Table of Contents Author Guidelines Submit a Manuscript
International Journal of Dentistry
Volume 2010, Article ID 981072, 23 pages
http://dx.doi.org/10.1155/2010/981072
Review Article

Sugar Alcohols, Caries Incidence, and Remineralization of Caries Lesions: A Literature Review

Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland

Received 27 August 2009; Accepted 15 October 2009

Academic Editor: Figen Seymen

Copyright © 2010 Kauko K. Mäkinen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. J. Head, “A study on saliva and its action on tooth enamel in reference to its hardening and softening,” The Journal of the American Medical Association, vol. 59, no. 24, pp. 2118–2122, 1912. View at Google Scholar
  2. T. Koulourides and W. Pigman, “Studies on rehardening of artificially softened enamel,” Journal of Dental Research, vol. 39, no. 1, p. 198, 1960. View at Publisher · View at Google Scholar
  3. T. Kolourides, “Remineralization of enamel and dentin,” in Dental Clinics of North America, E. Johansen and M. Shapiro, Eds., pp. 485–497, WB Saunders, Philadelphia, Pa, USA, 1962. View at Google Scholar
  4. T. Koulourides, F. Feagin, and W. Pigman, “Remineralization of dental enamel by saliva in vitro,” Annals of the New York Academy of Sciences, vol. 131, no. 2, pp. 751–757, 1965. View at Google Scholar · View at Scopus
  5. “Demineralization/remineralization—Working Group Consensus Report,” Journal of Dental Research, vol. 65, pp. 1532–1536, 1986.
  6. S. Kashket, “Historical review of remineralization research,” Journal of Clinical Dentistry, vol. 10, no. 2, pp. 56–64, 1999. View at Google Scholar · View at Scopus
  7. S. A. Leach, E. A. Agalamanyi, and R. M. Green, “Remineralization of the teeth by dietary means,” in Remineralization of the Teeth, S. A. Leach and W. M. Edgar, Eds., pp. 51–73, IRL Press, Oxford, UK, 1983. View at Google Scholar
  8. W. M. Edgar, “Diet, functional foods and oral health,” in Functional Foods, Ageing and Degenerative Disease, C. Remarcle and B. Reusens, Eds., pp. 184–199, Woodhead, Cambridge, UK, 2004. View at Google Scholar
  9. P. Fejerskov and A. Thylstrup, “Pathology of dental caries,” in Textbook of Cariology, P. Fejerskov and A. Thylstrup, Eds., pp. 204–234, Munksgaard, Copenhagen, Denmark, 1st edition, 1986. View at Google Scholar
  10. W. E. Herbert and W. A. Vale, Operative Dental Surgery, Edward Arnold, London, UK, 8th edition, 1962.
  11. A. Scheinin and K. K. Mäkinen, “The effect of various sugars on the formation and chemical composition of dental plaque,” The International Dental Journal, vol. 21, no. 3, pp. 302–321, 1971. View at Google Scholar · View at Scopus
  12. A. Scheinin and K. K. Mäkinen, “Effect of sugars and sugar mixtures on dental plaque,” Acta Odontologica Scandinavica, vol. 30, no. 2, pp. 235–257, 1972. View at Google Scholar · View at Scopus
  13. A. Scheinin and K. K. Mäkinen, “Turku sugar studies I-XXI,” Acta Odontologica Scandinavica, vol. 33, supplement 70, pp. 1–351, 1975. View at Google Scholar
  14. K. K. Mäkinen, “New biochemical aspects of sweeteners,” The International Dental Journal, vol. 35, no. 1, pp. 23–35, 1985. View at Google Scholar · View at Scopus
  15. K. K. Mäkinen, “Latest dental studies on xylitol and mechanism of action of xylitol in caries limitation,” in Progress in Sweeteners, T. H. Grenby, Ed., pp. 331–362, Elsevier, London, UK, 1989. View at Google Scholar
  16. K. K. Mäkinen, “Prevention of dental caries by xylitol: issues relating to health claims,” in America's Foods Health Messages and Claims, J. E. Tillotson, Ed., pp. 167–192, CRC Press, Boca Raton, Fla, USA, 1993. View at Google Scholar
  17. K. K. Mäkinen, “Sugar alcohols,” in Functional Foods, Designer Foods, Pharmafoods, Nutraceuticals, I. Goldberg, Ed., pp. 219–241, Chapman & Hall, New York, NY, USA, 1994. View at Google Scholar
  18. K. K. Mäkinen, “Can the pentitol-hexitol theory explain the clinical observations made with xylitol?” Medical Hypotheses, vol. 54, no. 4, pp. 603–613, 2000. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  19. K. K. Mäkinen, “The rocky road of xylitol to its clinical application,” Journal of Dental Research, vol. 79, no. 6, pp. 1352–1355, 2000. View at Google Scholar · View at Scopus
  20. K. K. Mäkinen, “Sweeteners and dental health,” in Functional Foods, Degenerative Disease, and Ageing, C. Remacle and B. Reusens, Eds., pp. 200–219, Woodhead, Cambridge, UK, 2004. View at Google Scholar
  21. D. Birkhed, “Cariologic aspects of xylitol and its use in chewing gumml: a review,” Acta Odontologica Scandinavica, vol. 52, no. 2, pp. 116–127, 1994. View at Google Scholar · View at Scopus
  22. J. Tanzer, “Xylitol chewing gum and dental caries,” The International Dental Journal, vol. 45, supplement 1, pp. 65–76, 1995. View at Google Scholar
  23. L. Trahan, “Xylitol: a review of its action on mutans streptococci and dental plaque—its clinical significance,” The International Dental Journal, vol. 45, supplement 1, pp. 77–92, 1995. View at Google Scholar · View at Scopus
  24. W. M. Edgar, “Sugar substitutes, chewing gum and dental caries—a review,” British Dental Journal, vol. 184, no. 1, pp. 29–32, 1998. View at Google Scholar · View at Scopus
  25. R. S. Levine, “Briefing paper: xylitol, caries and plaque,” British Dental Journal, vol. 185, no. 10, p. 520, 1998. View at Google Scholar · View at Scopus
  26. C. Hayes, “The effect of non-cariogenic sweeteners on the prevention of dental caries: a review of the evidence,” Journal of Dental Education, vol. 65, no. 10, pp. 1106–1109, 2001. View at Google Scholar · View at Scopus
  27. J. Peldyak and K. K. Mäkinen, “Xylitol for caries prevention,” Journal of Dental Hygiene, vol. 76, no. 4, pp. 276–285, 2002. View at Google Scholar · View at Scopus
  28. A. Maguire and A. J. Rugg-Gunn, “Xylitol and caries prevention—is it a magic bullet?” British Dental Journal, vol. 194, no. 8, pp. 429–436, 2003. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  29. B. A. Burt, “The use of sorbitol- and xylitol-sweetened chewing gum in caries control,” Journal of the American Dental Association, vol. 137, no. 2, pp. 190–196, 2006. View at Google Scholar · View at Scopus
  30. K. K. Mäkinen, “Public use and recommendations of xylitol in the prevention of dental caries,” Finnish Dental Journal, vol. 13, supplement 1, pp. 66–75, 2006. View at Google Scholar
  31. K. K. Mäkinen, “Oral care gum products,” in Food Constituents and Oral Health, M. Wilson, Ed., pp. 433–454, Woodhead, Cambridge, UK, 2009. View at Google Scholar
  32. National Institutes of Health, “Consensus development conference statement. Diagnosis and management of dental caries through life,” March 2002, http://nidcr.gov/news/consensus.asp.
