A recent systematic review of clinical trials investigating the effects of xylitol challenged the greater caries reduction claimed for gums containing xylitol compared with other sugar alcohol. On the other hand, the use of xylitol sweetened gum has been found to be more effective on rehardening of dentinal lesions than sorbitol sweetened gums. In an in situ study, comparing the remineralizing effect of gums containing sorbitol and a mixture of sorbitol/xylitol on caries-like enamel lesions, no differences were observed between the gums. There are contradictory findings regarding the effects of polyols’ types in chewing gums on caries lesions. There are various reports that evaluated the effect of polyol gums on the remineralization of denimeralized enamel. mutans and levels of lactic acid produced by these bacteria. Xylitol is a caloric sugar substitute that is not readily fermented by oral microorganisms and also actively protective against tooth decay through reduction in S. Sorbitol is metabolized not at all by most microorganisms, it can be fermented at a slow rate by all of the mutans streptococci including Streptococcus mutans while xylitol is considered to be non-acidogenic. Thus, sugar substitution and salivary stimulation could be equally responsible for the non-cariogenicity of sugar-free chewing gum. Both stimulate a gustatory reflex that together with the chewing process, enhances saliva stimulation. Xylitol is a sugar alcohol derived from pentose sugar xylose and sorbitol is a sugar alcohol derived from glucose. Most oral bacteria do not metabolize xylitol and sorbitol to form acid. The most common dietary polyols used in sugar-free chewing gums are xylitol and sorbitol. Increased levels of calcium and phosphate in gum-stimulated saliva also limit demineralization and enhance remineralization. The increase in flow enhances the buffering capacity of saliva, which effectively neutralizes the drop in plaque pH that occurs after eating. In recent years, the use of chewing gum after meals has gained popularity as it prevents the formation of dental caries by stimulating salivary flow. This effect is based on the action of two factors: Saliva stimulation through the chewing process and integration of dietary polyols. Sugar-free chewing gums have been suggested to decrease the caries incidence as they have an anti-cariogenic effect.
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