Ly Kiet A, Riedy Christine A, Milgrom Peter, Rothen Marilynn, Roberts Marilyn C, Zhou Lingmei
Northwest/Alaska Center to Reduce Oral Health Disparities, Department of Dental Public Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
BMC Oral Health. 2008 Jul 25;8:20. doi: 10.1186/1472-6831-8-20.
Habitual consumption of xylitol reduces mutans streptococci (MS) levels but the effect on Lactobacillus spp. is less clear. Reduction is dependent on daily dose and frequency of consumption. For xylitol to be successfully used in prevention programs to reduce MS and prevent caries, effective xylitol delivery methods must be identified. This study examines the response of MS, specifically S. mutans/sobrinus and Lactobacillus spp., levels to xylitol delivered via gummy bears at optimal exposures.
Children, first to fifth grade (n = 154), from two elementary schools in rural Washington State, USA, were randomized to xylitol 15.6 g/day (X16, n = 53) or 11.7 g/day (X12, n = 49), or maltitol 44.7 g/day (M45, n = 52). Gummy bear snacks were pre-packaged in unit-doses, labeled with ID numbers, and distributed three times/day during school hours. No snacks were sent home. Plaque was sampled at baseline and six weeks and cultured on modified Mitis Salivarius agar for S. mutans/sobrinus and Rogosa SL agar for Lactobacillus spp. enumeration.
There were no differences in S. mutans/sobrinus and Lactobacillus spp. levels in plaque between the groups at baseline. At six weeks, log10 S. mutans/sobrinus levels showed significant reductions for all groups (p = 0.0001): X16 = 1.13 (SD = 1.65); X12 = 0.89 (SD = 1.11); M45 = 0.91 (SD = 1.46). Reductions were not statistically different between groups. Results for Lactobacillus spp. were mixed. Group X16 and M45 showed 0.31 (SD = 2.35), and 0.52 (SD = 2.41) log10 reductions, respectively, while X12 showed a 0.11 (SD = 2.26) log10 increase. These changes were not significant. Post-study discussions with school staff indicated that it is feasible to implement an in-classroom gummy bear snack program. Parents are accepting and children willing to consume gummy bear snacks daily.
Reductions in S. mutans/sobrinus levels were observed after six weeks of gummy bear snack consumption containing xylitol at 11.7 or 15.6 g/day or maltitol at 44.7 g/day divided in three exposures. Lactobacillus spp. levels were essentially unchanged in all groups. These results suggest that a xylitol gummy bear snack may be an alternative to xylitol chewing gum for dental caries prevention. Positive results with high dose maltitol limit the validity of xylitol findings. A larger clinical trial is needed to confirm the xylitol results.
[ISRCTN63160504].
习惯性食用木糖醇可降低变形链球菌（MS）水平，但对乳酸杆菌属的影响尚不清楚。这种降低取决于每日剂量和食用频率。为使木糖醇成功用于预防项目以降低MS并预防龋齿，必须确定有效的木糖醇递送方法。本研究考察了MS，特别是变形链球菌/远缘链球菌和乳酸杆菌属的水平对通过小熊软糖以最佳暴露量递送木糖醇的反应。
来自美国华盛顿州农村地区两所小学的一至五年级儿童（n = 154）被随机分为三组，分别为每天食用15.6克木糖醇组（X16，n = 53）、每天食用11.7克木糖醇组（X12，n = 49）或每天食用44.7克麦芽糖醇组（M45，n = 52）。小熊软糖零食预先按单位剂量包装，标有身份识别号码，并在上课时间每天分发三次。不往家里送零食。在基线和六周时采集菌斑样本，在改良的米氏唾液琼脂上培养以计数变形链球菌/远缘链球菌，在罗戈萨SL琼脂上培养以计数乳酸杆菌属。
基线时各组菌斑中的变形链球菌/远缘链球菌和乳酸杆菌属水平无差异。六周时，所有组的log10变形链球菌/远缘链球菌水平均显著降低（p = 0.0001）：X16组为1.13（标准差 = 1.65）；X12组为0.89（标准差 = 1.11）；M45组为0.91（标准差 = 1.46）。各组间的降低无统计学差异。乳酸杆菌属的结果不一。X16组和M45组的log10降低值分别为0.31（标准差 = 2.35）和0.52（标准差 = 2.41），而X12组的log10升高值为0.11（标准差 = 2.26）。这些变化不显著。研究结束后与学校工作人员的讨论表明，实施课堂小熊软糖零食项目是可行的。家长们接受，孩子们也愿意每天食用小熊软糖零食。
在每天分三次食用含11.7或15.6克木糖醇或44.7克麦芽糖醇的小熊软糖零食六周后，观察到变形链球菌/远缘链球菌水平降低。所有组中乳酸杆菌属水平基本未变。这些结果表明，木糖醇小熊软糖零食可能是预防龋齿的木糖醇口香糖的替代品。高剂量麦芽糖醇的阳性结果限制了木糖醇研究结果的有效性。需要进行更大规模的临床试验来证实木糖醇的结果。
[ISRCTN63160504]