  33. A. Deshpande and A. R. Jadad, “The impact of polyol-containing chewing gums on dental caries: a systematic review of original randomized controlled trials and observational studies,” Journal of the American Dental Association, vol. 139, no. 12, pp. 1602–1614, 2008. View at Google Scholar · View at Scopus
  34. S. Mickenautsch, S. C. Leal, V. Yengopal, A. C. Bezerra, and V. Cruvinel, “Sugar-free chewing gum and dental caries—a systematic review,” Journal of Applied Oral Science, vol. 15, no. 2, pp. 83–88, 2007. View at Google Scholar · View at Scopus
  35. V. Machiulskiene, B. Nyvad, and V. Baelum, “Caries preventive effect of sugar-substituted chewing gum,” Community Dentistry and Oral Epidemiology, vol. 29, no. 4, pp. 278–288, 2001. View at Google Scholar · View at Scopus
  36. C. Hayes, “Xylitol gum decreases the decayed, missing, and filled surfaces (DMFS) score over a 3-year period by an average of 1.9,” Evidence-Based Dental Practice, vol. 2, pp. 14–15, 2002. View at Google Scholar
  37. K. A. Ly, P. Milgrom, and M. Rothen, “The potential of dental-protective chewing gum in oral health interventions,” Journal of the American Dental Association, vol. 139, no. 5, pp. 553–563, 2008. View at Google Scholar · View at Scopus
  38. P. Milgrom, K. A. Ly, M. C. Roberts, M. Rothen, G. Mueller, and D. K. Yamaguchi, “Mutans streptococci dose response to xylitol chewing gum,” Journal of Dental Research, vol. 85, no. 2, pp. 177–181, 2006. View at Google Scholar · View at Scopus
  39. P. Milgrom, M. Rothen, and L. Milgrom, “Developing public health interventions with xylitol for the US and US-associated territories and states,” Finnish Dental Journal, vol. 13, supplement 1, pp. 28–37, 2006. View at Google Scholar
  40. K. A. Ly, P. Milgrom, M. C. Roberts, D. K. Yamaguchi, M. Rothen, and G. Mueller, “Linear response of mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial,” BMC Oral Health, vol. 6, article 6, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  41. K. A. Ly, C. A. Riedy, P. Milgrom, M. Rothen, M. C. Roberts, and L. Zhou, “Xylitol gummy bear snacks: a school-based randomized clinical trial,” BMC Oral Health, vol. 8, no. 1, article 20, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  42. M. Svanberg and D. Birkhed, “Effect of dentifrices containing either xylitol and glycerol or sorbitol on mutans streptococci in saliva,” Caries Research, vol. 25, no. 6, pp. 449–453, 1991. View at Google Scholar · View at Scopus
  43. L. G. Petersson, D. Birkhed, A. Gleerup, M. Johansson, and G. Jönsson, “Caries-preventive effect of dentifrices containing various types and concentrations of fluorides and sugar alcohols,” Caries Research, vol. 25, no. 1, pp. 74–79, 1991. View at Google Scholar · View at Scopus
  44. J. L. Sintes, C. Escalante, B. Stewart et al., “Enhanced anticaries efficacy of a 0.243% sodium fluoride/xylitol/silica dentifrice: 3-year clinical results,” American Journal of Dentistry, vol. 8, no. 5, pp. 231–235, 1995. View at Google Scholar · View at Scopus
  45. J. L. Sintes, A. Elías-Boneta, B. Stewart, A. R. Volpe, and J. Lovett, “Anticaries efficacy of a sodium monofluorophosphate dentifrice containing xylitol in a dicalcium phosphate dihydrate base. A 30-month caries clinical study in Costa Rica,” American Journal of Dentistry, vol. 15, no. 4, pp. 215–219, 2002. View at Google Scholar · View at Scopus
  46. A. S. Aaltonen, J. T. Suhonen, J. Tenovuo, and I. Inkilä-Saari, “Efficacy of a slow-release device containing fluoride, xylitol and sorbitol in preventing infant caries,” Acta Odontologica Scandinavica, vol. 58, no. 6, pp. 285–292, 2000. View at Publisher · View at Google Scholar · View at Scopus
  47. H. Maehara, Y. Iwami, H. Mayanagi, and N. Takahashi, “Synergistic inhibition by combination of fluoride and xylitol on glycolysis by mutans streptococci and its biochemical mechanism,” Caries Research, vol. 39, no. 6, pp. 521–528, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  48. V. G. Petin, J. K. Kim, R. O. Kritsky, and L. N. Komarova, “Mathematical description, optimization and prediction of synergistic interaction of fluoride and xylitol,” Chemosphere, vol. 72, no. 5, pp. 844–849, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  49. G. H. Hildebrandt and B. S. Sparks, “Maintaining mutans streptococci suppression: with xylitol chewing gum,” Journal of the American Dental Association, vol. 131, no. 7, pp. 909–916, 2000. View at Google Scholar · View at Scopus
  50. E.-M. Decker, G. Maier, D. Axmann, M. Brecx, and C. von Ohle, “Effect of xylitol/chlorhexidine versus xylitol or chlorhexidine as single rinses on initial biofilm formation of cariogenic streptococci,” Quintessence International, vol. 39, no. 1, pp. 17–22, 2008. View at Google Scholar · View at Scopus
  51. P. Alanen, P. Isokangas, and K. Gutmann, “Xylitol candies in caries prevention: results of a field study in Estonian children,” Community Dentistry and Oral Epidemiology, vol. 28, no. 3, pp. 218–224, 2000. View at Google Scholar · View at Scopus
