Tooth eruption usually starts at about six months with the emergence of the upper and lower central teeth, and all the baby teeth have generally appeared by about 3 years of age. Baby teeth are important for chewing food, for speaking clearly, and for acting as a placeholder for the permanent teeth that replace them. These baby teeth are susceptible to decay as soon as they erupt. If a primary tooth becomes decayed and infected, the permanent tooth developing beneath it can be damaged. If the baby’s teeth are exposed to sugary substances for long periods of time, nursing bottle caries, a serious condition of extensive tooth decay can develop. This can happen when babies are allowed to fall asleep with the bottle in their mouths, when they walk around sucking on a bottle or sweetened pacifier for long periods of time and when their teeth are not routinely wiped clean.

Xylitol acts by inhibiting the growth of specific enamel destroying bacteria, streptococcus mutans.

In 2000, in the Surgeon General’s Oral Health in America Report, tooth decay was described as the most prevalent childhood chronic disease. At that time, it was five times more common than asthma. The medical and dental communities have responded to this problem by developing intradisciplinary provisions of dental health education and dental services. The application of dental sealants and fluoride are two strategies that have been successful. Another successful substance, xylitol, acts by inhibiting the growth of specific enamel destroying bacteria, streptococcus mutans, and its ability to stick to the tooth surface. It is a naturally occurring compound called a sugar−alcohol that can be extracted from many plant fibers. Unlike sealants and fluoride treatments, xylitol must be administered daily. Chewing gum and lozenges containing xylitol have been used with older children, but they cannot be used safely by infants and toddlers whose teeth are newly erupting.

A recent study reported in the July issue of Archives of Pediatric and Adolescent Medicine described a preventive therapy for this age group. Researchers administered xylitol in syrup form to a study population of healthy children ages 9−15 months, who were at especially high risk of early childhood cavities because of their poor nutrition, high exposure to sugary drinks and fruit juices, and lack of access to fluoride. They predicted that xylitol, when given in two or three doses daily would reduce the number of cavities that the children developed during the year of treatment. The results supported their prediction.

After an average of 10.5 months in the study, there was a significant decrease in the group treated with xylitol syrup 2 or 3 times a day. They projected that xylitol exposure twice a day during the period when the baby teeth were coming in could prevent up to 70% of decayed teeth. The possible side effects of xylitol, which are increased intestinal gas and diarrhea or loose stools did not occur more in the treated group than the control group and no child dropped out of the study because of gastrointestinal problems.

The investigators concluded that xylitol syrup was a safe and effective way to administer xylitol to the youngest age groups and that it was a useful tool in the effort the decrease early tooth decay. It should be considered along with the use of sealants, fluoride, and good dental hygiene practices. It could be especially useful in areas that lack fluoride sources and access to dental care. Parents should not administer xylitol to their infants or toddlers without discussing it with their child’s doctor.

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