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Xylitol is a wood sugar/alcohol that
is extracted from birch wood sap or
fermented yeast cells to make medi-
cine and a sugar substitute in “sugar
free” chewing gums, mints and
candies. Sorbitol is more commonly
used as a sweetener in sugarless
gums because it is less expensive
than other sugars.
As a medicine, xylitol is used to
prevent middle ear infections in
infants, and is used as a sugar substi-
tute for diabetics. It is also used to
prevent tooth decay, but it is not as
effective as fluoride. It reduces decay-
causing bacteria in saliva and some
bacteria that cause ear infections.
Since xylitol is a poorly fermentable
sugar alcohol, it is not easily used
by bacteria as an energy source. Less
acidogenic strains survive if xylitol
gum or mints are used routinely.
The cell receptors accept xylitol into
the cell (due to its similar shape),
leaving no room for the six carbon
sugars, thus tricking the bacteria
into starvation. Because it can rear-
range with polyvalent cations like
calcium, transporting through the
gut wall and saliva, it may allow
enamel to remineralize before decay
can form. At least six grams of
xylitol per day is required for dental
efficacy. Most sugar alcohols like
xylitol have a laxative effect. A small
percentage of patients have other GI
discomfort. This has occurred after
the ingestion of over 65 grams in
some children. It is extremely toxic
to dogs and birds and can be fatal.
Xylitol
Recaldent (casein phosphopeptide,
amorphous calcium phosphate,
or CPP-ACP) is composed of the
minerals that teeth and bones are
made of, in a cheese protein base.
CPP has the ability to stabilize
calcium, phosphate, and fluoride
ions in a water soluble complex
that makes these ions bioavailable
to the tooth. The combination of
these ions helps penetrate tooth
surfaces deeper than fluoride itself.
This process slows the progression
of dental decay and repairs the
early stages of decay. Recaldent is
applied to the teeth as either sugar
free gum, a medicated tooth cream,
toothpastes/gels, or fortified dairy
milk. Those who are allergic to milk
will be allergic to these products.
Or ig ina l ly produced only in
Canada, many U.S. products now
contain recaldent including Trident
Xtra Care gum, GC America’s MI
Paste, and 3M ESPE Clinpro 5000
toothpaste. Some products that
contain ACP but no CCP are Arm
&Hammer Age Defying toothpaste
and Discus Dental Relief ACP Oral
Care Gel.
Recaldent
NovaMin, a particulate bioac-
tive glass, calcium sodium phos-
phosilicate, binds to the tooth
surface. When the par ticles
come into contact with saliva and
water, the sodium ions exchange
with the hydrogen ions releasing
calcium and phosphate ions on
to the tooth surface crystalizing
as hydroxyapatite occluding the
dentinal tubules. The addition
of f luoride penetrates deeper
than the same product without
fluoride.
Even though NovaMin was
invented by a U.S. company, it
is mostly sold in Europe, India,
China, Brazil and Canada. Prod-
ucts available in the U.S. market
include Sultan Topex ReNew
Toothpaste, Dentsply Nupro
Nusolutions Fluoride Reminer-
alizing and Desensitizing Tooth-
paste that contain 5,000 ppm
f luoride, and Oravive Tooth
Revitalizing Toothpaste which
contains no fluoride.
NovaMin
It is important to note that these enamel remineralization products
discussed on this page have demonstrated only limited effectiveness,
unless they are used routinely as directed, and also used in the presence
of a cariogenic diet (especially soda and fruit drinks), which can chroni-
cally affect the pH of resting or unstimulated salivary flow. Additionally,
many prescription and street drugs (like methamphetamine) adversely
affect salivary flow, which reduces the protection from decay that saliva
naturally provides. Thus, a sugary diet (simple carbohydrates) and certain
medications may overwhelm the potential benefits of remineralization
products and fluoride.
continues See references on page 409
nmdental.org
How Do We Prevent Decay?,
continued
ToothDecayPrevention