  52. P. Alanen, M.-L. Holsti, and K. Pienihäkkinen, “Sealants and xylitol chewing gum are equal in caries prevention,” Acta Odontologica Scandinavica, vol. 58, no. 6, pp. 279–284, 2000. View at Publisher · View at Google Scholar · View at Scopus
  53. G. Westergren, B. Krasse, D. Birkhed, and S. Edwardsson, “Genetic transfer of markers for sorbitol (D-glucitol) metabolism in oral streptococci,” Archives of Oral Biology, vol. 26, no. 5, pp. 403–407, 1981. View at Google Scholar · View at Scopus
  54. S. Kalfas, G. Svensäter, D. Birkhed, and S. Edwardsson, “Sorbitol adaptation of dental plaque in people with low and normal salivary-secretion rates,” Journal of Dental Research, vol. 69, no. 2, pp. 442–446, 1990. View at Google Scholar · View at Scopus
  55. A. Nordblad, L. Suominen-Taipale, H. Murtomaa, E. Vartiainen, and K. Koskela, “Smart Habit Xylitol campaign, a new approach in oral health promotion,” Community Dental Health, vol. 12, no. 4, pp. 230–234, 1995. View at Google Scholar · View at Scopus
  56. S. Honkala, E. Honkala, J. Tynjälä, and L. Kannas, “Use of xylitol chewing gum among Finnish schoolchildren,” Acta Odontologica Scandinavica, vol. 57, no. 6, pp. 306–309, 1999. View at Publisher · View at Google Scholar · View at Scopus
  57. E. Honkala, S. Honkala, M. Shyama, and S. A. Al-Mutawa, “Field trial on caries prevention with xylitol candies among disabled school students,” Caries Research, vol. 40, no. 6, pp. 508–513, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  58. A. Trummler and W. Strübig, “Beeinflussung verschiedener speichelparameters nach täglicher verwendung von xylit-kaugummi in der schule,” Oralprophylaxe Kinderzahnheilkunde, vol. 30, pp. 101–105, 2008. View at Google Scholar
  59. W. Strübig, Über den Abbau von Zucker und Zuckeraustauschstoffen durch die Mischflora der Menschlichen Mundhöhle, Quintessant, Berlin, Germany, 1986.
  60. W. Strübig, “Caries etiologic aspects of sugar and sugar substitutes,” Zahnärztlicher Gesundheitsdienst, vol. 19, no. 2, pp. 10–13, 1989. View at Google Scholar · View at Scopus
  61. K. K. Mäkinen, C. A. Bennett, P. P. Hujoel et al., “Xylitol chewing gums and caries rates: a 40-month cohort study,” Journal of Dental Research, vol. 74, no. 12, pp. 1904–1913, 1995. View at Google Scholar
  62. S. A. Leach and R. M. Green, “Effect of xylitol-supplemented diets on the progression and regression of fissure caries in the albino rat,” Caries Research, vol. 14, no. 1, pp. 16–23, 1980. View at Google Scholar
  63. K. W. Shyu and M. Y. Hsu, “The cariogenicity of xylitol, mannitol, sorbitol, and sucrose,” Proceedings of the National Science Council, Republic of China, vol. 4, pp. 21–26, 1980. View at Google Scholar
  64. R. Havenaar, J. H. J. Huis in't Veld, J. D. de Stoppelaar, and O. Backer Dirks, “Anti-cariogenic and remineralizing properties of xylitol in combination with sucrose in rats inoculated with Streptococcus mutans,” Caries Research, vol. 18, no. 3, pp. 269–277, 1984. View at Google Scholar
  65. A. Scheinin, K. K. Mäkinen, and K. Ylitalo, “Turku sugar studies V. Final report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man,” Acta Odontologica Scandinavica, vol. 34, no. 4, pp. 179–216, 1976. View at Publisher · View at Google Scholar
  66. A. N. Galiullin, “Evaluation of the caries-preventive action of xylitol,” Kazan Medical Journal, vol. 67, pp. 16–18, 1981 (Russian). View at Google Scholar
  67. D. Kandelman, A. Bär, and A. Hefti, “Collaborative WHO xylitol field study in French Polynesia. I. Baseline prevalence and 32-month caries increment,” Caries Research, vol. 22, no. 1, pp. 55–62, 1988. View at Google Scholar
  68. A. Scheinin, J. Bánóczy, J. Szöke et al., “Collaborative WHO xylitol field studies in Hungary. I. Three-year caries activity in institutionalized children,” Acta Odontologica Scandinavica, vol. 43, no. 6, pp. 327–347, 1985. View at Google Scholar
  69. A. Scheinin, K. Pienihäkkinen, J. Tiekso et al., “Collaborative WHO xylitol field studies in Hungary. VII. Two-year caries indicence in 976 institutionalized children,” Acta Odontologica Scandinavica, vol. 43, no. 6, pp. 381–387, 1985. View at Google Scholar
  70. D. Kandelman and G. Gagnon, “A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs,” Journal of Dental Research, vol. 69, no. 11, pp. 1771–1775, 1990. View at Google Scholar
  71. P. Isokangas, P. Alanen, J. Tiekso, and K. K. Mäkinen, “Xylitol chewing gum in caries prevention: a field study in children,” The Journal of the American Dental Association, vol. 117, no. 2, pp. 315–320, 1988. View at Google Scholar
  72. K. K. Mäkinen, P. P. Hujoel, C. A. Bennett, K. P. Isotupa, P.-L. Mäkinen, and P. Allen, “Polyol chewing gums and caries rates in primary dentition: a 24-month cohort study,” Caries Research, vol. 30, no. 6, pp. 408–417, 1996. View at Google Scholar
  73. K. K. Mäkinen, D. Pemberton, P.-L. Mäkinen et al., “Polyol-combinant saliva stimulants and oral health in veterans affairs patients—an exploratory study,” Special Care in Dentistry, vol. 16, no. 3, pp. 104–115, 1996. View at Google Scholar
