There have been many products over the years that have improved our dental hygiene like an electric toothbrush and a water flosser.

For me, xylitol is a big game-changer. Xylitol is changing our approach to prevention and increasing success in our fight against cavities.

Traditional prevention includes brushing, flossing, and fluoride toothpaste, but it isn’t working very well. Cavities are still the # 1 preventable childhood disease. This has been the case for the thirty years plus I have been a dental hygienist. You may have kids who are cavity-free, but by adulthood, nearly 100 percent of our population have experienced some form of dental disease. Traditional prevention just isn’t working. Brushing, flossing, and fluoride were what I was taught in school, which would prevent cavities. We now know those three are just pieces of the puzzle when it comes to preventing cavities. With wearing masks for over a year now, there has been an increase in mouth breathing which has become a habit for many adults and children. It dries out our mouth and we are seeing an increase in cavities among other issues.

This is where xylitol becomes the game-changer.

The research is showing five exposures to xylitol each day will reduce plaque as effectively as toothbrushing. Mostly due to the fact that the majority of people only brush once a day for less than a minute. Now I am never suggesting you stop brushing your teeth. Xylitol is a good sugar that can significantly enhance the other tools we use to prevent cavities and improve oral and systemic health.

There are over 900 research articles published about xylitol, but we are just now beginning to include it in our preventive strategies. Since the early 1970s, there have been two approaches to the prevention of cavities: fluoride and non-fluoride. While the U.S. was totally focused on fluoride with water fluoridation, foams, gels, and pastes, and eventually fluoride varnishes, the rest of the world was seeking alternatives to fluoride.

Xylitol was first reported in the 1960s to be beneficial for diabetics. In the 1970s, the first dental research demonstrated a 50 percent reduction in plaque levels by eating foods sweetened with xylitol. A 50-percent reduction in plaque levels is better than most people can achieve with a toothbrush! This was very exciting news among the researchers and for us.

At first, xylitol was used to replace all sugar in the diet, which resulted in a significant reduction in cavities. However, replacing all sugar in our diet is a difficult concept to sell to a population addicted to sugar. I know firsthand how difficult it is to stop consuming sugar and find alternatives. Sugar has many names and It is in almost everything we eat in one form or another. So Instead, researchers delivered xylitol following meals,  in snacks, and in chewing gum. Using gum sweetened only with xylitol seems to be as beneficial as a complete sugar replacement.

Following these early studies came hundreds of more studies measuring the benefit of 100-percent xylitol-sweetened chewing gum to prevent tooth decay.  Not everyone chews gum. There are many other products that contain Xylitol you can use instead of chewing gum. I have a list of products I recommend on my products page at or you can always do a google search. Xylitol has also been added to a nasal spray and is very promising in helping our aging population prevent cavities in nursing homes where teeth brushing is not a priority. Listen to episode eleven Dying of Dirty Teeth with my friend Angie Stone for more on this subject. She has done a lot of research herself in nursing homes. It is fascinating and very informative.

What is xylitol?

Xylitol is a naturally occurring five-carbon sugar alcohol derived from plants, it has been found to be promising in reducing dental caries disease and also reversing the process of early cavities.

Xylitol is a natural sugar; the most common source today is from fibers in corn cobs and corn stalks. It is not an artificial sweetener. 

Xylitol inhibits the growth of the bacteria that cause cavities because these bacteria known as (Streptococcus mutans) cannot utilize xylitol to grow. Over time with xylitol use, the quality of the bacteria and the microbiome in the mouth changes, and fewer and fewer decay-causing bacteria survive on tooth surfaces.

The human body makes 5-10 grams of xylitol each day in the metabolism of carbohydrates. Xylitol’s crystalline form looks and tastes like “table sugar,” but contains only 2.4 calories per gram, providing 40 percent fewer calories than other carbohydrates. With a glycemic index of 7, it’s safe for diabetics. It’s digested as a fiber with no insulin released.

How does xylitol work to prevent cavities?

Xylitol prevents cavities in several ways.

  1. It interferes with the bacteria’s ability to produce acid. 
  2.  It blocks communication between bacteria so they stop producing slime that holds the biofilm together. 
  1. It raises the pH of the mouth. 

Bacteria that cause cavities prefer living in a low pH environment 6.5 and below and produce the acid that weakens the enamel of our teeth. In the presence of xylitol, the bacteria stop producing acid and the polysaccharide slime that holds the biofilm together, and they simply slide off the teeth. In the presence of sugar, bacteria thrive and feed, producing acid that sticks to the teeth and demineralizes the surface of the enamel. Creating a whole that eventually becomes a cavity. Bacterial numbers are significantly reduced in the presence of xylitol. Xylitol promotes an alkaline oral environment which is monumental for oral health.

Xylitol forms complexes with calcium that do not produce acid and maintain a supersaturated calcium level in saliva, which is important for the remineralization of enamel. This is critical when teeth first erupt and are not completely mineralized. Xylitol has the ability to maintain high salivary calcium levels that enhance the final mineralization process as the teeth erupt.  The ability of xylitol to bind with calcium is also evident in higher calcium levels measured in plaque when xylitol is present.


