Scolaris Content Display Scolaris Content Display

Study flow diagram.
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Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Adults: xylitol lozenges versus control lozenges, Outcome 1 Caries increment at 33 months follow‐up (DFS).
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Analysis 1.1

Comparison 1 Adults: xylitol lozenges versus control lozenges, Outcome 1 Caries increment at 33 months follow‐up (DFS).

Comparison 2 Children: xylitol lozenges versus no treatment, Outcome 1 Caries increment at 4 years follow‐up (DMFS).
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Analysis 2.1

Comparison 2 Children: xylitol lozenges versus no treatment, Outcome 1 Caries increment at 4 years follow‐up (DMFS).

Comparison 2 Children: xylitol lozenges versus no treatment, Outcome 2 Number with caries increment at 4 years follow‐up (as opposed to none/no change).
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Analysis 2.2

Comparison 2 Children: xylitol lozenges versus no treatment, Outcome 2 Number with caries increment at 4 years follow‐up (as opposed to none/no change).

Comparison 3 Children: xylitol topical oral syrup versus control syrup (very low dose xylitol), Outcome 1 Number of decayed primary teeth at 1 year follow‐up.
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Analysis 3.1

Comparison 3 Children: xylitol topical oral syrup versus control syrup (very low dose xylitol), Outcome 1 Number of decayed primary teeth at 1 year follow‐up.

Comparison 4 Children: xylitol sucking tablets versus no treatment, Outcome 1 Caries increment at 2 years follow‐up (dmfs).
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Analysis 4.1

Comparison 4 Children: xylitol sucking tablets versus no treatment, Outcome 1 Caries increment at 2 years follow‐up (dmfs).

Comparison 4 Children: xylitol sucking tablets versus no treatment, Outcome 2 Number with caries increment at 2 years follow‐up (as opposed to none/no change).
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Analysis 4.2

Comparison 4 Children: xylitol sucking tablets versus no treatment, Outcome 2 Number with caries increment at 2 years follow‐up (as opposed to none/no change).

Comparison 5 Children: xylitol plus fluoride toothpaste versus fluoride toothpaste, Outcome 1 Caries increment at 2.5 to 3 years follow‐up (Prevented Fraction).
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Analysis 5.1

Comparison 5 Children: xylitol plus fluoride toothpaste versus fluoride toothpaste, Outcome 1 Caries increment at 2.5 to 3 years follow‐up (Prevented Fraction).

Comparison 5 Children: xylitol plus fluoride toothpaste versus fluoride toothpaste, Outcome 2 Caries increment at 2.5 to 3 years follow‐up (DFS).
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Analysis 5.2

Comparison 5 Children: xylitol plus fluoride toothpaste versus fluoride toothpaste, Outcome 2 Caries increment at 2.5 to 3 years follow‐up (DFS).

Comparison 6 Children: xylitol tablets versus control (sorbitol) tablets, Outcome 1 Number with caries increment at 4 years follow‐up (as opposed to none/no change).
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Analysis 6.1

Comparison 6 Children: xylitol tablets versus control (sorbitol) tablets, Outcome 1 Number with caries increment at 4 years follow‐up (as opposed to none/no change).

Comparison 7 Children: xylitol wipes versus control wipes, Outcome 1 Number with caries increment at 1 year follow‐up (as opposed to none/no change).
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Analysis 7.1

Comparison 7 Children: xylitol wipes versus control wipes, Outcome 1 Number with caries increment at 1 year follow‐up (as opposed to none/no change).

Summary of findings for the main comparison. Xylitol toothpaste versus control toothpaste for preventing dental caries

Xylitol toothpaste compared with control toothpaste for preventing dental caries

Patient or population: children with permanent teeth

Settings: schools

Intervention: fluoride toothpaste containing 10% xylitol

Comparison: fluoride toothpaste

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Xylitol

Caries: increment (DFS) prevented fraction (PF) at 2.5 to 3 years follow‐up

(higher DFS score indicates worse caries)

The (weighted) mean caries increment for control groups was
2.1

The mean caries increment in the xylitol groups was

0.28 lower

(0.42 to 0.14 lower)

PF¹ = 0.13 (0.08 to 0.18)

4216
(2 studies)

⊕⊕⊝⊝
low²

The PF of 0.13 means that there was a 13% reduction in caries in the xylitol group

There is no compelling evidence, from other comparisons in this systematic review, to support the use of xylitol products. The body of evidence for all other comparisons and caries outcomes is rated as being low to very low quality. This is because they are single studies with imprecision mostly due to very small sample sizes, and most of which have a high risk of bias