  74. P. Isokangas, E. Söderling, K. Pienihäkkinen, and P. Alanen, “Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age,” Journal of Dental Research, vol. 79, no. 11, pp. 1885–1889, 2000. View at Google Scholar
  75. I. Thorild, B. Lindau, and S. Twetman, “Effect of maternal use of chewing gums containing xylitol, chlorhexidine or fluoride on mutans streptococci colonization in the mothers' infant children,” Oral Health Preventive Dentistry, vol. 1, no. 1, pp. 53–57, 2003. View at Google Scholar
  76. I. Thorild, B. Lindau, and S. Twetman, “Caries in 4-year-old children after maternal chewing of gums containing combinations of xylitol, sorbitol, chlorhexidine and fluoride,” European Archives of Paediatric Dentistry, vol. 7, no. 4, pp. 241–245, 2006. View at Google Scholar
  77. H. Hausen, L. Seppä, R. Poutanen et al., “Noninvasive control of dental caries in children with active initial lesions: a randomized clinical trial,” Caries Research, vol. 41, no. 5, pp. 384–391, 2007. View at Publisher · View at Google Scholar · View at PubMed
  78. P. Isokangas, J. Tiekso, P. Alanen, and K. K. Mäkinen, “Long-term effect of xylitol chewing gum on dental caries,” Community Dentistry and Oral Epidemiology, vol. 17, no. 4, pp. 200–203, 1989. View at Google Scholar
  79. P. Isokangas, J. Tenovuo, E. Söderling, H. Männistö, and K. K. Mäkinen, “Dental caries and mutans streptococci in the proximal areas of molars affected by the habitual use of xylitol chewing gum,” Caries Research, vol. 25, no. 6, pp. 444–448, 1991. View at Google Scholar
  80. P. Isogangas, K. K. Mäkinen, J. Tiekso, and P. Alanen, “Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5 years after termination of a prevention program,” Caries Research, vol. 27, no. 6, pp. 495–498, 1993. View at Google Scholar
  81. J. I. Virtanen, R. S. Bloigu, and M. A. Larmas, “Timing of first restorations before, during, and after a preventive xylitol trial,” Acta Odontologica Scandinavica, vol. 54, no. 4, pp. 211–216, 1996. View at Google Scholar
  82. K. K. Mäkinen, P. P. Hujoel, C. A. Bennett et al., “A descriptive report of the effects of a 16-month xylitol chewing-gum programme subsequent to a 40-month sucrose gum programme,” Caries Research, vol. 32, no. 2, pp. 107–112, 1998. View at Google Scholar
  83. P. P. Hujoel, K. K. Mäkinen, C. A. Bennett et al., “The optimum time to initiate habitual xylitol gum-chewing for obtaining long-term caries prevention,” Journal of Dental Research, vol. 78, no. 3, pp. 797–803, 1999. View at Google Scholar
  84. C. J. Carr and J. C. Krantz, “Metabolism of the sugar alcohols and their derivatives,” Advances in Carbohydrate Chemistry, vol. 1, pp. 175–192, 1945. View at Google Scholar
  85. R. L. Lohmar, “The polyols,” in The Carbohydrates, Chemistry, Biochemistry, Physiology, W. Pigman, Ed., pp. 241–298, Academic Press, New York, NY, USA, 1962. View at Google Scholar
  86. O. Touster and D. R. D. Shaw, “Biochemistry of the acyclic polyols,” Physiological Reviews, vol. 42, pp. 181–225, 1962. View at Google Scholar
  87. J. A. Mills, “Conformations of higher alditols,” Australian Journal of Chemistry, vol. 27, pp. 1433–1446, 1974. View at Google Scholar
  88. G. A. Scangos and A. M. Reiner, “Acquisition of ability to utilize xylitol: disadvantages of a constitutive catabolic pathway in Escherichia coli,” Journal of Bacteriology, vol. 134, no. 2, pp. 501–505, 1978. View at Google Scholar
  89. R. M. Corrales, L. Luo, E. Y. Chang, and S. C. Pflugfelder, “Effects of osmoprotectants on hyperosmolar stress in cultured human corneal epithelial cells,” Cornea, vol. 27, no. 5, pp. 574–579, 2008. View at Publisher · View at Google Scholar · View at PubMed
  90. P. de Cock and C.-L. Bechert, “Erythritol. Functionality in noncaloric functional beverages,” Pure and Applied Chemistry, vol. 74, no. 7, pp. 1281–1289, 2002. View at Google Scholar
  91. H. Bundgaard and C. Larsen, “The influence of carbohydrates and polyhydric alcohols on the stability of cephalosporins in aqueous solution,” International Journal of Pharmaceutics, vol. 16, no. 3, pp. 319–325, 1983. View at Publisher · View at Google Scholar
  92. R. B. Killion Jr. and V. J. Stella, “The nucleophilicity of dextrose, sucrose, sorbitol, and mannitol with p-nitrophenyl esters in aqueous solution,” International Journal of Pharmaceutics, vol. 66, no. 1–3, pp. 149–155, 1990. View at Publisher · View at Google Scholar
  93. K. Kiyosawa, “Volumetric properties of polyols (ethylene glycol, glycerol, meso-erythritol, xylitol and mannitol) in relation to their membrane permeability: group additivity and estimation of the maximum radius of their molecules,” Biochimica et Biophysica Acta, vol. 1064, no. 2, pp. 251–255, 1991. View at Publisher · View at Google Scholar
  94. R. Schöllner, D. Sieler, and E. Brettner, “Komplexbildung von geradkettigen Polyolen in wäßriger Lösung mit partiell hydratisierten K+ and Ca2+ Ionen in X- und Y-Zeolithen,” Journal für Praktische Chemie, vol. 337, pp. 567–575, 1995. View at Google Scholar
