Xylitol and Xerostomia

Xerostomia is a term that refers to dry mouth resulting from reduced or absent saliva flow. While xerostomia is not a disease, it may be a symptom of various health conditions, side effect of medications, or an adverse reaction of radiation to the head and neck. Dry mouth can be an uncomfortable and frustrating problem, but it is manageable. Xylitol is usually connected with the successful management of xerostomia and this post aimed to expect the accuracy of those claims. At the end of today’s article, you will be able to form an accurate opinion on whether or not you should use Xylitol to treat your xerostomia symptoms.

What is there to know about Xerostomia?

As we mentioned in the introduction part of today’s article, xerostomia, also known as dry mouth, is the term that is being used to describe a condition in which the mouth is severely dry due to the changes in the saliva flow. As you probably know, the saliva is what keeps your mouth clean, helping with the digestion of the food, removing any present bacteria, lubricating the oral cavity and maintaining your pH levels normal. Your saliva flow can be either reduced or absent, thus resulting in dry mouth, caused by numerous reasons. Doctors do not refer to xerostomia as a disease, they refer to it as a symptom usually caused by the use of certain medications such as antidepressants, antihistamines, and diuretics, certain medical conditions – Sjorgen’s syndrome, diabetes, anemia, cystic fibrosis, nerve damage, dehydration etc. The symptoms of xerostomia are severe dryness of the mouth, severe thirst, sores in the mouth, sticky feeling in the mouth etc. Xerostomia is easy to diagnose and easily treated. Usually, detecting the cause and taking measures to remove it is all that it takes to treat xerostomia in a matter of days.

What is xylitol?

Xylitol is a natural substance defined as sugar alcohol or polyalcohol and it delivers antimicrobial effects. It’s considered a natural substance because xylitol is present, in small amounts, in many fruits and vegetables. That is the reason why xylitol is considered to be a natural substance. Your body produces small amounts of this sugar alcohol through normal metabolism. Xylitol is also found in sugar-free chewing gums, mints, candies, products for diabetics, and in oral care products. What makes it different than “regular” sugar is that xylitol is lower in calories. While one gram of table sugar contains 4 calories, the same amount of xylitol delivers 2.4 calories[i]. Xylitol, despite the fact that it is a carbohydrate, it does not raise the blood sugar levels which is why it is commonly being used in low-carb products and sugar-free products. Keep in mind that xylitol is, after all, a refined sugar so do not expect to find any minerals, vitamins or anything that is remotely nutritional when it comes to xylitol. Xylitol is commonly being used to treat conditions such as dry mouth and tooth decay, but also prevent middle ear infections. So let’s see how exactly can xylitol help you with your dry mouth.

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Can xylitol help with xerostomia?

Bearing in mind that xylitol is found in oral care products, it is impossible not to wonder whether it’s truly beneficial for problems affecting your dental health. Numerous studies have been conducted on this subject. A research from the Journal of Oral Rehabilitation found that the use of products containing xylitol, olive oil, and betaine is safe and effective in relieving symptoms of polypharmacy-induced xerostomia[ii]. The term polypharmacy refers to the concurrent use of multiple medications.

The January-February 2017 issue of the Reports of Practical Oncology and Radiotherapy featured a study which evaluated the efficacy of xylitol, olive oil, and betaine in radiotherapy-induced xerostomia. Findings showed that the use of topical products containing these ingredients improved quality of life and decreased symptoms (dry mouth) in patients. In fact, these ingredients improved salivary flow by 45%[iii].

How does xylitol help dry mouth?

The use of products containing xylitol proves to be effective in xerostomia induced by different factors, as shown above. Now, you’re probably wondering how it works. Not only does it help reduce xerostomia, but xylitol also prevents dental caries[iv] and it decreases the number of carcinogenic and periodontopathic bacteria, plaque levels, teeth erosion, and gingival inflammation.