Cavities are one of the most common infections that occurs in the oral cavity that affects populations across developed and developing nations. Studies show that cavities are still a major health problem affecting 60–90% of schoolchildren and the majority of adults.[1] Epidemiological studies reveal that refined sugar such as sucrose, which is said to be the arch-enemy, is the leading cause of cavities in children and adults. The transmissible bacterial disease progresses as the acids from bacteria dissolve the minerals on the enamel surface and break through to the inner dentin layer of the tooth. Once this happens you will need to see a dentist have a filling. It is no longer reversible.

Chewing gum comparisons are promising and showed that 100-percent xylitol-sweetened chewing gum reduces plaque accumulation significantly as opposed to 100-percent sorbitol-sweetened gum and is better than gum sweetened with both xylitol and sorbitol. Sorbitol can be metabolized by bacteria to produce acid; therefore, adding sorbitol to chewing gum sweetened with xylitol will significantly reduce the benefits of xylitol. This is why chewing gum that is 100% Xylitol is better.

A three-year study in Hungary with nearly 700 students showed that xylitol-sweetened candy eaten several times each day reduced the incidence of cavities better than fluoridated toothpaste.

A  long-term study was conducted by faculty from the University of Michigan in Belize. This 40-month study, conducted in the early 1990s, included nearly 1,300 students. Several different chewing gums were tested, with the 100-percent xylitol-sweetened gum providing the greatest reduction in tooth decay, at 73 percent.

Numerous published studies report cavity reductions from 21 percent to 85 percent, presenting a significant gap between reports. Differences in study outcomes are attributed to many variables. Subjects with low caries experience will not demonstrate a large difference. A small study with an insufficient number of subjects will fail to show a difference. Studies using too low a concentration of xylitol, too short an exposure to xylitol or too few exposures each day will not show significant results. 

A recent Cochrane Review, reported in the Journal of the American Dental Association, suggested less exciting results. Of the research articles on xylitol, the review only included 10 studies. These systematic reviews require that all studies be randomized, double-blind, and placebo-controlled. Based on those criteria, chewing gum studies will never qualify as subjects are not willing to chew a flavorless gum five times a day for three years. Even still, the review of 10 papers showed that adding xylitol to fluoride toothpaste resulted in 13 percent better cavity prevention than fluoride toothpaste alone. More research is needed.

Chewing gum is not a replacement for brushing your teeth

It is another tool to help prevent cavities, especially when you can not brush your teeth.

Studies have found that chewing sugarless gum increases the flow of saliva in your mouth, Which can help dilute sugars and food particles stuck in your teeth. The increase in saliva can neutralize and get rid of harmful acids that are produced when the bacteria on your teeth feed on the food you eat. When chewing gum increases the flow of saliva it carries more calcium which aids in strengthening tooth enamel.

Warning: Keep xylitol away from pets

Even though things may be safe for us to eat may not be safe for our pets. There are many foods dogs shouldn’t eat chocolate, grapes, raisins … and xylitol. Under-nourished dogs are the most likely to experience a severe reaction to xylitol. When they ingest xylitol, insulin is released, – the quickest –and the best antidote for them is table sugar. If you wait and take the dog to the vet, they will start a glucose IV. So, we recommend you keep xylitol away from your pets.

There may be side effects in humans too, usually caused by over-ingesting xylitol. A common mistake is eating too many chocolate chip cookies made with xylitol because they taste so good. If you eat too much too quickly of the baked goods you made using xylitol to replace sugar, the results can include gas, bloating, and diarrhea.

To avoid over-ingesting, replace sugar in your diet slowly over two weeks. This way your gut adjusts with minimal gastric upset. Xylitol in toothpaste, mouth rinse, sprays, gels, gums, and candies shouldn’t be a problem. The issues usually arise when replacing all sugar at once with xylitol.

Many chewing gums are available in the grocery stores that contain a little xylitol, but also contain sorbitol, sucralose, aspartame, or mannitol.  Artificial sweeteners added to chewing gum reduce the benefits of xylitol. To achieve results similar to those reported in the research, the only sweetener used should be xylitol and it should be the first active ingredient. Besides chewing gum, there are many other products available with xylitol: candy, mints, toothpaste, mouth rinse, dry mouth spray, and oral gel.

The recommended amount of Xylitol per day

The recommended dose is 5 grams of xylitol daily separated into three to five exposures. 

The gum is chewed for only five minutes, just enough to release the xylitol. 

There are mints, candies, suckers, and chews also available. 

I hope you’ll see that xylitol is one of the big game-changers in dental hygiene. Like anything in life, you will have opposite viewpoints. This is for informational purposes and I always recommend you be your own advocate.

Xylitol has changed our plan of attack in the prevention of cavities and adds to our success in maintaining a healthy mouth and body.