Adverse effects

Both studies reported that there were no adverse effects in either the xylitol or control group

CI: Confidence interval; DFS: decayed filled surfaces; PF: prevented fraction

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

¹ The prevented fraction (PF) is calculated as follows: the mean increment in the controls minus the mean increment in the treated group divided by the mean increment in the controls

² Downgraded due to high risk of bias in the included studies (due to high attrition) and both studies were conducted by the same authors in the same population

Figures and Tables -
Summary of findings for the main comparison. Xylitol toothpaste versus control toothpaste for preventing dental caries
Table 1. Prevented fractions (PF) for caries incremental data

Comparison (number)

Increment (Study)

PF (95% CI)

Notes

Adults

Xylitol lozenges versus control lozenges (1.1)

33‐month caries increment (Bader 2013)

0.08 (–0.03 to 0.20)

8% reduction in caries in test group

 Children

Xylitol lozenges versus no treatment (2.1)

4 year caries increment (Lenkkeri 2012)

 

‐0.10 (‐0.59 to 0.39)

10% increase in caries in test group compared to control

 

Xylitol topical oral syrup versus control syrup (3.1)

Caries in primary teeth over 1 year follow‐up (Milgrom 2009)

0.58 (0.33 to 0.83)

58% reduction in caries in test group

 

Xylitol sucking tablets versus no treatment (4.1)

2 year caries increment (Oscarson 2006)

0.53 (0.001 to 1.04)

53% reduction in caries in test group

 

Xylitol plus fluoride toothpaste versus fluoride toothpaste (5.1)

2.5 to 3 year caries increment (Sintes 1995)

0.12 (0.06 to 0.18)

12% reduction in caries in test group

2.5 to 3 year caries increment (Sintes 2002)

0.14 (0.05 to 0.23)

14% reduction in caries in test group

CI = confidence interval

Figures and Tables -
Table 1. Prevented fractions (PF) for caries incremental data
Comparison 1. Adults: xylitol lozenges versus control lozenges

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Caries increment at 33 months follow‐up (DFS) Show forest plot

1

669

Mean Difference (IV, Fixed, 95% CI)

‐0.64 [‐1.58, 0.30]

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Comparison 1. Adults: xylitol lozenges versus control lozenges
Comparison 2. Children: xylitol lozenges versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Caries increment at 4 years follow‐up (DMFS) Show forest plot

1

97

Mean Difference (IV, Fixed, 95% CI)

0.28 [‐0.99, 1.55]

2 Number with caries increment at 4 years follow‐up (as opposed to none/no change) Show forest plot

1

97

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.83, 1.26]

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Comparison 2. Children: xylitol lozenges versus no treatment
Comparison 3. Children: xylitol topical oral syrup versus control syrup (very low dose xylitol)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of decayed primary teeth at 1 year follow‐up Show forest plot

1

94

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐2.03, ‐0.18]

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Comparison 3. Children: xylitol topical oral syrup versus control syrup (very low dose xylitol)
Comparison 4. Children: xylitol sucking tablets versus no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Caries increment at 2 years follow‐up (dmfs) Show forest plot

1

118

Mean Difference (IV, Fixed, 95% CI)

‐0.42 [‐1.12, 0.28]

2 Number with caries increment at 2 years follow‐up (as opposed to none/no change) Show forest plot

1

118

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.35, 1.45]

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Comparison 4. Children: xylitol sucking tablets versus no treatment
Comparison 5. Children: xylitol plus fluoride toothpaste versus fluoride toothpaste

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Caries increment at 2.5 to 3 years follow‐up (Prevented Fraction) Show forest plot

2

Prevented Fraction (Fixed, 95% CI)

0.13 [0.08, 0.18]

2 Caries increment at 2.5 to 3 years follow‐up (DFS) Show forest plot

2

4216

Mean Difference (IV, Fixed, 95% CI)

‐0.28 [‐0.42, ‐0.14]

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Comparison 5. Children: xylitol plus fluoride toothpaste versus fluoride toothpaste
Comparison 6. Children: xylitol tablets versus control (sorbitol) tablets

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with caries increment at 4 years follow‐up (as opposed to none/no change) Show forest plot

1

62

Risk Ratio (M‐H, Fixed, 95% CI)

3.08 [0.69, 13.65]

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Comparison 6. Children: xylitol tablets versus control (sorbitol) tablets
Comparison 7. Children: xylitol wipes versus control wipes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with caries increment at 1 year follow‐up (as opposed to none/no change) Show forest plot

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.02, 1.07]

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Comparison 7. Children: xylitol wipes versus control wipes