Lack of evidence

Xylitol is a natural sweetener that is widely promoted globally, and can be found in wide range of everyday products including sugar free chewing gum, toothpaste, gels, lozenges and sweets.

Xylitol is a popular sugar substitute in sweets and it is already known to cause less damage to teeth than sugar. It has also been suggested that the addition of xylitol to products may help to prevent tooth decay by stopping the growth of decay-producing bacteria. However, according to new evidence published in the Cochrane Library there is little high quality evidence that it is beneficial in the fight against tooth decay, which affects up to 90 per cent of children and most adults worldwide.

The authors gathered together data from 5,903 participants in ten different studies. In most cases, the studies used such different methods that the researchers could not combine the results to create a summary effect estimate. Based on information from 4,216 school children who took part in two Costa Rican studies, they found low quality evidence that levels of tooth decay were 13 per cent lower in those who used a fluoride toothpaste containing xylitol for three years, compared to those who used fluoride-only toothpaste. For other xylitol-containing products, such as xylitol syrup, lozenges and tablets, there was little or no evidence of any benefit.