Xylitol works by reducing the level of Streptococcus mutans bacteria in plaque and saliva by impairing their energy production processes. This useful sugar alcohol reduces the adhesion of these tiny bacteria to the teeth surface, thus preventing their harmful effects. Like any other sweetener, xylitol increases salivary flow which helps combat dry mouth. As seen above, lack of saliva is the reason your mouth gets dry. Increased salivary flow also promotes mineralization that is much-needed for strong and healthy teeth and gums[v].

Bearing in mind that xylitol is, in fact, a carbohydrate it cannot be processed by harmful bacteria that cause tooth decay, gum disease, and other problems. That way, xylitol is able to produce saliva that combats xerostomia. This is particularly beneficial because dry mouth paves the way to bad breath.

Is xylitol safe?

Generally yes, but taking too much can cause certain side effects. Xylitol is found in a vast majority of sugar-free chewing gums (and other products) and we are inclined to believe that the more we use, the better results occur. That’s not always the case. While the continuous presence of xylitol is best for optimal results, you should strive not to use too many gums or other products. Typically, when exceeding 40-50g a day[vi], xylitol can lead to side effects such as diarrhea, bloating, colic, nausea, increased bowel movements, and borborygmi or rambling sounds of gas moving through the intestine. You see, just because it comes in the form of a chewing gum – a thing that we are raised to believe that it does not do any harm, that does not mean that it will not cause any side-effects when used more than recommended. Make sure that you read the instructions and consult your dentist and doctor before you start using xylitol, only then will you be able to get the most out of xylitol. You might wonder whether or not will xylitol harm a diabetic patient since we are talking about a sugar alcohol. And the answer is no – the use of xylitol will not harm a diabetic patient by raising the blood sugar levels because although xylitol tastes and looks like sugar, it does not raise the blood sugar levels after all. Of course, these patients are exposed to the risk of the potential side-effects that occur if an overdose happens, but that is everything that there is to fear of.

Conclusion

Xylitol is a sugar alcohol, a natural substance with antimicrobial effects. Found both in natural and in the human body, xylitol has been used for decades now as a sugar substitute for diabetics, treatment method for tooth decay and as it turns out – xerostomia as well! A growing body of evidence confirms that the use of products containing xylitol can alleviate problems with xerostomia. Although it is generally safe, xylitol can cause side effects when taken excessively. Especially when it comes to using the right daily dose, and the effects that you will experience if you at any time overstep the recommended daily dose. Consult your dentist and doctor about the possibility of using oral hygiene products or at least chewing gums that have xylitol added to their composition as a treatment method for your dry mouth. You will be surprised by the things that something as little as sugar alcohol can do for you!

References

[i] Xylitol: everything you need to know (literally), Healthline https://www.healthline.com/nutrition/xylitol-101
[ii] Ship JA, McCutcheon JA, Spivakovsky S, Kerr AR. Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia in polypharmacy-induced dry mouth. Journal of Oral Rehabilitation 2007 Oct;34(10):724-32. Doi: 10/1111j.1365-2842.2006.01718.x https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2842.2006.01718.x
[iii] Martín M, Marín A, López M, et al. Products based on olive oil, betaine, and xylitol in the post-radiotherapy xerostomia. Reports of Practical Oncology and Radiotherapy. 2017;22(1):71-76. doi:10.1016/j.rpor.2016.09.008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126143/
[iv] Makinen KK. The rocky road of xylitol to its clinical application. Journal of Dental Research 2000 Jun;79(6):1352-5. Doi:10.1177/00220345000790060101 http://journals.sagepub.com/doi/abs/10.1177/00220345000790060101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
[v] Nayak PA, Nayak UA, Khandelwal V. The effect of xylitol on dental caries and oral flora. Clinical, Cosmetic and Investigational Dentistry. 2014;6:89-94. doi:10.2147/CCIDE.S55761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232036/
[vi] Xylitol side effects: safe or dangerous? Dr.Axe https://draxe.com/xylitol-side-effects/

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