of the study was to evaluate the effectiveness of using xylitol gum on the status of Strepptococus mutans bacteria in saliva.

METHODS: The study design was an uncontrolled clinical study conducted at the Hanvinco Texture Factory (Hanoi). Two hundred and fifty-four subjects between the ages of 18 and 63 were included in the clinical trial. These subjects brushed their teeth for 2 weeks before providing a saliva sample for S. mutans. The 80 subjects with the highest number of salivary S. mutans were recruited for the further analysis (at least 104 CFU/ml). After each clinical intervention, participant chewed Lotte xylitol gum after each meal, two capsules each time and 1 time in the evening (total 4 times/day), continuously for 4 weeks. Saliva samples were quantified for S. mutans by real-time PCR method.

RESULTS: Quantitative analysis of S. mutans bacteria in saliva of 254 subjects showed that 19.7% had S. mutans detected within 105 CFU/ml of saliva. These result shows that nearly 20% of the subjects examined have a high risk of tooth decay. After continuous use of xylitol chewing gum 4 times a day for 4 weeks by 80 subjects, it showed a decrease in the number of S. mutans in the saliva of participants, and the difference was statistically significant.

CONCLUSIONS: The use of xylitol chewing gum taken 4 times/day is effective in reducing the number of S. mutans bacteria in saliva when combined with brushing your teeth.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Petersen PE. Global policy for improvement of oral health in the 21st century-implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol. 2009;37(1):1-8. https://doi.org/10.1111/j.1600-0528.2008.00448.x PMid:19046331 DOI: https://doi.org/10.1111/j.1600-0528.2008.00448.x

Hải TĐ, Minh NT, Binh TC. National Oral Health Survey of Vienam. India: Medical Publishing House; 2019.

Gadiyar A, Gaunkar R, Kamat AK, Tiwari A, Kumar A. Impact of oral health-related behaviors on dental caries among children with special health-care needs in Goa: A cross-sectional study. J Indian Soc Pedod Prev Dent. 2018;36(1):33-7. https://doi.org/0.4103/jisppd.jisppd_214_17 PMid:29607836

Taqi M, Razak IA, Ab-Murat N. Comparing dental caries status using modified international caries detection and assessment system (ICDAS) and World Health Organization (WHO) indices among school children of Bhakkar, Pakistan. J Pak Med Assoc. 2019;69(7):950-4. PMid:31308560

Ghasemianpour M, Bakhshandeh S, Shirvani A, Emadi N, Samadzadeh H, Moosavi Fatemi N, et al. Dental caries experience and socio-economic status among Iranian children: A multilevel analysis. BMC Public Health. 2019;19(1):1569. https://doi.org/10.1186/s12889-019-7693-1 PMid:31775741 DOI: https://doi.org/10.1186/s12889-019-7693-1

Fejerskov O. Changing paradigms in concepts on dental caries: Consequences for oral health care. Caries Res. 2004;38(3):182-191. https://doi.org/10.1159/000077753 PMid:15153687 DOI: https://doi.org/10.1159/000077753

Gao X, Jiang S, Koh D, Hsu CY. Salivary biomarkers for dental caries. Periodontol 2000. 2016;70(1):128-41. https://doi.org/10.1111/prd.12100 PMid:26662487 DOI: https://doi.org/10.1111/prd.12100

Struzycka I. The oral microbiome in dental caries. Pol J Microbiol. 2014;63(2):127-35. PMid:25115106 DOI: https://doi.org/10.33073/pjm-2014-018

Fakhruddin KS, Ngo HC, Samaranayake LP. Cariogenic microbiome and microbiota of the early primary dentition: A contemporary overview. Oral Dis. 2019;25(4):982-95. https://doi.org/10.1111/odi.12932 PMid:29969843 DOI: https://doi.org/10.1111/odi.12932

Cocco F, Carta G, Cagetti MG, Strohmenger L, Lingström P, Campus G. The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults. Clin Oral Investig. 2017;21(9):2733-40. https://doi.org/10.1007/s00784-017-2075-5 PMid:28303470 DOI: https://doi.org/10.1007/s00784-017-2075-5

Watthanasaen S, Merchant AT, Luengpailin S, Chansamak N, Pisek A, Pitiphat W. Xylitol-containing chewing gum for caries prevention in students with disabilities: A randomised trial. Oral Health Prev Dent. 2017;15(6):519-27. https://doi.org/10.3290/j.ohpd.a39668 PMid:29319061

Toors FA. Chewing gum and dental health. Literature review. Rev Belge Med Dent (1984). 1992;47(3):67-92. PMid:1305985

Aluckal E, Ankola AV. Effectiveness of xylitol and polyol chewing gum on salivary streptococcus mutans in children: A randomized controlled trial. Indian J Dent Res. 2018;29(4):445-9. https://doi.org/10.4103/ijdr.ijdr_307_16 PMid:30127194 DOI: https://doi.org/10.4103/ijdr.IJDR_307_16

Shinde MR, Winnier J. Comparative evaluation of Stevia and Xylitol chewing gum on salivary Streptococcus mutans count-a pilot study. J Clin Exp Dent. 2020;12(6):e568-573. https://doi.org/10.4317%2Fjced.55720 PMid:32665816 DOI: https://doi.org/10.4317/jced.55720