  95. J. F. Back, D. Oakenfull, and M. B. Smith, “Increased thermal stability of proteins in the presence of sugars and polyols,” Biochemistry, vol. 18, no. 23, pp. 5191–5196, 1979. View at Google Scholar
  96. K. Kiyosawa, “Permeability of the Chara cell membrane for ethylene glycol, glycerol, meso-erythritol, xylitol and mannitol,” Plant Physiology, vol. 88, pp. 366–371, 1993. View at Google Scholar
  97. J. Chirife, G. Favetto, and C. Ferro Fontán, “Microbial growth at reduced water activities: some physicochemical properties of compatible solutes,” Journal of Applied Bacteriology, vol. 56, pp. 259–268, 1984. View at Google Scholar
  98. J. K. Beattie and M. T. Kelso, “Equilibrium and dynamics of the binding of calcium ion to sorbitol (D-glucitol),” Australian Journal of Chemistry, vol. 34, pp. 2563–2568, 1981. View at Google Scholar
  99. T. H. Grenby, A. H. Bashaarat, and K. H. Gey, “A clinical trial to compare the effects of xylitol and sucrose chewing-gums on dental plaque growth,” British Dental Journal, vol. 152, no. 10, pp. 339–343, 1982. View at Publisher · View at Google Scholar
  100. H. Hurttia, V.-M. Multanen, K. K. Mäkinen, J. Tenovuo, and K. Paunio, “Effects on oral health of mouthrinses containing xylitol, sodium cyclamate and sucrose sweeteners in the absence of oral hygiene. III. Composition and bone resorbing potential of dental plaque,” Proceedings of the Finnish Dental Society, vol. 80, no. 1, pp. 20–27, 1984. View at Google Scholar
  101. L. M. Steinberg, F. Odusola, and I. D. Mandel, “Remineralizing potential, antiplaque and antigingivitis effects of xylitol and sorbitol sweetened chewing gum,” Clinical Preventive Dentistry, vol. 14, no. 5, pp. 31–34, 1992. View at Google Scholar
  102. K. K. Mäkinen and E. Söderling, “Solubility of calcium salts, enamel, and hydroxyapatite in aqueous solutions of simple carbohydrates,” Calcified Tissue International, vol. 36, no. 1, pp. 64–74, 1984. View at Google Scholar
  103. E. Söderling and K. K. Mäkinen, “Aggregation of human salivary Ca-proteinates in the presence of simple carbohydrates in vitro,” Scandinavian Journal of Dental Research, vol. 94, no. 2, pp. 125–131, 1986. View at Google Scholar
  104. K. K. Mäkinen, E. Söderling, D. R. Peacor, P.-L. Mäkinen, and L. M. Park, “Carbohydrate-controlled precipitation of apatite with coprecipitation of organic molecules in human saliva: stabilizing role of polyols,” Calcified Tissue International, vol. 44, pp. 258–268, 1989. View at Google Scholar
  105. M. Carlevaro, E. R. Caffarena, and J. R. Grigera, “Hydration properties of xylitol: computer simulation,” International Journal of Biological Macromolecules, vol. 23, no. 2, pp. 149–155, 1998. View at Publisher · View at Google Scholar
  106. K. Izumori and K. Yamanaka, “Selective inhibition of Klebsiella aerogenes growth on pentoses by pentitols,” Journal of Bacteriology, vol. 134, no. 3, pp. 713–717, 1978. View at Google Scholar
  107. S. Schauder, K. H. Schneider, and F. Giffhorn, “Polyol metabolism of Rhodobacter sphaeroides: biochemical characterization of a short-chain sorbitol dehydrogenase,” Microbiology, vol. 14, part 8, pp. 1857–1863, 1995. View at Google Scholar
  108. C. Kahle, K. H. Schneider, and F. Giffhorn, “Pentitol metabolism of Rhodobacter sphaeroides Si4: purification and characterization of a ribitol dehydrogenase,” Journal of General Microbiology, vol. 138, no. 6, pp. 1277–1281, 1992. View at Google Scholar
  109. H. S. Singh, V. P. Singh, B. S. Arya, and G. R. Varma, “Kinetics and mechanism of oxidation of xylitol and galactitol by hexacyanoferrate(III) ion in aqueous alkaline medium,” Monatshefte für Chemie, vol. 112, pp. 1253–1260, 1981. View at Google Scholar
  110. C. J. Kleber, M. S. Putt, and J. C. Muhler, “Enamel dissolution by various food acidulants in a sorbitol candy,” Journal of Dental Research, vol. 57, no. 3, pp. 447–451, 1978. View at Google Scholar
  111. V. Luostarinen, K. Paunio, J. Varrela et al., “Turku sugar studies, XV. Vascular reactions in the hamster cheek pouch to human gingival exudate,” Acta Odontologica Scandinavica, vol. 33, supplement 70, pp. 287–291, 1975. View at Google Scholar
  112. V. Luostarinen, K. K. Mäkinen, and P.-L. Mäkinen, “Effects on oral health of mouthrinses containing xylitol, sodium cyclamate and sucrose sweeteners in the absence of oral hygiene. V. Response of hamster cheek pouch microcirculation to dental plaque,” Proceedings of the Finnish Dental Society, vol. 80, no. 1, pp. 35–39, 1984. View at Google Scholar
  113. J. Tenovuo, H. Mielityinen, and K. Paunio, “Effect of dental plaque grown in the presence of xylitol or sucrose on bone resorption in vitro,” Pharmacology and Therapeutics in Dentistry, vol. 6, no. 1-2, pp. 35–43, 1981. View at Google Scholar
  114. H. Mielityinen, J. Tenovuo, E. Söderling, and K. Paunio, “Effect of xylitol and sucrose plaque on release of lysosomal enzymes from bones and macrophages in vitro,” Acta Odontologica Scandinavica, vol. 41, no. 3, pp. 173–180, 1983. View at Google Scholar
