Wednesday, September 6, 2017

Effects of Xylitol Wipes on Cariogenic Bacteria and Caries in Young Children
Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Suhyun Rue                                                                         Date: 9/6/2017
Article Title:  
Effects of Xylitol Wipes on Cariogenic Bacteria and Caries in Young Children
Author(s):
L. Zhan1, J. Cheng, P. Chang, M. Ngo, P.K. DenBesten, C.I. Hoover, J.D.B. Featherstone
Journal: Journal of Dental Research
Date: 2012
Major Topic:
Compare xylitol and placebo wipes in decreasing caries
Type of Article:
Randomized controlled double-blinded clinical trial
Main Purpose:
Evaluate the efficacy of daily xylitol-wipe use for 1 year on caries and levels of mutans streptococci (MS)  and  lactobacilli (LB) in young children
Key Points/Summary:
Introduction:
-         - Children with early MS colonization have a higher risk of developing caries than those with later colonization àPrevention of MS and LB colonization may be advantageous for the prevention of early childhood caries (ECC).
-          -Maternal consumption of xylitol gum has been shown to reduce MS colonization and caries significantly in their children up to 10 years old.
-         - It may be more effective to focus on the destination of the bacteria, the children, than on the various sources.
-         - The American Academy of Pediatric Dentistry (2008) has recommended tooth wipes as an important tool for oral hygiene care in infants and toddlers.
Methods:
-         - 44 mothers with active caries and their 6 to 35- month-old children were randomized to xylitol-wipe or placebo-wipe groups.
-         - Inclusion criteria were: (1) mothers with healthy children aged 6 to 35 months; and (2) mothers who were primary caregivers (>8 hrs per day) and had at least one active caries lesion within a year
-         - Exclusion criteria included: (1) children who had oral or systemic diseases; and (2) mothers or children who in the previous 3 months had taken antibiotics or other medication that would affect oral flora
-          -The children’s caries scores were recorded at baseline and 1 year. Salivary levels of mutans streptococci and lactobacilli were enumerated at baseline, 3, 6, and 12 months. Data were analyzed then.
Results:
-          -Caries status at 1 year in the xylitol-wipe group: Significantly fewer children developed new caries lesions compared with those in the placebo-wipe group. Fewer new decayed surfaces were detected in children in the xylitol-wipe group than in the placebo-wipe group.
-         - MS levels remained stable from baseline to 6 months in both groups, but doubled or tripled at 1 year compared with baseline. LB levels remained stable with no significant differences over time within each group.
-         - Daily xylitol wipe application significantly reduced the caries incidence in young children as compared with wipes without xylitol, suggesting that the use of xylitol wipes may be a useful adjunct for caries control in infants.
Discussion:
-          -No significant reductions of MS and LB in children treated with xylitol wipes . This result is in agreement with  Söderling et al. (2000) ,who showed no reduction of MS in mothers after xylitol-gum use for 2 years, although both MS transmission and caries were significantly reduced in their children à Xylitol modifies the cariogenicity of bacteria or the ecology of the oral flora to be less cariogenic or less transmissible.
-         - MS levels in both groups remained relatively low in the first 6 months and then increased at 1 year. (Li and Caufield reported MS colonization peaks between 13 and 21 months of age and steadily increases subsequently)
-        -  Acceptance by the participants is a key to success of all home-use preventive regimens.  Found that xylitol wipes were better accepted by the parents and their children, with fewer study dropouts than for the placebo-wipe group.
-          -Study limitations: (1) Poor acceptance of the placebo wipe limited the sample size; (2) Using active caries experience in mothers as a criterion for high caries risk (vs. MS levels and caries experience); (3) Extensive cross-examiner calibration may have been useful.
Assessment of Article:  Level of Evidence/Comments:  Level II


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