Akgül Ö, Ak AT, Zorlu S, Özdaş DO, Uslu M, Çayirgan D. Effects of short-term xylitol chewing gum on pro-inflammatory cytokines and Streptococcus mutans: A randomised, placebo-controlled trial. Int J Clin Pract. 2020;74(9):e13623. https://doi.org/10.1111/ijcp.13623 PMid:32729244 DOI: https://doi.org/10.1111/ijcp.13623

Abdelwahab DH, Allam GG, Aziz AM. Effect of Xylitol and sugar-free chewing gums on salivary bacterial count of Streptococcus mutans and Lactobacilli in a group of Egyptian school children of different ages: A randomized clinical trial. Futur Dent J. 2018;4:216-20. DOI: https://doi.org/10.1016/j.fdj.2018.07.001

Llop MR, Jimeno FG, Acién RM, Dalmau LJ. Effects of xylitol chewing gum on salivary flow rate, pH, buffering capacity and presence of Streptococcus mutans in saliva. Eur J Paediatr Dent. 2010;11(1):9-14. PMid:20359274

Mira A. Oral microbiome studies: Potential diagnostic and therapeutic implications. Adv Dent Res. 2018;29(1):71-7. https://doi.org/10.1177/0022034517737024 PMid:29355422 DOI: https://doi.org/10.1177/0022034517737024

Valm AM. The structure of dental plaque microbial communities in the transition from health to dental caries and periodontal disease. J Mol Biol. 2019;431(16):2957-69. https://doi.org/10.1016/j.jmb.2019.05.016 PMid:31103772 DOI: https://doi.org/10.1016/j.jmb.2019.05.016

Forssten SD, Björklund M, Ouwehand AC. Streptococcus mutans, caries and simulation models. Nutrients. 2010;2(3):290-8. https://doi.org/10.3390/nu2030290 PMid:22254021 DOI: https://doi.org/10.3390/nu2030290

Klein MI, Hwang G, Santos PH, Campanella OH, Koo H. Streptococcus mutans-derived extracellular matrix in cariogenic oral biofilms. Front Cell Infect Microbiol. 2015;5:10. https://doi.org/10.3389/fcimb.2015.00010 PMid:25763359 DOI: https://doi.org/10.3389/fcimb.2015.00010

Esberg A, Sheng N, Mårell L, Claesson R, Persson K, Borén T, et al. Streptococcus mutans adhesin biotypes that match and predict individual caries development. EBioMedicine. 2017;24:205-15. https://doi.org/10.1016/j.ebiom.2017.09.027 PMid:28958656 DOI: https://doi.org/10.1016/j.ebiom.2017.09.027

Bowen WH. Dental caries-not just holes in teeth! A perspective. Mol Oral Microbiol. 2016;31(3):228-33. https://doi.org/10.1111/omi.12132 PMid:26343264 DOI: https://doi.org/10.1111/omi.12132

Janakiram C, Deepan Kumar CV, Joseph J. Xylitol in preventing dental caries: A systematic review and meta-analyses. J Nat Sci Biol Med. 2017;8(1):16-21. https://doi.org/10.4103%2F0976-9668.198344 PMid:28250669 DOI: https://doi.org/10.4103/0976-9668.198344

Marghalani AA, Guinto E, Phan M, Dhar V, Tinanoff N. Effectiveness of xylitol in reducing dental caries in children. Pediatr Dent. 2017;39(2):103-10. PMid:28390459

Salli K, Lehtinen MJ, Tiihonen K, Ouwehand AC. Xylitol’s health benefits beyond dental health: A comprehensive review. Nutrients. 2019;11(8):1813. https://doi.org/10.3390/nu11081813 PMid:31390800 DOI: https://doi.org/10.3390/nu11081813

Söderling EM. Xylitol, mutans streptococci, and dental plaque. Adv Dent Res. 2009;21(1):74-8. https://doi.org/10.1177/0895937409335642 PMid:19717413 DOI: https://doi.org/10.1177/0895937409335642

Baimbetov AK, Abzaliev KB, Jukenova AM, Bizhanov KA, Bairamov BA, Ualiyeva AY. The efficacy and safety of cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation. Ir J Med Sci. 2021. https://doi.org/10.1007/s11845-021-02560-z DOI: https://doi.org/10.1007/s11845-021-02560-z

Baimbetov AK, Bizhanov KA, Abzaliyev KB, Bairamov BA, Yakupova IA. Prediction of arrhythmia recurrence after atrial fibrillation ablation in patients with normal anatomy of the left atrium. Int J Clin Pract. 2021;75(6):e14083. https://doi.org/10.1111/ijcp.14083 PMid:33555091 DOI: https://doi.org/10.1111/ijcp.14083




How to Cite

Minh NTH, Hai L, Lien TTN, Binh TC. Effect of Xylitol Chewing Gum on Presence of Streptococcus mutans in Saliva. Open Access Maced J Med Sci [Internet]. 2021 Oct. 8 [cited 2024 Jul. 21];9(D):319-23. Available from: https://oamjms.eu/index.php/mjms/article/view/6928



Periodontology and Oral Medicine