  115. K. Paunio, H. Hurttia, J. Tenovuo, K. K. Mäkinen, and J. Tiekso, “Effects on oral health of mouthrinses containing xylitol, sodium cyclamate and sucrose sweeteners in the absence of oral hygiene. I. Clinical findings and analysis of gingival exudates,” Proceedings of the Finnish Dental Society, vol. 80, no. 1, pp. 3–12, 1984. View at Google Scholar
  116. U. Harjola and H. Liesmaa, “Effects of polyol and sucrose candies on plaque, gingivitis and lactobacillus index scores,” Acta Odontologica Scandinavica, vol. 36, no. 4, pp. 237–242, 1978. View at Google Scholar
  117. U. Pakkala, H. Liesmaa, and K. K. Mäkinen, “Use of xylitol in the control of oral hygiene in mentally retarded children: a clinical and biochemical study,” Proceedings of the Finnish Dental Society, vol. 71, no. 5, pp. 271–277, 1981. View at Google Scholar
  118. S. J. Han, S. Y. Jeong, Y. J. Nam, K. H. Yang, H. S. Lim, and J. Chung, “Xylitol inhibits inflammatory cytokine expression induced by lipopolysaccharide from Porphyromonas gingivalis,” Clinical and Diagnostic Laboratory Immunology, vol. 12, no. 11, pp. 1285–1291, 2005. View at Publisher · View at Google Scholar · View at PubMed
  119. A. M. Vacca Smith and W. H. Bowen, “In situ studies of pellicle formation on hydroxyapatite discs,” Archives of Oral Biology, vol. 45, pp. 277–291, 2000. View at Google Scholar
  120. H. Meyer-Lueckel, N. Umland, W. Hopfenmuller, and A. M. Kielbassa, “Effect of mucin alone and in combination with various dentifrices on in vitro remineralization,” Caries Research, vol. 38, no. 5, pp. 478–483, 2004. View at Publisher · View at Google Scholar · View at PubMed
  121. A. M. Kielbassa, U. Oeschger, J. Schulte-Monting, and H. Meyer-Lueckel, “Microradiographic study on the effects of salivary proteins on in vitro demineralization of bovine enamel,” Journal of Oral Rehabilitation, vol. 32, no. 2, pp. 90–96, 2005. View at Publisher · View at Google Scholar · View at PubMed
  122. H. Meyer-Lueckel and A. M. Kielbassa, “Influence of calcium phosphates added to mucin-based saliva substitutes on bovine dentin,” Quintessence International, vol. 37, no. 7, pp. 537–544, 2006. View at Google Scholar
  123. R. K. Rose, G. H. Dibdin, and R. P. Shellis, “A quantitative study of calcium binding and aggregation in selected oral bacteria,” Journal of Dental Research, vol. 72, no. 1, pp. 78–84, 1993. View at Google Scholar
  124. R. K. Rose, S. D. Hogg, and R. P. Shellis, “A quantitative study of calcium binding by isolated streptococcal cell walls and lipoteichoic acid: comparison with whole cells,” Journal of Dental Research, vol. 73, no. 11, pp. 1742–1747, 1994. View at Google Scholar
  125. E. C. Reynolds, “Calcium phosphate-based remineralization systems: scientific evidence?” Australian Dental Journal, vol. 53, pp. 268–273, 2008. View at Google Scholar
  126. E. C. Reynolds, F. Cai, P. Shen, and G. D. Walker, “Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum,” Journal of Dental Research, vol. 82, no. 3, pp. 206–211, 2003. View at Google Scholar
  127. I. Tarján and L.-Å. Linden, “Investigation of enamel permeability with marked saccharose and xylit,” Fogorvos Szle, vol. 74, pp. 235–238, 1981 (Hungarian). View at Google Scholar
  128. A. Scheinin, K. K. Mäkinen, and K. Ylitalo, “Turku sugar studies. I. An intermediate report on the effect of sucrose, fructose and xylitol diets on the caries incidence in man,” Acta Odontologica Scandinavica, vol. 32, no. 6, pp. 383–412, 1974. View at Google Scholar
  129. A. Scheinin, K. K. Mäkinen, E. Tammisalo, and M. Rekola, “Turku sugar studies XVIII. Incidence of dental caries in relation to 1-year consumption of xylitol chewing gum,” Acta Odontologica Scandinavica, vol. 33, supplement 70, pp. 307–316, 1975. View at Google Scholar
  130. M. Rekola, “Changes in buccal white spots during 2-year consumption of dietary sucrose or xylitol,” Acta Odontologica Scandinavica, vol. 44, no. 5, pp. 285–290, 1986. View at Google Scholar
  131. M. Rekola, “Approximal caries development during 2-year total substitution of dietary sucrose with xylitol,” Caries Research, vol. 21, no. 1, pp. 87–94, 1987. View at Google Scholar
  132. J. D. B. Featherstone, T. W. Cutress, B. E. Rodgers, and P. J. Dennison, “Remineralization of artificial caries-like lesions in vivo by a self-administered mouthrinse or paste,” Caries Research, vol. 16, pp. 235–242, 1982. View at Google Scholar
  133. A. Vissink, E. J. S'Gravenmade, T. B. F. M. Gelhard, A. K. Panders, and M. H. Franken, “Properties of mucin- or CMC-containing saliva substitutes on softened human enamel,” Caries Research, vol. 19, pp. 212–218, 1985. View at Google Scholar
  134. M. T. Smits and J. Arends, “Influence of extraoral xylitol and sucrose dippings on enamel demineralization in vivo,” Caries Research, vol. 22, no. 3, pp. 160–165, 1988. View at Google Scholar
  135. M. T. Smits, Xylitol and dental caries, Academic dissertation, University of Groningen, Amsterdam, The Netherlands, 1987.
