Xylitol has been claimed to reduce mutans streptococci (MS) in dental plaque by energy-consuming futile metabolic cycles. This study aimed to investigate the effects of xylitol on MS in an in vitro 6-species oral biofilm model. Each multispecies biofilm contained either a laboratory reference strain, a fresh isolate, a xylitol-sensitive or a xylitol-resistant strain of Streptococcus mutans or Streptococcus sobrinus. Biofilms, grown on pellicle-coated hydroxyapatite discs, were fed with a glucose/sucrose-supplemented medium 3 times daily for 45 min and incubated in saliva between feedings. Before or after feeding, biofilms were exposed to either 7.5% xylitol, 7.5% sorbitol or to saliva (control) for 20 min. After 64.5 h, biofilms were harvested and the microbial composition was analysed by non-selective and selective culturing. Strain variability in the ability to colonize biofilms was observed. However, the response patterns in the biofilms to the 4 polyol treatments were similar. None of the MS were inhibited by xylitol provided either before or after feeding. Sorbitol given before feeding did not affect microbial growth whereas sorbitol provided after feeding showed a slight, albeit statistically significant increase in MS counts for some of the tested strains. It did so at the expense of Streptococcus oralis, which decreased in numbers. The present findings do not support the contention that xylitol reduces MS in plaque by futile metabolic cycles.

1.
Assev S, Rølla G: Evidence for presence of a xylitol phosphotransferase system in Streptococcus mutans OMZ 176. Acta Pathol Microbiol Immunol Scand B 1984;92:89–92.
2.
Assev S, Rølla G: Further studies on the growth inhibition of Streptococcus mutans OMZ 176 by xylitol. Acta Pathol Microbiol Immunol Scand B 1986;94:97–102.
3.
Assev S, Wåler SM, Rølla G: Further studies on the growth inhibition of some oral bacteria by xylitol. Acta Pathol Microbiol Immunol Scand B 1983;91:261–265.
4.
Bär A: Caries prevention with xylitol: a review of the scientific evidence. World Rev Nutr Diet 1988;55:183–209.
5.
Beighton D: The complex oral microflora of high-risk individuals and groups and its role in the caries process. Community Dent Oral Epidemiol 2005;33:248–255.
6.
Birkhed D, Bär A: Sorbitol and dental caries. World Rev Nutr Diet 1991;65:1–37.
7.
Birkhed D, Edwardsson S: Acid production from sucrose substitutes in human dental plaque; in Guggenheim B (ed): ERGOB Conference on Sugar Substitutes. Basel, Karger, 1978, pp 211–217.
8.
Birkhed D, Edwardsson S, Ahldén ML, Frostell G: Effects of 3 months frequent consumption of hydrogenated starch hydrolysate (Lycasin®), maltitol, sorbitol and xylitol on human dental plaque. Acta Odontol Scand 1979;37:103–115.
9.
Bowen WH: Clinical relevance of adaptation to sorbitol by plaque bacteria: a review. J Clin Dent 1996;7:1–5.
10.
Brown AT, Wittenberger CL: Mannitol and sorbitol catabolism in Streptococcusmutans. Arch Oral Biol 1973;18:117–126.
11.
Carlsson J: Potentials of the oral microflora to utilize sugar substitutes as energy source; in Guggenheim B (ed): ERGOB Conference on Sugar Substitutes. Basel, Karger, 1978, pp 205–210.
12.
Carlsson J, Hamilton I: Metabolic activity of oral bacteria; in Thylstrup A, Fejerskov O (eds): Textbook of Clinical Cariology, ed 2. Copenhagen, Munksgaard, 1994, pp 71–88.
13.
Edwardsson S, Birkhed D, Mejàre B: Acid production from Lycasin®, maltitol, sorbitol and xylitol by oral streptococci and lactobacilli. Acta Odontol Scand 1977;35:257–263.
14.
Gauthier L, Vadeboncoeur C, Mayrand D: Loss of sensitivity to xylitol by Streptococcus mutans LG-1. Caries Res 1984;18:289–295.
15.
Geddes DAM: Acids produced by human dental plaque metabolism in situ. Caries Res 1975;9:98–109.
16.
Giertsen E, Emberland H, Scheie AAa: Effects of mouth rinses with xylitol and fluoride on dental plaque and saliva. Caries Res 1999;33:23–31.
17.
Gmür R, Guggenheim B: Antigenic heterogeneity of Bacteroides intermedius as recognized by monoclonal antibodies. Infect Immun 1983;42:459–470.
