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

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