  136. T. H. Grenby, A. Phillips, and M. Mistry, “Studies of the dental properties of lactitol compared with five other bulk sweeteners in vitro,” Caries Research, vol. 23, no. 5, pp. 315–319, 1989. View at Google Scholar
  137. F. N. Hattab, R. M. Green, K. M. Pang, and Y. C. Mok, “Effect of fluoride-containing chewing gum on remineralization of carious lesions and on fluoride uptake in man,” Clinical Preventive Dentistry, vol. 11, no. 6, pp. 6–11, 1989. View at Google Scholar
  138. J. Arends, M. Smits, J. L. Ruben, and J. Christoffersen, “Combined effect of xylitol and fluoride on enamel demineralization in vitro,” Caries Research, vol. 24, no. 4, pp. 256–257, 1990. View at Google Scholar
  139. S. L. Creanor, R. Strang, W. H. Gilmour et al., “The effect of chewing gum use on in situ enamel lesion remineralization,” Journal of Dental Research, vol. 71, pp. 1895–1900, 1992. View at Google Scholar
  140. W. H. Bowen and S. K. Pearson, “The effects of sucralose, xylitol, and sorbitol on remineralization of caries lesions in rats,” Journal of Dental Research, vol. 71, no. 5, pp. 1166–1168, 1992. View at Google Scholar
  141. R. H. Manning, W. M. Edgar, and E. A. Agalamanyi, “Effects of chewing gums sweetened with sorbitol or a sorbitol/xylitol mixture on the remineralisation of human enamel lesions in situ,” Caries Research, vol. 26, no. 2, pp. 104–109, 1992. View at Google Scholar
  142. A. Scheinin, E. Söderling, U. Scheinin, R. L. Glass, and M.-L. Kallio, “Xylitol-induced changes of enamel microhardness paralleled by microradiographic observations,” Acta Odontologica Scandinavica, vol. 51, no. 4, pp. 241–246, 1993. View at Google Scholar
  143. K. Wennerholm, J. Arends, D. Birkhed, J. Ruben, C. G. Emilson, and A. G. Dijkman, “Effect of xylitol and sorbitol in chewing-gums on mutans streptococci, plaque pH and mineral loss of enamel,” Caries Research, vol. 28, no. 1, pp. 48–54, 1994. View at Google Scholar
  144. K. K. Mäkinen, “An end to crossover designs for studies on the effect of sugar substitutes on caries?” Caries Research, vol. 43, pp. 331–333, 2009. View at Google Scholar
  145. K. K. Mäkinen, P.-L. Mäkinen, H. R. Pape Jr. et al., “Stabilization of rampant caries: polyol gums and arrest of dentine caries in two long-term cohort studies in young subjects,” International Dental Journal, vol. 45, pp. 93–107, 1995. View at Google Scholar
  146. K. K. Mäkinen, P.-L. Mäkinen, H. R. Pape Jr. et al., “Conclusion and review of the ‘Michigan Xylitol Programme’ (1986–1995) for the prevention of dental caries,” International Dental Journal, vol. 46, pp. 22–34, 1996. View at Google Scholar
  147. K. K. Mäkinen, D. J. Chiego Jr., P. Allen et al., “Physical, chemical, and histologic changes in dentin caries lesions of primary teeth induced by regular use of polyol chewing gums,” Acta Odontologica Scandinavica, vol. 56, pp. 148–156, 1998. View at Google Scholar
  148. B. T. Amaechi, S. M. Higham, and W. M. Edgar, “The influence of xylitol and fluoride on dental erosion in vitro,” Archives of Oral Biology, vol. 43, no. 2, pp. 157–161, 1998. View at Publisher · View at Google Scholar
  149. B. T. Amaechi, S. M. Higham, and W. M. Edgar, “Caries inhibiting and remineralizing effect of xylitol in vitro,” Journal of Oral Science, vol. 41, no. 2, pp. 71–76, 1999. View at Google Scholar
  150. T. Yanagisawa, “Ultrastructure of crystals in enamel carious lesions,” Journal of Japanese Dental Association, vol. 46, pp. 1167–1176, 1994. View at Google Scholar
  151. T. Yanagisawa, Y. Miake, Y. Saeki, and M. Takahashi, “Remineralization in enamel caries and restoration of carious lesions by enhanced remineralization induced by saliva and xylitol,” Dentistry in Japan, vol. 39, pp. 208–215, 2003. View at Google Scholar
  152. Y. Miake, M. Takahashi, Y. Saeki, and T. Yanagisawa, “Effect of xylitol on remineralization of demineralized enamel,” The Shikwa Gakuho, vol. 99, pp. 393–399, 1999 (Japanese). View at Google Scholar
  153. Y. Miake and T. Yanagisawa, “Effects of xylitol on remineralization of artificial demineralized enamel,” Japanese Journal of Oral Biology, vol. 42, pp. 580–589, 2000. View at Google Scholar
  154. M. Takahashi, Y. Saeki, Y. Miake, and T. Yanagisawa, “Effects of sugar alcohols and calcium compounds on remineralization,” Shikwa Gakuho, vol. 100, pp. 755–762, 2000 (Japanese). View at Google Scholar
  155. Y. Saeki, M. Takahashi, S. Kamikawa et al., “Remineralization effect of xylitol chewing gum containing Gloipeltis furcata extract and calcium hydrogenphosphate on initial caries-like enamel lesions,” Japanese Journal of Oral Biology, vol. 42, pp. 590–600, 2000 (Japanese). View at Google Scholar
  156. M. Takahashi, Y. Saeki, K. Fujimoto, H. Matsuzaki, Y. Miake, and T. Yanagisawa, “Remineralization effects of xylitol dragee gum containing Gloipeltis furcata extract and calcium hydrogenphosphate on initial caries-like enamel lesions in vivo,” The Shikwa Gakuho, vol. 101, pp. 1033–1042, 2001 (Japanese). View at Google Scholar
  157. Y. Saeki, “Effect of seaweed extracts on Streptococcus sobrinus adsorption to saliva-coated hydroxyapatite,” The Bulletin of Tokyo Dental College, vol. 35, no. 1, pp. 9–15, 1994. View at Google Scholar
  158. Y. Saeki, T. Kato, and K. Okuda, “Inhibitory effects of funoran on the adherence and colonization of oral bacteria,” The Bulletin of Tokyo Dental College, vol. 37, no. 2, pp. 77–92, 1996. View at Google Scholar
  159. Y. Saeki, T. Kato, Y. Naito, I. Takazoe, and K. Okuda, “Inhibitory effects of funoran on the adherence and colonization of mutans streptococci,” Caries Research, vol. 30, no. 2, pp. 119–125, 1996. View at Google Scholar
  160. S. Thaweboon, S. Nakornchai, Y. Miyake et al., “Remineralizaron of enamel subsurface lesions by xylitol chewing gum containing funoran and calcium hydrogenphosphate,” Southeast Asian Journal of Tropical Medicine and Public Health, vol. 40, no. 2, pp. 345–353, 2009. View at Google Scholar
  161. P. Shen, F. Cai, A. Nowicki, J. Vincent, and E. C. Reynolds, “Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate,” Journal of Dental Research, vol. 80, no. 12, pp. 2066–2070, 2001. View at Google Scholar