18.
Guggenheim B, Giertsen E, Schüpbach P, Shapiro S: Validation of an in vitro biofilm model of supragingival plaque. J Dent Res 2001;80:363–370.
19.
Havenaar R, Huis in’t Veld JHJ, Backer Dirks O, de Stoppelaar JD: Some bacteriological aspects of sugar substitutes; in Guggenheim B (ed): ERGOB Conference on Sugar Substitutes. Basel, Karger, 1978, pp 192–198.
20.
Hayes ML, Roberts KR: The breakdown of glucose, xylitol and other sugar alcohols by human dental plaque bacteria. Arch Oral Biol 1978;23:445–451.
21.
Hotz P, Guggenheim B, Schmid R: Carbohydrates in pooled dental plaque. Caries Res 1972;6:103–121.
22.
Kalfas S, Edwardsson S: Sorbitol-fermenting predominant cultivable flora of human dental plaque in relation to sorbitol adaptation and salivary secretion rate. Oral Microbiol Immunol 1990;5:33–38.
23.
Kalfas S, Maki Y, Birkhed D, Edwardsson S: Effect of pH on acid production from sorbitol in washed cell suspensions of oral bacteria. Caries Res 1990;24:107–112.
24.
Kelsey JL, McCague KE, Holden JM: Variations in flow rate, metabolites and enzyme activities of fasting human parotid saliva. Arch Oral Biol 1972;17:439–445.
25.
Mäkinen KK, Saag M, Isotupa KP, Olak J, Nõmmela R, Söderling E, Mäkinen PL: Similarity of the effects of erythritol and xylitol on some risk factors of dental caries. Caries Res 2005;39:207–215.
26.
Slee AM, Tanzer JM: The repressible metabolism of sorbitol (D-glucitol) by intact cells of the oral plaque-forming bacterium Streptococcusmutans. Arch Oral Biol 1983;28:839–845.
27.
Söderling E, Mäkinen KK, Chen CY, Pape HR Jr, Loesche W, Mäkinen PL: Effect of sorbitol, xylitol, and xylitol/sorbitol chewing gums on dental plaque. Caries Res 1989;23:378–384.
28.
Tanzer JM: Xylitol chewing gum and dental caries. Int Dent J 1995;45:65–76.
29.
Thurnheer T, van der Ploeg JR, Giertsen E, Guggenheim B: Effects of StreptococcusmutansgtfC deficiency on mixed oral biofilms in vitro. Caries Res 2006;40:163–171.
30.
Trahan L: Xylitol: a review of its action on mutans streptococci and dental plaque – its clinical significance. Int Dent J 1995;45:77–92.
31.
Trahan L, Bareil M, Gauthier L, Vadeboncoeur C: Transport and phosphorylation of xylitol by a fructose phosphotransferase system in Streptococcusmutans. Caries Res 1985;19:53–63.
32.
Trahan L, Mouton C: Selection for Streptococcusmutans with an altered xylitol transport capacity in chronic xylitol consumers. J Dent Res 1987;66:982–988.
33.
Trahan L, Néron S, Bareil M: Intracellular xylitol-phosphate hydrolysis and efflux of xylitol in Streptococcussobrinus. Oral Microbiol Immunol 1991;6:41–50.
34.
Trahan L, Söderling E, Dréan MF, Chevrier MC, Isokangas P: Effect of xylitol consumption on the plaque-saliva distribution of mutans streptococci and the occurrence and long-term survival of xylitol-resistant strains. J Dent Res 1992;71:1785–1791.
35.
Twetman S, Holgerson PL: Xylitol für die Kariesprävention – einige praktische Aspekte und Richtlinien. ZWR 2004;113:265–268.
36.
van der Ploeg JR, Guggenheim B: Deletion of gtfC of Streptococcusmutans has no influence on the composition of a mixed-species in vitro biofilm model of supragingival plaque. Eur J Oral Sci 2004;112:433–438.
37.
van Loveren C: Sugar alcohols: what is the evidence for caries-preventive and caries-therapeutic effects? Caries Res 2004;38:286–293.
38.
Wåler SM: Evidence for xylitol 5-P production in human dental plaque. Scand J Dent Res 1992;100:204–206.
39.
Yamada T, Takahashi-Abbe S, Abbe K: Effects of oxygen on pyruvate formate-lyase in situ and sugar metabolism of Streptococcus mutans and Streptococcussanguis. Infect Immun 1985;47:129–134.
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