258626 Implications of the xylitol for adult caries ( X-ACT) trial for prevention programs and individuals

Monday, October 29, 2012 : 2:30 PM - 2:50 PM

John P. Brown, BDS PhD , Department of Comprehensive Dentistry, UT HSC San Antonio, San Antonio, TX
Bennett T. Amaechi, BDS MS PhD , UT HSC San Antonio, Department of Comprehensive Dentistry, San Antonio, TX
James D. Bader, DDS MPH , School of Dentistry, University of North Carolina, Chapel Hill, NC
Gregg H. Gilbert, DDS, MBA , Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
Daniel A. Shugars, DDS PhD MPH , School of Dentistry, University of North Carolina, Chapel Hill, NC
William M. Vollmer, PhD , Kaiser Permanente CHR, Center for Health Research, Portland, OR
Although caries is prevalent in adults, few preventive therapies have been adequately tested in adult populations . Xylitol efficacy has been controversial , with lack of Stage III trials and evidence based reviews reaching disparate conclusions. This three year , randomized , placebo controlled clinical trial ( CCT ) evaluated the effectiveness of xylitol mints in preventing dental caries in 691 caries-active adults at three fluoridated US sites ; UNC, UAB and UTHSCSA , with KPCHR as the data center. Participants aged 21-80 consumed five 1gm xylitol or placebo mints daily for 33 months. Clinical examinations occurred at baseline, 12, 24 and 33 months. Subjects usual preventive activities continued . Xylitol mints reduced the caries increment in the treatment group by 11% , a reduction that was not statistically significant. There was no indication of a dose-response effect. Essentially the same result was found when uncavitated plus cavitated caries lesions were used in the assessment of disease increment. Daily use of xylitol mints did not result in a statistically or clinically significant reduction in annual caries increment among caries active adults . Crude annualized D2FS increment , xylitol group 2.72 vs 3.05 placebo group (95% confidence interval (CI) for (RR) = 0.78, 1.03) The results of this trial temper overly optimistic expectations that xylitol used as a supplement in patients receiving dental care , for the public generally , or in organized preventive programs will substantially reduce their caries experience . ClinicalTrials.Gov NCT00393055

Learning Areas:
Administer health education strategies, interventions and programs
Chronic disease management and prevention
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public

Learning Objectives:
Describe the caries prevention efficacy of xylitol when used in caries active adults .

Keywords: Oral Health, Primary Prevention

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: we did not test a product but xylitol itself

Qualified on the content I am responsible for because: I was a coinvestigator on the NIDCR-NIH sponsored multicenter, blinded, placebo controlled, clinical trial of xylitol in caries active adults ( X-ACT ).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.