Dental Deasise

EMT-I

5/3/06

Robert Petrucci

Use of Xylitol Gum and Caries Risk Status in Elementary School Children

The objective of this research is to determine the optimal concentration and frequency of

Xylitol that will influence the outcome of the Caries Risk Assessment in second grade students.

A Caries Risk Assessment is a systematic process of categorizing patients into risk groups for

developing new carious lesions within a defined period of time. 50% of enamel fissure lesions

progress into dentin within 2 years and 75% will progress to dentinal lesions after 4 years, so the

defined period of time for this study is 3 years. The caries process for developing a new carious

lesion is based on the "caries balance" concept which states that caries will progress or regress

depending on demineralization and remineralization and the factors that influence both. It has

been suggested that the use of Xylitol gum affects this balance either in a manner that favors

remineralization or discourages demineralization. Xylitol has a cariostatic affect due to its slow

absorption rate and its ability to only be partially metabolized. Xylitol in the form of gum has an

affect by habitual consumption. This study will be conducted on school-aged children in the

Clark County School District (CCSD). The Clark County School District will be divided into

four partitions: northwest, northeast, southwest and southeast. The schools and students will be

randomly chosen through computer software discussed in the paper. After chosen, the students

will be randomly divided into three groups: those that chew Xylitol gum, those that chew gum

base, and those who do not chew anything. These students will be followed for a period of 3

years and will be evaluated according to the American Academy of Pediatric Dentistry Caries

Risk Assessment.

Introduction:

More than 40% of children have caries by the time they reach kindergarten (Pierce KM, Rozier RG, and Vann WF Jr. 2002). Early childhood caries can be particularly a virulent form of caries, beginning soon after tooth eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. (Pierce KM, Rozier RG, Vann WF Jr. 2002). The effect of sugar substitutes on changes in caries rates has been evaluated in several observational studies as well as clinical trials with results consistently demonstrating a protective effect of xylitol on caries incidence (Hujoel, P.P., et al 1999). Caries in primary teeth can affect children's growth, result in significant pain and potentially life-threatening infection, and diminish overall quality of life. Caries is a disease that is, by and large, preventable. The objectives of the present study were to highlight the trend over time in dental caries prevalence of children aged 6 to 9 years after consuming xylitol gum and to examine the clinical and economical findings for three years following the instigation of the targeted programs, from the perspective of public health care. Studies have also been done on the impact of this practice on caries risk status in children (Machiulskiene, V., Nyvad, B., Baelum, and V 2001). The importance of chewing xylitol gum for a certain length of time, at least three times a day after meals, in caries management among children has not been resolute. By correlating caries risk status with gum use, we hope to provide scientific background for future recommendations. In addition, a methodological problem is obvious: if the preventive measures are implemented in early childhood with success, the learned habits such as maintenance of good oral hygiene and use of fluorides may remain even after cessation of the intensive prevention program. When xylitol is incorporated to chewing-gum, its action is increased due to the stimulation of salivary secretion.

Background and Rationale:

There is no current Caries Risk Assessment (CRA) protocol that is both universal and validated. However, by definition, a CRA is a systematic process of categorizing patients into