  162. H. Meyer-Lueckel, P. Tschoppe, W. Hopfenmuller, W.-R. Stenzel, and A. M. Kielbassa, “Effect of polymers used in saliva substitutes on demineralized bovine enamel and dentin,” American Journal of Dentistry, vol. 19, no. 5, pp. 308–312, 2006. View at Google Scholar
  163. R. Suda, T. Suzuki, R. Takiguchi, K. Egawa, T. Sano, and K. Hasegawa, “The effect of adding calcium lactate to xylitol chewing gum on remineralization of enamel lesions,” Caries Research, vol. 40, no. 1, pp. 43–46, 2006. View at Publisher · View at Google Scholar · View at PubMed
  164. H. Sano, S. Nakashima, Y. Songpaisan, and P. Phantumvanit, “Effect of a xylitol and fluoride containing toothpaste on the remineralization of human enamel in vitro,” Journal of Oral Science, vol. 49, no. 1, pp. 67–73, 2007. View at Publisher · View at Google Scholar
  165. S. Chunmuang, S. S. Jitpukdeebodintra, C. Chuenarrom, and P. Benjakul, “Effect of xylitol and fluoride on enamel erosion in vitro,” Journal of Oral Science, vol. 49, no. 4, pp. 293–297, 2007. View at Publisher · View at Google Scholar
  166. T. Takatsuka, R. A. Exterkate, and J. M. ten Cate, “Effects of isomalt on de- and remineralization, a combined in vitro pH-cycling model and in situ study,” Clinical Oral Investigations, vol. 12, pp. 173–177, 2008. View at Google Scholar
  167. J. Kawanabe, M. Hirasawa, T. Takeuchi, T. Oda, and T. Ikeda, “Noncariogenicity of erythritol as a substrate,” Caries Research, vol. 26, no. 5, pp. 358–362, 1992. View at Google Scholar
  168. K. K. Mäkinen, K. P. Isotupa, T. Kivilompolo, P.-L. Mäkinen, J. Toivanen, and E. Söderling, “Comparison of erythritol and xylitol saliva stimulants in the control of dental plaque and mutans streptococci,” Caries Research, vol. 35, no. 2, pp. 129–135, 2001. View at Publisher · View at Google Scholar
  169. K. K. Mäkinen, K. P. Isotupa, T. Kivilompolo et al., “The effect of polyol-combinant saliva stimulants on S. mutans levels in plaque and saliva of patients with mental retardation,” Special Care in Dentistry, vol. 22, no. 5, pp. 187–193, 2002. View at Google Scholar
  170. K. K. Mäkinen, M. Saag, K. P. Isotupa et al., “Similarity of the effects of erythritol and xylitol on some risk factors of dental caries,” Caries Research, vol. 39, pp. 207–215, 2005. View at Google Scholar
  171. T. Ichikawa, Y. Yano, Y. Fujita, T. Kashiwabara, and K. Nagao, “The enhancement effect of three sugar alcohols on the fungicidal effect of benzethonium chloride toward Candida albicans,” Journal of Dentistry, vol. 36, no. 11, pp. 965–968, 2008. View at Publisher · View at Google Scholar · View at PubMed
  172. M. Fontana, D. Catt, G. J. Eckert et al., “Xylitol: effects on the acquisition of cariogenic species in infants,” Pediatric Dentistry, vol. 31, no. 3, pp. 257–266, 2009. View at Google Scholar
  173. P. Milgrom, K. A. Ly, O. K. Tut et al., “Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy,” Archives of Pediatrics and Adolescent Medicine, vol. 163, no. 7, pp. 601–607, 2009. View at Publisher · View at Google Scholar · View at PubMed
  174. C. Badet, A. Furiga, and N. Thébaud, “Effect of xylitol on an in vitro model of oral biofilm,” Oral Health & Preventive Dentistry, vol. 6, no. 4, pp. 337–341, 2008. View at Google Scholar
  175. Anonymous, “Xylitol-containing oral syrup may prevent caries in children,” The Journal of the American Dental Association, vol. 140, p. 972, 2009. View at Google Scholar
  176. Anonymous, “Xylitol cleared for anti-caries health claims,” British Dental Journal, vol. 206, no. 3, p. 123, 2009. View at Google Scholar
  177. “American Academy on Pediatric Dentistry Council on Clinical Affairs,” Pediatric Dental, vol. 30, supplement, pp. 36–37, 2008-2009.
  178. S. Twetman, “Consistent evidence to support the use of xylitol- and sorbitol-containing chewing gum to prevent dental caries,” The Journal of Evidence-Based Dental, vol. 10, pp. 10–11, 2009. View at Google Scholar
  179. B. L. Edelstein, “Solving the problem of early childhood caries: a challenge for us all,” Archives of Pediatrics and Adolescent Medicine, vol. 163, no. 7, pp. 667–668, 2009. View at Publisher · View at Google Scholar · View at PubMed
  180. P. Milgrom, D. T. Zero, and J. M. Tanzer, “An examination of the advances in science technology of prevention of tooth decay in young children since the Surgeon General's report on oral health,” Academic Pediatrics, vol. 9, no. 6, pp. 404–409, 2009. View at Google Scholar
  181. C. H. Splieth, M. Alkilzy, J. Schmitt, C. Berndt, and A. Welk, “Effect of xylitol and sorbitol on plaque acidogenesis,” Quintessence International, vol. 40, no. 4, pp. 279–285, 2009. View at Google Scholar
  182. E. Söderling, K. K. Mäkinen, C.-Y. Chen, H. R. Pape Jr., W. Loesche, and P.-L. Mäkinen, “Effect of sorbitol, xylitol, and xylitol/sorbitol chewing gums on dental plaque,” Caries Research, vol. 23, pp. 378–384, 1989. View at Google Scholar
  183. O. Aguirre-Zero, D. T. Zero, and H. M. Proskin, “Effect of chewing xylitol chewing gum on salivary flow rate and the acidogenic potential of dental plaque,” Caries Research, vol. 27, no. 1, pp. 55–59, 1993. View at Google Scholar
  184. H. Tuompo, J. H. Meurman, K. Lounatmaa, and J. Linkola, “Effect of xylitol and other carbon sources on the cell wall of Streptococcus mutans,” Scandinavian Journal of Dental Research, vol. 91, no. 1, pp. 17–25, 1983. View at Google Scholar
  185. Y. E. Lee, Y. H. Choi, S. H. Jeong, H. S. Kim, S. H. Lee, and K. B. Song, “Morphological changes in Streptococcus mutans after chewing gum containing xylitol for twelve months,” Current Microbiology, vol. 58, pp. 332–337, 2009. View at Google Scholar
  186. E. M. Söderling and A. M. Hietala-Lenkkeri, “Xylitol and erythritol decrease adherence of polysaccharide-producing oral streptococci,” Current Microbiology, vol. 60, no. 1, pp. 25–29, 2010. View at Publisher · View at Google Scholar · View at PubMed
  187. S. Aizawa, H. Miyasawa-Hori, K. Nakajo et al., “Effects of α-amylase and its inhibitors on acid production from cooked starch by oral streptococci,” Caries Research, vol. 43, no. 1, pp. 17–24, 2009. View at Publisher · View at Google Scholar · View at PubMed